1
|
Meyer J, Silas P, Ouedraogo GL, McElwee K, Keep G, Trammel J, Peng Y, Scully IL, Gruber WC, Scott DA, Watson W. A Phase 3, Single-arm Trial to Evaluate the Safety and Immunogenicity of a 20-Valent Pneumococcal Conjugate Vaccine in Healthy Children 15 Months Through <18 Years of Age. Pediatr Infect Dis J 2024; 43:574-581. [PMID: 38502894 PMCID: PMC11090515 DOI: 10.1097/inf.0000000000004318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND A 20-valent pneumococcal conjugate vaccine (PCV20), containing 13-valent PCV (PCV13) components and 7 additional polysaccharide conjugates, was developed to extend protection for pneumococcal disease. This phase 3 study assessed the safety and immunogenicity of PCV20 in children. METHODS In this single-arm study, children (≥15 months-<18 years of age) received 1 dose of PCV20. Children <5 years of age had ≥3 prior doses of PCV13; children ≥5 years were recruited regardless of previous PCV receipt. Serotype-specific IgG concentrations and opsonophagocytic activity (OPA) titers were measured before and 1 month after PCV20. Local reactions and systemic events, adverse events (AEs), serious AEs, and newly diagnosed chronic medical conditions were collected. RESULTS Of 839 enrolled participants, 831 (>99%) were vaccinated, and 819 (>97%) completed all study visits. Local reactions and systemic events were mostly mild to moderate in severity. No serious AEs were considered PCV20-related. IgG geometric mean fold rises (GMFRs) from before to 1 month after PCV20 ranged from 27.9-1847.7 (7 additional serotypes) and 2.9-44.9 (PCV13 serotypes) in children <5 years of age, and 10.5-187.7 (7 additional serotypes) and 4.3-127.9 (PCV13 serotypes) in children ≥5 years old. OPA GMFRs from before to 1 month after PCV20 ranged from 12.4-983.6 to 2.8-52.9 in children <5 years of age and from 11.5-499.0 to 5.3-147.9 in children ≥5 years of age. CONCLUSIONS Among children ≥15 months through <18 years of age, PCV20 was well tolerated and induced robust responses to all 20 serotypes, supporting the use of PCV20 in children.
Collapse
Affiliation(s)
- Jay Meyer
- From the Meridan Clinical Research, Lincoln, Nebraska
| | | | | | - Kathleen McElwee
- Vaccine Research and Development, Pfizer Inc, Collegeville, Pennsylvania
| | - Georgina Keep
- Vaccine Research and Development, Pfizer UK, Hurley, UK
| | - James Trammel
- Vaccine Research and Development, Pfizer Inc, Collegeville, Pennsylvania
| | - Yahong Peng
- Vaccine Research and Development, Pfizer Inc, Collegeville, Pennsylvania
| | - Ingrid L. Scully
- Vaccine Research and Development, Pfizer Inc, Pearl River, New York
| | | | - Daniel A. Scott
- Vaccine Research and Development, Pfizer Inc, Collegeville, Pennsylvania
| | - Wendy Watson
- Vaccine Research and Development, Pfizer Inc, Collegeville, Pennsylvania
| |
Collapse
|
2
|
Senders S, Klein NP, Tamimi N, Thompson A, Baugher G, Trammel J, Peng Y, Giardina P, Scully IL, Pride M, Center KJ, Gruber WC, Scott DA, Watson W. A Phase Three Study of the Safety and Immunogenicity of a Four-dose Series of 20-Valent Pneumococcal Conjugate Vaccine in Healthy Infants. Pediatr Infect Dis J 2024; 43:596-603. [PMID: 38535409 PMCID: PMC11090512 DOI: 10.1097/inf.0000000000004334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/02/2024] [Indexed: 05/15/2024]
Abstract
BACKGROUND The 20-valent pneumococcal conjugate vaccine (PCV20) was developed to extend pneumococcal disease protection beyond 13-valent PCV (PCV13). METHODS This phase 3, double-blind study conducted in the United States/Puerto Rico evaluated PCV20 safety and immunogenicity. Healthy infants were randomized to receive a 4-dose series of PCV20 or PCV13 at 2, 4, 6 and 12-15 months old. Objectives included demonstrating noninferiority (NI) of PCV20 to PCV13 immunoglobulin G (IgG) geometric mean concentrations after doses 3 and 4 and percentages of participants with predefined IgG concentrations after dose 3, with 7 additional PCV20 serotypes compared with the lowest result among vaccine serotypes in the PCV13 group. Safety assessments included local reactions, systemic events, adverse events, serious adverse events and newly diagnosed chronic medical conditions. RESULTS Overall, 1991 participants were vaccinated (PCV20, n = 1001; PCV13, n = 990). For IgG geometric mean concentrations 1 month after both doses 3 and 4, all 20 serotypes met NI criteria (geometric mean ratio lower 2-sided 95% confidence interval > 0.5). For percentages of participants with predefined IgG concentrations after dose 3, NI (percentage differences lower 2-sided 95% confidence interval > -10%) was met for 8/13 matched serotypes and 6/7 additional serotypes; 4 serotypes missed the statistical NI criterion by small margins. PCV20 also elicited functional and boosting responses to all 20 serotypes. The safety profile of PCV20 was similar to PCV13. CONCLUSION A 4-dose series of PVC20 was well tolerated and elicited robust serotype-specific immune responses expected to help protect infants and young children against pneumococcal disease due to the 20 vaccine serotypes. Clinical trial registration: NCT04382326.
Collapse
Affiliation(s)
| | | | - Noor Tamimi
- Vaccine Research and Development, Pfizer Inc, Collegeville, Pennsylvania
| | - Allison Thompson
- Vaccine Research and Development, Pfizer Inc, Pearl River, New York
| | - Gary Baugher
- Vaccine Research and Development, Pfizer Inc, Collegeville, Pennsylvania
| | - James Trammel
- Vaccine Research and Development, Pfizer Inc, Collegeville, Pennsylvania
| | - Yahong Peng
- Vaccine Research and Development, Pfizer Inc, Collegeville, Pennsylvania
| | - Peter Giardina
- Vaccine Research and Development, Pfizer Inc, Pearl River, New York
| | - Ingrid L. Scully
- Vaccine Research and Development, Pfizer Inc, Pearl River, New York
| | - Michael Pride
- Vaccine Research and Development, Pfizer Inc, Pearl River, New York
| | - Kimberly J. Center
- Vaccine Research and Development, Pfizer Inc, Collegeville, Pennsylvania
| | | | - Daniel A. Scott
- Vaccine Research and Development, Pfizer Inc, Collegeville, Pennsylvania
| | - Wendy Watson
- Vaccine Research and Development, Pfizer Inc, Collegeville, Pennsylvania
| |
Collapse
|
3
|
Korbal P, Wysocki J, Jackowska T, Kline M, Tamimi N, Drozd J, Lei L, Peng Y, Giardina PC, Gruber W, Scott D, Watson W. Phase 3 Safety and Immunogenicity Study of a Three-dose Series of Twenty-valent Pneumococcal Conjugate Vaccine in Healthy Infants and Toddlers. Pediatr Infect Dis J 2024; 43:587-595. [PMID: 38456705 PMCID: PMC11090518 DOI: 10.1097/inf.0000000000004300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Global pediatric immunization programs with pneumococcal conjugate vaccines (PCVs) have reduced vaccine-type pneumococcal disease, but a substantial disease burden of non-PCV serotypes remains. METHODS This phase 3, randomized (1:1), double-blind study evaluated safety and immunogenicity of 20-valent PCV (PCV20) relative to 13-valent PCV (PCV13) in healthy infants. Participants received 2 infant doses and a toddler dose of PCV20 or PCV13, with diphtheria-tetanus-acellular pertussis combination vaccine at all doses and measles, mumps, rubella and varicella vaccines at the toddler dose. Primary pneumococcal immunogenicity objectives were to demonstrate noninferiority (NI) of PCV20 to PCV13 for immunoglobulin G geometric mean concentrations after infant and toddler doses and percentages of participants with predefined serotype-specific immunoglobulin G concentrations after infant doses. Safety endpoints included local reactions, systemic events and adverse events. RESULTS Overall, 1204 participants were vaccinated (PCV20, n = 601; PCV13, n = 603). One month after the toddler dose, 19/20 serotypes met NI for immunoglobulin G geometric mean concentrations; serotype 6B narrowly missed NI [PCV20/PCV13 geometric mean ratio: 0.57 (2-sided 95% confidence interval: 0.48-0.67); NI criterion: lower 2-sided 95% confidence interval >0.5]. Sixteen/twenty serotypes met NI for ≥1 primary objective after 2 infant doses. PCV20 induced robust opsonophagocytic activity, and boosting responses were observed for all vaccine serotypes, including those missing statistical NI. The safety/tolerability profile of PCV20 was like that of PCV13. CONCLUSIONS PCV20 3-dose series in infants was safe and elicited robust immune responses. Based on these results and PCV13 experience, PCV20 3-dose series is expected to be protective for all 20 vaccine serotypes. NCT04546425.
