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Higgins RA, Temple B, Dai VTT, Phan TV, Toan NT, Spry L, Toh ZQ, Nation ML, Ortika BD, Uyen DY, Cheung YB, Nguyen CD, Bright K, Hinds J, Balloch A, Smith-Vaughan H, Huu TN, Mulholland K, Satzke C, Licciardi PV. IMMUNOGENICITY AND IMPACT ON NASOPHARYNGEAL CARRIAGE OF A SINGLE DOSE OF PCV10 GIVEN TO VIETNAMESE CHILDREN AT 18 MONTHS OF AGE. Lancet Reg Health West Pac 2021; 16:100273. [PMID: 34590071 PMCID: PMC8453212 DOI: 10.1016/j.lanwpc.2021.100273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/12/2021] [Accepted: 08/24/2021] [Indexed: 11/04/2022]
Abstract
Background This study investigated the immunogenicity and impact on nasopharyngeal carriage of a single dose of PCV10 given to 18-month-old Vietnamese children. This information is important for countries considering catch-up vaccination during PCV introduction and in the context of vaccination during humanitarian crises. Methods Two groups of PCV-naïve children within the Vietnam Pneumococcal Project received PCV10 (n=197) or no PCV (unvaccinated; n=199) at 18 months of age. Blood samples were collected at 18, 19, and 24 months of age, and nasopharyngeal swabs at 18 and 24 months of age. Immunogenicity was assessed by measuring serotype-specific IgG, opsonophagocytosis (OPA) and memory B cells (Bmem). Pneumococci were detected and quantified using real-time PCR and serotyped by microarray. Findings At 19 months of age, IgG and OPA responses were higher in the PCV10 group compared with the unvaccinated group for all PCV10 serotypes and cross-reactive serotypes 6A and 19A. This was sustained out to 24 months of age, at which point PCV10-type carriage was 60% lower in the PCV10 group than the unvaccinated group. Bmem levels increased between 18 and 24 months of age in the vaccinated group. Interpretation We demonstrate strong protective immune responses in vaccinees following a single dose of PCV10 at 18 months of age, and a potential impact on herd protection through a substantial reduction in vaccine-type carriage. A single dose of PCV10 in the second year of life could be considered as part of catch-up campaigns or in humanitarian crises to protect children at high-risk of pneumococcal disease.
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Affiliation(s)
- Rachel A Higgins
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia
| | - Beth Temple
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia.,Global Health, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.,Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Vo Thi Trang Dai
- Microbiology and Immunology, Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Thanh V Phan
- Microbiology and Immunology, Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nguyen Trong Toan
- Department of Disease Control and Prevention, Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Leena Spry
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia
| | - Zheng Quan Toh
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Monica L Nation
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia
| | - Belinda D Ortika
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia
| | - Doan Y Uyen
- Department of Disease Control and Prevention, Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Yin Bun Cheung
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore.,Centre for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Cattram D Nguyen
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Kathryn Bright
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia
| | - Jason Hinds
- Institute for Infection and Immunity, St George's, University of London, London, UK.,BUGS Bioscience, London Bioscience Innovation Centre, London, UK
| | - Anne Balloch
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia
| | - Heidi Smith-Vaughan
- Global Health, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Tran Ngoc Huu
- Department of Disease Control and Prevention, Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Kim Mulholland
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Catherine Satzke
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Australia
| | - Paul V Licciardi
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
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2
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Chan J, Mungun T, Batsaixan P, Ulziibayar M, Suuri B, Otgonbayar D, Luvsantseren D, Nguyen CD, Narangarel D, Dunne EM, Fox K, Hinds J, Nation ML, Pell CL, Mulholland EK, Satzke C, von Mollendorf C, Russell FM. Direct and indirect effects of 13-valent pneumococcal conjugate vaccine on pneumococcal carriage in children hospitalised with pneumonia from formal and informal settlements in Mongolia: an observational study. Lancet Reg Health West Pac 2021; 15:100231. [PMID: 34528012 PMCID: PMC8342962 DOI: 10.1016/j.lanwpc.2021.100231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/07/2021] [Accepted: 07/12/2021] [Indexed: 11/24/2022]
Abstract
Background Within Ulaanbaatar, Mongolia, risk factors for pneumonia are concentrated among children living in informal settlements comprised of temporary shelters (gers). We used pneumococcal carriage surveillance among children from formal and informal settlements hospitalised with pneumonia to evaluate the direct and indirect effects of 13-valent pneumococcal conjugate vaccine (PCV13) against vaccine-type (VT) pneumococcal carriage following a phased introduction of PCV13. Methods We enrolled and collected nasopharyngeal swabs from children 2-59 months of age presenting to hospital. Pneumococci were detected using lytA qPCR and serotyped using microarray on a random monthly selection of swabs between November 2015 and March 2019 from two districts in Ulaanbaatar. PCV13 status was determined using written records. We quantified the associations between individual PCV13 status (direct effects) and district-level PCV13 coverage (indirect effects) and VT carriage using generalised estimating equations and explored interactions by settlement type. Findings A total of 1 292 swabs from 6 046 participants were tested for pneumococci. Receipt of PCV13 and increasing PCV13 coverage independently reduced the risk of VT carriage. For each percent increase in PCV13 coverage, the adjusted odds of VT carriage decreased by 1•0% (OR 95% CI 0•983-0•996; p=0•001), with a predicted decrease in VT carriage rate from 29•1% to 13•1% as coverage reached 100%. There was a trend towards a slower decline within informal settlements (p=0•100). Adjusted PCV13 vaccine effectiveness against VT carriage was 39•1% (95% CI 11•4-58•1%, p=0•009). Interpretation Substantial indirect effects were observed following PCV13 introduction, including among children living within informal settlements. Funding Bill & Melinda Gates Foundation; Gavi, the Vaccine Alliance.
