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Ricci Conesa H, Skröder H, Norton N, Bencina G, Tsoumani E. Clinical and economic burden of acute otitis media caused by Streptococcus pneumoniae in European children, after widespread use of PCVs-A systematic literature review of published evidence. PLoS One 2024; 19:e0297098. [PMID: 38564583 PMCID: PMC10986968 DOI: 10.1371/journal.pone.0297098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/21/2023] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Acute otitis media (AOM) is a common childhood disease frequently caused by Streptococcus pneumoniae. Pneumococcal conjugate vaccines (PCV7, PCV10, PCV13) can reduce the risk of AOM but may also shift AOM etiology and serotype distribution. The aim of this study was to review estimates from published literature of the burden of AOM in Europe after widespread use of PCVs over the past 10 years, focusing on incidence, etiology, serotype distribution and antibiotic resistance of Streptococcus pneumoniae, and economic burden. METHODS This systematic review included published literature from 31 European countries, for children aged ≤5 years, published after 2011. Searches were conducted using PubMed, Embase, Google, and three disease conference websites. Risk of bias was assessed with ISPOR-AMCP-NPC, ECOBIAS or ROBIS, depending on the type of study. RESULTS In total, 107 relevant records were identified, which revealed wide variation in study methodology and reporting, thus limiting comparisons across outcomes. No homogenous trends were identified in incidence rates across countries, or in detection of S. pneumoniae as a cause of AOM over time. There were indications of a reduction in hospitalization rates (decreases between 24.5-38.8% points, depending on country, PCV type and time since PCV introduction) and antibiotic resistance (decreases between 14-24%, depending on country), following the widespread use of PCVs over time. The last two trends imply a potential decrease in economic burden, though this was not possible to confirm with the identified cost data. There was also evidence of an increase in serotype distributions towards non-vaccine serotypes in all of the countries where non-PCV serotype data were available, as well as limited data of increased antibiotic resistance within non-vaccine serotypes. CONCLUSIONS Though some factors point to a reduction in AOM burden in Europe, the burden still remains high, residual burden from uncovered serotypes is present and it is difficult to provide comprehensive, accurate and up-to-date estimates of said burden from the published literature. This could be improved by standardised methodology, reporting and wider use of surveillance systems.
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Affiliation(s)
| | | | | | - Goran Bencina
- Center for Observational and Real-World Evidence, MSD, Madrid, Spain
| | - Eleana Tsoumani
- Center for Observational and Real-World Evidence, MSD, Athens, Greece
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Arya S, Norton N, Kaushik P, Brandtmüller A, Tsoumani E. Recent changes to adult national immunization programs for pneumococcal vaccination in Europe and how they impact coverage: A systematic review of published and grey literature. Hum Vaccin Immunother 2023; 19:2279394. [PMID: 38014651 PMCID: PMC10760380 DOI: 10.1080/21645515.2023.2279394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/01/2023] [Indexed: 11/29/2023] Open
Abstract
Despite widespread use of pneumococcal vaccines throughout Europe, the burden of pneumococcal disease (PD) in adults is considerable. To mitigate this burden, National Immunization Technical Advisory Groups (NITAGs) and Health Technology Assessment (HTA) agencies assess the value of different vaccine schedules for protecting against PD. The aim of this review was to assess the evidence and rationales used by NITAGs/HTA agencies, when considering recent changes to National Immunization Programs (NIPs) for adults, and how identified changes affected vaccine coverage rates (VCRs). A systematic review was conducted of published literature from PubMed® and Embase®, and gray literature from HTA/NITAG websites from the last 5 y, covering 31 European countries. Evidence related to NIP recommendations, epidemiology (invasive PD, pneumonia), health economic assessments and VCRs were collected and synthesized. Eighty-four records providing data for 26 countries were identified. Of these, eight described explicit changes to NIPs for adults in seven countries. Despite data gaps, some trends were observed; first, there appears to be a convergence of NIP recommendations in many countries toward sequential vaccination, with a pneumococcal conjugate vaccine (PCV), followed by pneumococcal polysaccharide vaccine 23. Second, reducing economic or healthcare burden were common rationales for implementing changes. Third, most health economic analyses assessing higher-valency PCVs for adults found its inclusion in NIPs cost-effective. Finally, higher coverage rates were seen in most cases where countries had expanded their NIPs to cover at-risk populations. The findings can encourage agencies to improve surveillance systems and work to reach the NIP's target populations more effectively.
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Affiliation(s)
- Stuti Arya
- Evidence Review and Synthesis, Quantify Research, Mohali, India
| | - Nicholas Norton
- Evidence Review and Synthesis, Quantify Research, Stockholm, Sweden
| | - Puneet Kaushik
- Evidence Review and Synthesis, Quantify Research, Mohali, India
| | - Agnes Brandtmüller
- Center for Observational and Real-World Evidence, MSD, Budapest, Hungary
| | - Eleana Tsoumani
- Center for Observational and Real-World Evidence, MSD, Athens, Greece
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Zarabi N, Aldvén M, Sjölander S, Fues Wahl H, Bencina G, Johnson KD, Silfverdal SA. Clinical and economic burden of pneumococcal disease among adults in Sweden: A population-based register study. PLoS One 2023; 18:e0287581. [PMID: 37418396 PMCID: PMC10328229 DOI: 10.1371/journal.pone.0287581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 06/08/2023] [Indexed: 07/09/2023] Open
Abstract
Pneumococcal disease is a major cause of clinical and economic burden worldwide. This study investigated the burden of pneumococcal disease in Swedish adults. A retrospective population-based study was conducted using Swedish national registers, including all adults aged ≥18 years with a diagnosis of pneumococcal disease (defined as pneumococcal pneumonia, meningitis, or septicemia) in inpatient or outpatient specialist care between 2015-2019. Incidence and 30-day case fatality rates, healthcare resource utilization, and costs were estimated. Results were stratified by age (18-64, 65-74, and ≥75 years) and the presence of medical risk factors. A total of 10,391 infections among 9,619 adults were identified. Medical factors associated with higher risk for pneumococcal disease were present in 53% of patients. These factors were associated with increased pneumococcal disease incidence in the youngest cohort. In the cohort aged 65-74 years, having a very high risk for pneumococcal disease was not associated with an increased incidence. Pneumococcal disease incidence was estimated at 12.3 (18-64), 52.1 (64-74), and 85.3 (≥75) per 100,000 population. The 30-day case fatality rate increased with age (18-64: 2.2%, 65-74: 5.4%, ≥75: 11.7%), and was highest among septicemia patients aged ≥75 (21.4%). The 30-day average number of hospitalizations was 1.13 (18-64), 1.24 (64-74) and 1.31 (≥75). The average 30-day cost/infection was estimated at €4,467 (18-64), €5,278 (65-74), and €5,898 (≥75). The 30-day total direct cost of pneumococcal disease between 2015-2019 was €54.2 million, with 95% of costs from hospitalizations. The clinical and economic burden of pneumococcal disease in adults was found to increase with age, with nearly all costs associated with pneumococcal disease from hospitalizations. The 30-day case fatality rate was highest in the oldest age group, though not negligible in the younger age groups. The findings of this study can inform the prioritization of pneumococcal disease prevention in adult and elderly populations.
