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Basile M, Rumi F, Fortunato A, Antonini D, Di Virgilio R, Novelli G, Pagliaro A, Di Brino E. An Italian cost-utility analysis of 20-valent pneumococcal conjugate vaccine for routine vaccination in infants. J Med Econ 2025; 28:674-687. [PMID: 40257854 DOI: 10.1080/13696998.2025.2495461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2024] [Revised: 04/16/2025] [Accepted: 04/16/2025] [Indexed: 04/23/2025]
Abstract
BACKGROUND Streptococcus pneumoniae represents a significant global public health threat, causing approximately 45 million lower respiratory tract infections and 350,000 deaths annually among children under 5 years of age. Conjugate pneumococcal vaccines (PCVs), such as PCV15 and PCV20, have been developed to mitigate this burden by providing protection against serotypes responsible for the disease. The present analysis aims to evaluate the cost-utility of PCV20 compared to PCV15 as a vaccination strategy for preventing pneumococcal diseases in children in Italy. METHODS AND MATERIALS A cost-utility analysis (CUA) was conducted using a static Markov model adapted to the Italian context to simulate the economic and clinical effects of vaccination over a 10-year time horizon. The study adopted the perspective of the Italian National Health Service (NHS), considering only direct healthcare costs. Deterministic and probabilistic sensitivity analyses were performed to explore parameter uncertainty. RESULTS The model showed that PCV20 is a dominant strategy compared to PCV15, generating cost savings of €6.45 million and a gain of 101,708 QALYs (quality-adjusted life years). These benefits are attributed to PCV20's broader serotype coverage, which significantly reduces the incidence of invasive and non-invasive pneumococcal diseases. Vaccination with PCV20 offers substantial clinical and economic advantages over PCV15. CONCLUSIONS The introduction of PCV20 as a vaccination strategy for children in Italy represents a cost-effective and clinically advantageous option. Its implementation can reduce the burden of pneumococcal disease and associated healthcare costs, improving public health outcomes and the economic efficiency of the healthcare system.
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Affiliation(s)
- Michele Basile
- ALTEMS ADVISORY, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Filippo Rumi
- ALTEMS ADVISORY, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Debora Antonini
- ALTEMS ADVISORY, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | | | - Eugenio Di Brino
- ALTEMS ADVISORY, Università Cattolica del Sacro Cuore, Rome, Italy
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Huerta JL, Ta A, Vinand E, Torres GI, Wannaadisai W, Huang L. PCV20 for the prevention of invasive pneumococcal disease in the Mexican pediatric population: A cost-effectiveness analysis. Hum Vaccin Immunother 2025; 21:2475594. [PMID: 40178501 PMCID: PMC11980462 DOI: 10.1080/21645515.2025.2475594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2024] [Revised: 02/14/2025] [Accepted: 03/01/2025] [Indexed: 04/05/2025] Open
Abstract
The introduction of a pneumococcal conjugate vaccine (PCV) covering 13 serotypes (PCV13) into the Mexican pediatric national immunization program (NIP) has substantially reduced the burden of pneumococcal disease (PD) since 2010. This study aimed to estimate the impact of replacing either PCV13 or 15valent PCV (PCV15) with 20-valent PCV (PCV20) in the Mexican pediatric NIP. A decision-analytic Markov model was developed to compare the cost-effectiveness of PCV20 versus lower-valent vaccines from a Mexican public health sector (payer) perspective over 10 years. Epidemiological and cost inputs were sourced from Mexican data. Direct and indirect vaccine effects were estimated using PCV13 clinical effectiveness, 7-valent PCV efficacy studies, and PCV13 impact data in Mexico. The estimated disease and cost impact of PCV20 was compared with PCV13 and PCV15, all under a 2 + 1 dosing schedule. A discount rate of 5% per annum was applied to costs and health outcomes. Model robustness was evaluated through sensitivity analyses, including deterministic sensitivity analysis (DSA), probabilistic sensitivity analysis (PSA), and additional scenario assessments. PCV20 was estimated to provide considerably more health benefits than both comparators by averting more cases of PD compared with both PCV13 and PCV15, as well as a total cost saving of over 10 billion Mexican pesos. The DSA, PSA, and scenario assessments confirmed minimal deviation from the base case. Therefore, the introduction of PCV20 (2 + 1) into the Mexican pediatric NIP is expected to reduce the burden of PD and medical costs compared with lower-valent alternatives.
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Affiliation(s)
| | - An Ta
- Evidence Value and Access (EVA) Health Economics team, Real-World Analytics (RWA) at Cytel, London, UK
| | - Elizabeth Vinand
- Evidence Value and Access (EVA) Health Economics team, Real-World Analytics (RWA) at Cytel, London, UK
| | | | | | - Liping Huang
- Global Value and Evidence, Vaccines, Pfizer Inc., New York, NY, USA
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Preda A, Ta A, Vinand E, Purdel V, Zdrafcovici AM, Ilic A, Perdrizet J. Cost-effectiveness analysis of implementing 20-valent pneumococcal conjugate vaccine into the Romanian pediatric national immunization program. J Med Econ 2025; 28:696-708. [PMID: 40304629 DOI: 10.1080/13696998.2025.2499333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2025] [Revised: 04/21/2025] [Accepted: 04/24/2025] [Indexed: 05/02/2025]
Abstract
INTRODUCTION Despite the inclusion of pneumococcal conjugate vaccines (PCV) in the pediatric national immunization program (NIP) since 2017, Romania continues to face a substantial clinical, economic, and societal burden of pneumococcal disease. Higher-valent vaccines, such as 20-valent PCV (PCV20), offer broader serotype coverage versus the current standard of care (13-valent PCV; PCV13) with the potential to reduce disease burden. To test this, we conducted a cost-effectiveness analysis of switching from PCV13 or a potential future comparator (15-valent PCV; PCV15), both under a 2 + 1 schedule, to PCV20 under a 3 + 1 schedule in the Romanian pediatric NIP. METHODS A population-based, multi-cohort Markov model with a target population of children aged <2 years was utilized to estimate the cost and health impact of PCV20 versus lower-valent comparators over 10 years. The model adopted a Romanian societal perspective, encompassing both direct and indirect costs, with an annual cycle. Sensitivity and scenario analyses were conducted to assess the robustness of the model and its assumptions. RESULTS In the base-case analysis, PCV20 demonstrated dominance versus PCV13 and PCV15 (i.e. was more effective and less costly), with total predicted cost-savings of 79,123,267 and 206,623,098 Romanian Leu, respectively, plus reduction in pneumococcal disease cases by 246,245 and 223,914, respectively. The majority of sensitivity and scenario analyses of both pairwise comparisons were aligned with the base case. CONCLUSION The results of this analysis indicate that PCV20 implementation into the Romanian pediatric NIP would greatly reduce pneumococcal disease burden and would be a cost-effective approach versus PCV13 or PCV15 from a societal perspective over 10 years.
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Affiliation(s)
| | - An Ta
- Cytel, London, United Kingdom
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Çakar E, Ta A, Peters M, Vinand E, Waterval-Overbeek A, Ilic A, Perdrizet J. Economic Evaluation of Transitioning to the 20-Valent Pneumococcal Conjugate Vaccine in the Dutch Paediatric National Immunisation Programme. Infect Dis Ther 2025; 14:527-547. [PMID: 39915436 PMCID: PMC11933628 DOI: 10.1007/s40121-025-01109-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Accepted: 01/17/2025] [Indexed: 03/26/2025] Open
Abstract
INTRODUCTION In 2024, the vaccination strategy against pneumococcal disease in the Dutch paediatric population was changed from the 10-valent pneumococcal conjugate vaccine (PCV) (PCV10) to a 15-valent PCV (PCV15) under a 2 + 1 schedule. We aimed to assess whether switching from PCV15 under a 2 + 1 schedule to 20-valent PCV (PCV20) under a 3 + 1 schedule in the Dutch paediatric national immunisation programme (NIP) would yield economic savings and health benefits. METHODS A multiple-cohort population model with an annual cycle and 10-year time horizon was adapted for the Dutch population from a societal perspective. Discounting was set at 3.0% and 1.5% for costs and benefits, respectively. Medical and societal costs were calculated, along with cases of invasive and non-invasive pneumococcal disease, and quality-adjusted life years (QALY) for PCV15 and PCV20, from which, the incremental cost-effectiveness ratio (ICER) per QALY was calculated for PCV20 versus PCV15 to determine the economic benefits of PCV20. The model assumptions were tested in probabilistic and deterministic sensitivity analyses, as well as a series of scenario analyses. RESULTS Both medical and societal cost of disease were substantially lower with PCV20 versus PCV15 (incremental cost-savings of €130,113,010 and €61,593,168, respectively), with total incremental cost-savings of €29,365,696 when considering the cost of the vaccination programme. With an overall QALY gain of 33,232, the ICER per QALY placed PCV20 as the dominant strategy, as it was both more effective and less costly than PCV15. PCV20 was estimated to result in 57,657 fewer pneumococcal disease cases across invasive and non-invasive disease and 1561 fewer disease-related deaths. The sensitivity and scenario analyses demonstrated the robustness of the model results. CONCLUSION This cost-effectiveness analysis demonstrated that switching from PCV15 2 + 1 to PCV20 3 + 1 in the Dutch paediatric NIP would reduce both the clinical burden and projected costs of pneumococcal disease over 10 years.