Collapse
Affiliation(s)
| | - Jacek Wysocki
- Poznań University of Medical Sciences, Poznań, Poland
| | - Teresa Jackowska
- Department of Pediatrics, Center of Postgraduate Medical Education, Warsaw, Poland
| | - Mary Kline
- Vaccine Research and Development, Pfizer Inc, Collegeville, Pennsylvania
| | - Noor Tamimi
- Vaccine Research and Development, Pfizer Inc, Collegeville, Pennsylvania
| | - Jelena Drozd
- Vaccine Research and Development, Pfizer Inc, Collegeville, Pennsylvania
| | - Lanyu Lei
- Vaccine Research and Development, Pfizer Inc, Collegeville, Pennsylvania
| | - Yahong Peng
- Vaccine Research and Development, Pfizer Inc, Collegeville, Pennsylvania
| | | | - William Gruber
- Vaccine Research and Development, Pfizer Inc, Pearl River, New York
| | - Daniel Scott
- Vaccine Research and Development, Pfizer Inc, Collegeville, Pennsylvania
| | - Wendy Watson
- Vaccine Research and Development, Pfizer Inc, Collegeville, Pennsylvania
| |
Collapse
|
4
|
Rozenbaum MH, Chilson E, Farkouh R, Huang L, Cane A, Arguedas A, Tort MJ, Snow V, Averin A, Weycker D, Hariharan D, Atwood M. Cost-Effectiveness of 20-Valent Pneumococcal Conjugate Vaccine Among US Children with Underlying Medical Conditions. Infect Dis Ther 2024; 13:745-760. [PMID: 38491269 PMCID: PMC11058137 DOI: 10.1007/s40121-024-00944-z] [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: 11/20/2023] [Accepted: 02/15/2024] [Indexed: 03/18/2024] Open
Abstract
INTRODUCTION A 20-valent pneumococcal conjugate vaccine (PCV20) was recently recommended for use among US children. We evaluated the cost-effectiveness of PCV20 among children aged 6 years with chronic medical conditions (CMC+) and children aged 6 years with immunocompromising conditions (IC) versus one and two doses of 23-valent pneumococcal polysaccharide vaccine (PPSV23), respectively. METHODS A probabilistic model was employed to depict 10-year risk of clinical outcomes and economic costs of pneumococcal disease, reduction in life years from premature death, and expected impact of vaccination among one cohort of children with CMC+ and IC aged 6 years. Vaccine uptake was assumed to be 20% for both PCV20 and PPSV23. Cost per quality-adjusted life year (QALY) gained was evaluated from the US societal and healthcare system perspectives; deterministic and probabilistic sensitivity analyses (DSA/PSA) were also conducted. RESULTS Among the 226,817 children with CMC+ aged 6 years in the US, use of PCV20 (in lieu of PPSV23) was projected to reduce the number cases of pneumococcal disease by 5203 cases, medical costs by US$8.7 million, and nonmedical costs by US$6.2 million. PCV20 was the dominant strategy versus PPSV23 from both the healthcare and societal perspectives. In the PSA, 99.9% of the 1000 simulations yielded a finding of dominance for PCV20. Findings in analyses of children with IC aged 6 years in the USA were comparable (i.e., PCV20 was the dominant vaccination strategy). Scenario analyses showed that increasing PCV20 uptake to 100% could potentially prevent > 22,000 additional cases of pneumococcal disease and further reduce medical and nonmedical costs by US$70.0 million among children with CMC+ and IC. CONCLUSIONS Use of PCV20 among young children with CMC+ and IC in the USA would reduce the clinical burden of pneumococcal disease and yield overall cost savings from both the US healthcare system and societal perspectives. Higher PCV20 uptake could further reduce the number of pneumococcal disease cases in this population.
Collapse
Affiliation(s)
- Mark H Rozenbaum
- Value and Evidence Team, Pneumococcal Vaccines, Pfizer Inc., Capelle a/d Ijssel, The Netherlands.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Alexandrova Nikolova K, Andersson M, Slotved HC, Koch A. Mortality of Invasive Pneumococcal Disease following Introduction of the 13-Valent Pneumococcal Conjugate Vaccine in Greenland. Vaccines (Basel) 2024; 12:179. [PMID: 38400162 PMCID: PMC10891528 DOI: 10.3390/vaccines12020179] [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: 01/12/2024] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024] Open
Abstract
Before the incorporation of the 13-valent pneumococcal conjugate vaccine (PCV13) into the childhood vaccination regimen in Greenland in 2010, Inuit populations experienced a substantial prevalence of invasive pneumococcal disease (IPD). The PCV13 introduction has been shown to markedly reduce the incidence of IPD. This current study estimated the impact of PCV13 introduction on IPD mortality in Greenland. This was a nationwide register-based study using all available data on IPD cases 1995-2020 in Greenland. Thirty-one-day IPD case fatality rates (CFR), and all-cause and mortality rates associated with IPD during the period before the introduction of PCV13 (January 1995 to September 2010) were compared with those observed in the post-PCV13 era (September 2010 to October 2020). Standardized mortality ratios (SMRs) expressed differences in mortality by sex, age, region, ethnicity, comorbidity, and serotype. IPD CFR decreased with 24.5% from the pre- to the post-PCV13 period. SMR in IPD patients decreased by 57% (95% CI, 36-75%), and a reduction occurred in all age groups. While SMR in IPD persons ≥60 years remained virtually unchanged, there were no IPD-related deaths in persons ≤39 years in the post-PCV13 period. In conclusion, IPD-related mortality has decreased in Greenland following PCV13 introduction in 2010 in the country.