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Affiliation(s)
- Jocelyn Chan
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Tuya Mungun
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia.,National Centre for Communicable Diseases (NCCD), Ministry of Health, Ulaanbaatar, Mongolia
| | - Purevsuren Batsaixan
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia.,National Centre for Communicable Diseases (NCCD), Ministry of Health, Ulaanbaatar, Mongolia
| | - Mukhchuluun Ulziibayar
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia.,National Centre for Communicable Diseases (NCCD), Ministry of Health, Ulaanbaatar, Mongolia
| | - Bujinlkham Suuri
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia.,National Centre for Communicable Diseases (NCCD), Ministry of Health, Ulaanbaatar, Mongolia
| | - Dashpagam Otgonbayar
- National Centre for Communicable Diseases (NCCD), Ministry of Health, Ulaanbaatar, Mongolia
| | - Dashtseren Luvsantseren
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia.,National Centre for Communicable Diseases (NCCD), Ministry of Health, Ulaanbaatar, Mongolia
| | - Cattram D Nguyen
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Dorj Narangarel
- National Centre for Communicable Diseases (NCCD), Ministry of Health, Ulaanbaatar, Mongolia
| | - Eileen M Dunne
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia
| | - Kimberley Fox
- Regional Office for the Western Pacific, World Health Organization, Manila, Philippines
| | - Jason Hinds
- Institute for Infection and Immunity, St George's University of London, London, United Kingdom.,BUGS Bioscience, London Bioscience Innovation Centre, London, United Kingdom
| | - Monica L Nation
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia
| | - Casey L Pell
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia
| | - E Kim Mulholland
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Catherine Satzke
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia.,Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Claire von Mollendorf
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Fiona M Russell
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
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3
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Britton KJ, Pickering JL, Pomat WS, de Gier C, Nation ML, Pell CL, Granland CM, Solomon V, Ford RL, Greenhill A, Hinds J, Moore HC, Richmond PC, Blyth CC, Lehmann D, Satzke C, Kirkham LAS. Lack of effectiveness of 13-valent pneumococcal conjugate vaccination against pneumococcal carriage density in Papua New Guinean infants. Vaccine 2021; 39:5401-5409. [PMID: 34384633 DOI: 10.1016/j.vaccine.2021.07.085] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/22/2021] [Accepted: 07/26/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Papua New Guinea (PNG) introduced the 13-valent pneumococcal conjugate vaccine (PCV13) in 2014, with administration at 1, 2, and 3 months of age. PCV13 has reduced or eliminated carriage of vaccine types in populations with low pneumococcal carriage prevalence, carriage density and serotype diversity. This study investigated PCV13 impact on serotype-specific pneumococcal carriage prevalence, density, and serotype diversity in PNG infants, who have some of the highest reported rates of pneumococcal carriage and disease in the world. METHODS Nasopharyngeal swabs were collected at 1, 4 and 9 months of age from PCV13-vaccinated infants (n = 57) and age-/season-matched, unvaccinated infants (at approximately 1 month, n = 53; 4 months, n = 57; 9 months, n = 52). Serotype-specific pneumococcal carriage density and antimicrobial resistance genes were identified by qPCR and microarray. RESULTS Pneumococci were present in 89% of swabs, with 60 different serotypes and four non-encapsulated variants detected. Multiple serotype carriage was common (47% of swabs). Vaccine type carriage prevalence was similar between PCV13-vaccinated and unvaccinated infants at 4 and 9 months of age. The prevalence of non-vaccine type carriage was also similar between cohorts, with non-vaccine types present in three-quarters of samples (from both vaccinated and unvaccinated infants) by 4 months of age. The median pneumococcal carriage density was high and similar at each age group (~7.0 log10genome equivalents/mL). PCV13 had no effect on overall pneumococcal carriage density, vaccine type density, non-vaccine type density, or the prevalence of antimicrobial resistance genes. CONCLUSION PNG infants experience dense and diverse pneumococcal colonisation with concurrent serotypes from 1 month of age. PCV13 had no impact on pneumococcal carriage density, even for vaccine serotypes. The low prevalence of vaccine serotypes, high pneumococcal carriage density and abundance of non-vaccine serotypes likely contribute to the lack of PCV13 impact on carriage in PNG infants. Indirect effects of the infant PCV programs are likely to be limited in PNG. Alternative vaccines with broader coverage should be considered.