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Affiliation(s)
- Esra Çakar
- Pfizer BV, Capelle Aan Den IJssel, Netherlands
| | | | | | | | | | | | - Johnna Perdrizet
- Global Value and Evidence, Pfizer Canada, 17300 Trans-Canada Hwy, Kirkland, QC, H9J 2M5, Canada.
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Rey-Ares L, Ta A, Freigofaite D, Warren S, Mac Mullen M, Carballo C, Huang L. Cost-effectiveness analysis of the pediatric 20-valent pneumococcal conjugate vaccine compared with lower-valent alternatives in Argentina. Vaccine 2024; 42:126043. [PMID: 38879409 DOI: 10.1016/j.vaccine.2024.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 05/31/2024] [Accepted: 06/03/2024] [Indexed: 09/15/2024]
Abstract
OBJECTIVES The 13-valent pneumococcal conjugate vaccine (PCV13) has been recommended for infants in Argentina's national immunization program (NIP) in a 2 + 1 schedule since 2012. Licensure of the 15-valent vaccine (PCV15) is anticipated soon, and the 20-valent vaccine (PCV20) recently received regulatory approval. This cost-effectiveness analysis examined the public health and economic implications of transitioning from PCV13 to either PCV15 or PCV20 in Argentina's pediatric NIP. METHODS A decision-analytic Markov model was used with a 10-year time horizon and a 3.0% annual discount rate for costs and benefits. Vaccine effectiveness estimates were derived from Argentinian surveillance data, PCV13 clinical effectiveness and impact studies, and PCV7 efficacy studies. Population, epidemiologic, and economic inputs were obtained from literature and Argentinian-specific data. The study adopted a healthcare system perspective; sensitivity and scenario analyses were conducted to assess input parameters and structural uncertainty. RESULTS Compared with PCV13, PCV20 was estimated to avert an additional 7,378, 42,884, and 172,389 cases of invasive pneumococcal disease (IPD), all-cause pneumonia, and all-cause otitis media (OM), respectively, as well as 3,308 deaths, resulting in savings of United States Dollars (USD) 50,973,962 in direct medical costs. Compared with PCV15, PCV20 was also estimated to have greater benefit, averting an additional 6,140, 35,258, and 142,366 cases of IPD, pneumonia, and OM, respectively, as well as 2,624 deaths, resulting in savings of USD 37,697,868 in direct medical costs. PCV20 was associated with a higher quality-adjusted life year gain and a lower cost (i.e., dominance) versus both PCV13 and PCV15. Results remained robust in sensitivity analyses and scenario assessments. CONCLUSION Over a 10-year horizon, vaccination with PCV20 was expected to be the dominant, cost-saving strategy versus PCV13 and PCV15 in children in Argentina. Policymakers should consider the PCV20 vaccination strategy to achieve the greatest clinical and economic benefit compared with lower-valent options.
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Affiliation(s)
| | | | | | - Sophie Warren
- Global Health Economics & Outcomes Research, Pfizer Inc, New York, NY, United States
| | | | | | - Liping Huang
- Global Health Economics & Outcomes Research, Pfizer Inc, Collegeville, PA, United States
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Huynh D, Tung N, Dam Q, Tran T, Hulten KG, Harrison CJ, Kaplan SL, Nguyen A, Do TH, Setty A, Le J. Amoxicillin and penicillin G dosing in pediatric community-acquired pneumococcal pneumonia in the era of conjugate pneumococcal vaccines. Pharmacotherapy 2024; 44:606-614. [PMID: 36571459 DOI: 10.1002/phar.2756] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 11/11/2022] [Accepted: 11/13/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Parenteral penicillin G (PENG) and oral amoxicillin (AMOX) are recommended as treatment for pediatric community-acquired pneumonia (CAP). With recent epidemiologic penicillin susceptibility data for Streptococcus pneumoniae, the most common etiology of CAP, the objective of this study was to evaluate optimal dosing regimens of PENG and AMOX based on population pharmacokinetics linked to current susceptibility data. METHODS Using NONMEM v7.3, Monte Carlo simulations (N = 10,000) were conducted for AMOX 15 mg/kg/dose PO every 8 h (standard-dose), AMOX 45 mg/kg/dose PO every 12 h (high-dose), and PENG 62,500 units/kg/day IV every 6 h using six virtual subjects with ages spanning 3 months to 15 years old. The probability of target attainment (PTA) was determined for both serum and epithelial lining fluid (ELF) to achieve free drug concentrations above the minimum inhibitory concentration (%fT>MIC) across the population of pneumococci for 30%-50% of the dosing interval. RESULTS In 2018, all 21 (100%) pneumococcal isolates were susceptible to both PENG and AMOX based on Clinical and Laboratory Standards Institute (CLSI; MIC at 2 mg/L) breakpoints, and 15 of 21 (71%) were susceptible based on EUCAST (MIC at 0.5 mg/L) breakpoints. As compared to CLSI, EUCAST breakpoints consistently achieved higher PTA for all antibiotic regimens. At 50% fT>MIC in the serum at the susceptible MICs, standard-dose AMOX achieved >4% PTA (CLSI) and >86% PTA (EUCAST); high-dose AMOX achieved >73% PTA (CLSI) and >99% PTA (EUCAST); and PENG achieved 0% PTA (using CLSI) and 100% PTA (using EUCAST). Standard-dose AMOX, high-dose AMOX, and PENG achieved >71%, >93%, and 100% PTA, respectively, in the serum at 30%-50% fT>MIC when each patient was stochastically linked to an MIC based on the frequency distribution of national susceptibility data. The PTA was consistently lower in ELF as compared with serum for all regimens. CONCLUSION Based on the recent rates of resistance, antibiotic doses evaluated provide appropriate exposure for pediatric CAP based on the serum and ELF data associated with predicted clinical and microbiologic success for pneumococcus. High-dose AMOX may still be required to treat pediatric CAP, especially if using CLSI breakpoints. Ongoing surveillance for resistance is essential.
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Affiliation(s)
- Dustin Huynh
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California at San Diego, San Diego, California, USA
| | - Norint Tung
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California at San Diego, San Diego, California, USA
| | - Quang Dam
- Miller Children's and Women's Hospital of Long Beach, Long Beach, California, USA
| | - Tri Tran
- School of Medicine, University of California Riverside, Riverside, California, USA
| | - Kristina G Hulten
- Department of Pediatrics, Division of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | - Christopher J Harrison
- School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri, USA
- Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Sheldon L Kaplan
- Department of Pediatrics, Division of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | - Allison Nguyen
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California at San Diego, San Diego, California, USA
| | - Tyler H Do
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California at San Diego, San Diego, California, USA
| | - Amartya Setty
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California at San Diego, San Diego, California, USA
| | - Jennifer Le
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California at San Diego, San Diego, California, USA
- Miller Children's and Women's Hospital of Long Beach, Long Beach, California, USA
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Ta A, Kühne F, Laurenz M, von Eiff C, Warren S, Perdrizet J. Cost-effectiveness of PCV20 to Prevent Pneumococcal Disease in the Pediatric Population: A German Societal Perspective Analysis. Infect Dis Ther 2024; 13:1333-1358. [PMID: 38733494 PMCID: PMC11128430 DOI: 10.1007/s40121-024-00977-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/11/2024] [Indexed: 05/13/2024] Open
Abstract
INTRODUCTION Since 2009, a pneumococcal conjugate vaccine (PCV) covering 13 serotypes (PCV13) has been included by Germany's Standing Committee on Vaccinations for infants, resulting in major reductions in pneumococcal disease (PD). Higher-valent vaccines may further reduce PD burden. This cost-effectiveness analysis compared 20-valent PCV (PCV20) under a 3+1 schedule with 15-valent PCV (PCV15) and PCV13, both under 2+1 schedule, in Germany's pediatric population. METHODS A Markov model with annual cycles over a 10-year time horizon was adapted to simulate the clinical and economic impact of pediatric vaccination with PCV20 versus lower-valent PCVs in Germany. The model used PCV13 clinical effectiveness and impact studies as well as PCV7 efficacy studies for vaccine direct and indirect effect estimates. Epidemiologic, utility, and medical cost inputs were obtained from published sources. Benefits and costs were discounted at 3% from a German societal perspective. Outcomes included PD cases, deaths, costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs). RESULTS In the base case, PCV20 provided greater health benefits than PCV13, averting more cases of invasive pneumococcal disease (IPD; 15,301), hospitalized and non-hospitalized pneumonia (460,197 and 472,365, respectively), otitis media (531,634), and 59,265 deaths over 10 years. This resulted in 904,854 additional QALYs and a total cost saving of €2,393,263,611, making PCV20 a dominant strategy compared with PCV13. Compared to PCV15, PCV20 was estimated to avert an additional 11,334 IPD, 704,948 pneumonia, and 441,643 otitis media cases, as well as 41,596 deaths. PCV20 was associated with a higher QALY gain and lower cost (i.e., dominance) compared with PCV15. The robustness of the results was confirmed through scenario analyses as well as deterministic and probabilistic sensitivity analyses. CONCLUSION PCV20 3+1 dominated both PCV13 2+1 and PCV15 2+1 over 10 years. Replacing lower-valent PCVs with PCV20 would result in greater clinical and economic benefits, given PCV20's broader serotype coverage.