Collapse
Affiliation(s)
| | - Mikael Andersson
- Department of Epidemiology Research, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen, Denmark;
| | - Hans-Christian Slotved
- Department of Bacteria, Parasites & Fungi, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen, Denmark;
| | - Anders Koch
- Department of Infectious Diseases, Rigshospitalet University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark;
- Department of Infectious Disease Epidemiology & Prevention, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen, Denmark
- Greenland Center for Health Research, Institute of Health and Nature, Ilisimatusarfik (University of Greenland), Manutooq 1, P.O. Box 1061, Nuussuaq 3905, Greenland
- Department of Internal Medicine, Queen Ingrids Hospital, Nuuk 3900, Greenland
| |
Collapse
|
6
|
Rozenbaum MH, Huang L, Perdrizet J, Cane A, Arguedas A, Hayford K, Tort MJ, Chapman R, Dillon-Murphy D, Snow V, Chilson E, Farkouh RA. Cost-effectiveness of 20-valent pneumococcal conjugate vaccine in US infants. Vaccine 2024; 42:573-582. [PMID: 38191278 DOI: 10.1016/j.vaccine.2023.12.057] [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: 09/25/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND As of June 2023, two pneumococcal conjugate vaccines, 20- (PCV20) and 15- (PCV15) valent formulations, are recommended for US infants under a 3 + 1 schedule. This study evaluated the health and economic impact of vaccinating US infants with a new expanded valency PCV20 formulation. METHODS A population-based, multi cohort, decision-analytic Markov model was developed to estimate the public health impact and cost-effectiveness of PCV20 from both societal and healthcare system perspectives over 10 years. Epidemiological data were based on published studies and unpublished Active Bacterial Core Surveillance System (ABCs) data. Vaccine effectiveness was based on PCV13 effectiveness and PCV7 efficacy studies. Indirect impact was based on observational studies. Costs and disutilities were based on published data. PCV20 was compared to both PCV13 and PCV15 in separate scenarios. RESULTS Replacing PCV13 with PCV20 in infants has the potential to avert over 55,000 invasive pneumococcal disease (IPD) cases, 2.5 million pneumonia cases, 5.4 million otitis media (OM) cases, and 19,000 deaths across all ages over a 10-year time horizon, corresponding to net gains of 515,000 life years and 271,000 QALYs. Acquisition costs of PCV20 were offset by monetary savings from averted cases resulting in net savings of $20.6 billion. The same trend was observed when comparing PCV20 versus PCV15, with a net gain of 146,000 QALYs and $9.9 billion in net savings. A large proportion of the avoided costs and cases were attributable to indirect effects in unvaccinated adults and elderly. From a health-care perspective, PCV20 was also the dominant strategy compared to both PCV13 and PCV15. CONCLUSIONS Infant vaccination with PCV20 is estimated to further reduce pneumococcal disease and associated healthcare system and societal costs compared to both PCV13 and PCV15.
Collapse
Affiliation(s)
| | - Liping Huang
- Medial Development & Scientific/Clinical Affairs, Pfizer Vaccines, Collegeville, PA, United States
| | | | - Alejandro Cane
- Medial Development & Scientific/Clinical Affairs, Pfizer Vaccines, Collegeville, PA, United States
| | - Adriano Arguedas
- Medial Development & Scientific/Clinical Affairs, Pfizer Vaccines, Collegeville, PA, United States
| | - Kyla Hayford
- Medial Development & Scientific/Clinical Affairs, Pfizer Vaccines, Collegeville, PA, United States
| | - Maria J Tort
- Medial Development & Scientific/Clinical Affairs, Pfizer Vaccines, Collegeville, PA, United States
| | | | | | - Vincenza Snow
- Medial Development & Scientific/Clinical Affairs, Pfizer Vaccines, Collegeville, PA, United States
| | - Erica Chilson
- Medial Development & Scientific/Clinical Affairs, Pfizer Vaccines, Collegeville, PA, United States
| | | |
Collapse
|
7
|
Rozenbaum MH, Huang L, Cane A, Arguedas A, Chapman R, Dillon-Murphy D, Tort MJ, Snow V, Chilson E, Farkouh R. Cost-effectiveness and impact on infections and associated antimicrobial resistance of 20-valent pneumococcal conjugate vaccine in US children previously immunized with PCV13. J Med Econ 2024; 27:644-652. [PMID: 38577742 DOI: 10.1080/13696998.2024.2339638] [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: 02/16/2024] [Accepted: 04/03/2024] [Indexed: 04/06/2024]
Abstract
AIM The US Food and Drug Administration approved the 20-valent pneumococcal conjugate vaccine (PCV20) to prevent pneumococcal disease. In the context of routine PCV20 vaccination, we evaluated the cost-effectiveness and public health and economic impact of a PCV20 catch-up program and estimated the number of antibiotic prescriptions and antibiotic-resistant infections averted. MATERIALS AND METHODS A population-based, multi-cohort, decision-analytic Markov model was developed using parameters consistent with previous PCV20 cost-effectiveness analyses. In the intervention arm, children aged 14-59 months who previously completed PCV13 vaccination received a supplemental dose of PCV20. In the comparator arm, no catch-up PCV20 dose was given. The direct and indirect benefits of vaccination were captured over a 10-year time horizon. RESULTS A PCV20 catch-up program would prevent 5,469 invasive pneumococcal disease cases, 50,286 hospitalized pneumonia cases, 218,240 outpatient pneumonia cases, 582,302 otitis media cases, and 1,800 deaths, representing a net gain of 30,014 life years and 55,583 quality-adjusted life years. Furthermore, 720,938 antibiotic prescriptions and 256,889 antibiotic-resistant infections would be averted. A catch-up program would result in cost savings of $800 million. These results were robust to sensitivity and scenario analyses. CONCLUSIONS A PCV20 catch-up program could prevent pneumococcal infections, antibiotic prescriptions, and antimicrobial-resistant infections and would be cost-saving in the US.
Collapse
|
8
|
Papachristidou S, Lapea V, Charisi M, Kourkouni E, Kousi D, Xirogianni A, Dedousi O, Papaconstadopoulos I, Eleftheriou E, Krepis P, Pasparaki S, Pantalos G, Doudoulakakis A, Bozavoutoglou E, Daskalaki M, Kostaridou-Nikolopoulou S, Tzanakaki G, Spoulou V, Tsolia M. A multicenter study on the epidemiology of complicated parapneumonic effusion in the era of currently available pneumococcal conjugate vaccines. Vaccine 2023; 41:6727-6733. [PMID: 37805358 DOI: 10.1016/j.vaccine.2023.10.004] [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: 03/07/2023] [Revised: 09/27/2023] [Accepted: 10/02/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND Parapneumonic effusion (PPE) is a common complication of pneumonia. Streptococcus pneumoniae is the most common cause of bacterial pneumonia. A reduction in pneumonia hospitalizations has been observed since the introduction of the 7-valent pneumococcal conjugate vaccine (PCV7). Despite this apparent benefit, an increase in the incidence of PPE was recorded in some countries following PCV7 implementation. As the 13-valent pneumococcal conjugate vaccine (PCV13) was expected to provide a wider protection against PPE, the aim of the present study was to evaluate the impact of PCV13 introduction on the epidemiology of complicated parapneumonic effusion (c-PPE) among children in the Athens greater area. METHODS All cases of community-acquired pneumonia (CAP) with PPE requiring chest tube insertion (complicated PPE, c-PPE) hospitalized in the 3 public Children's hospitals in Athens between 01/01/2004 and 31/12/2019 were included in the study. RESULTS A total of 426 cases of c-PPE associated with pneumonia were recorded of which 198 were admitted during 2004-2010 (period A, prePCV13/PCV -7 introduction period) and 228 during 2011-2018 (period B, post - PCV13 period). A definite bacterial etiology was established in 44.4 % of all cases and of those 25.4 % were caused by S. pneumoniae. An increasing trend in c-PPE incidence was observed during period A; although, a significant decrease on c-PPE annual rates was observed during the period B (p = 0.011), a remarkable increase in serotype 3 cases was recorded. CONCLUSION A decreasing time trend in c-PPE cases among children was shown after the introduction of PCV13 in our area. However, serotype 3 is nowadays a common cause of PPE. Hence, continuous surveillance is imperative in order to follow c-PPE epidemiology over time.