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Affiliation(s)
- Kathryn J Britton
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia; Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Australia.
| | - Janessa L Pickering
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia.
| | - William S Pomat
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia; Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
| | - Camilla de Gier
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia; Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Australia.
| | - Monica L Nation
- Translational Microbiology Group, Murdoch Children's Research Institute, Melbourne, Australia.
| | - Casey L Pell
- Translational Microbiology Group, Murdoch Children's Research Institute, Melbourne, Australia.
| | - Caitlyn M Granland
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia.
| | - Vela Solomon
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
| | - Rebecca L Ford
- Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea.
| | - Andrew Greenhill
- School of Health and Life Sciences, Federation University, Victoria, Australia.
| | - Jason Hinds
- Institute for Infection and Immunity, St. George's University of London, London, United Kingdom.
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia.
| | - Peter C Richmond
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia; Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Australia.
| | - Christopher C Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia; Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Australia; Department of Paediatric Infectious Diseases, Perth Children's Hospital, Perth, Australia; Department of Microbiology, PathWest Laboratory Medicine WA, QEII Medical Centre, Perth, Australia.
| | - Deborah Lehmann
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia.
| | - Catherine Satzke
- Translational Microbiology Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.
| | - Lea-Ann S Kirkham
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia; Centre for Child Health Research, The University of Western Australia, Perth, Australia.
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4
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Chan J, Lai JYR, Nguyen CD, Vilivong K, Dunne EM, Dubot-Pérès A, Fox K, Hinds J, Moore KA, Nation ML, Pell CL, Xeuatvongsa A, Vongsouvath M, Newton PN, Mulholland K, Satzke C, Dance DAB, Russell FM. Indirect effects of 13-valent pneumococcal conjugate vaccine on pneumococcal carriage in children hospitalised with acute respiratory infection despite heterogeneous vaccine coverage: an observational study in Lao People's Democratic Republic. BMJ Glob Health 2021; 6:bmjgh-2021-005187. [PMID: 34108146 PMCID: PMC8191607 DOI: 10.1136/bmjgh-2021-005187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/21/2021] [Indexed: 12/29/2022] Open
Abstract
Introduction Empiric data on indirect (herd) effects of pneumococcal conjugate vaccines (PCVs) in settings with low or heterogeneous PCV coverage are limited. The indirect effects of PCV, which benefits both vaccinated and non-vaccinated individuals, are mediated by reductions in vaccine-type (VT) carriage (a prerequisite for disease). The aim of this study among hospitalised children in Lao People’s Democratic Republic (Lao PDR) is to determine the effectiveness of a 13-valent PCV (PCV13) against VT pneumococcal nasopharyngeal carriage (direct effects) and the association between village-level PCV13 coverage and VT carriage (indirect effects). Methods Pneumococcal nasopharyngeal carriage surveillance commenced in December 2013, shortly after PCV13 introduction (October 2013). We recruited and swabbed children aged 2–59 months admitted to hospital with acute respiratory infection. Pneumococci were detected using lytA quantitative real-time PCR and serotyped using microarray. PCV13 status and village-level PCV13 coverage were determined using written immunisation records. Associations between both PCV13 status and village-level PCV13 coverage and VT carriage were calculated using generalised estimating equations, controlling for potential confounders. Results We enrolled 1423 participants and determined PCV13 coverage for 368 villages (269 863 children aged under 5 years). By 2017, median village-level vaccine coverage reached 37.5%, however, the IQR indicated wide variation among villages (24.1–56.4). Both receipt of PCV13 and the level of PCV13 coverage were independently associated with a reduced odds of VT carriage: adjusted PCV13 effectiveness was 38.1% (95% CI 4.1% to 60.0%; p=0.032); and for each per cent increase in PCV13 coverage, the estimated odds of VT carriage decreased by 1.1% (95% CI 0.0% to 2.2%; p=0.056). After adjustment, VT carriage decreased from 20.0% to 12.8% as PCV13 coverage increased from zero to 60% among under 5. Conclusions Despite marked heterogeneity in PCV13 coverage, we found evidence of indirect effects in Lao PDR. Individual vaccination with PCV13 was effective against VT carriage.