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Affiliation(s)
- An Ta
- Cytel, London, United Kingdom
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Assad Z, Valtuille Z, Rybak A, Kaguelidou F, Lazzati A, Varon E, Pham LL, Lenglart L, Faye A, Caseris M, Cohen R, Levy C, Vabret A, Gravey F, Angoulvant F, Koehl B, Ouldali N. Unique Changes in the Incidence of Acute Chest Syndrome in Children With Sickle Cell Disease Unravel the Role of Respiratory Pathogens: A Time Series Analysis. Chest 2024; 165:150-160. [PMID: 37544426 DOI: 10.1016/j.chest.2023.07.4219] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/27/2023] [Accepted: 07/30/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Acute chest syndrome (ACS) is a life-threatening complication of sickle cell disease (SCD). Although respiratory pathogens are frequently detected in children with ACS, their respective role in triggering the disease is still unclear. We hypothesized that the incidence of ACS followed the unprecedented population-level changes in respiratory pathogen dynamics after COVID-19-related nonpharmaceutical interventions (NPIs). RESEARCH QUESTION What is the respective role of respiratory pathogens in ACS epidemiology? STUDY DESIGN AND METHODS This study was an interrupted time series analysis of patient records from a national hospital-based surveillance system. All children aged < 18 years with SCD hospitalized for ACS in France between January 2015 and May 2022 were included. The monthly incidence of ACS per 1,000 children with SCD over time was analyzed by using a quasi-Poisson regression model. The circulation of 12 respiratory pathogens in the general pediatric population over the same period was included in the model to assess the fraction of ACS potentially attributable to each respiratory pathogen. RESULTS Among the 55,941 hospitalizations of children with SCD, 2,306 episodes of ACS were included (median [interquartile range] age, 9 [5-13] years). A significant decrease was observed in ACS incidence after NPI implementation in March 2020 (-29.5%; 95% CI, -46.8 to -12.2; P = .001) and a significant increase after lifting of the NPIs in April 2021 (24.4%; 95% CI, 7.2 to 41.6; P = .007). Using population-level incidence of several respiratory pathogens, Streptococcus pneumoniae accounted for 30.9% (95% CI, 4.9 to 56.9; P = .02) of ACS incidence over the study period and influenza 6.8% (95% CI, 2.3 to 11.3; P = .004); other respiratory pathogens had only a minor role. INTERPRETATION NPIs were associated with significant changes in ACS incidence concomitantly with major changes in the circulation of several respiratory pathogens in the general population. This unique epidemiologic situation allowed determination of the contribution of these respiratory pathogens, in particular S pneumoniae and influenza, to the burden of childhood ACS, highlighting the potential benefit of vaccine prevention in this vulnerable population.
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Affiliation(s)
- Zein Assad
- Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM UMR 1137, Infection, Antimicrobials, Modelling, Evolution (IAME), Paris Cité University, Paris, France.
| | - Zaba Valtuille
- Centre d'Investigation Clinique, INSERM CIC1426, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; EA7323 Perinatal and Pediatric Pharmacology and Therapeutic Assessment, Paris Cité University, Paris, France
| | - Alexis Rybak
- INSERM UMR 1123, ECEVE, Paris Cité University, Paris, France; Urgences Pédiatriques, Hôpital Trousseau, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France; Association Clinique et Thérapeutique Infantile du Val-de-Marne (ACTIV), St Maur-des-Fossés, France
| | - Florentia Kaguelidou
- Centre d'Investigation Clinique, INSERM CIC1426, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; EA7323 Perinatal and Pediatric Pharmacology and Therapeutic Assessment, Paris Cité University, Paris, France
| | - Andrea Lazzati
- Department of General Surgery, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Emmanuelle Varon
- National Reference Center for Pneumococci, Centre de Recherche Clinique et Biologique, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Luu-Ly Pham
- INSERM UMR 1137, Infection, Antimicrobials, Modelling, Evolution (IAME), Paris Cité University, Paris, France; Department of General Pediatrics, Jean Verdier University Hospital, Assistance Publique-Hôpitaux de Paris, Bondy, France
| | - Léa Lenglart
- INSERM UMR 1137, Infection, Antimicrobials, Modelling, Evolution (IAME), Paris Cité University, Paris, France; Service d'Accueil des Urgences Pédiatriques, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Albert Faye
- Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM UMR 1123, ECEVE, Paris Cité University, Paris, France
| | - Marion Caseris
- Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Robert Cohen
- Association Clinique et Thérapeutique Infantile du Val-de-Marne (ACTIV), St Maur-des-Fossés, France; Centre Hospitalier Intercommunal, Research Centre, Université Paris Est, IMRB-GRC GEMINI, Créteil, France
| | - Corinne Levy
- Association Clinique et Thérapeutique Infantile du Val-de-Marne (ACTIV), St Maur-des-Fossés, France; Centre Hospitalier Intercommunal, Research Centre, Université Paris Est, IMRB-GRC GEMINI, Créteil, France
| | - Astrid Vabret
- Department of Virology, Caen University Hospital, Caen, France; Univ Caen Normandie, Univ Rouen Normandie, INSERM UMR 1311, DYNAMICURE, Caen, France
| | - François Gravey
- Univ Caen Normandie, Univ Rouen Normandie, INSERM UMR 1311, DYNAMICURE, Caen, France
| | - François Angoulvant
- Paris Sorbonne University, Centre de Recherche des Cordeliers, INSERM UMRS 1138, Paris, France
| | - Bérengère Koehl
- Department of Child Hematology, Reference Center for Sickle-Cell Disease, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM UMR S1134, Integrated Biology of Red Blood Cells, Paris Cité University, Paris, France
| | - Naïm Ouldali
- Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM UMR 1137, Infection, Antimicrobials, Modelling, Evolution (IAME), Paris Cité University, Paris, France; INSERM UMR 1123, ECEVE, Paris Cité University, Paris, France
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Tian J, Zheng B, Yang L, Guan Y, Xu C, Wang W. Effectiveness of 13-valent pneumococcal conjugate vaccine on all-cause pneumonia in children under 5 years in Shanghai, China: An observational study. Vaccine 2023; 41:5979-5986. [PMID: 37620204 PMCID: PMC10549215 DOI: 10.1016/j.vaccine.2023.08.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 07/28/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Streptococcus pneumoniae (Spn) is a common respiratory pathogen and the main cause of bacterial pneumonia, meningitis, and bacteremia, acute otitis media. Imported 13-valent pneumococcal conjugate vaccine (PCV13) was licensed in China and introduced in Shanghai in 2017. We aim to describe PCV13 vaccination trends and pneumonia incidence of children under 5 from 2017 to 2020, then estimate the effectiveness of PCV13 against community-acquired pneumonia (CAP) in children under 5 in Shanghai, China. METHODS By calculating propensity scores with logistic regression, a comparison group was formed by frequency matching one unvaccinated child to one vaccinated child. For matching, we used the nearest-neighbor matching algorithm and exact matching, and then created distinct matched analysis sets for two cohorts. A Kaplan-Meier analysis was conducted to measure the cumulative incidence of all-cause pneumonia in both groups and used the log-rank test to assess the differences between the two cumulative incidence curves. Cox proportional hazards regression was used to compare the adjusted hazard ratios (HR) of differences in all-cause pneumonia between the two groups. RESULTS Children received three or more doses PCV13 accounted for 85.7% of all vaccinated children. The incidence of pneumonia in Shanghai's Songjiang district decreased rapidly from 2017, when PCV13 vaccination presented an overall increasing trend. The estimated vaccine effectiveness against visits for all-cause pneumonia was 19% (95% CI: 3 to 32) after the first dose in children vaccinated with at least one dose of PCV13. The protective effectiveness of PCV13 was found to be higher for hospitalized pneumonia (30%, 95% CI: 5% to 49%) than for outpatient pneumonia (19%, 95% CI: 4% to 32%). CONCLUSIONS PCV13 vaccination among children aged 0-5 years substantially reduced the incidence of all-cause pneumonia. Direct immunization of children under 5 years is an effective strategy to combat outpatient pneumonia, and hospitalized pneumonia.
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Affiliation(s)
- Jie Tian
- School of Public Health, Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai 200032, China
| | - Bo Zheng
- School of Public Health, Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai 200032, China
| | - Laibao Yang
- Department of Immunization, Pudong New Area Center for Disease Control and Prevention, Shanghai 200136, China
| | - Ying Guan
- Department of Health Information, Songjiang Center for Disease Control and Prevention, Shanghai 201620, China
| | - Chunze Xu
- Department of Health Information, Songjiang Center for Disease Control and Prevention, Shanghai 201620, China
| | - Weibing Wang
- School of Public Health, Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai 200032, China; Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, 138 Yi Xue Yuan Road, Shanghai 200032, China.