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Affiliation(s)
| | | | | | | | - Goran Bencina
- Center for Observational and Real-World Evidence, MSD, Madrid, Spain
| | - Kelly D. Johnson
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Rahway, NJ, United States of America
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Egorova E, Kumar N, Gladstone RA, Urban Y, Voropaeva E, Chaplin A, Rumiantseva E, Svistunova TS, Hawkins PA, Klugman KP, Breiman RF, McGee L, Bentley SD, Lo SW. Key features of pneumococcal isolates recovered in Central and Northwestern Russia in 2011–2018 determined through whole-genome sequencing. Microb Genom 2022; 8. [PMID: 36112007 PMCID: PMC9676041 DOI: 10.1099/mgen.0.000851] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Invasive pneumococcal disease remains one of the leading causes of morbidity and mortality worldwide. In Russia, 13- valent pneumococcal conjugate vaccine (PCV13) was introduced into the childhood immunization programme nationwide in 2014. As part of the Global Pneumococcal Sequencing Project (GPS), we used genome data to characterize 179 pneumococcal isolates collected from Russia in 2011–2018 to investigate the circulating pneumococcal strains using a standardized genomic definition of pneumococcal lineages (global pneumococcal sequence clusters, GPSCs), prevalent serotypes and antimicrobial resistance profiles. We observed high serotype and lineage diversity among the 179 isolates recovered from cerebrospinal fluid (n=77), nasopharyngeal swabs (n=99) and other non-sterile site swabs (n=3). Overall, 60 GPSCs were identified, including 48 clonal complexes (CCs) and 14 singletons, and expressed 42 serotypes (including non-typable). Among PCV13 serotypes, 19F, 6B and 23F were the top three serotypes while 11A, 15B/C and 8 were the top three among non-PCV13 serotypes in the collection. Two lineages (GPSC6 and GPSC47) expressed both PCV13 and non-PCV13 serotypes that caused invasive disease, and were penicillin- and multidrug-resistant (MDR), highlighting their potential to adapt and continue to cause infections under vaccine and antibiotic selective pressure. PCV13 serotypes comprised 92 % (11/12) of the CSF isolates from the children aged below 5 years; however, the prevalence of PCV13 serotype isolates dropped to 53 % (31/58) among the nasopharyngeal isolates. Our analysis showed that 59 % (105/179) of the isolates were predicted to be non-susceptible to at least one class of antibiotics and 26 % (46/179) were MDR. Four MDR lineages (GPSC1, GPSC6, GPSC10 and GPSC47) accounted for 65 % (30/46) of the MDR isolates and expressed PCV13 serotypes (93 %, 28/30). This study provides evidence of high genetic and serotype diversity contributed by a mix of globally spreading and regionally circulating lineages in Russia. The observations suggest that the PCV13 vaccine could be important in reducing both invasive disease and antimicrobial resistance. We also identify potential lineages (GPSC6 and GPSC47) that may evade the vaccine.
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Affiliation(s)
- Ekaterina Egorova
- G. N. Gabrichevsky Research Institute for Epidemiology and Microbiology, Moscow, Russia
| | - Narender Kumar
- Parasites and Microbes, Wellcome Sanger Institute, Hinxton, UK
| | - Rebecca A. Gladstone
- Department of Biostatistics, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
- Parasites and Microbes, Wellcome Sanger Institute, Hinxton, UK
| | - Yulia Urban
- G. N. Gabrichevsky Research Institute for Epidemiology and Microbiology, Moscow, Russia
| | - Elena Voropaeva
- G. N. Gabrichevsky Research Institute for Epidemiology and Microbiology, Moscow, Russia
| | - A.V. Chaplin
- G. N. Gabrichevsky Research Institute for Epidemiology and Microbiology, Moscow, Russia
| | | | | | | | - Keith P. Klugman
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | | | - Lesley McGee
- Centers for Disease Control and Prevention, Atlanta, USA
| | - Stephen D. Bentley
- Department of Pathology, University of Cambridge, Cambridge, UK
- Parasites and Microbes, Wellcome Sanger Institute, Hinxton, UK
| | - Stephanie W. Lo
- Parasites and Microbes, Wellcome Sanger Institute, Hinxton, UK
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Root-Bernstein R. Pneumococcal and Influenza Vaccination Rates and Pneumococcal Invasive Disease Rates Set Geographical and Ethnic Population Susceptibility to Serious COVID-19 Cases and Deaths. Vaccines (Basel) 2021; 9:474. [PMID: 34066697 PMCID: PMC8151685 DOI: 10.3390/vaccines9050474] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/01/2021] [Accepted: 05/05/2021] [Indexed: 12/21/2022] Open
Abstract
This study examines the relationship of pneumococcal vaccination rates, influenza, measles-mumps-rubella (MMR) diphtheria-tetanus-pertussis vaccinations (DTP), polio, Haemophilus influenzae type B (Hib), and Bacillus Calmette-Guerin (tuberculosis) vaccination rates to COVID-19 case and death rates for 51 nations that have high rates of COVID-19 testing and for which nearly complete childhood, at-risk adult and elderly pneumococcal vaccination data were available. The study is unique in a large number of nations examined, the range of vaccine controls, in testing effects of combinations of vaccinations, and in examining the relationship of COVID-19 and vaccination rates to invasive pneumococcal disease (IPD). Analysis of Italian regions and the states of the United States were also performed. Significant positive correlations were found between IPD (but not lower respiratory infections) and COVID-19 rates, while significant negative correlations were found between pneumococcal vaccination and COVID-19 rates. Influenza and MMR vaccination rates were negatively correlated with lower respiratory infection (LRI) rates and may synergize with pneumococcal vaccination rates to protect against COVID-19. Pneumococcal and influenza vaccination rates were independent of other vaccination rates. These results suggest that endemic rates of bacterial pneumonias, for which pneumococci are a sentinel, may set regional and national susceptibility to severe COVID-19 disease and death.