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Affiliation(s)
- Jocelyn Chan
- Infection and Immunity, Murdoch Childrens Research Institute (MCRI), Parkville, Victoria, Australia
| | - Jana Y R Lai
- Infection and Immunity, Murdoch Childrens Research Institute (MCRI), Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Cattram D Nguyen
- Infection and Immunity, Murdoch Childrens Research Institute (MCRI), Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Keoudomphone Vilivong
- Infection and Immunity, Murdoch Childrens Research Institute (MCRI), Parkville, Victoria, Australia.,Microbiology Laboratory, Mahosot Hospital, Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMHWRU), Vientiane, Vientiane, Lao People's Democratic Republic
| | - Eileen M Dunne
- Infection and Immunity, Murdoch Childrens Research Institute (MCRI), Parkville, Victoria, Australia
| | - Audrey Dubot-Pérès
- Microbiology Laboratory, Mahosot Hospital, Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMHWRU), Vientiane, Vientiane, Lao People's Democratic Republic.,Unité des Virus Émergents, UVE: Aix-Marseille Univ - IRD 190 - Inserm 1207 - IHU Méditerranée Infection, Marseille, France
| | - Kimberley Fox
- Regional Office for the Western Pacific, World Health Organization (WHO), Manila, Philippines
| | - Jason Hinds
- Institute for Infection and Immunity, St George's University of London, London, UK.,BUGS Bioscience London Bioscience Innovation Centre, London, UK
| | - Kerryn A Moore
- Infection and Immunity, Murdoch Childrens Research Institute (MCRI), Parkville, Victoria, Australia
| | - Monica L Nation
- Infection and Immunity, Murdoch Childrens Research Institute (MCRI), Parkville, Victoria, Australia
| | - Casey L Pell
- Infection and Immunity, Murdoch Childrens Research Institute (MCRI), Parkville, Victoria, Australia
| | - Anonh Xeuatvongsa
- National Immunization Programme, Ministry of Health, Vientiane, Lao People's Democratic Republic
| | | | - Paul N Newton
- Microbiology Laboratory, Mahosot Hospital, Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMHWRU), Vientiane, Vientiane, Lao People's Democratic Republic.,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Kim Mulholland
- Infection and Immunity, Murdoch Childrens Research Institute (MCRI), Parkville, Victoria, Australia.,Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, London, UK
| | - Catherine Satzke
- Infection and Immunity, Murdoch Childrens Research Institute (MCRI), Parkville, Victoria, Australia.,Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - David A B Dance
- Microbiology Laboratory, Mahosot Hospital, Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMHWRU), Vientiane, Vientiane, Lao People's Democratic Republic.,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Fiona M Russell
- Infection and Immunity, Murdoch Childrens Research Institute (MCRI), Parkville, Victoria, Australia.,Centre for International Child Health, Department of Paediatrics, The University of Melbourne, The Royal Children's Hospital, Parkville, Victoria, Australia
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5
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Mohamed YH, Toizumi M, Uematsu M, Nguyen HAT, Le LT, Takegata M, Iwasaki C, Kitamura N, Nation ML, Dunne EM, Hinds J, Do HT, Vien MQ, Satzke C, Flasche S, Mulholland K, Dang DA, Kitaoka T, Yoshida LM. Prevalence of Streptococcus pneumoniae in conjunctival flora and association with nasopharyngeal carriage among children in a Vietnamese community. Sci Rep 2021; 11:337. [PMID: 33431887 PMCID: PMC7801475 DOI: 10.1038/s41598-020-79175-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 11/30/2020] [Indexed: 11/22/2022] Open
Abstract
Conjunctival pneumococcal serotypes among members of a community have not been investigated well. We determined the prevalence and association of Streptococcus pneumoniae in the nasopharynx and conjunctiva among children in a community before pneumococcal conjugate vaccine introduction. In October 2016, conjunctival and nasopharyngeal swabs were collected from children (< 24 months old) and nasopharyngeal swabs from mothers in Nha Trang, Vietnam. Quantitative lytA PCR and DNA microarray were performed to detect and serotype S. pneumoniae. The association between S. pneumoniae in the nasopharynx and conjunctiva was evaluated using multivariable logistic regression model. Among 698 children, 62 (8.9%, 95% CI 6.9-11.2%) were positive for S. pneumoniae in the conjunctiva. Non-encapsulated S. pneumoniae were most commonly identified, followed by serotypes 6A, 6B, and 14. Nasopharyngeal and conjunctival detection were positively associated (aOR 47.30, 95% CI 24.07-92.97). Low birth-weight, day-care attendance, and recent eye symptoms were independently associated with S. pneumoniae detection in the conjunctiva (aOR 11.14, 95% CI 3.76-32.98, aOR 2.19, 95% CI 1.45-3.31, and aOR 3.59, 95% CI 2.21-5.84, respectively). Serotypes and genotypes in the conjunctiva and nasopharynx matched in 87% of the children. Three mothers' nasopharyngeal pneumococcal samples had matched serotype and genotype with their child's in the conjunctiva and nasopharynx. S. pneumoniae presence in nasopharynx and conjunctiva were strongly associated. The high concordance of serotypes suggests nasopharyngeal carriage may be a source of transmission to the conjunctiva.