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10
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Lytle D, Grajales Beltrán AG, Perdrizet J, Ait Yahia N, Cane A, Yarnoff B, Chapman R. Cost-effectiveness analysis of PCV20 to prevent pneumococcal disease in the Canadian pediatric population. Hum Vaccin Immunother 2023; 19:2257426. [PMID: 37771288 PMCID: PMC10543337 DOI: 10.1080/21645515.2023.2257426] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 09/07/2023] [Indexed: 09/30/2023] Open
Abstract
This study assessed the cost-effectiveness of the 20-valent pneumococcal conjugate vaccine (PCV20) in Canadian infants aged <2 years versus the standard of care (SoC), a 13-valent pneumococcal conjugate vaccine (PCV13), or a potential 15-valent pneumococcal conjugate vaccine (PCV15). A decision-analytic Markov model was developed to compare PCV20 with PCV13 or PCV15 in a 2 + 1 schedule over 10 years. Vaccine effect estimates (direct and indirect) across all ages were informed by PCV13 clinical effectiveness and impact studies as well as PCV7 efficacy studies. Epidemiologic, clinical, health state utilities, utility decrements, cost per event, and list price data were from Canadian sources where available. Clinical and economic outcomes related to invasive pneumococcal disease (IPD), hospitalized and non-hospitalized pneumonia, and simple and complex otitis media (OM) were calculated for each strategy. Cost-effectiveness was evaluated from the publicly funded healthcare system perspective. Over 10 years, PCV20 versus PCV13 was estimated to avert over 11,000 IPD cases, 316,000 hospitalized and non-hospitalized pneumonia cases, 335,000 simple and complex OM cases, and 15,000 deaths, resulting in cost savings of over 3.2 billion Canadian dollars (CAD) and 47,000 more quality-adjusted life years (i.e. dominant strategy). Compared with PCV15, PCV20 was estimated to result in over 1.4 billion CAD in cost savings and 21,000 more QALYs (i.e. dominant strategy). PCV20 was dominant over both PCV13 and PCV15. Given broader serotype coverage, substantial incremental benefits and cost-savings, PCV20 should be considered as a replacement for the SoC in the publicly funded Canadian infant immunization program.
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Affiliation(s)
- Derek Lytle
- Market Access, Pfizer Canada, Kirkland, QC, Canada
| | | | | | | | - Alejandro Cane
- Vaccines Medical and Scientific Affairs, North America, Pfizer Inc, Collegeville, PA, USA
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11
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Assad Z, Michel M, Valtuille Z, Lazzati A, Boizeau P, Madhi F, Gaschignard J, Pham LL, Caseris M, Cohen R, Kaguelidou F, Varon E, Alberti C, Faye A, Angoulvant F, Koehl B, Ouldali N. Incidence of Acute Chest Syndrome in Children With Sickle Cell Disease Following Implementation of the 13-Valent Pneumococcal Conjugate Vaccine in France. JAMA Netw Open 2022; 5:e2225141. [PMID: 35917121 PMCID: PMC9346553 DOI: 10.1001/jamanetworkopen.2022.25141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Acute chest syndrome (ACS) is one of the leading acute severe complications of sickle-cell disease (SCD). Although Streptococcus pneumoniae (S pneumoniae) is highly prevalent in children with SCD, its precise role in ACS is unclear. The efficacy of 13-valent pneumococcal conjugate vaccine (PCV13) implementation on ACS is still unknown. OBJECTIVE To assess the association of PCV13 implementation in the general pediatric population with the incidence of ACS in children with SCD. DESIGN, SETTING, AND PARTICIPANTS This cohort study used an interrupted time-series analysis of patient records from a national hospital-based French surveillance system. All children younger than 18 years with SCD (based on the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision definition) hospitalized in France between January 2007 and December 2019 were included. EXPOSURES PCV13 implementation. MAIN OUTCOMES AND MEASURES Monthly incidence of ACS per 1000 children with SCD over time as analyzed by segmented linear regression with autoregressive error; monthly incidence of hospitalization for vaso-occlusive crisis, asthma crisis, and acute pyelonephritis per 1000 children with SCD over the same period as the control outcomes. RESULTS Among the 107 694 hospitalizations of children with SCD, 4007 episodes of ACS were included (median [IQR] age, 8 [4-12] years; 2228 [55.6%] boys). PCV13 implementation in 2010 was followed by a significant decrease in the incidence of ACS (-0.9% per month; 95% CI, -1.4% to -0.4%; P < .001), with an estimated cumulative change of -41.8% (95% CI, -70.8% to -12.7%) by 2019. Sensitivity analyses yielded the same results, including the incidence of ACS adjusted for that of vaso-occlusive crisis over time. The results were similar among different age groups. By contrast, no change was found for the 3 control outcomes over the study period. CONCLUSIONS AND RELEVANCE PCV13 implementation was associated with an important reduction in the incidence of ACS in children with SCD. This vaccine benefit provides new evidence of the key role of S pneumoniae in ACS and should be considered when estimating outcomes associated with current PCVs and the potential benefit of next-generation PCVs in children.
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Affiliation(s)
- Zein Assad
- Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Clinical Epidemiology Unit, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Caen-Normandie, Caen, France
| | - Morgane Michel
- Clinical Epidemiology Unit, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Unité de Recherche Clinique en Économie de la Santé, Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
- ECEVE (Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables), Institut national de la santé et de la recherche médicale, Unité mixte de recherche 1123, Paris University, Paris, France
| | - Zaba Valtuille
- Institut national de la santé et de la recherche médicale, Centre d'Investigation Clinique 1426, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Andrea Lazzati
- Department of General Surgery, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Priscilla Boizeau
- Clinical Epidemiology Unit, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Fouad Madhi
- Department of General Pediatrics, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Jean Gaschignard
- Department of General Pediatrics, Groupe Hospitalier Nord Essonne, Longjumeaux, France
- IAME (Infection, Antimicrobials, Modelling, Evolution), Institut national de la santé et de la recherche médicale, Unité mixte de recherche 1137, Paris University, Paris, France
| | - Luu-Ly Pham
- Department of General Pediatrics, Jean Verdier University Hospital, Assistance Publique-Hôpitaux de Paris, Bondy, France
| | - Marion Caseris
- Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Robert Cohen
- Association Clinique et Thérapeutique Infantile du Val-de-Marne, St Maur-des-Fossés, France
- Centre Hospitalier Intercommunal, Research Centre, Université Paris Est, IMRB-GRC GEMINI, Créteil, France
| | - Florentia Kaguelidou
- Institut national de la santé et de la recherche médicale, Centre d'Investigation Clinique 1426, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Emmanuelle Varon
- National Reference Center for Pneumococci, Laboratoire de Microbiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France
| | - Corinne Alberti
- Clinical Epidemiology Unit, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- ECEVE (Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables), Institut national de la santé et de la recherche médicale, Unité mixte de recherche 1123, Paris University, Paris, France
| | - Albert Faye
- Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- ECEVE (Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables), Institut national de la santé et de la recherche médicale, Unité mixte de recherche 1123, Paris University, Paris, France
| | - François Angoulvant
- Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Centre de Recherche des Cordeliers, Institut national de la santé et de la recherche médicale (Unité mixte de recherche S1138), Sorbonne Université, Université de Paris, Paris, France
| | - Bérengère Koehl
- Department of Child Hematology, Reference Center for Sickle-Cell Disease Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Integrated Biology of Red Blood Cells, Institut national de la santé et de la recherche médicale, Unité mixte de recherche S1134, Paris University, Paris, France
| | - Naïm Ouldali
- Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- ECEVE (Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables), Institut national de la santé et de la recherche médicale, Unité mixte de recherche 1123, Paris University, Paris, France
- Association Clinique et Thérapeutique Infantile du Val-de-Marne, St Maur-des-Fossés, France
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12
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Rybak A, Ouldali N, Angoulvant F, Minodier P, Biscardi S, Madhi F, Hau I, Santos A, Bouvy E, Dubos F, Martinot A, Dommergues MA, Gras-Le Guen C, Launay E, Levieux K, Zenkhri F, Craiu I, Lorrot M, Gillet Y, Mezgueldi E, Faye A, Béchet S, Varon E, Cohen R, Levy C. Shift in Clinical Profile of Hospitalized Pneumonia in Children in the Non-pharmaceutical Interventions Period During the COVID-19 Pandemic: A Prospective Multicenter Study. Front Pediatr 2022; 10:782894. [PMID: 35391746 PMCID: PMC8980475 DOI: 10.3389/fped.2022.782894] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/31/2022] [Indexed: 01/13/2023] Open
Abstract
Non-pharmaceutical interventions (NPIs) against coronavirus disease 2019 were implemented in March 2020. These measures were followed by a major impact on viral and non-viral diseases. We aimed to assess the impact of NPI implementation in France on hospitalized community-acquired pneumonia (hCAP) frequency and the clinical and biological characteristics of the remaining cases in children. We performed a quasi-experimental interrupted time-series analysis. Between June 2014 and December 2020, eight pediatric emergency departments throughout France reported prospectively all cases of hCAP in children from age 1 month to 15 years. We estimated the impact on the monthly number of hCAP using segmented linear regression with autoregressive error model. We included 2,972 hCAP cases; 115 occurred during the NPI implementation period. We observed a sharp decrease in the monthly number of hCAP after NPI implementation [-63.0% (95 confidence interval, -86.8 to -39.2%); p < 0.001]. Children with hCAP were significantly older during than before the NPI period (median age, 3.9 vs. 2.3 years; p < 0.0001), and we observed a higher proportion of low inflammatory marker status (43.5 vs. 33.1%; p = 0.02). Furthermore, we observed a trend with a decrease in the proportion of cases with pleural effusion (5.3% during the NPI period vs. 10.9% before the NPI; p = 0.06). NPI implementation during the COVID-19 (coronavirus disease 2019) pandemic led not only to a strong decrease in the number of hCAP cases but also a modification in the clinical profile of children affected, which may reflect a change in pathogens involved.