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Affiliation(s)
- Robert Root-Bernstein
- Department of Physiology, 567 Wilson Road, Room 1104 Biomedical and Physical Sciences Building, Michigan State University, East Lansing, MI 48824, USA
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Savrasova L, Krumina A, Cupeca H, Zeltina I, Villerusha A, Grope I, Viksna L, Dimina E, Balasegaram S. Invasive Pneumococcal Disease in Latvia in PCV10 Vaccination Era, 2012-2018. Front Pediatr 2021; 9:532489. [PMID: 34692599 PMCID: PMC8529945 DOI: 10.3389/fped.2021.532489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 07/21/2021] [Indexed: 12/03/2022] Open
Abstract
In 2010 in Latvia, invasive pneumococcal disease (IPD) became a cause for concern and vaccination of infants with four doses of 7-valent pneumococcal conjugate vaccine (PCV7) commenced. In 2012, 10-valent pneumococcal conjugate vaccine (PCV10) (three doses at 2, 4, and 12-15 month of age) vaccination was introduced. We described incidence and serotype distribution of IPD in Latvia and investigated serotypes associated with death from IPD based on surveillance data. Adult vaccination against pneumococcal infection is not included in the national immunization program. Laboratory confirmed IPD cases are passively notified to the Center for Disease Prevention and Control of Latvia (CDPC) by laboratories and clinicians. We calculated incidence by age, sex, case fatality, and trend in serotypes by conducting a retrospective population-based cross-sectional study based on national IPD surveillance data. From 2012 to 2018 466 cases of IPD were reported. The highest notified incidence was in 2015 at 4.4/100,000, which fell to 3.9 in 2018. The highest mean annual IPD incidence was in infants (4.8) and in the elderly (6.0). PCV10 vaccine serotypes were the most prevalent in IPD cases up to 2015 with a decreasing trend from 50% (20/40) in 2012 to 19% (14/74) in 2018 (chi2 test for trend of odds = 0.000). PCV23nonPCV13 vaccine serotypes had an increasing trend and rose from 18% (7/40) to 34% (25/74) (chi2 test for trend of odds = 0.000). Non-Vaccine serotypes had an increasing trend and rose from 13% (5/40) to 27% (20/74) (chi2 test for trend of odds = 0.038). Reported total case fatality was 19% (87/466). The highest, at 36% (20/56), was reported in 2013. After adjusting for age, Streptococcus pneumoniae serotype 3 was associated with death from IPD (adjusted OR 2.3 95%CI 1.25-4.12 p 0.007). Surveillance data indicate evidence of serotype replacement with an increasing trend of serotype 19A and PPV23nonPCV13 and Non-Vaccine serotypes. Serotype 3 and age were associated with fatal IPD outcome. Further studies of S. pneumoniae carriage would be useful in providing more evidence to characterize serotypes' circulation.
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Affiliation(s)
- Larisa Savrasova
- Centre for Disease Prevention and Control of Latvia, The European Programme for Intervention Epidemiology Training (EPIET), Riga Stradinš University, Riga, Latvia
| | - Angelika Krumina
- Department of Infectology, Riga Stradinš University, Riga, Latvia
| | - Hedija Cupeca
- Department of Pediatrics, Riga Stradinš University, Riga, Latvia
| | - Indra Zeltina
- Department of Infectology, Riga Stradinš University, Riga, Latvia
| | - Anita Villerusha
- Department of Public Health and Epidemiology, Riga Stradinš University, Riga, Latvia
| | - Ilze Grope
- Department of Pediatrics, Riga Stradinš University, Riga, Latvia
| | - Ludmila Viksna
- Department of Infectology, Riga Stradinš University, Riga, Latvia
| | - Elina Dimina
- Centre for Disease Prevention and Control of Latvia, Riga, Latvia
| | - Sooria Balasegaram
- The European Programme for Intervention Epidemiology Training (EPIET) Coordinator, Public Health England Field Epidemiology Service South East and London, London, United Kingdom
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Quattrone F, Donzelli G, D'Arienzo S, Fornili M, Innocenti F, Forni S, Baglietto L, Tavoschi L, Lopalco PL. Invasive Pneumococcal Disease in Tuscany Region, Italy, 2016-2017: Integrating Multiple Data Sources to Investigate Underreporting. Int J Environ Res Public Health 2020; 17:E7581. [PMID: 33086480 DOI: 10.3390/ijerph17207581] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/09/2020] [Accepted: 10/16/2020] [Indexed: 12/23/2022]
Abstract
Invasive pneumococcal disease (IPD) is a vaccine-preventable disease characterized by the presence of Streptococcus pneumoniae in normally sterile sites. Since 2007, Italy has implemented an IPD national surveillance system (IPD-NSS). This system suffers from high rates of underreporting. To estimate the level of underreporting of IPD in 2016–2017 in Tuscany (Italy), we integrated data from IPD-NSS and two other regional data sources, i.e., Tuscany regional microbiological surveillance (Microbiological Surveillance and Antibiotic Resistance in Tuscany, SMART) and hospitalization discharge records (HDRs). We collected (1) notifications to IPD-NSS, (2) SMART records positive for S. pneumoniae from normally sterile sites, and (3) hospitalization records with IPD-related International Classification of Diseases, Ninth Revision, Clinical Modification (ICD9) codes in discharge diagnoses. We performed data linkage of the three sources to obtain a combined surveillance system (CSS). Using the CSS, we calculated the completeness of the three sources and performed a three-source log-linear capture–recapture analysis to estimate total IPD underreporting. In total, 127 IPD cases were identified from IPD-NSS, 320 were identified from SMART, and 658 were identified from HDRs. After data linkage, a total of 904 unique cases were detected. The average yearly CSS notification rate was 12.1/100,000 inhabitants. Completeness was 14.0% for IPD-NSS, 35.4% for SMART, and 72.8% for HDRs. The capture–recapture analysis suggested a total estimate of 3419 cases of IPD (95% confidence interval (CI): 1364–5474), corresponding to an underreporting rate of 73.7% (95% CI: 34.0–83.6) for CSS. This study shows substantial underreporting in the Tuscany IPD surveillance system. Integration of available data sources may be a useful approach to complement notification-based surveillance and provide decision-makers with better information to plan effective control strategies against IPD.