Collapse
Affiliation(s)
- Smaragda Papachristidou
- Second Department of Paediatrics, School of Medicine, National and Kapodistrian University of Athens (NKUA), P.& A. Kyriakou Children's Hospital, Athens, Greece.
| | - Vasiliki Lapea
- First Department of Paediatrics, School of Medicine, National and Kapodistrian University of Athens (NKUA), Aghia Sophia Children's Hospital, Athens, Greece
| | - Martha Charisi
- Department of Paediatrics, Penteli Children's Hospital, Athens, Greece
| | - Eleni Kourkouni
- Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), Athens, Greece
| | - Dimitra Kousi
- Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), Athens, Greece
| | - Athanasia Xirogianni
- National Meningitis Reference Laboratory, Dept of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece
| | - Olga Dedousi
- Second Department of Paediatrics, School of Medicine, National and Kapodistrian University of Athens (NKUA), P.& A. Kyriakou Children's Hospital, Athens, Greece
| | - Irene Papaconstadopoulos
- First Department of Paediatrics, School of Medicine, National and Kapodistrian University of Athens (NKUA), Aghia Sophia Children's Hospital, Athens, Greece
| | - Eirini Eleftheriou
- Second Department of Paediatrics, School of Medicine, National and Kapodistrian University of Athens (NKUA), P.& A. Kyriakou Children's Hospital, Athens, Greece
| | - Panagiotis Krepis
- Second Department of Paediatrics, School of Medicine, National and Kapodistrian University of Athens (NKUA), P.& A. Kyriakou Children's Hospital, Athens, Greece
| | - Sophia Pasparaki
- Second Department of Paediatrics, School of Medicine, National and Kapodistrian University of Athens (NKUA), P.& A. Kyriakou Children's Hospital, Athens, Greece
| | - Georgios Pantalos
- Pediatric Intensive Care Unit, Penteli's Children Hospital, Penteli, Greece
| | | | | | - Maria Daskalaki
- Microbiology Laboratory, Penteli Children's Hospital, Athens, Greece
| | | | - Georgina Tzanakaki
- National Meningitis Reference Laboratory, Dept of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece
| | - Vana Spoulou
- First Department of Paediatrics, School of Medicine, National and Kapodistrian University of Athens (NKUA), Aghia Sophia Children's Hospital, Athens, Greece
| | - Maria Tsolia
- Second Department of Paediatrics, School of Medicine, National and Kapodistrian University of Athens (NKUA), P.& A. Kyriakou Children's Hospital, Athens, Greece
| |
Collapse
|
9
|
Papadatou I, Moudaki A, Mentessidou A, Tsakogiannis D, Georgiadou E, Spoulou V. Intrafamilial Transmission of Pneumococcal Acute Spontaneous Peritonitis. Infect Dis Rep 2023; 15:299-306. [PMID: 37367189 DOI: 10.3390/idr15030030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 05/05/2023] [Accepted: 05/12/2023] [Indexed: 06/28/2023] Open
Abstract
Streptococcus pneumonia (S. pneumoniae, Pneumococcus) is a major cause of childhood morbidity and mortality worldwide. The most common presentations of invasive pneumococcal disease (IPD) in children include bacteremic pneumonia, meningitis, and septicemia. However, pneumococcal acute spontaneous peritonitis is a highly uncommon-and potentially life-threatening-presentation of invasive pneumococcal disease and should be considered in cases of abdominal sepsis. To our knowledge, we report the first case of intrafamilial transmission of pneumococcal peritonitis in two previously healthy children.
Collapse
Affiliation(s)
- Ioanna Papadatou
- First Department of Paediatrics, National and Kapodistrian University of Athens, 'Aghia Sophia' Children's Hospital, 115 27 Athens, Greece
- Immunology and Vaccinology Research Lab, First Department of Paediatrics, National and Kapodistrian University of Athens, 115 27 Athens, Greece
- University Research Institute for the Study of Genetic & Malignant Disorders in Childhood, School of Medicine, National and Kapodistrian University of Athens, 'Aghia Sophia' Children's Hospital, 115 27 Athens, Greece
| | - Angeliki Moudaki
- First Department of Paediatrics, National and Kapodistrian University of Athens, 'Aghia Sophia' Children's Hospital, 115 27 Athens, Greece
| | - Anastasia Mentessidou
- Department of Paediatric Surgery, 'Aghia Sophia' Children's Hospital, 115 27 Athens, Greece
| | | | - Elissavet Georgiadou
- First Department of Paediatrics, National and Kapodistrian University of Athens, 'Aghia Sophia' Children's Hospital, 115 27 Athens, Greece
| | - Vana Spoulou
- First Department of Paediatrics, National and Kapodistrian University of Athens, 'Aghia Sophia' Children's Hospital, 115 27 Athens, Greece
- Immunology and Vaccinology Research Lab, First Department of Paediatrics, National and Kapodistrian University of Athens, 115 27 Athens, Greece
- University Research Institute for the Study of Genetic & Malignant Disorders in Childhood, School of Medicine, National and Kapodistrian University of Athens, 'Aghia Sophia' Children's Hospital, 115 27 Athens, Greece
| |
Collapse
|
10
|
Paternina-Caicedo A, Smith AD, Buchanich J, Garcia-Calavaro C, Alvis-Guzman N, Narvaez J, de Oliveira LH, De la Hoz-Restrepo F. Reductions in Childhood Pneumonia Mortality After Vaccination in the United States. Pediatr Infect Dis J 2023; Publish Ahead of Print:00006454-990000000-00456. [PMID: 37235761 DOI: 10.1097/inf.0000000000003971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND We aim to estimate the magnitude of the reduction in pneumococcal pneumonia and meningitis mortality after the mass introduction of pneumococcal conjugate vaccine (PCV)7 and PCV13 in children in the United States. METHODS We assessed the trends in mortality rates from pneumococcal pneumonia and meningitis, in the United States between 1994 and 2017. We fitted an interrupted time-series negative binomial regression model (adjusted by trend, seasonality, PCV7/PCV13 coverage, and H. influenzae type b vaccine coverage) to estimate the counterfactual rates without vaccination. We reported a percent reduction in mortality estimates relative to the projected no-vaccination scenario, using the formula 1 minus the incidence risk ratio, with 95% confidence intervals (CIs). RESULTS Between 1994 and 1999 (the prevaccination period), the all-cause pneumonia mortality rate for 0-1-month-old children was 2.55 per 100,00 pop., whereas for 2-11 months-old children, this rate was 0.82 deaths per 100,000 pop. During the PCV7-period in 0-59-month-old children in the United States, the adjusted reduction of all-cause pneumonia was 13% (95% CI: 4-21) and 19% (95% CI: 0-33) of all-cause meningitis For PCV13, the reductions in this age group were 21% (95% CI: 4-35) for all-cause pneumonia mortality and 22% (95% CI: -19 to 48) for all-cause meningitis mortality. PCV13 had greater reductions of all-cause pneumonia than PCV13 in 6-11-month-old infants. CONCLUSIONS The universal introduction of PCV7, and later PCV13, for children 0-59 months old in the United States was associated with decreases in mortality due to all-cause pneumonia.