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Affiliation(s)
- Alexis Rybak
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France.,Assistance Publique - Hôpitaux de Paris, Pediatric Emergency Department, Robert Debré University Hospital, Université de Paris, Paris, France.,INSERM, Unité Mixte de Recherche 1123 Epidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables, Université de Paris, Paris, France
| | - Naïm Ouldali
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France.,INSERM, Unité Mixte de Recherche 1123 Epidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables, Université de Paris, Paris, France.,Assistance Publique-Hôpitaux de Paris, Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Université de Paris, Paris, France
| | - François Angoulvant
- Assistance Publique-Hôpitaux de Paris, Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Université de Paris, Paris, France.,INSERM, Centre de Recherche des Cordeliers, UMRS 1138, Sorbonne Université, Université de Paris, Paris, France.,Groupe de Pathologie Infectieuse Pédiatrique, Paris, France
| | - Philippe Minodier
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,Department of Pediatric Emergency, Centre Hospitalier Universitaire Nord, Marseille, France
| | - Sandra Biscardi
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,Department of Pediatric Emergency, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Fouad Madhi
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,Department of General Pediatrics, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Isabelle Hau
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,Department of General Pediatrics, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Audrey Santos
- Assistance Publique - Hôpitaux de Paris, Pediatric Emergency Department, Robert Debré University Hospital, Université de Paris, Paris, France
| | - Emilie Bouvy
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,Pediatric Emergency Unit and Infectious Diseases, Université de Lille, Centre Hospitalier Universitaire Lille, Lille, France
| | - François Dubos
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,Pediatric Emergency Unit and Infectious Diseases, Université de Lille, Centre Hospitalier Universitaire Lille, Lille, France
| | - Alain Martinot
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,Pediatric Emergency Unit and Infectious Diseases, Université de Lille, Centre Hospitalier Universitaire Lille, Lille, France
| | - Marie-Aliette Dommergues
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,Department of General Pediatrics, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Christèle Gras-Le Guen
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,Department of Pediatrics, Centre Hospitalier Universitaire Nantes, Nantes, France
| | - Elise Launay
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,Department of Pediatrics, Centre Hospitalier Universitaire Nantes, Nantes, France
| | - Karine Levieux
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,Department of Pediatrics, Centre Hospitalier Universitaire Nantes, Nantes, France
| | - Ferielle Zenkhri
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,Department of Pediatric Emergency, Assistance Publique-Hôpitaux de Paris, Hôpital Le Kremlin-Bicêtre, Université Paris, Paris, France
| | - Irina Craiu
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,Department of Pediatric Emergency, Assistance Publique-Hôpitaux de Paris, Hôpital Le Kremlin-Bicêtre, Université Paris, Paris, France
| | - Mathie Lorrot
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,Department of General Pediatrics, Assistance Publique-Hôpitaux de Paris, Hôpital Armand Trousseau, Université Sorbonne Paris Cité, Paris, France
| | - Yves Gillet
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,Department of Pediatric Emergency, L'Hôpital Femme Mère Enfant Lyon, Lyon, France
| | - Ellia Mezgueldi
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,Department of Pediatric Emergency, L'Hôpital Femme Mère Enfant Lyon, Lyon, France
| | - Albert Faye
- INSERM, Unité Mixte de Recherche 1123 Epidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables, Université de Paris, Paris, France.,Assistance Publique-Hôpitaux de Paris, Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Université de Paris, Paris, France.,Groupe de Pathologie Infectieuse Pédiatrique, Paris, France
| | - Stéphane Béchet
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France.,Groupe de Pathologie Infectieuse Pédiatrique, Paris, France
| | - Emmanuelle Varon
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,National Reference Center for Pneumococci, Laboratoire de Microbiologie, Hôpital Intercommunal, Créteil, France
| | - Robert Cohen
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France.,Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,Paris Est University, IMRB-GRC GEMINI, Créteil, France.,Clinical Research Center, Centre Hospitalier Intercommunal de Créteil, Créteil, France.,Neonates Department, Centre Hospitalier Intercommunal de Créteil, Université Paris Est, Créteil, France
| | - Corinne Levy
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France.,Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,Paris Est University, IMRB-GRC GEMINI, Créteil, France.,Clinical Research Center, Centre Hospitalier Intercommunal de Créteil, Créteil, France
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13
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Valim C, Olatunji YA, Isa YS, Salaudeen R, Golam S, Knol EF, Kanyi S, Jammeh A, Bassat Q, de Jager W, Diaz AA, Wiegand RC, Ramirez J, Moses MA, D'Alessandro U, Hibberd PL, Mackenzie GA. Seeking diagnostic and prognostic biomarkers for childhood bacterial pneumonia in sub-Saharan Africa: study protocol for an observational study. BMJ Open 2021; 11:e046590. [PMID: 34593486 PMCID: PMC8487183 DOI: 10.1136/bmjopen-2020-046590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Clinically diagnosed pneumonia in children is a leading cause of paediatric hospitalisation and mortality. The aetiology is usually bacterial or viral, but malaria can cause a syndrome indistinguishable from clinical pneumonia. There is no method with high sensitivity to detect a bacterial infection in these patients and, as result, antibiotics are frequently overprescribed. Conversely, unrecognised concomitant bacterial infection in patients with malarial infections occur with omission of antibiotic therapy from patients with bacterial infections. Previously, we identified two combinations of blood proteins with 96% sensitivity and 86% specificity for detecting bacterial disease. The current project aimed to validate and improve these combinations by evaluating additional biomarkers in paediatric patients with clinical pneumonia. Our goal was to describe combinations of a limited number of proteins with high sensitivity and specificity for bacterial infection to be incorporated in future point-of-care tests. Furthermore, we seek to explore signatures to prognosticate clinical pneumonia. METHODS AND ANALYSIS Patients (n=900) aged 2-59 months presenting with clinical pneumonia at two Gambian hospitals will be enrolled and classified according to criteria for definitive bacterial aetiology (based on microbiological tests and chest radiographs). We will measure proteins at admission using Luminex-based immunoassays in 90 children with definitive and 160 with probable bacterial aetiology, and 160 children classified according to the prognosis of their disease. Previously identified diagnostic signatures will be assessed through accuracy measures. Moreover, we will seek new diagnostic and prognostic signatures through machine learning methods, including support vector machine, penalised regression and classification trees. ETHICS AND DISSEMINATION Ethics approval has been obtained from the Gambia Government/Medical Research Council Unit The Gambia Joint Ethics Committee (protocol 1616) and the institutional review board of Boston University Medical Centre (STUDY00000958). Study results will be disseminated to the staff of the study hospitals, in scientific seminars and meetings, and in publications. TRIAL REGISTRATION NUMBER H-38462.
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Affiliation(s)
- Clarissa Valim
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Yekin Ajauoi Olatunji
- Medical Research Council Unit, The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Yasir Shitu Isa
- Medical Research Council Unit, The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Rasheed Salaudeen
- Medical Research Council Unit, The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Sarwar Golam
- Medical Research Council Unit, The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Edward F Knol
- Center of Translational Immunology, Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | - Quique Bassat
- Hospital Clínic, Universitat de Barcelona, ISGlobal, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Wilco de Jager
- Center of Translational Immunology, Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
- Luminex Corp, Austin, Texas, USA
| | - Alejandro A Diaz
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Julio Ramirez
- Division of Infectious Diseases, University of Louisville, Louisville, Kentucky, USA
| | - Marsha A Moses
- Vascular Biology Program, Children's Hospital Boston, Boston, Massachusetts, USA
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Umberto D'Alessandro
- Disease Elimination and Control, Medical Research Council Unit, Fajara, Gambia
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Grant A Mackenzie
- Medical Research Council Unit, The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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14
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Chen Y, Roberts CS, Ou W, Petigara T, Goldmacher GV, Fancourt N, Knoll MD. Deep learning for classification of pediatric chest radiographs by WHO's standardized methodology. PLoS One 2021; 16:e0253239. [PMID: 34153076 PMCID: PMC8216551 DOI: 10.1371/journal.pone.0253239] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/31/2021] [Indexed: 11/05/2022] Open
Abstract
Background The World Health Organization (WHO)-defined radiological pneumonia is a preferred endpoint in pneumococcal vaccine efficacy and effectiveness studies in children. Automating the WHO methodology may support more widespread application of this endpoint. Methods We trained a deep learning model to classify pneumonia CXRs in children using the World Health Organization (WHO)’s standardized methodology. The model was pretrained on CheXpert, a dataset containing 224,316 adult CXRs, and fine-tuned on PERCH, a pediatric dataset containing 4,172 CXRs. The model was then tested on two pediatric CXR datasets released by WHO. We also compared the model’s performance to that of radiologists and pediatricians. Results The average area under the receiver operating characteristic curve (AUC) for primary endpoint pneumonia (PEP) across 10-fold validation of PERCH images was 0.928; average AUC after testing on WHO images was 0.977. The model’s classification performance was better on test images with high inter-observer agreement; however, the model still outperformed human assessments in AUC and precision-recall spaces on low agreement images. Conclusion A deep learning model can classify pneumonia CXR images in children at a performance comparable to human readers. Our method lays a strong foundation for the potential inclusion of computer-aided readings of pediatric CXRs in vaccine trials and epidemiology studies.