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Panagiotou S, Chaguza C, Yahya R, Audshasai T, Baltazar M, Ressel L, Khandaker S, Alsahag M, Mitchell TJ, Prudhomme M, Kadioglu A, Yang M. Hypervirulent pneumococcal serotype 1 harbours two pneumolysin variants with differential haemolytic activity. Sci Rep 2020; 10:17313. [PMID: 33057054 DOI: 10.1038/s41598-020-73454-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/14/2020] [Indexed: 12/13/2022] Open
Abstract
Streptococcus pneumoniae is a devastating global pathogen. Prevalent in sub-Saharan Africa, pneumococcal serotype 1 is atypical in that it is rarely found as a nasopharyngeal coloniser, yet is described as one of the most common causes of invasive pneumococcal disease. Clonal sequence type (ST)-306 and ST615 are representative of the two major serotype 1 lineages A and C, respectively. Here we investigated the virulence properties and haemolytic activities of these 2 clonal types using in vivo mouse models and in vitro assays. A lethal dose of ST615 administered intranasally to mice led to the rapid onset of disease symptoms and resulted in 90% mortality. In contrast, mice exposed to the same infection dose of ST306 or a pneumolysin (Ply)-deficient ST615 failed to develop any disease symptoms. Interestingly, the 2 strains did not differ in their ability to bind the immune complement or to undergo neutrophil-mediated phagocytosis. Upon comparative genomic analysis, we found higher within-ST sequence diversity in ST615 compared with ST306 and determined that ZmpA, ZmpD proteins, and IgA protease, were uniquely found in ST615. Using cell fractionation and cell contact-dependent assay, we made the unexpected finding that ST615 harbours the expression of two haemolytic variants of Ply: a cell-wall restricted fully haemolytic Ply, and a cytosolic pool of Ply void of any detectable haemolytic activity. This is the first time such a phenomenon has been described. We discuss the biological significance of our observation in relation to the aptitude of the pneumococcus for sustaining its human reservoir.
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Monali R, De Vita E, Mariottini F, Privitera G, Lopalco PL, Tavoschi L. Impact of vaccination on invasive pneumococcal disease in Italy 2007-2017: surveillance challenges and epidemiological changes. Epidemiol Infect 2020; 148:e187. [PMID: 32418558 PMCID: PMC7482190 DOI: 10.1017/s0950268820001077] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 01/10/2020] [Accepted: 03/09/2020] [Indexed: 01/20/2023] Open
Abstract
Surveillance of new cases of invasive pneumococcal disease (IPD) in Italy was started in 2007 by the Ministry of Health (MoH). In 2012, pneumococcal childhood vaccination was introduced at the national level and, in 2017, for citizens aged 65 years and over. We describe here IPD epidemiology in Italy over the past 10 years investigating the impact of the vaccine programme on disease burden. Reports of IPD cases, data on serotype and vaccination coverage (VC) data were obtained from MoH annual reports, for the period 2007-2017. IPD notification rate and proportion by year, region, age and serotype were calculated. In 2007, 525 cases were reported (rate 0.88/100 000), rising to 1703 cases (rate 2.82/100 000) in 2017. The distribution of IPD cases by age group over time registered the largest share among individuals aged 65 years and over. A decreasing trend in notification rate was observed among those aged 0-4 years. During the same period, the 24-month VC increased, ranging from 80.9% to 96.7% in 2017. Molecular data indicated re-emergence of PPSV23-specific serotypes and non-vaccine serotypes. We observed an increase in IPD notifications during 2007-2017, likely due to an improved surveillance system, at least in some regions, with the relative quota of IPD notifications decreasing among vaccinated children cohorts. Further strengthening of IPD surveillance system, including molecular and vaccine coverage data, would be needed to assess and inform pneumococcal vaccination strategies in Italy.
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Affiliation(s)
- R. Monali
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - E. De Vita
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - F. Mariottini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - G. Privitera
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - P. L. Lopalco
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - L. Tavoschi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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Sevilla JP, Stawasz A, Burnes D, Agarwal A, Hacibedel B, Helvacioglu K, Sato R, Bloom DE. Indirect costs of adult pneumococcal disease and the productivity-based rate of return to the 13-valent pneumococcal conjugate vaccine for adults in Turkey. Hum Vaccin Immunother 2020; 16:1923-1936. [PMID: 31995443 PMCID: PMC7482724 DOI: 10.1080/21645515.2019.1708668] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Productivity benefits of health technologies are ignored in typical economic evaluations from a health payer’s perspective, risking undervaluation. We conduct a productivity-based cost-benefit analysis from a societal perspective and estimate indirect costs of adult pneumococcal disease, vaccination benefits from the adult 13-valent pneumococcal conjugate vaccine (PCV13 Adult), and rates of return to PCV13 Adult for a range of hypothetical vaccination costs. Our context is Turkey’s funding PCV13 for the elderly and for non-elderly adults with select comorbidities within the Ministry of Health’s National Immunization Program. We use a Markov model with one-year cycles. Indirect costs from death or disability equal the expected present discounted value of lifetime losses in the infected individual’s paid and unpaid work and in caregivers’ paid work. Vaccination benefits comprise averted indirect costs. Rates of return equal vaccination benefits divided by vaccination costs, minus one. Input parameters are from public data sources. We model comorbidities’ effects by scalar multiplication of the parameters of the general population. Indirect costs per treatment episode of inpatient community-acquired pneumonia (CAP), bacteremia, and meningitis – but not for outpatient CAP – approach or exceed Turkish per capita gross domestic product. Vaccination benefits equal $207.02 per vaccination in 2017 US dollars. The rate of return is positive for all hypothetical costs below this. Results are sensitive to herd effects from pediatric vaccination and vaccine efficacy rates. For a wide range of hypothetical vaccination costs, the rate of return compares favorably with those of other global development interventions with well-established strong investment cases.