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Affiliation(s)
- Yasser Helmy Mohamed
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Michiko Toizumi
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Masafumi Uematsu
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | | | - Lien Thuy Le
- Pasteur Institute in Nha Trang, Nha Trang, Vietnam
| | - Mizuki Takegata
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Chihiro Iwasaki
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Noriko Kitamura
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Monica L Nation
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Eileen M Dunne
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Jason Hinds
- Institute for Infection and Immunity, St. George's, University of London, London, UK
- London Bioscience Innovation Centre, BUGS Bioscience, London, UK
| | - Hung Thai Do
- Pasteur Institute in Nha Trang, Nha Trang, Vietnam
| | | | - Catherine Satzke
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Parkville, VIC, Australia
| | - Stefan Flasche
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Kim Mulholland
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Duc-Anh Dang
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Takashi Kitaoka
- Department of Ophthalmology and Visual Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Lay-Myint Yoshida
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan.
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6
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Nation ML, Moss R, Spittal MJ, Kotsimbos T, Kelly PM, Cheng AC. Influenza Vaccine Effectiveness Against Influenza-Related Mortality in Australian Hospitalized Patients: A Propensity Score Analysis. Clin Infect Dis 2020; 72:99-107. [DOI: 10.1093/cid/ciz1238] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 01/02/2020] [Indexed: 01/09/2023] Open
Abstract
Abstract
Background
Data on influenza vaccine effectiveness (IVE) against mortality are limited, with no Australian data to guide vaccine uptake. We aimed to assess IVE against influenza-related mortality in Australian hospitalized patients, assess residual confounding in the association between influenza vaccination and mortality, and assess whether influenza vaccination reduces the severity of influenza illness.
Methods
Data were collected between 2010 and 2017 from a national Australian hospital-based sentinel surveillance system using a case-control design. Adults and children admitted to the 17 study hospitals with acute respiratory symptoms were tested for influenza using nucleic acid testing; all eligible test-positive cases, and a subset of test-negative controls, were included. Propensity score analysis and multivariable logistic regression were used to determine the adjusted odds ratio (aOR) of vaccination, with IVE = 1 – aOR × 100%. Residual confounding was assessed by examining mortality in controls.
Results
Over 8 seasons, 14038 patients were admitted with laboratory-confirmed influenza. The primary analysis included 9298 cases and 6451 controls, with 194 cases and 136 controls dying during hospitalization. Vaccination was associated with a 31% (95% confidence interval [CI], 3%–51%; P = .033) reduction in influenza-related mortality, with similar estimates in the National Immunisation Program target group. Residual confounding was identified in patients ≥65 years old (aOR, 1.92 [95% CI, 1.06–3.46]; P = .031). There was no evidence that vaccination reduced the severity of influenza illness (aOR, 1.07 [95% CI, .76–1.50]; P = .713).
Conclusions
Influenza vaccination is associated with a moderate reduction in influenza-related mortality. This finding reinforces the utility of the Australian vaccination program in protecting those most at risk of influenza-related deaths.
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Affiliation(s)
- Monica L Nation
- Infection and Immunity, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Robert Moss
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Matthew J Spittal
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Tom Kotsimbos
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Health, Monash University, Monash University, Melbourne, Victoria, Australia
| | - Paul M Kelly
- Australian National University Medical School, Monash University, Canberra, Australian Capital Territory, Australia
| | - Allen C Cheng
- Infection Prevention and Healthcare Epidemiology Unit, Alfred Health and School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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7
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von Mollendorf C, Dunne EM, La Vincente S, Ulziibayar M, Suuri B, Luvsantseren D, Narangerel D, Ortika BD, Pell CL, Nation ML, Alamrousi A, Hinds J, Demberelsuren S, Nguyen C, Mungun T, Mulholland EK, Satzke C. Pneumococcal carriage in children in Ulaanbaatar, Mongolia before and one year after the introduction of the 13-valent pneumococcal conjugate vaccine. Vaccine 2019; 37:4068-4075. [PMID: 31174939 DOI: 10.1016/j.vaccine.2019.05.078] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/24/2019] [Accepted: 05/26/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Nasopharyngeal carriage of Streptococcus pneumoniae precedes disease, is the source of pneumococcal community spread, and the mechanism for herd protection provided by pneumococcal conjugate vaccines (PCVs). There are few PCV impact studies in low- and middle-income countries, particularly in Asia. In 2016, Mongolia introduced the 13-valent PCV (PCV13) in a phased manner using a 2 + 1 schedule, with catch-up. We aimed to assess the impact of PCV13 introduction on nasopharyngeal pneumococcal carriage and density in children in Mongolia. METHODS We conducted two cross-sectional carriage surveys (pre- and one year post-PCV) at community health clinics in two districts of the capital city, Ulaanbaatar in both May-July 2015 and 2017. The study analysis included 961 children too young to be vaccinated (5-8 weeks old) and 989 children eligible for vaccination (12-23 months old). Pneumococci were detected by quantitative real-time PCR and molecular serotyping performed using DNA microarray. FINDINGS One year post-PCV introduction, PCV13 serotype carriage reduced by 52% in 12-23 month olds (adjusted prevalence ratio [aPR] 0.48 [95% confidence interval [CI] 0.39-0.59]), with evidence of non-PCV13 serotype replacement (aPR 1.55 [95% CI 1.30-1.85]), compared with the pre-PCV period. In 5-8 week olds, PCV13 serotype carriage reduced by 51% (aPR 0.49 [95% CI 0.33-0.73]) with no significant change in non-PCV13 serotype carriage (aPR 1.10 [95% CI 0.83-1.46]). An increase was observed in both PCV13 and non-PCV13 pneumococcal density post-PCV introduction. Antimicrobial resistance (AMR) genes were common, with 82.3% of samples containing at least one of the 10 AMR genes assessed. CONCLUSION This study demonstrates substantive PCV13 impact on pneumococcal carriage one year post-vaccine introduction in Mongolia. The reductions in PCV13 serotype carriage are likely to result in reductions in pneumococcal disease including indirect effects. Increases in non-PCV13 serotypes require further monitoring.