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Affiliation(s)
- Yiyun Chen
- Merck & Co., Inc., Kenilworth, New Jersey, United States of America
- * E-mail:
| | - Craig S. Roberts
- Merck & Co., Inc., Kenilworth, New Jersey, United States of America
| | - Wanmei Ou
- Merck & Co., Inc., Kenilworth, New Jersey, United States of America
| | - Tanaz Petigara
- Merck & Co., Inc., Kenilworth, New Jersey, United States of America
| | | | - Nicholas Fancourt
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Maria Deloria Knoll
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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15
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Dudognon D, Levy C, Chalumeau M, Biscardi S, Dommergues MA, Dubos F, Levieux K, Aurel M, Minodier P, Zenkhri F, Mezgueldi E, Craiu I, Morin L, Béchet S, Varon E, Cohen R, Cohen JF. Diagnostic Accuracy of Routinely Available Biomarkers to Predict Bacteremia in Children With Community-Acquired Pneumonia: A Secondary Analysis of the GPIP/ACTIV Pneumonia Study in France, 2009-2018. Front Pediatr 2021; 9:684628. [PMID: 34746044 PMCID: PMC8567958 DOI: 10.3389/fped.2021.684628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 09/09/2021] [Indexed: 11/13/2022] Open
Abstract
Objective(s): Blood cultures (BC), when performed in children seen in the emergency department with community-acquired pneumonia (CAP), are most of the time sterile. We described the diagnostic accuracy of white blood cells (WBC), absolute neutrophils count (ANC), C-reactive protein (CRP), and procalcitonin (PCT) to predict blood culture (BC) result in childhood CAP. Study Design: Secondary analysis of a prospective study carried out in eight pediatric emergency departments (France, 2009-2018), including children (≤15 years) with CAP. Analyses involved univariate comparisons and ROC curves. Results: We included 13,752 children with CAP. BC was positive in 137 (3.6%) of the 3,829 children (mean age 3.7 years) in whom it was performed, mostly with Streptococcus pneumoniae (n = 107). In children with bacteremia, ANC, CRP and PCT levels were higher (median 12,256 vs. 9,251/mm3, 223 vs. 72 mg/L and 8.6 vs. 1.0 ng/mL, respectively; p ≤ 0.002), but WBC levels were not. The area under the ROC curve of PCT (0.73 [95%CI 0.64-0.82]) was significantly higher (p ≤ 0.01) than that of WBC (0.51 [0.43-0.60]) and of ANC (0.55 [0.46-0.64]), but not than that of CRP (0.66 [0.56-0.76]; p = 0.21). CRP and PCT thresholds that provided a sensitivity of at least 90% were 30 mg/L and 0.25 ng/mL, respectively, for a specificity of 25.4 and 23.4%, respectively. CRP and PCT thresholds that provided a specificity of at least 90% were 300 mg/L and 20 ng/mL, respectively, for a sensitivity of 31.3 and 28.9%, respectively. Conclusions: PCT and CRP are the best routinely available predictive biomarkers of bacteremia in childhood CAP.
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Affiliation(s)
- Danaé Dudognon
- Department of General Pediatrics and Pediatric Infectious Diseases, AP-HP, Hôpital Necker-Enfants Malades, Université de Paris, Paris, France
| | - Corinne Levy
- Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Créteil, France.,Groupe de Pathologie Infectieuse Pédiatrique (GPIP), Paris, France.,Clinical Research Centre, Centre Hospitalier Intercommunal de Créteil, Créteil, France.,Paris Est University, IMRB-GRC GEMINI, Créteil, France
| | - Martin Chalumeau
- Department of General Pediatrics and Pediatric Infectious Diseases, AP-HP, Hôpital Necker-Enfants Malades, Université de Paris, Paris, France.,Epidemiology and Statistics Research Centre - CRESS, INSERM, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Université de Paris, Paris, France
| | - Sandra Biscardi
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP), Paris, France.,Pediatric Emergency Department, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Marie-Aliette Dommergues
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP), Paris, France.,Department of General Pediatrics, Centre Hospitalier de Versailles-Le Chesnay, Versailles, France
| | - François Dubos
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP), Paris, France.,Pediatric Emergency Unit and Infectious Diseases, Univ. Lille, CHU Lille, Lille, France
| | - Karine Levieux
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP), Paris, France.,Department of Pediatrics, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Marie Aurel
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP), Paris, France.,Department of General Pediatrics, AP-HP, Hôpital Robert Debré, Université de Paris, Paris, France
| | - Philippe Minodier
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP), Paris, France.,Pediatric Emergency Department, Centre Hospitalier Universitaire Nord, Marseille, France
| | - Ferielle Zenkhri
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP), Paris, France.,Pediatric Emergency Department, AP-HP, Hôpital Le Kremlin-Bicêtre, Université Paris Sud, Bicêtre, France
| | - Ellia Mezgueldi
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP), Paris, France.,Pediatric Emergency Department, Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Lyon, France
| | - Irina Craiu
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP), Paris, France.,Pediatric Emergency Department, AP-HP, Hôpital Le Kremlin-Bicêtre, Université Paris Sud, Bicêtre, France
| | - Laurence Morin
- Groupe de Pathologie Infectieuse Pédiatrique (GPIP), Paris, France.,Pediatric Emergency Department, AP-HP, Hôpital Robert Debré, Université de Paris, Paris, France
| | - Stéphane Béchet
- Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Créteil, France
| | - Emmanuelle Varon
- Centre National de Référence des Pneumocoques, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Robert Cohen
- Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Créteil, France.,Groupe de Pathologie Infectieuse Pédiatrique (GPIP), Paris, France.,Clinical Research Centre, Centre Hospitalier Intercommunal de Créteil, Créteil, France.,Paris Est University, IMRB-GRC GEMINI, Créteil, France.,Service des Petits Nourrissons, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Jérémie F Cohen
- Department of General Pediatrics and Pediatric Infectious Diseases, AP-HP, Hôpital Necker-Enfants Malades, Université de Paris, Paris, France.,Epidemiology and Statistics Research Centre - CRESS, INSERM, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Université de Paris, Paris, France
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16
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Chevalier-Cottin EP, Ashbaugh H, Brooke N, Gavazzi G, Santillana M, Burlet N, Tin Tin Htar M. Communicating Benefits from Vaccines Beyond Preventing Infectious Diseases. Infect Dis Ther 2020; 9:467-480. [PMID: 32583334 PMCID: PMC7452969 DOI: 10.1007/s40121-020-00312-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Indexed: 02/06/2023] Open
Abstract
Despite immunisation being one of the greatest medical success stories of the twentieth century, there is a growing lack of confidence in some vaccines. Improving communication about the direct benefits of vaccination as well as its benefits beyond preventing infectious diseases may help regain this lost confidence. A conference was organised at the Fondation Merieux in France to discuss what benefits could be communicated and how innovative digital initiatives can used for communication. During this meeting, a wide range of indirect benefits of vaccination were discussed. For example, influenza vaccination can reduce hospitalisations and deaths in older persons with diabetes by 45% and 38%, respectively, but the link between influenza and complications from underlying chronic non-communicable diseases such as diabetes is frequently underestimated. Vaccination can reduce antimicrobial resistance (AMR), which is growing, by reducing the incidence of infectious disease (though direct and indirect or herd protection), by reducing the number of circulating AMR strains, and by reducing the need for antimicrobial use. Disease morbidity and treatment costs in the elderly population are likely to rise substantially, with the ageing global population. Healthy ageing and life-course vaccination approaches can reduce the burden of vaccine-preventable diseases, such as seasonal influenza and pneumococcal diseases, which place a significant burden on individuals and society, while improving quality of life. Novel disease surveillance systems based on information from Internet search engines, mobile phone apps, social media, cloud-based electronic health records, and crowd-sourced systems, contribute to improved awareness of disease burden. Examples of the role of new techniques and tools to process data generated by multiple sources, such as artificial intelligence, to support vaccination programmes, such as influenza and dengue, were discussed. The conference participants agreed that continual efforts are needed from all stakeholders to ensure effective, transparent communication of the full benefits and risks of vaccination.
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Affiliation(s)
| | - Hayley Ashbaugh
- Department of Epidemiology, UCLA Fielding School of Public Health, UCLA Fielding School of Public Health, South, Los Angeles, CA, USA
| | | | - Gaetan Gavazzi
- Geriatric Clinic, Grenoble-Alpes University Hospital, GREPI EA, Grenoble-Alpes University, 7408, Grenoble, France
| | | | - Nansa Burlet
- Global head Patient Insights Innovation, Sanofi Pasteur, Lyon, France
| | - Myint Tin Tin Htar
- Medical Development and Scientific/Clinical Affairs, Pfizer Inc., Paris, France
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17
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[Antibiotic strategy in pleural empyema in children: Consensus by the DELPHI method]. Rev Mal Respir 2020; 37:443-450. [PMID: 32439250 DOI: 10.1016/j.rmr.2020.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 04/11/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The evolution of the microbial epidemiology of pleuropulmonary infections complicating community-acquired pneumonia has resulted in a change in empirical or targeted antibiotic therapy in children in the post Prevenar 13 era. The three main pathogens involved in pleural empyema in children are Streptococcus pneumoniae, Staphylococcus aureus and group A Streptococcus. METHODS A questionnaire according to the DELPHI method was sent to experts in the field (paediatric pulmonologists and infectious disease specialists) in France with the purpose of reaching a consensus on the conservative antibiotic treatment of pleural empyema in children. Two rounds were completed as part of this DELPHI process. RESULTS Our work has shown that in the absence of clinical signs of severity, the prescription of an intravenous monotherapy is consensual but there is no agreement on the choice of drug to use. A consensus was also reached on treatment adjustment based on the results of blood cultures, the non-systematic use of a combination therapy, the need for continued oral therapy and the lack of impact of pleural drainage on infection control. On the other hand, after the second round of DELPHI, there was no consensus on the duration of intravenous antibiotic therapy and on the treatment of severe pleural empyema, especially when caused by Staphylococci. CONCLUSIONS The result of this work highlights the needed for new French recommendations based on the evolution of microbial epidemiology in the post PCV13 era.