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Affiliation(s)
- J P Sevilla
- Life Sciences Group, Data for Decisions, LLC , Waltham, MA, USA
| | - Andrew Stawasz
- Life Sciences Group, Data for Decisions, LLC , Waltham, MA, USA
| | - Daria Burnes
- Life Sciences Group, Data for Decisions, LLC , Waltham, MA, USA
| | - Anubhav Agarwal
- Life Sciences Group, Data for Decisions, LLC , Waltham, MA, USA
| | - Basak Hacibedel
- Health Economics and Outcomes Research, Pfizer Turkey , Istanbul, Turkey
| | - Kerem Helvacioglu
- Health Economics and Outcomes Research, Pfizer Turkey , Istanbul, Turkey
| | - Reiko Sato
- Health Economics and Outcomes Research, Pfizer Inc , Collegeville, PA, USA
| | - David E Bloom
- Life Sciences Group, Data for Decisions, LLC , Waltham, MA, USA
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Sidorenko S, Rennert W, Lobzin Y, Briko N, Kozlov R, Namazova-Baranova L, Tsvetkova I, Ageevets V, Nikitina E, Ardysheva A, Bikmieva A, Bolgarova E, Volkova M, Verentsova I, Girina A, Gordeeva N, Demko I, Dushchenko A, Evseeva G, Zharkova L, Yelistratova T, Zakharova J, Ivakhnishina N, Zubova E, Kalinogorskaya O, Klimashina A, Kozeeva T, Kraposhina A, Krechikova O, Mamaeva M, Nagovitsyna E, Protasova I, Semerikov V, Sokolova N, Soloveva I, Strelnikova N, Telepneva R, Feldblium I, Kholodok G, Chagaryan A, Sheglinkova N. Multicenter study of serotype distribution of Streptococcus pneumoniae nasopharyngeal isolates from healthy children in the Russian Federation after introduction of PCV13 into the National Vaccination Calendar. Diagn Microbiol Infect Dis 2019; 96:114914. [PMID: 31704066 DOI: 10.1016/j.diagmicrobio.2019.114914] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/13/2019] [Accepted: 09/22/2019] [Indexed: 10/25/2022]
Abstract
Russia introduced PCV13 in 2014. We studied the serotype composition of S. pneumoniae isolated from the nasopharynx of healthy children younger than 6 years in St. Petersburg, Smolensk, Perm, Krasnoyarsk, Khanty-Mansiysk and Khabarovsk, between 2016 and 2018. 2.4% of children had completed a 3-dose course of PCV13, while 25.6% had received 1 or 2 doses. Pneumococcal DNA detection by PCR demonstrated S. pneumoniae in 37.2% of samples with regional variation between sites (27.3 to 56.9%). There was little difference between vaccinated, partially vaccinated and un-vaccinated children. Children who had received at least 1 dose of PCV13 had lower carriage rates of vaccine serotypes than their unvaccinated peers (49.9 vs. 61.4%; p < 0.001). Children who had received at least 1 dose of PCV13 showed increased carriage rates of non-vaccine serotypes (50 vs 38.6%; P < 0.001). Especially serogroup 15AF was more prevalent among fully immunized children than among their peers (12.5 vs 2.7%; P < 0.05).
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Affiliation(s)
- Sergey Sidorenko
- Pediatric Research and Clinical Center for Infectious Diseases, Popov Str.9, Saint Petersburg, Russia, 197022 and North Western State Medical University named after I.I. Mechnikov, Kirochnaya Str. 41, St Petersburg, Russia, 191015.
| | - Wolfgang Rennert
- Rostropovich Vishnevskaya Foundation and Georgetown University Hospital Department of Pediatrics, 4200 Wisconsin Ave. # 200, Washington, DC, 20016, USA.
| | - Yuri Lobzin
- Pediatric Research and Clinical Center for Infectious Diseases, Popov Str.9, Saint Petersburg, Russia, 197022 and North Western State Medical University named after I.I. Mechnikov, Kirochnaya Str. 41, St Petersburg, Russia, 191015.
| | - Nikolay Briko
- I.M. Sechenov First Moscow State Medical University, Trubetskaya Str. 8-2, Moscow, Russia, 119991.
| | - Roman Kozlov
- Smolensk State Medical University, Krupskoy Str. 28, Smolensk, Russia 214019.
| | - Leila Namazova-Baranova
- Pirogov Russian National Research Medical University, Ostrovityanova Str. 1, Moskva, Russia, 11799.
| | - Irina Tsvetkova
- Pediatric Research and Clinical Center for Infectious Diseases, Professor Popov Str.9, Saint Petersburg, Russia, 197022.
| | - Vladimir Ageevets
- Pediatric Research and Clinical Center for Infectious Diseases, Professor Popov Str.9, Saint Petersburg, Russia, 197022.
| | - Ekaterina Nikitina
- Pediatric Research and Clinical Center for Infectious Diseases, Professor Popov Str.9, Saint Petersburg, Russia, 198022.
| | - Anastasia Ardysheva
- Perm Clinical Center of the Federal Medical and Biological Agency, Tselinnaya Str., 27, Perm, Russia, 614056.
| | - Alina Bikmieva
- E.A.Vagner Perm State Medical University, 26 Petropavlovskaya Str, Perm, Russia 614990.
| | - Ekaterina Bolgarova
- Yekaterinburg Research Institute of Viral Infections, Letnyaya Str 23, Yekaterinburg, Russia 620030.
| | - Marina Volkova
- Pediatric Research and Clinical Center for Infectious Diseases, Professor Popov Str.9, Saint Petersburg, Russia, 197022.
| | - Irina Verentsova
- Regional Clinical Hospital, Kalinina Str. 40, Khanty-Mansiysk, Russia 628012.
| | - Asiya Girina
- Khanty-Mansiysk State Medical Academy, Mira Str. 40. Khanty-Mansyisk, Russia 628011.
| | - Natalia Gordeeva
- Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Partizana Zheleznyaka Str. 1, Krasnoyarsk, Russia 660022.
| | - Irina Demko
- Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Partizana Zheleznyaka Str. 1, Krasnoyarsk, Russia 660022.
| | - Anna Dushchenko
- Far Eastern State Medical University, Karl Marx Str. 35, Khabarovsk, Russia 680000.
| | - Galina Evseeva
- Khabarovsk Branch of Far Eastern Scientific Center of Physiology and Pathology of Respiration, - Research Institute of Maternity and Childhood Protection, Voronezhskaya Str. 49, Khabarovsk, Russia 680022.
| | - Ludmila Zharkova
- Smolensk State Medical University, Krupskoy Str. 28, Smolensk, Russia 214019.
| | - Tatyana Yelistratova
- Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Partizana Zheleznyaka Str. 1, Krasnoyarsk, Russia 660022.
| | - Julia Zakharova
- Yekaterinburg Research Institute of Viral Infections, Letnyaya Str 23, Yekaterinburg, Russia 620030.
| | - Natalia Ivakhnishina
- Khabarovsk Branch of Far Eastern Scientific Center of Physiology and Pathology of Respiration, - Research Institute of Maternity and Childhood Protection, Voronezhskaya Str. 49, Khabarovsk, Russia 680022.
| | - Elena Zubova
- Regional Pediatric Hospital, Baumana Str 22, Perm, Russia 614066.
| | - Olga Kalinogorskaya
- Pediatric Research and Clinical Center for Infectious Diseases, Professor Popov Str. 9, Saint Petersburg, Russia, 194100.
| | - Alla Klimashina
- Perm Clinical Center of the Federal Medical and Biological Agency, Tselinnaya Str., 27, Perm, Russia, 614056.
| | - Tatiana Kozeeva
- Perm Clinical Center of the Federal Medical and Biological Agency, Tselinnaya Str., 27, Perm, Russia, 614056.