Collapse
Affiliation(s)
| | - Adrian D Smith
- Departament of Population Health, University of Oxford, Oxford, United Kingdom
| | - Jeanine Buchanich
- Department of Biostatistics, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | | | | | | |
Collapse
|
11
|
Bertran M, Amin-Chowdhury Z, Davies HG, Allen H, Clare T, Davison C, Sinnathamby M, Seghezzo G, Kall M, Williams H, Gent N, Ramsay ME, Ladhani SN, Oligbu G. COVID-19 deaths in children and young people in England, March 2020 to December 2021: An active prospective national surveillance study. PLoS Med 2022; 19:e1004118. [PMID: 36346784 PMCID: PMC9642873 DOI: 10.1371/journal.pmed.1004118] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Coronavirus Disease 2019 (COVID-19) deaths are rare in children and young people (CYP). The high rates of asymptomatic and mild infections complicate assessment of cause of death in CYP. We assessed the cause of death in all CYP with a positive Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) test since the start of the pandemic in England. METHODS AND FINDINGS CYP aged <20 years who died within 100 days of laboratory-confirmed SARS-CoV-2 infection between 01 March 2020 and 31 December 2021 in England were followed up in detail, using national databases, surveillance questionnaires, post-mortem reports, and clinician interviews. There were 185 deaths during the 22-month follow-up and 81 (43.8%) were due to COVID-19. Compared to non-COVID-19 deaths in CYP with a positive SARS-CoV-2 test, death due to COVID-19 was independently associated with older age (aOR 1.06 95% confidence interval (CI) 1.01 to 1.11, p = 0.02) and underlying comorbidities (aOR 2.52 95% CI 1.27 to 5.01, p = 0.008), after adjusting for age, sex, ethnicity group, and underlying conditions, with a shorter interval between SARS-CoV-2 testing and death. Half the COVID-19 deaths (41/81, 50.6%) occurred within 7 days of confirmation of SARS-CoV-2 infection and 91% (74/81) within 30 days. Of the COVID-19 deaths, 61 (75.3%) had an underlying condition, especially severe neurodisability (n = 27) and immunocompromising conditions (n = 12). Over the 22-month surveillance period, SARS-CoV-2 was responsible for 1.2% (81/6,790) of all deaths in CYP aged <20 years, with an infection fatality rate of 0.70/100,000 SARS-CoV-2 infections in this age group estimated through real-time, nowcasting modelling, and a mortality rate of 0.61/100,000. Limitations include possible under-ascertainment of deaths in CYP who were not tested for SARS-CoV-2 and lack of direct access to clinical data for hospitalised CYP. CONCLUSIONS COVID-19 deaths remain extremely rare in CYP, with most fatalities occurring within 30 days of infection and in children with specific underlying conditions.
Collapse
Affiliation(s)
- Marta Bertran
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Zahin Amin-Chowdhury
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Hannah G. Davies
- Paediatric Infectious Diseases Research Group, St George’s University of London, London, United Kingdom
| | - Hester Allen
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, United Kingdom
| | - Tom Clare
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, United Kingdom
| | - Chloe Davison
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, United Kingdom
| | - Mary Sinnathamby
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, United Kingdom
| | - Giulia Seghezzo
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, United Kingdom
| | - Meaghan Kall
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, United Kingdom
| | - Hannah Williams
- Joint Modelling Team (JMT), UK Health Security Agency, London, United Kingdom
- Emergency Preparedness, Response and Resilience, UK Health Security Agency, Porton Down, United Kingdom
| | - Nick Gent
- Joint Modelling Team (JMT), UK Health Security Agency, London, United Kingdom
- Emergency Preparedness, Response and Resilience, UK Health Security Agency, Porton Down, United Kingdom
| | - Mary E. Ramsay
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Shamez N. Ladhani
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
- Paediatric Infectious Diseases Research Group, St George’s University of London, London, United Kingdom
- * E-mail:
| | - Godwin Oligbu
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
- Paediatric Infectious Diseases Research Group, St George’s University of London, London, United Kingdom
| |
Collapse
|
12
|
Versluys KA, Eurich DT, Marrie TJ, Forgie S, Tyrrell GJ. Invasive pneumococcal disease and long-term outcomes in children: A 20-year population cohort study. LANCET REGIONAL HEALTH. AMERICAS 2022; 14:100341. [PMID: 36777393 PMCID: PMC9903925 DOI: 10.1016/j.lana.2022.100341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND Although vaccination against Streptococcus pneumoniae infections (such as invasive pneumococcal disease (IPD)) are available, challenges remain in prevention efforts. Moreover, downstream sequelae in children is relatively unknown. Thus, we aimed to evaluate short and long-term health outcomes among children with IPD. METHODS Analysis of Streptococcus pneumoniae positive isolates from sterile body sites in children (0-17 years) in Alberta (Canada) from 1999 to 2019 was performed retrospectively (n=888). Cases were age and sex-matched to hospitalized population controls. Linkage to administrative health datasets was done to determine comorbidities and healthcare related outcomes. Cox proportional hazards were used to assess differences in time to mortality and hospitalisation between cases and controls in short (<30-day), intermediate (30-90 day), long-term (>90-day) follow-up. FINDINGS Proportionally more deaths occurred in cases (4.8 deaths/1000 person-years (PY)) than controls (2.7 deaths/1000 PY), leading to a significant adjusted hazard ratio (aHR) of 1.80 (95% CI 1.22-2.64). This increased risk of death was influenced primarily by short-term mortality (319 vs 36 deaths/1000 PY in cases vs controls respectively, aHR 8.78 [95% CI 3.33-23.18]), as no differences were seen in intermediate (14 vs 7 deaths/1000 PY; aHR 2.03, 95% CI 0.41-10.04) or long-term time intervals (2.4 vs 2.3 deaths/1000 PY, aHR 1.03, 95% CI 0.63-1.69). INTERPRETATION IPD continues to negatively impact survival in children despite vaccination. Although long-term impact on mortality and hospitalisations may not be substantial, the immediate effects of IPD are significant. FUNDING This work was supported by grants-in-aid from Pfizer Canada and Wyeth Canada Inc all to GJT.