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18
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Increase in Streptococcus pneumoniae serotype 3 associated parapneumonic pleural effusion/empyema after the introduction of PCV13 in Germany. Vaccine 2019; 38:570-577. [PMID: 31735502 DOI: 10.1016/j.vaccine.2019.10.056] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/19/2019] [Accepted: 10/21/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Pediatric pneumococcal pneumonia complicated by parapneumonic pleural effusion/empyema (PPE/PE) remains a major concern despite general immunization with pneumococcal conjugate vaccines (PCVs). METHODS In a nationwide pediatric hospital surveillance study in Germany we identified 584 children <18 years of age with bacteriologically confirmed PPE/PE from October 2010 to June 2018. Streptococcus pneumoniae was identified by culture and/or PCR of blood samples and/or pleural fluid and serotyped. RESULTS S. pneumoniae was identified in 256 of 584 (43.8%) children by culture (n = 122) and/or PCR (n = 207). The following pneumococcal serotypes were detected in 114 children: serotype 3 (42.1%), 1 (25.4%), 7F (12.3%), 19A (7.9%), other PCV13 serotypes (4.4%) and non-PCV13 serotypes (7.9%). Between October 2010 and June 2014 serotype 1 (38.1%) and serotype 3 (25.4%) were most prevalent, whereas between July 2014 and June 2018 serotype 3 (62.7%) and non-PCV13 serotypes (15.7%) were dominant. Compared to children with other pneumococcal serotypes, children with serotype 3 associated PPE/PE were younger (median 3.2 years [IQR 2.1-4.3 years] vs. median 5.6 years [IQR 3.8-8.2 years]; p < 0.001) and more frequently admitted to intensive care (43 [89.6%] vs. 48 [73.8%]; p = 0.04). Seventy-six of 114 (66.7%) children with pneumococcal PPE/PE had been vaccinated with pneumococcal vaccines. Thirty-nine of 76 (51.3%) had received a vaccine covering the serotype detected. Thirty of these 39 breakthrough cases were age-appropriately vaccinated with PCV13 and considered vaccine failures, including 26 children with serotype 3, three children with serotype 19A and one child with serotype 1. CONCLUSION Following the introduction of PCV13 in general childhood vaccination we observed a strong emergence of serotype 3 associated PPE/PE in the German pediatric population, including a considerable number of younger children with serotype 3 vaccine breakthrough cases and failures. Future PCVs should not only cover newly emerging serotypes, but also include a more effective component against serotype 3.
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19
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Madhi F, Levy C, Morin L, Minodier P, Dubos F, Zenkhri F, Dommergues MA, Mezgueldi E, Levieux K, Béchet S, Varon E, Cohen R. Change in Bacterial Causes of Community-Acquired Parapneumonic Effusion and Pleural Empyema in Children 6 Years After 13-Valent Pneumococcal Conjugate Vaccine Implementation. J Pediatric Infect Dis Soc 2019; 8:474-477. [PMID: 30407519 DOI: 10.1093/jpids/piy103] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 09/22/2018] [Indexed: 11/14/2022]
Abstract
We describe here changes in the bacterial causes of pleural empyema before and after implementation of the 13-valent pneumococcal conjugate vaccine (PCV13) program in France (2009-2017). For 220 (39.3%) of 560 children, a bacterial cause was found. The frequency of pneumococcal infection decreased during the study from 79.1% in 2009 to 36.4% in 2017 (P < .001). Group A streptococcus is now the leading cause of documented empyema (45.5%).
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Affiliation(s)
- Fouad Madhi
- Service de Pédiatrie, Centre Hospitalier Intercommunal, Créteil, France.,Université Paris Est, IMRB-GRC GEMINI, Créteil, France
| | - Corinne Levy
- Université Paris Est, IMRB-GRC GEMINI, Créteil, France.,ACTIV, Pediatric Clinical and Therapeutical Association of the Val de Marne, Saint-Maur des Fossés, France.,Clinical Research Center, Centre Hospitalier Intercommunal de Créteil, France
| | - Laurence Morin
- Department of General Pediatrics, AP-HP, Hôpital Robert Debré, Université Paris Diderot, France
| | | | - François Dubos
- Pediatric Emergency Unit and Infectious Diseases, University of Lille, CHU Lille, France
| | - Ferielle Zenkhri
- Department of Pediatric Emergency, AP-HP, Hôpital Le Kremlin-Bicêtre, Université Paris Sud, Bicêtre, France
| | | | | | | | | | - Stéphane Béchet
- Université Paris Est, IMRB-GRC GEMINI, Créteil, France.,ACTIV, Pediatric Clinical and Therapeutical Association of the Val de Marne, Saint-Maur des Fossés, France.,Clinical Research Center, Centre Hospitalier Intercommunal de Créteil, France
| | - Emmanuelle Varon
- National Reference Center for Pneumococci, Laboratoire de Microbiologie, AP-HP, Hopital Européen Georges-Pompidou, Paris, France
| | - Robert Cohen
- Université Paris Est, IMRB-GRC GEMINI, Créteil, France.,ACTIV, Pediatric Clinical and Therapeutical Association of the Val de Marne, Saint-Maur des Fossés, France.,Clinical Research Center, Centre Hospitalier Intercommunal de Créteil, France.,Unité Court Séjour, Petits Nourrissons, Service de Néonatologie, Centre Hospitalier Intercommunal de Créteil, France
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20
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Faingelernt Y, Dagan R, Givon-Lavi N, Ben-Shimol S, Bar-Ziv J, Greenberg D. Nasopharyngeal Carriage of Invasive Pneumococcal Serotypes During Childhood Community-Acquired Alveolar Pneumonia Is Associated With Specific Clinical Presentation. J Infect Dis 2019; 221:812-819. [DOI: 10.1093/infdis/jiz513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 10/02/2019] [Indexed: 01/10/2023] Open
Abstract
Abstract
Background
Streptococcus pneumoniae (Pnc) serotypes differ in invasive potential. We examined whether community-acquired alveolar pneumonia (CAAP) in children carrying commonly recognized pneumonia invasive pneumococcal serotypes ([PnIST] 1, 5, 7F, 14, and 19A) differs from CAAP in children carrying less invasive serotypes (non-PnIST) or no Pnc (Pnc-neg).
Methods
Children <5 years, visiting the only regional Pediatric Emergency Room, with radiologically proven CAAP were enrolled. Nasopharyngeal cultures were processed for pneumococcal isolation and serotyping. Clinical and demographic characteristics were recorded. The study was conducted before pneumococcal conjugate vaccine implementation in Israel.
Results
A total of 1423 CAAP episodes were recorded: PnIST, 300 (21.1%); non-PnIST, 591 (41.5%); and Pnc-neg, 532 (37.4%). After adjustment for age, ethnicity, seasonality, and previous antibiotics, the following variables were positively associated with PnIST carriage compared with both groups: temperature ≥39°C, peripheral white blood cell count ≥20 000/mm3, C-reactive protein ≥70.0 mg/L, and serum sodium <135 mEq/L. Lower oxygen saturation, viral detection, and comorbidities were negatively associated with Pn-IST carriage (odds ratios, <1.0). Differences between non-PnIST carriers and Pnc-neg groups were smaller or nonsignificant.
Conclusions
Young children with CAAP carrying common PnIST had a lower proportion of comorbidities, hypoxemia, and viral detection and had more intense systemic inflammatory response than those carrying non-PnIST or not carrying Pnc.
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Affiliation(s)
- Yaniv Faingelernt
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ron Dagan
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Noga Givon-Lavi
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Shalom Ben-Shimol
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Jacob Bar-Ziv
- Department of Radiology, Hadassah University Medical Center, Jerusalem
| | - David Greenberg
- The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel
- The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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21
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Ouldali N, Levy C, Minodier P, Morin L, Biscardi S, Aurel M, Dubos F, Dommergues MA, Mezgueldi E, Levieux K, Madhi F, Hees L, Craiu I, Gras Le Guen C, Launay E, Zenkhri F, Lorrot M, Gillet Y, Béchet S, Hau I, Martinot A, Varon E, Angoulvant F, Cohen R. Long-term Association of 13-Valent Pneumococcal Conjugate Vaccine Implementation With Rates of Community-Acquired Pneumonia in Children. JAMA Pediatr 2019; 173:362-370. [PMID: 30715140 PMCID: PMC6450280 DOI: 10.1001/jamapediatrics.2018.5273] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE In several countries, 5 years after 13-valent pneumococcal conjugate vaccine (PCV13) implementation, serotype replacement has been reported for invasive pneumococcal disease, which raises concerns about the long-term outcome of PCV13 implementation. The long-term effect of vaccination on community-acquired pneumonia (CAP) remains unknown. OBJECTIVE To assess the long-term outcome of PCV13 implementation on CAP in children. DESIGN, SETTING, AND PARTICIPANTS This quasi-experimental, population-based, interrupted time-series analysis was based on a prospective multicenter study conducted from June 2009 to May 2017 in 8 French pediatric emergency departments. All patients 15 years and younger with chest radiography-confirmed CAP were included. EXPOSURES Community-acquired pneumonia. MAIN OUTCOMES AND MEASURES The number of CAP cases per 1000 pediatric emergency department visits over time, analyzed using a segmented regression model, adjusted for influenza-like illness syndromes. RESULTS We enrolled 12 587 children with CAP, including 673 cases of CAP with pleural effusion (5.3%), 4273 cases of CAP requiring hospitalization (33.9%), 2379 cases of CAP with high inflammatory biomarkers (18.9%), and 221 cases of proven pneumococcal CAP (1.8%). The implementation of PCV13 in 2010 was followed by a sharp decrease in the frequency of CAP (-0.8% per month [95% CI, -1.0% to -0.5% per month]), from 6.3 to 3.5 cases of CAP per 1000 pediatric emergency department visits until May 2014, then a slight increase since June 2014 (0.9% per month [95% CI, 0.4%-1.4% per month]), until 3.8 cases of CAP per 1000 pediatric emergency department visits in May 2017. There were marked immediate decreases in cases of CAP with pleural effusion (-48% [95% CI, -84% to -12%]), CAP requiring hospitalization (-30% [95% CI, -56% to -5%]), and CAP with high inflammatory biomarkers (-30% [95% CI, -54% to -6%]), without any rebound thereafter. CONCLUSIONS AND RELEVANCE The changes associated with PCV13 use 7 years after implementation remain substantial, especially for CAP with pleural effusion, CAP requiring hospitalization, and CAP with high inflammatory biomarkers. Emerging non-PCV13 serotypes may be less likely involved in severe CAP than invasive pneumococcal disease.