| | - Angelina Kraposhina
- Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Partizana Zheleznyaka Str. 1, Krasnoyarsk, Russia 660022.
| | - Olga Krechikova
- Smolensk State Medical University, Krupskoy Str. 28, Smolensk, Russia 214019.
| | - Marina Mamaeva
- Krasnoyarsk State Medical University named after Professor V. F. Voino-Yasenetsky, Partizana Zheleznyaka Str. 1, Krasnoyarsk, Russia 660022.
| | - Elena Nagovitsyna
- Khabarovsk Branch of Far Eastern Scientific Center of Physiology and Pathology of Respiration, - Research Institute of Maternity and Childhood Protection, Voronezhskaya Str. 49, Khabarovsk, Russia 680022.
| | - Irina Protasova
- Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Partizana Zheleznyaka Str. 1, Krasnoyarsk, Russia 660022.
| | | | - Natalia Sokolova
- Perm Clinical Center of the Federal Medical and Biological Agency, Tselinnaya Str., 27, Perm, Russia, 614056.
| | - Irina Soloveva
- Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Partizana Zheleznyaka Str. 1, Krasnoyarsk, Russia 660022.
| | - Natalia Strelnikova
- Far Eastern State Medical University, Karl Marx Str. 35, Khabarovsk, Russia 680000.
| | - Regina Telepneva
- Khabarovsk Branch of Far Eastern Scientific Center of Physiology and Pathology of Respiration, - Research Institute of Maternity and Childhood Protection, Voronezhskaya Str. 49, Khabarovsk, Russia 680022.
| | - Irina Feldblium
- E.A.Vagner Perm State Medical University, Petropavlovskaya Str. 26, Perm, Russia 614990.
| | - Galina Kholodok
- Khabarovsk Branch of Far Eastern Scientific Center of Physiology and Pathology of Respiration, - Research Institute of Maternity and Childhood Protection, Voronezhskaya Str. 49, Khabarovsk, Russia 680022.
| | - Aida Chagaryan
- Smolensk State Medical University, Krupskoy Str. 28, Smolensk, Russia 214019.
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Torumkuney D, Nica M, Nistor I, Vatcheva-Dobrevska R, Petrovic V, Stoica A, Hanicar B, Antic D, Morrissey I. Results from the Survey of Antibiotic Resistance (SOAR) 2014-16 in Bulgaria, Romania, Serbia and Croatia. J Antimicrob Chemother 2019; 73:v2-v13. [PMID: 29659882 DOI: 10.1093/jac/dky066] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Objectives To determine antibiotic susceptibility of isolates of Streptococcus pneumoniae (n = 573) and Haemophilus influenzae (n = 345) collected in 2014-16 from Bulgaria, Romania, Serbia and Croatia. Methods MICs were determined by CLSI broth microdilution and susceptibility was assessed using CLSI, EUCAST and pharmacokinetic/pharmacodynamic (PK/PD) breakpoints. Results Among S. pneumoniae, susceptibility was generally lowest in Romania and Serbia and highest in Bulgaria. Rates of susceptibility to penicillin (CLSI oral or EUCAST) were 22.3% and 21.8% in Romania and Serbia respectively, 57% in Croatia and 86.6% in Bulgaria. Similarly, macrolide susceptibility using CLSI/EUCAST breakpoints was low in Romania and Serbia (∼28% and 34.5%, respectively), higher in Croatia (55.9%) and highest in Bulgaria (∼75%). Only fluoroquinolones were active against all isolates in all four countries. Susceptibility was higher and variability across countries less pronounced for H. influenzae. Susceptibility by CLSI criteria to amoxicillin/clavulanic acid, azithromycin, cefuroxime, ceftriaxone and fluoroquinolones was ≥98% in all countries. Ampicillin susceptibility ranged from 85.3% in Romania to 100% in Bulgaria. Much greater variability was seen across breakpoints. Susceptibility to azithromycin and cefuroxime using CLSI criteria was ≥98% in all four countries, but was 0%-1% by EUCAST criteria. Conclusions The variability in antimicrobial susceptibility using different breakpoints makes it difficult for clinicians to interpret antimicrobial resistance data, and efforts should be made to harmonize breakpoints. The variability found across the four neighbouring countries demonstrates the need to monitor and publish national and local resistance patterns. These findings provide information critical for the selection of appropriate antimicrobial agents for the treatment of S. pneumoniae and H. influenzae.
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Affiliation(s)
- D Torumkuney
- GlaxoSmithKline, 980 Great West Road, Brentford, Middlesex TW8 9GS, UK
| | - M Nica
- Infectious and Tropical Diseases Hospital 'Dr. Victor Babes', Mihai Bravu str. 281, 030303, Bucharest, Romania
| | - I Nistor
- Grigore Alexandrescu Children's Emergency Hospital, Iancu de Hunedoara str, 30-32, 011743, Bucharest, Romania
| | - R Vatcheva-Dobrevska
- University Hospital 'Tsaritsa Yoanna' ISUL Dept Microbiology and Virology, Byalo more str. 8, 1527, Sofia, Bulgaria
| | - V Petrovic
- Institute of Public Health of Vojvodina, Futoska 121, 21000, Novi Sad, Serbia
| | - A Stoica
- GlaxoSmithKline, Opera Center 1, Costache Negri str. 1-5, 050552, Bucharest, Romania
| | - B Hanicar
- GlaxoSmithKline, Ulica Damira Tomljanovica Gavrana 15, 10020, Zagreb, Croatia
| | - Dj Antic
- GlaxoSmithKline, Omladinskih brigada 88, 11070, Belgrade, Serbia
| | - I Morrissey
- IHMA Europe Sàrl, Route de l'Ile-au-Bois 1A, 1870 Monthey/VS, Switzerland
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Torumkuney D, Zemlickova H, Maruscak M, Morrissey I. Results from the Survey of Antibiotic Resistance (SOAR) 2014-16 in the Czech Republic. J Antimicrob Chemother 2019; 73:v22-v27. [PMID: 29659883 DOI: 10.1093/jac/dky067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objectives To determine the antibiotic susceptibility of isolates of Streptococcus pneumoniae and Haemophilus influenzae collected in 2014-16 from patients with community-acquired respiratory infections in the Czech Republic. Methods MICs were determined by CLSI broth microdilution and susceptibility was assessed using CLSI, EUCAST and pharmacokinetic/pharmacodynamic (PK/PD) breakpoints. Results S. pneumoniae isolates (n = 200) showed high rates of susceptibility (>95%) to amoxicillin, amoxicillin/clavulanic acid, penicillin [intravenous (iv) non-meningitis], ceftriaxone, cefuroxime and the fluoroquinolones using CLSI breakpoints. Susceptibility to cefaclor and trimethoprim/sulfamethoxazole was 94%-94.5%, to penicillin (oral) 91.5% and to the macrolides 89.5%. Susceptibility of H. influenzae (n = 197) to amoxicillin/clavulanic acid, ceftriaxone, cefuroxime, azithromycin and the fluoroquinolones was ≥98% by CLSI criteria. Rates of susceptibility to the remaining agents were ≥75% except for clarithromycin at 37.1%. Great variability was seen across breakpoints, especially for the macrolides, cefaclor and cefuroxime (oral), 98.0% of H. influenzae showing susceptibility to the latter by CLSI criteria, 69.5% by PK/PD and 1.5% by EUCAST standards. The β-lactamase rate was 13.7% with no β-lactamase-negative-ampicillin-resistant (BLNAR) isolates by CLSI criteria. Conclusions Antibiotic resistance among the two major respiratory pathogens remained low in the Czech Republic. These findings support local clinicians in continuing the historically restrictive use of antibiotics in the Czech Republic, with selection of narrower-spectrum agents for the empirical therapy of community-acquired respiratory tract infections. This highlights one of the great benefits of continuous surveillance of antimicrobial resistance: knowledge of current local resistance patterns reduces the need to choose broad-spectrum agents that contribute to increasing resistance worldwide.