Collapse
Affiliation(s)
- Kristen A. Versluys
- School of Public Health, University of Alberta, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB T6G 1C9, Canada
| | - Dean T. Eurich
- School of Public Health, University of Alberta, Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB T6G 1C9, Canada
| | - Thomas J. Marrie
- Faculty of Medicine, Dalhousie University, 1459 Oxford Street, Halifax, NS B3H 4R2, Canada
| | - Sarah Forgie
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Alberta, 3-509 Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB T6G 1C9, Canada
| | - Gregory J. Tyrrell
- The Department of Laboratory Medicine and Pathology, Division of Diagnostic and Applied Microbiology, University of Alberta, Walter C. Mackenzie Health Sciences Centre, Edmonton, AB T6G 2H2, Canada
- The Provincial Laboratory for Public Health, 8440 112 Street NW, Edmonton, AB T6G 2J2, Canada
| |
Collapse
|
13
|
Hao L, Kuttel MM, Ravenscroft N, Thompson A, Prasad AK, Gangolli S, Tan C, Cooper D, Watson W, Liberator P, Pride MW, Jansen KU, Anderson AS, Scully IL. Streptococcus pneumoniae serotype 15B polysaccharide conjugate elicits a cross-functional immune response against serotype 15C but not 15A. Vaccine 2022; 40:4872-4880. [PMID: 35810060 DOI: 10.1016/j.vaccine.2022.06.041] [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: 03/02/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 11/25/2022]
Abstract
Protection conferred by pneumococcal polysaccharide conjugate vaccines (PCVs) is associated with PCV-induced antibodies against vaccine-covered serotypes that exhibit functional opsonophagocytic activity (OPA). Structural similarity between capsular polysaccharides of closely related serotypes may result in induction of cross-reactive antibodies with or without a cross-functional activity against a serotype not covered by a PCV, with the former providing an additional protective clinical benefit. Serotypes 15B, 15A, and 15C, in the serogroup 15, are among the most prevalent Streptococcus pneumoniae serotypes associated with invasive pneumococcal disease following the implementation of a 13-valent PCV; in addition, 15B contributes significantly to acute otitis media. Serological discrimination between closely related serotypes such as 15B and 15C is complicated; here, we implemented an algorithm to quickly differentiate 15B from its closely related serotypes 15C and 15A directly from whole-genome sequencing data. In addition, molecular dynamics simulations of serotypes 15A, 15B, and 15C polysaccharides demonstrated that while 15B and 15C polysaccharides assume rigid branched conformation, 15A polysaccharide assumes a flexible linear conformation. A serotype 15B conjugate, included in a 20-valent PCV (PCV20), induced cross-functional OPA serum antibody responses against the structurally similar serotype 15C but not against serotype 15A, both not included in PCV20. In PCV20-vaccinated adults (18-49 years), robust OPA antibody titers were detected against both serotypes 15B (the geometric mean titer [GMT] of 19,334) and 15C (GMTs of 1692 and 2747 for strains PFE344340 and PFE1160, respectively), but were negligible against serotype 15A (GMTs of 10 and 30 for strains PFE593551 and PFE647449, respectively). Cross-functional 15B/C responses were also confirmed using sera from a larger group of older adults (60-64 years).
Collapse
Affiliation(s)
- Li Hao
- Pfizer Vaccine Research & Development, 401 N. Middletown Rd, Pearl River, NY 10965, USA
| | - Michelle M Kuttel
- Department of Computer Science, University of Cape Town, Rondebosch 7701, South Africa
| | - Neil Ravenscroft
- Department of Chemistry, University of Cape Town, Rondebosch 7701, South Africa
| | - Allison Thompson
- Pfizer Vaccine Research & Development, 401 N. Middletown Rd, Pearl River, NY 10965, USA
| | - A Krishna Prasad
- Pfizer Vaccine Research & Development, 401 N. Middletown Rd, Pearl River, NY 10965, USA
| | - Seema Gangolli
- Pfizer Vaccine Research & Development, 401 N. Middletown Rd, Pearl River, NY 10965, USA
| | - Charles Tan
- Pfizer Vaccine Research & Development, 401 N. Middletown Rd, Pearl River, NY 10965, USA
| | - David Cooper
- Pfizer Vaccine Research & Development, 401 N. Middletown Rd, Pearl River, NY 10965, USA
| | - Wendy Watson
- Pfizer Vaccine Clinical Research & Development, 500 Arcola Rd, Collegeville, PA 19422, USA
| | - Paul Liberator
- Pfizer Vaccine Research & Development, 401 N. Middletown Rd, Pearl River, NY 10965, USA
| | - Michael W Pride
- Pfizer Vaccine Research & Development, 401 N. Middletown Rd, Pearl River, NY 10965, USA
| | - Kathrin U Jansen
- Pfizer Vaccine Research & Development, 401 N. Middletown Rd, Pearl River, NY 10965, USA
| | - Annaliesa S Anderson
- Pfizer Vaccine Research & Development, 401 N. Middletown Rd, Pearl River, NY 10965, USA
| | - Ingrid L Scully
- Pfizer Vaccine Research & Development, 401 N. Middletown Rd, Pearl River, NY 10965, USA.
| |
Collapse
|
14
|
Grant LR, Slack MPE, Theilacker C, Vojicic J, Dion S, Reinert RR, Jodar L, Gessner BD. Distribution of Serotypes Causing Invasive Pneumococcal Disease in Children From High-Income Countries and the Impact of Pediatric Pneumococcal Vaccination. Clin Infect Dis 2022; 76:e1062-e1070. [PMID: 35789262 PMCID: PMC9907512 DOI: 10.1093/cid/ciac475] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 04/25/2022] [Accepted: 06/08/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The introduction and adoption of pneumococcal conjugate vaccines (PCVs) into pediatric national immunization programs (NIPs) has led to large decreases in invasive pneumococcal disease (IPD) incidence caused by vaccine serotypes. Despite these reductions, the global IPD burden in children remains significant. METHODS We collected serotype-specific IPD data from surveillance systems or hospital networks of all 30 high-income countries that met inclusion criteria. Data sources included online databases, surveillance system reports, and peer-reviewed literature. Percentage of serotyped cases covered were calculated for all countries combined and by PCV type in the pediatric NIP. RESULTS We identified 8012 serotyped IPD cases in children <5 or ≤5 years old. PCV13 serotype IPD caused 37.4% of total IPD cases, including 57.1% and 25.2% for countries with PCV10 or PCV13 in the pediatric NIP, respectively, most commonly due to serotypes 3 and 19A (11.4% and 13.3%, respectively, across all countries). In PCV10 countries, PCV15 and PCV20 would cover an additional 45.1% and 55.6% of IPD beyond serotypes contained in PCV10, largely due to coverage of serotype 19A. In PCV13 countries, PCV15 and PCV20 would cover an additional 10.6% and 38.2% of IPD beyond serotypes contained in PCV13. The most common IPD serotypes covered by higher valency PCVs were 10A (5.2%), 12F (5.1%), and 22F and 33F (3.5% each). CONCLUSIONS Much of the remaining IPD burden is due to serotypes included in PCV15 and PCV20. The inclusion of these next generation PCVs into existing pediatric NIPs may further reduce the incidence of childhood IPD.