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Affiliation(s)
- Naïm Ouldali
- Association Clinique et Thérapeutique Infantile du Val-de-Marne, St Maur-des-Fossés, France,Groupe de Pathologie Infectieuse Pédiatrique, Paris, France,Unité d’Épidémiologie Clinique, Assistance Publique–Hôpitaux de Paris, Hôpital Robert Debré, Unité Mixte de Recherche 1123–Epidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables, Institut National de la Santé et de la Recherche Médicale, Paris, France,Urgences Pédiatriques, Hôpital Necker Enfants Malades, Université Paris Descartes, Paris, France
| | - Corinne Levy
- Association Clinique et Thérapeutique Infantile du Val-de-Marne, St Maur-des-Fossés, France,Groupe de Pathologie Infectieuse Pédiatrique, Paris, France,Université Paris Est, L’Institut Mondor de Recherche Biomédicale Groupement de Recherche Clinique Groupe d'Etude de Maladies Infectieuses Néonatales et Infantiles, Créteil, France,Clinical Research Center, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Philippe Minodier
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France,Department of Pediatric Emergency, Centre Hospitalier Universitaire Nord, Marseille, France
| | - Laurence Morin
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France,Department of General Pediatrics, Assistance Publique–Hôpitaux de Paris, Hôpital Robert Debré, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Sandra Biscardi
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France,Université Paris Est, L’Institut Mondor de Recherche Biomédicale Groupement de Recherche Clinique Groupe d'Etude de Maladies Infectieuses Néonatales et Infantiles, Créteil, France,Clinical Research Center, Centre Hospitalier Intercommunal de Créteil, Créteil, France,Department of Pediatric Emergency, Hôpital Intercommunal, Créteil, France
| | - Marie Aurel
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France,Department of General Pediatrics, Assistance Publique–Hôpitaux de Paris, Hôpital Robert Debré, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - François Dubos
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France,Pediatric Emergency Unit and Infectious Diseases, Université de Lille, Centre Hospitalier Universitaire Lille, Lille, France
| | - Marie Alliette Dommergues
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France,Department of General Pediatrics, Centre Hospitalier de Versailles, Le Chesnay, France
| | - Ellia Mezgueldi
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France,Pediatric Nephrology, Rheumatology, Dermatology Unit, Femme Mère Enfant Hospital, Hospices Civils de Lyon, University Lyon 1 Lyon, Lyon, France
| | - Karine Levieux
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France,Department of Pediatrics, Centre Hospitalier Universitaire Nantes, Nantes, France
| | - Fouad Madhi
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France,Université Paris Est, L’Institut Mondor de Recherche Biomédicale Groupement de Recherche Clinique Groupe d'Etude de Maladies Infectieuses Néonatales et Infantiles, Créteil, France,Department of General Pediatrics, Hôpital Intercommunal, Créteil, France
| | - Laure Hees
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France,Department of Pediatric Emergency, L'Hôpital Femme Mère Enfant Lyon, Lyon, France
| | - Irina Craiu
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France,Department of Pediatric Emergency, Assistance Publique–Hôpitaux de Paris, Hôpital Le Kremlin-Bicêtre, Université Paris, Paris, France
| | - Chrystèle Gras Le Guen
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France,Department of Pediatrics, Centre Hospitalier Universitaire Nantes, Nantes, France
| | - Elise Launay
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France,Department of Pediatrics, Centre Hospitalier Universitaire Nantes, Nantes, France
| | - Ferielle Zenkhri
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France,Department of Pediatric Emergency, Assistance Publique–Hôpitaux de Paris, Hôpital Le Kremlin-Bicêtre, Université Paris, Paris, France
| | - Mathie Lorrot
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France,Department of General Pediatrics, Assistance Publique–Hôpitaux de Paris, Hôpital Armand Trousseau, Université Sorbonne Paris Cité, Paris, France
| | - Yves Gillet
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France,Department of Pediatric Emergency, L'Hôpital Femme Mère Enfant Lyon, Lyon, France
| | - Stéphane Béchet
- Association Clinique et Thérapeutique Infantile du Val-de-Marne, St Maur-des-Fossés, France,Université Paris Est, L’Institut Mondor de Recherche Biomédicale Groupement de Recherche Clinique Groupe d'Etude de Maladies Infectieuses Néonatales et Infantiles, Créteil, France
| | - Isabelle Hau
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France,Université Paris Est, L’Institut Mondor de Recherche Biomédicale Groupement de Recherche Clinique Groupe d'Etude de Maladies Infectieuses Néonatales et Infantiles, Créteil, France,Department of General Pediatrics, Hôpital Intercommunal, Créteil, France
| | - Alain Martinot
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France,Pediatric Emergency Unit and Infectious Diseases, Université de Lille, Centre Hospitalier Universitaire Lille, Lille, France
| | - Emmanuelle Varon
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France,National Reference Center for Pneumococci, Laboratoire de Microbiologie, Assistance Publique–Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France
| | - François Angoulvant
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France,Unité d’Épidémiologie Clinique, Assistance Publique–Hôpitaux de Paris, Hôpital Robert Debré, Unité Mixte de Recherche 1123–Epidémiologie Clinique et Évaluation Économique Appliquées aux Populations Vulnérables, Institut National de la Santé et de la Recherche Médicale, Paris, France,Urgences Pédiatriques, Hôpital Necker Enfants Malades, Université Paris Descartes, Paris, France
| | - Robert Cohen
- Association Clinique et Thérapeutique Infantile du Val-de-Marne, St Maur-des-Fossés, France,Groupe de Pathologie Infectieuse Pédiatrique, Paris, France,Université Paris Est, L’Institut Mondor de Recherche Biomédicale Groupement de Recherche Clinique Groupe d'Etude de Maladies Infectieuses Néonatales et Infantiles, Créteil, France,Clinical Research Center, Centre Hospitalier Intercommunal de Créteil, Créteil, France,Unité Court Séjour, Petits Nourrissons, Service de Néonatologie, Centre Hospitalier Intercommunal de Créteil, Créteil, France
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22
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Levy C, Vie le Sage F, Varon E, Chalumeau M, Grimprel E, Cohen R. Pediatric Ambulatory and Hospital Networks for Surveillance and Clinical Epidemiology of Community-Acquired Infections. J Pediatr 2018; 194:269-270.e2. [PMID: 29637893 DOI: 10.1016/j.jpeds.2017.11.050] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 11/22/2017] [Indexed: 01/01/2023]
Affiliation(s)
- Corinne Levy
- University Paris Est, IMRB- GRC GEMINI, Créteil, France; ACTIV, Pediatric Clinical and Therapeutical Association of the Val de Marne, Saint-Maur des Fossés, France; Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, France; GPIP, Pediatric Infectious Disease Group, France; AFPA, French Association of Ambulatory Pediatricians, Saint-Germain-en-Laye, France
| | - François Vie le Sage
- GPIP, Pediatric Infectious Disease Group, France; AFPA, French Association of Ambulatory Pediatricians, Saint-Germain-en-Laye, France
| | - Emmanuelle Varon
- National Reference Center for Pneumococci, Microbiology Laboratory, Assistance Publique-Hôpitaux de Paris, Hospital Georges-Pompidou, Paris, France
| | - Martin Chalumeau
- GPIP, Pediatric Infectious Disease Group, France; Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS-INSERM U1153), Paris Descartes University, Paris, France; Department of General Pediatrics and Pediatric Infectious Diseases, Necker hospital for Sick Children, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France
| | - Emmanuel Grimprel
- GPIP, Pediatric Infectious Disease Group, France; Department of General Pediatrics, Hospital Trousseau, AP-HP, University Pierre et Marie Curie, Paris, France
| | - Robert Cohen
- University Paris Est, IMRB- GRC GEMINI, Créteil, France; ACTIV, Pediatric Clinical and Therapeutical Association of the Val de Marne, Saint-Maur des Fossés, France; Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, France; GPIP, Pediatric Infectious Disease Group, France; AFPA, French Association of Ambulatory Pediatricians, Saint-Germain-en-Laye, France; Unité Court Séjour, Petits Nourrissons, Neonatology Department, Centre Hospitalier Intercommunal de Créteil, France
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