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Affiliation(s)
- D Torumkuney
- GlaxoSmithKline, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK
| | - H Zemlickova
- National Institute of Public Health, Centre for Epidemiology and Microbiology, National Reference Laboratory for Antibiotics, Šrobárova 48, 100 42 Prague 10, Czech Republic
| | - M Maruscak
- GlaxoSmithKline, s.r.o., Hvezdova 1734/2c, 140 00, Prague 4, Czech Republic
| | - I Morrissey
- IHMA Europe Sàrl, Route de l'Ile-au-Bois 1A, 1870 Monthey/VS, Switzerland
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Mayanskiy N, Kulichenko T, Alyabieva N, Brzhozovskaya E, Ponomarenko O, Savinova T, Lazareva A. Changing serotype distribution and resistance patterns among pediatric nasopharyngeal pneumococci collected in Moscow, 2010–2017. Diagn Microbiol Infect Dis 2019; 94:385-390. [DOI: 10.1016/j.diagmicrobio.2019.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 02/10/2019] [Accepted: 02/11/2019] [Indexed: 10/27/2022]
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Nisar MI, Nayani K, Akhund T, Riaz A, Irfan O, Shakoor S, Muneer S, Muslim S, Hotwani A, Kabir F, Whitney C, Kim L, Srinivasan V, Ali A, Zaidi AKM, Jehan F. Nasopharyngeal carriage of Streptococcus pneumoniae in children under 5 years of age before introduction of pneumococcal vaccine (PCV10) in urban and rural districts in Pakistan. BMC Infect Dis 2018; 18:672. [PMID: 30563483 PMCID: PMC6299586 DOI: 10.1186/s12879-018-3608-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 12/10/2018] [Indexed: 11/10/2022] Open
Abstract
Background Benefits of pneumococcal conjugate vaccine programs have been linked to the vaccine’s ability to disrupt nasopharyngeal carriage and transmission. The 10-valent pneumococcal vaccine (PCV10) was included in the Expanded Program on Immunization (EPI) in Sindh, Pakistan in February 2013. This study was carried out immediately before PCV10 introduction to establish baseline pneumococcal carriage and prevalent serotypes in young children and to determine if carriage differed in urban and rural communities. Methods Nasopharyngeal specimens were collected from a random sample of children 3-11 and 12-59 months of age in an urban community (Karachi) and children 3-11 months of age in a rural community (Matiari). Samples were processed in a research laboratory in Karachi. Samples were transported in STGG media, enriched in Todd Hewitt broth, rabbit serum and yeast extract, cultured on 5% sheep blood agar, and serotyped using the CDC standardized sequential multiplex PCR assay. Serotypes were categorized into PCV10-type and non-vaccine types. Results We enrolled 670 children. Pneumococci were detected in 73.6% and 79.5 % of children in the infant group in Karachi and Matiari, respectively, and 78.2% of children 12 to 59 months of age in Karachi. In infants, 38.9% and 33.5% of those carrying pneumococci in Karachi and Matiari, respectively, had PCV10 types. In the older age group in Karachi, the proportion was 30.7%, not significantly different from infants. The most common serotypes were 6A, 23F, 19A, 6B and 19F. Conclusion We found that about 3 of 4 children carried pneumococci, and this figure did not vary with age group or urban or rural residence. Planned annual surveys in the same communities will inform change in carriage of PCV10 serotype pneumococci after the introduction and uptake of PCV10 in these communities Electronic supplementary material The online version of this article (10.1186/s12879-018-3608-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Muhammad Imran Nisar
- Department of Pediatrics and Child Health, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Kanwal Nayani
- Department of Pediatrics and Child Health, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Tauseef Akhund
- Department of Pediatrics and Child Health, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Atif Riaz
- Department of Pediatrics and Child Health, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Omar Irfan
- Department of Pediatrics and Child Health, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Sadia Shakoor
- Department of Pediatrics and Child Health, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Sehrish Muneer
- Department of Pediatrics and Child Health, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Sana Muslim
- Department of Pediatrics and Child Health, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Aneeta Hotwani
- Department of Pediatrics and Child Health, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Furqan Kabir
- Department of Pediatrics and Child Health, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | | | - Lindsay Kim
- Centre for Disease Control and Prevention, Atlanta, USA
| | | | - Asad Ali
- Department of Pediatrics and Child Health, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Anita K M Zaidi
- Department of Pediatrics and Child Health, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan.,Bill & Melinda Gates Foundation, Seattle, USA
| | - Fyezah Jehan
- Department of Pediatrics and Child Health, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan.