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Affiliation(s)
- Claire von Mollendorf
- New Vaccines, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Australia.
| | - Eileen M Dunne
- New Vaccines, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - Sophie La Vincente
- New Vaccines, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia
| | - Mukhchuluun Ulziibayar
- National Center of Communicable Diseases (NCCD), Ministry of Health, Ulaanbaatar, Mongolia
| | - Bujinlkham Suuri
- National Center of Communicable Diseases (NCCD), Ministry of Health, Ulaanbaatar, Mongolia
| | | | | | - Belinda D Ortika
- New Vaccines, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia
| | - Casey L Pell
- New Vaccines, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia
| | - Monica L Nation
- New Vaccines, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia
| | - Ahmed Alamrousi
- New Vaccines, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia
| | - Jason Hinds
- Institute for Infection and Immunity, St George's, University of London, London, UK; BUGS Bioscience, London Bioscience Innovation Centre, London, UK
| | | | - Cattram Nguyen
- New Vaccines, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - Tuya Mungun
- National Center of Communicable Diseases (NCCD), Ministry of Health, Ulaanbaatar, Mongolia
| | - E Kim Mulholland
- New Vaccines, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Australia; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Catherine Satzke
- New Vaccines, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Australia; Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Parkville, Australia
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8
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Chan J, Lai JY, von Mollendorf C, Blyth C, Dance DAB, Datta S, Dunne EM, Ford R, Fox K, Hinds J, Vilivong K, La Vincente S, Lehmann D, Moore KA, Mungun T, Nation ML, Newton PN, Nguyen CD, Pomat W, Xeuatvongsa A, Satzke C, Mulholland EK, Russell FM. Determining the pneumococcal conjugate vaccine coverage required for indirect protection within Asia and the Pacific: a prospective observational study. The Lancet Global Health 2019. [DOI: 10.1016/s2214-109x(19)30100-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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9
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Dunne EM, Satzke C, Ratu FT, Neal EFG, Boelsen LK, Matanitobua S, Pell CL, Nation ML, Ortika BD, Reyburn R, Jenkins K, Nguyen C, Gould K, Hinds J, Tikoduadua L, Kado J, Rafai E, Kama M, Mulholland EK, Russell FM. Effect of ten-valent pneumococcal conjugate vaccine introduction on pneumococcal carriage in Fiji: results from four annual cross-sectional carriage surveys. Lancet Glob Health 2018; 6:e1375-e1385. [PMID: 30420033 PMCID: PMC6231327 DOI: 10.1016/s2214-109x(18)30383-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 07/12/2018] [Accepted: 08/07/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND The indirect effects of pneumococcal conjugate vaccines (PCVs) are mediated through reductions in carriage of vaccine serotypes. Data on PCVs in Asia and the Pacific are scarce. Fiji introduced the ten-valent PCV (PCV10) in 2012, with a schedule consisting of three priming doses at 6, 10, and 14 weeks of age and no booster dose (3 + 0 schedule) without catch-up. We investigated the effects of PCV10 introduction using cross-sectional nasopharyngeal carriage surveys. METHODS We did four annual carriage surveys (one pre-PCV10 and three post-PCV10) in the greater Suva area in Fiji, during 2012-15, of 5-8-week-old infants, 12-23-month-old children, 2-6-year-old children, and their caregivers (total of 8109 participants). Eligible participants were of appropriate age, had axillary temperature lower than 37°C, and had lived in the community for at least 3 consecutive months. We used purposive quota sampling to ensure a proper representation of the Fiji population. Pneumococci were detected by real-time quantitative PCR, and molecular serotyping was done with microarray. FINDINGS 3 years after PCV10 introduction, vaccine-serotype carriage prevalence declined, with adjusted prevalences (2015 vs 2012) of 0·56 (95% CI 0·34-0·93) in 5-8-week-old infants, 0·34 (0·23-0·49) in 12-23-month-olds, 0·47 (0·34-0·66) in 2-6-year-olds, and 0·43 (0·13-1·42) in caregivers. Reductions in PCV10 serotype carriage were evident in both main ethnic groups in Fiji; however, carriage of non-PCV10 serotypes increased in Indigenous Fijian infants and children. Density of PCV10 serotypes and non-PCV10 serotypes was lower in PCV10-vaccinated children aged 12-23 months than in PCV10-unvaccinated children of the same age group (PCV10 serotypes -0·56 [95% CI -0·98 to -0·15], p=0·0077; non-PCV10 serotypes -0·29 [-0·57 to -0·02], p=0·0334). INTERPRETATION Direct and indirect effects on pneumococcal carriage post-PCV10 are likely to result in reductions in pneumococcal disease, including in infants too young to be vaccinated. Serotype replacement in carriage in Fijian children, particularly Indigenous children, warrants further monitoring. Observed changes in pneumococcal density might be temporal rather than vaccine related. FUNDING Department of Foreign Affairs and Trade of the Australian Government through the Fiji Health Sector Support Program; Victorian Government's Operational Infrastructure Support Program; Bill & Melinda Gates Foundation.