Collapse
Affiliation(s)
- Lindsay R Grant
- Correspondence: Lindsay R. Grant, Pfizer Inc, 500 Arcola Rd, Collegeville, PA 19426, USA ()
| | - Mary P E Slack
- School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia
| | | | | | | | | | | | | |
Collapse
|
15
|
Jiang M, Wang X, Zhu L, Yang YH, Yao KH, Dong F, Shi W, Wang Q, Song WQ, Liu G. Clinical characteristics, antimicrobial resistance, and risk factors for mortality in paediatric invasive pneumococcal disease in Beijing, 2012-2017. BMC Infect Dis 2022; 22:338. [PMID: 35382757 PMCID: PMC8981664 DOI: 10.1186/s12879-022-07179-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 02/18/2022] [Indexed: 12/03/2022] Open
Abstract
Background To analyse clinical characteristics, antibiotic susceptibility, and risk factors for mortality in paediatric invasive pneumococcal disease (IPD) in Beijing. Methods Paediatric IPD patients in our hospital were retrospectively collected from 2012 to 2017. Clinical manifestations, laboratory tests, antimicrobial susceptibility and serotype of isolates, and risk factors for mortality of IPD were analysed. Results Overall, 186 IPD cases were enrolled. The major manifestations were meningitis (76), pneumonia with bacteraemia (60), bacteraemia without focus (21), and pneumonia with empyaema (22). Of 72 cases with underlying diseases, leukaemia (18.0%), congenital heart disease (15.3%), primary immunodeficiency disease (12.5%), nephrotic syndrome (12.5%), and cerebrospinal fluid leakage (12.5%) were most common. In total 96.9% of isolates would have been covered by the pneumococcal conjugate vaccine (PCV13), including 19F (32.8%), 19A (23.4%), 4 (17.2%), and 23F (9.4%). Nonsusceptibility rates of penicillin, cefotaxime, and cefepime among nonmeningitis patients increased between 2012 and 2017; The mortality rate was 21.5%. Meningitis, respiratory failure, multiple organ failure, and white blood cell count < 4000 cells/μL were independent risk factors for mortality. Conclusion Meningitis was the most common clinical manifestation of IPD, and was frequently associated with death. Strains in the PCV13 vaccine would cover most of the cases, and so wider use of PCV13 should be considered.
Collapse
Affiliation(s)
- Man Jiang
- Key Laboratory of Major Diseases in Children, Ministry of Education, Department of Infectious Diseases, National Center for Children's Health, China, Beijing Children's Hospital Affiliated to Capital Medical University, No. 56 Nan Lishi Road, Beijing, 100045, China.,Department of Infectious Diseases, Shenzhen Children's Hospital, Shenzhen, 518035, China
| | - Xi Wang
- Key Laboratory of Major Diseases in Children, Ministry of Education, Department of Infectious Diseases, National Center for Children's Health, China, Beijing Children's Hospital Affiliated to Capital Medical University, No. 56 Nan Lishi Road, Beijing, 100045, China
| | - Liang Zhu
- Key Laboratory of Major Diseases in Children, Ministry of Education, Department of Infectious Diseases, National Center for Children's Health, China, Beijing Children's Hospital Affiliated to Capital Medical University, No. 56 Nan Lishi Road, Beijing, 100045, China
| | - Yong-Hong Yang
- Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline of Pediatrics (Capital Medical University), National Center for Children's Health, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China
| | - Kai-Hu Yao
- Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline of Pediatrics (Capital Medical University), National Center for Children's Health, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China
| | - Fang Dong
- Department of Laboratory Medicine, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China
| | - Wei Shi
- Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline of Pediatrics (Capital Medical University), National Center for Children's Health, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China
| | - Qing Wang
- Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline of Pediatrics (Capital Medical University), National Center for Children's Health, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China
| | - Wen-Qi Song
- Department of Laboratory Medicine, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China
| | - Gang Liu
- Key Laboratory of Major Diseases in Children, Ministry of Education, Department of Infectious Diseases, National Center for Children's Health, China, Beijing Children's Hospital Affiliated to Capital Medical University, No. 56 Nan Lishi Road, Beijing, 100045, China.
| |
Collapse
|
16
|
Nagy A, Reyes JA, Chiasson DA. Fatal Pediatric Streptococcal Infection: A Clinico-Pathological Study. Pediatr Dev Pathol 2022; 25:409-418. [PMID: 35227107 PMCID: PMC9277330 DOI: 10.1177/10935266211064696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE AND CONTEXT Streptococcal Infection (SI) is an important cause of pediatric death in children, yet limited reports exist on autopsy findings in fatal SI cases. METHOD Case records (1997-2019) of SI with no pre-existing risk factors were reviewed and selected. Their clinical and pathological findings in the autopsy reports were analyzed. RESULTS In our cohort of 38 cases based on bacterial culture results, SI was most commonly caused by Streptococcus pneumoniae (SPn; 45%) and Streptococcus pyogenes (SPy; 37%). 92% of decedents had some prodromal symptoms prior to terminal presentation. The clinical course was often rapid, with 89% found unresponsive, suddenly collapsing, or dying within 24 hours of hospital admission. 64% of deaths were attributed to sepsis, more frequently diagnosed in the SPy group than in the SPn group (71% vs 48%). Pneumonia was found in both SPn and SPy groups, whereas meningitis was exclusively associated with SPn. CONCLUSION Our study shows fatal SI is most commonly caused by either SPn or SPy, both of which are frequently associated with prodromal symptoms, rapid terminal clinical course, and evidence of sepsis. Postmortem diagnosis of sepsis is challenging and should be correlated with clinical features, bacterial culture results, and autopsy findings.
Collapse
Affiliation(s)
- Anita Nagy
- Division of Pathology, Department
of Paediatric Laboratory Medicine, The Hospital for Sick
Children, Toronto, ON, Canada,Anita Nagy, Division of Pathology,
Department of Paediatric Laboratory Medicine, The Hospital for Sick Children,
555 Universit venue, Toronto, ON M5G 1X8, Canada.
| | - Jeanette A. Reyes
- Division of Pathology, Department
of Paediatric Laboratory Medicine, The Hospital for Sick
Children, Toronto, ON, Canada
| | - David. A. Chiasson
- Division of Pathology, Department
of Paediatric Laboratory Medicine, The Hospital for Sick
Children, Toronto, ON, Canada,Department of Pathobiology and
Laboratory Medicine, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
17
|
Asai N, Mikamo H. Recent Topics of Pneumococcal Vaccination: Indication of Pneumococcal Vaccine for Individuals at a Risk of Pneumococcal Disease in Adults. Microorganisms 2021; 9:2342. [PMID: 34835468 PMCID: PMC8623678 DOI: 10.3390/microorganisms9112342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 11/05/2021] [Accepted: 11/06/2021] [Indexed: 11/16/2022] Open
Abstract
Pneumococcal disease is one of the most common and severe vaccine-preventable diseases (VPDs). Despite the advances in antimicrobial treatment, pneumococcal disease still remains a global burden and exhibits a high mortality rate among people of all ages worldwide. The immunization program of the pneumococcal conjugate vaccine (PCV) in children has decreased pneumococcal disease incidence in several countries. However, there are several problems regarding the pneumococcal vaccine, such as indications for immunocompetent persons with underlying medical conditions with a risk of pneumococcal disease, the balance of utility and cost, i.e., cost-effectiveness, vaccine coverage rate, serotype replacement, and adverse events. Especially for individuals aged 19-64 at risk of pneumococcal disease, physicians and vaccine providers should make a rational decision whether the patients should be vaccinated or not, since there is insufficient evidence supporting it. We describe this review regarding topics and problems regarding pneumococcal vaccination from the clinician's point of view.