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Dinleyici M, Iseri Nepesov M, Sipahi OR, Carman KB, Kilic O, Dinleyici EC. The attitudes, behaviors, and knowledge of healthcare professionals towards the diagnosis, treatment, and prevention of bacterial meningitis in Turkey. Hum Vaccin Immunother 2018; 15:134-140. [PMID: 30192703 DOI: 10.1080/21645515.2018.1520586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION Bacterial meningitis is one of the leading causes of morbidity and mortality among children and adults. Better understanding of the seroepidemiology of meningitis is critical for both the selection and implementation of an effective meningitis vaccine for the national immunization program. Because physicians play a crucial role in the implementation of this vaccine, the aim of this study was to evaluate the attitudes, behaviors, and knowledge of healthcare professionals in Turkey regarding the diagnosis, treatment and prevention of bacterial meningitis, especially pneumococcal and meningococcal meningitis. METHODS This study used a cross-sectional electronic survey with a national convenience sample of 339 physicians (171 pediatric age specialists [PAS] and 168 adult patient specialists [APS]) in Turkey. A web-based questionnaire which consisted 28 questions about the definition, diagnosis, and treatment of bacterial as well as knowledge and/or attitudes about meningococcal vaccines, was designed. RESULTS Approximately 72.9% (n = 247) of the respondents followed a patient with meningitis in the last year. A 49.5% of participants preferred to perform computerized cranial tomography (CCT) for suspected meningitis cases before lumbar puncture (LP) at 75-100% frequency (27.5% PAS; 72% APS, p < .01). In addition 27.1% of the respondents reported using a routine steroid as an adjunctive treatment (19% PAS; 35% APS, p < .01). For meningococcal meningitis, 72.5% of the participants preferred to use third-generation cephalosporins (63.1% PAS; 82.1% APS, p < .05). For pneumococcal meningitis, approximately 50% of the participants preferred to use a third-generation cephalosporin plus glycopeptide (41.5% PAS; 58.9% APS, p < .05). While 32.7% of the sample preferred to administer a 7-day course of antibiotics for meningococcal meningitis, 40.9% preferred a course of 14 days or more. For pneumococcal meningitis, 88.4% of the sample preferred a 10-14 day course of antibiotics. In addition, 67% of the PAS group and 50% (p < .001) of the APS group thought that a conjugated meningococcal vaccine should be a part of the National Immunization Program. The top five groups recommended for routine immunization included all children, asplenia/splenectomy patients, immunodeficient patients, those who planned to travel to endemic areas, including Hajj, and military personnel. CONCLUSION In this large convenient sample of physicians in Turkey, we showed that there are heterogenous approaches to the diagnosis and treatment of bacterial meningitis, also differences between pediatricians and non-pediatricians regarding their beliefs and attitudes, which may be due to differences in the epidemiology and clinical presentation between children and adults. We observed appropriate but unnecessary extended courses of antibiotics for meningitis. Most of the participants thought that children are a vulnerable risk group that should potentially be immunized and that meningococcal vaccines should be included in the National Immunization Program. Our results imply that more awareness is needed regarding diagnosis, treatment, and further recommendations for meningitis at the country level in Turkey.
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Affiliation(s)
- Meltem Dinleyici
- a Faculty of Medicine, Department of Pediatrics , Eskisehir Osmangazi University , Eskisehir , Turkey.,b Faculty of Medicine, Department of Social Pediatrics , Eskisehir Osmangazi University , Eskisehir , Turkey
| | - Merve Iseri Nepesov
- c Faculty of Medicine, Department of Pediatric Infectious Disease , Eskisehir Osmangazi University , Eskisehir , Turkey
| | - Oguz Resat Sipahi
- d Faculty of Medicine, Department of Infectious Disease and Clinical Microbiology , Ege University , Izmir , Turkey
| | - Kursat Bora Carman
- e Faculty of Medicine, Department of Pediatric Neurology , Eskisehir Osmangazi University , Eskisehir , Turkey
| | - Omer Kilic
- c Faculty of Medicine, Department of Pediatric Infectious Disease , Eskisehir Osmangazi University , Eskisehir , Turkey
| | - Ener Cagri Dinleyici
- a Faculty of Medicine, Department of Pediatrics , Eskisehir Osmangazi University , Eskisehir , Turkey
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Anderson R, Nel JG, Feldman C. Multifaceted Role of Pneumolysin in the Pathogenesis of Myocardial Injury in Community-Acquired Pneumonia. Int J Mol Sci 2018; 19:E1147. [PMID: 29641429 PMCID: PMC5979279 DOI: 10.3390/ijms19041147] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 03/14/2018] [Accepted: 03/21/2018] [Indexed: 12/14/2022] Open
Abstract
Pneumolysin (PLY), a member of the family of Gram-positive bacterial, cholesterol-dependent, β-barrel pore-forming cytolysins, is the major protein virulence factor of the dangerous respiratory pathogen, Streptococcus pneumoniae (pneumococcus). PLY plays a major role in the pathogenesis of community-acquired pneumonia (CAP), promoting colonization and invasion of the upper and lower respiratory tracts respectively, as well as extra-pulmonary dissemination of the pneumococcus. Notwithstanding its role in causing acute lung injury in severe CAP, PLY has also been implicated in the development of potentially fatal acute and delayed-onset cardiovascular events, which are now recognized as being fairly common complications of this condition. This review is focused firstly on updating mechanisms involved in the immunopathogenesis of PLY-mediated myocardial damage, specifically the direct cardiotoxic and immunosuppressive activities, as well as the indirect pro-inflammatory/pro-thrombotic activities of the toxin. Secondly, on PLY-targeted therapeutic strategies including, among others, macrolide antibiotics, natural product antagonists, cholesterol-containing liposomes, and fully humanized monoclonal antibodies, as well as on vaccine-based preventive strategies. These sections are preceded by overviews of CAP in general, the role of the pneumococcus as the causative pathogen, the occurrence and types of CAP-associated cardiac complication, and the structure and biological activities of PLY.
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Affiliation(s)
- Ronald Anderson
- Department of Immunology and Institute for Cellular and Molecular Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria 0001, South Africa.
| | - Jan G Nel
- Department of Haematology, Faculty of Health Sciences, University of Pretoria and Tshwane Academic Division of the National Health Laboratory Service, Pretoria 0001, South Africa.
| | - Charles Feldman
- Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 0002, South Africa.
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Intra J, Besana S, Savarino C, Brambilla P. Serotype Distribution and Antimicrobial Resistance of Streptococcus pneumoniae Invasive Isolates Collected at the Italian Hospital of Desio, Lombardy, from 2008 to 2016. Front Public Health 2017; 5:169. [PMID: 28770191 PMCID: PMC5510286 DOI: 10.3389/fpubh.2017.00169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 06/26/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jari Intra
- Department of Laboratory Medicine, University of Milano-Bicocca, Desio Hospital, Desio, Italy
| | - Silvia Besana
- Department of Laboratory Medicine, University of Milano-Bicocca, Desio Hospital, Desio, Italy
| | - Cinzia Savarino
- Department of Laboratory Medicine, University of Milano-Bicocca, Desio Hospital, Desio, Italy
| | - Paolo Brambilla
- Department of Laboratory Medicine, University of Milano-Bicocca, Desio Hospital, Desio, Italy
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