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Affiliation(s)
- Eileen M Dunne
- Pneumococcal Research, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia.
| | - Catherine Satzke
- Pneumococcal Research, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia; Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, University of Melbourne, Parkville, VIC, Australia
| | | | - Eleanor F G Neal
- Pneumococcal Research, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Laura K Boelsen
- Pneumococcal Research, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | | | - Casey L Pell
- Pneumococcal Research, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Monica L Nation
- Pneumococcal Research, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Belinda D Ortika
- Pneumococcal Research, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Rita Reyburn
- Pneumococcal Research, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Kylie Jenkins
- Fiji Health Sector Support Program, Suva, Fiji; Telethon Kids Institute, Subiaco, WA, Australia
| | - Cattram Nguyen
- Pneumococcal Research, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Katherine Gould
- Institute for Infection and Immunity, St George's, University of London, UK; BUGS Bioscience, London Bioscience Innovation Centre, London, UK
| | - Jason Hinds
- Institute for Infection and Immunity, St George's, University of London, UK; BUGS Bioscience, London Bioscience Innovation Centre, London, UK
| | | | - Joseph Kado
- Ministry of Health and Medical Services, Suva, Fiji; Telethon Kids Institute, Subiaco, WA, Australia; College of Medicine Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - Eric Rafai
- Ministry of Health and Medical Services, Suva, Fiji
| | - Mike Kama
- Ministry of Health and Medical Services, Suva, Fiji
| | - E Kim Mulholland
- Pneumococcal Research, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia; London School of Hygiene & Tropical Medicine, London, UK
| | - Fiona M Russell
- Pneumococcal Research, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
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10
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Satzke C, Dunne EM, Choummanivong M, Ortika BD, Neal EFG, Pell CL, Nation ML, Fox KK, Nguyen CD, Gould KA, Hinds J, Chanthongthip A, Xeuatvongsa A, Mulholland EK, Sychareun V, Russell FM. Pneumococcal carriage in vaccine-eligible children and unvaccinated infants in Lao PDR two years following the introduction of the 13-valent pneumococcal conjugate vaccine. Vaccine 2018; 37:296-305. [PMID: 30502068 DOI: 10.1016/j.vaccine.2018.10.077] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/11/2018] [Accepted: 10/23/2018] [Indexed: 01/27/2023]
Abstract
Pneumococcal carriage is a prerequisite for disease, and underpins herd protection provided by pneumococcal conjugate vaccines (PCVs). There are few data on the impact of PCVs in lower income settings, particularly in Asia. In 2013, the Lao People's Democratic Republic (Lao PDR) introduced 13-valent PCV (PCV13) as a 3 + 0 schedule (doses at 6, 10 and 14 weeks of age) with limited catch-up vaccination. We conducted two cross-sectional carriage surveys (pre- and two years post-PCV) to assess the impact of PCV13 on nasopharyngeal pneumococcal carriage in 5-8 week old infants (n = 1000) and 12-23 month old children (n = 1010). Pneumococci were detected by quantitative real-time PCR, and molecular serotyping was performed using DNA microarray. Post PCV13, there was a 23% relative reduction in PCV13-type carriage in children aged 12-23 months (adjusted prevalence ratio [aPR] 0.77 [0.61-0.96]), and no significant change in non-PCV13 serotype carriage (aPR 1.11 [0.89-1.38]). In infants too young to be vaccinated, there was no significant change in carriage of PCV13 serotypes (aPR 0.74 [0.43-1.27]) or non-PCV13 serotypes (aPR 1.29 [0.85-1.96]), although trends were suggestive of indirect effects. Over 70% of pneumococcal-positive samples contained at least one antimicrobial resistance gene, which were more common in PCV13 serotypes (p < 0.001). In 12-23 month old children, pneumococcal density of both PCV13 serotypes and non-PCV13 serotypes was higher in PCV13-vaccinated compared with undervaccinated children (p = 0.004 and p < 0.001, respectively). This study provides evidence of PCV13 impact on carriage in a population without prior PCV7 utilisation, and provides important data from a lower-middle income setting in Asia. The reductions in PCV13 serotype carriage in vaccine-eligible children are likely to result in reductions in pneumococcal transmission and disease in Lao PDR.
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Affiliation(s)
- Catherine Satzke
- Pneumococcal Research, Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Australia; Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Parkville, Australia.
| | - Eileen M Dunne
- Pneumococcal Research, Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | | | - Belinda D Ortika
- Pneumococcal Research, Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Australia
| | - Eleanor F G Neal
- Pneumococcal Research, Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Australia; Centre for International Child Health, Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - Casey L Pell
- Pneumococcal Research, Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Australia
| | - Monica L Nation
- Pneumococcal Research, Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Australia
| | - Kimberley K Fox
- Expanded Programme on Immunization, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Cattram D Nguyen
- Pneumococcal Research, Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - Katherine A Gould
- Institute for Infection and Immunity, St. George's, University of London, London, UK; BUGS Bioscience, London Bioscience Innovation Centre, London, UK
| | - Jason Hinds
- Institute for Infection and Immunity, St. George's, University of London, London, UK; BUGS Bioscience, London Bioscience Innovation Centre, London, UK
| | - Anisone Chanthongthip
- Laos-Oxford-Mahosot Hospital Wellcome Trust Research Unit, Vientiane, Lao People's Democratic Republic
| | | | - E Kim Mulholland
- Pneumococcal Research, Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Australia; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Fiona M Russell
- Pneumococcal Research, Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Australia; Centre for International Child Health, Department of Paediatrics, The University of Melbourne, Parkville, Australia
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11
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Sung V, Hiscock H, Tang MLK, Mensah FK, Nation ML, Satzke C, Heine RG, Stock A, Barr RG, Wake M. Treating infant colic with the probiotic Lactobacillus reuteri: double blind, placebo controlled randomised trial. BMJ 2014; 348:g2107. [PMID: 24690625 PMCID: PMC3972414 DOI: 10.1136/bmj.g2107] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine whether the probiotic Lactobacillus reuteri DSM 17938 reduces crying or fussing in a broad community based sample of breastfed infants and formula fed infants with colic aged less than 3 months. DESIGN Double blind, placebo controlled randomised trial. SETTING Community based sample (primary and secondary level care centres) in Melbourne, Australia. PARTICIPANTS 167 breastfed infants or formula fed infants aged less than 3 months meeting Wessel's criteria for crying or fussing: 85 were randomised to receive probiotic and 82 to receive placebo. INTERVENTIONS Oral daily L reuteri (1 × 10(8) colony forming units) versus placebo for one month. MAIN OUTCOMES MEASURES The primary outcome was daily duration of cry or fuss at 1 month. Secondary outcomes were duration of cry or fuss; number of cry or fuss episodes; sleep duration of infant at 7, 14, and 21 days, and 1 and 6 months; maternal mental health (Edinburgh postnatal depression subscale); family functioning (paediatric quality of life inventory), parent quality adjusted life years (assessment of quality of life) at 1 and 6 months; infant functioning (paediatric quality of life inventory) at 6 months; infant faecal microbiota (microbial diversity, colonisation with Escherichia coli), and calprotectin levels at 1 month. In intention to treat analyses the two groups were compared using regression models adjusted for potential confounders. RESULTS Of 167 infants randomised from August 2011 to August 2012, 127 (76%) were retained to primary outcome; of these, a subset was analysed for faecal microbial diversity, E coli colonisation, and calprotectin levels. Adherence was high. Mean daily cry or fuss time fell steadily in both groups. At 1 month, the probiotic group cried or fussed 49 minutes more than the placebo group (95% confidence interval 8 to 90 minutes, P=0.02); this mainly reflected more fussing, especially for formula fed infants. The groups were similar on all secondary outcomes. No study related adverse events occurred. CONCLUSIONS L reuteri DSM 17938 did not benefit a community sample of breastfed infants and formula fed infants with colic. These findings differ from previous smaller trials of selected populations and do not support a general recommendation for the use of probiotics to treat colic in infants. TRIAL REGISTRATION Current Controlled Trials ISRCTN95287767.
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Affiliation(s)
- Valerie Sung
- Royal Children's Hospital, Parkville, Victoria, Australia
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