Collapse
Affiliation(s)
- Nobuhiro Asai
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Nagakute 480-1195, Japan;
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Nagakute 480-1195, Japan
- Department of Pathology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Nagakute 480-1195, Japan;
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Nagakute 480-1195, Japan
| |
Collapse
|
18
|
Senders S, Klein NP, Lamberth E, Thompson A, Drozd J, Trammel J, Peng Y, Giardina PC, Jansen KU, Gruber WC, Scott DA, Watson W. Safety and Immunogenicity of a 20-valent Pneumococcal Conjugate Vaccine in Healthy Infants in the United States. Pediatr Infect Dis J 2021; 40:944-951. [PMID: 34525007 PMCID: PMC8443440 DOI: 10.1097/inf.0000000000003277] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2021] [Indexed: 12/05/2022]
Abstract
BACKGROUND The development and widespread use of pneumococcal conjugate vaccines (PCVs) substantially reduced the global burden of pneumococcal disease. Expanding the serotypes covered by PCVs may further reduce disease burden. A 20-valent PCV (PCV20) has been developed to add coverage for 7 additional serotypes (8, 10A, 11A, 12F, 15B, 22F and 33F) to those in the existing 13-valent PCV (PCV13). This phase 2 study evaluated the safety, tolerability and immunogenicity of PCV20 in healthy US infants. METHODS In this randomized, active-controlled, double-blind study, 460 infants were randomized 1:1 to receive a 4-dose series of either PCV20 or PCV13 at 2, 4, 6 and 12 months of age. Solicited local reactions and systemic events, adverse events (AEs) and serious AEs were recorded. Immunogenicity was assessed by measuring serotype-specific IgG concentrations and opsonophagocytic activity titers at 1 month after Dose 3, before Dose 4 and 1 month after Dose 4. RESULTS Of 460 infants, 82.8% completed the 1-month visit after Dose 4. Local reactions and systemic events were mostly mild to moderate in severity and similar between the PCV20 and PCV13 groups. Treatment-related AEs were uncommon, with no related serious AEs or deaths reported. IgG and opsonophagocytic activity responses elicited by PCV20 were robust and demonstrated a booster response after Dose 4. CONCLUSIONS Administration of PCV20 in US infants was well tolerated, with a safety profile similar to PCV13, and induced robust serotype-specific immune responses. These findings support continued development of PCV20 in the pediatric population.
Collapse
Affiliation(s)
| | | | - Erik Lamberth
- Vaccine Research and Development, Pfizer Inc, Collegeville, Pennsylvania
| | - Allison Thompson
- Vaccine Research and Development, Pfizer Inc, Pearl River, New York
| | - Jelena Drozd
- Vaccine Research and Development, Pfizer Inc, Collegeville, Pennsylvania
| | - James Trammel
- Vaccine Research and Development, Pfizer Inc, Collegeville, Pennsylvania
| | - Yahong Peng
- Vaccine Research and Development, Pfizer Inc, Collegeville, Pennsylvania
| | | | | | | | - Daniel A. Scott
- Vaccine Research and Development, Pfizer Inc, Collegeville, Pennsylvania
| | - Wendy Watson
- Vaccine Research and Development, Pfizer Inc, Collegeville, Pennsylvania
| |
Collapse
|
19
|
Isturiz R, Grant L, Gray S, Alexander-Parrish R, Jiang Q, Jodar L, Peyrani P, Ford KD, Pride MW, Self WH, Counselman F, Volturo G, Ostrosky-Zeichner L, Wunderink RG, Sherwin R, Overcash JS, File T, Ramirez J. Expanded Analysis of 20 Pneumococcal Serotypes Associated With Radiographically Confirmed Community-Acquired Pneumonia in Hospitalized US Adults. Clin Infect Dis 2021; 73:1216-1222. [PMID: 33982098 PMCID: PMC8492118 DOI: 10.1093/cid/ciab375] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Indexed: 11/29/2022] Open
Abstract
Background Streptococcus pneumoniae is a causative agent of community-acquired pneumonia (CAP). The 13-valent pneumococcal conjugate vaccine (PCV13) has significantly decreased the burden of PCV13-serotype pneumococcal disease; however, disease from nonvaccine serotypes remains substantial. A recent study documented the persistence of PCV13 serotypes among US adults hospitalized with radiographically confirmed CAP. The current analysis used a recently developed urinary antigen detection (UAD) assay (UAD2) to extend these results to additional serotypes included in an investigational PCV20 vaccine. Methods This prospective study enrolled adults aged ≥18 years hospitalized with radiographically confirmed CAP between October 2013 and September 2016. Presence of S pneumoniae was determined by blood and respiratory sample culture, BinaxNOW urine testing, and UAD. In addition to Quellung on cultured isolates when available, serotypes were identified from urine specimens using UAD1 for PCV13 serotypes and UAD2 for 7 PCV20-unique serotypes (8, 10A, 11A, 12F, 15B, 22F, and 33F) and 4 additional serotypes (2, 9N, 17F, and 20). Results Among 12 055 subjects with radiographically confirmed CAP, 1482 were positive for S pneumoniae. PCV13- and PCV20-unique serotypes were associated with 37.7% (n = 559) and 27.0% (n = 400) of cases, respectively; 288 subjects were exclusively diagnosed as positive for S pneumoniae by UAD2. Demographic and clinical disease characteristics were similar between subjects with CAP caused by PCV13 and PCV20-unique serotypes. Conclusions The current analysis using UAD2 identified a sizeable proportion of hospitalized adult CAP associated with PCV20-unique serotypes. PCV20 may therefore address the burden of CAP caused by the additional serotypes present in the vaccine.
Collapse
Affiliation(s)
- Raul Isturiz
- Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Lindsay Grant
- Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Sharon Gray
- Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | | | - Qin Jiang
- Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Luis Jodar
- Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Paula Peyrani
- Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Kimbal D Ford
- Medical Development, Scientific and Clinical Affairs, Pfizer Inc, Collegeville, PA, USA
| | - Michael W Pride
- Vaccine Research and Development, Pfizer Inc, Pearl River, NY, USA
| | - Wesley H Self
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Francis Counselman
- Department of Emergency Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Gregory Volturo
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | | | - Richard G Wunderink
- Department of Medicine, Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Robert Sherwin
- Department of Emergency Medicine, Wayne State University, Detroit, MI, USA
| | | | - Thomas File
- Summa Health, Northeast Ohio Medical University, Akron, OH, USA
| | - Julio Ramirez
- Division of Infectious Diseases, University of Louisville, Louisville, KY, USA
| |
Collapse
|
20
|
Xu Y, Wang Q, Yao K, Dong F, Song W, Liu G, Xu B, Shi W, Li Y, Li K, Liu Y, Qian S. Clinical characteristics and serotype distribution of invasive pneumococcal disease in pediatric patients from Beijing, China. Eur J Clin Microbiol Infect Dis 2021; 40:1833-1842. [PMID: 33786728 DOI: 10.1007/s10096-021-04238-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/24/2021] [Indexed: 12/14/2022]
Abstract
Invasive pneumococcal disease (IPD) is associated with significant morbidity and mortality. However, limited studies have reported clinical features of IPD cases among Chinese children. This study aimed to evaluate clinical characteristics as well as serotype distribution of hospitalized IPD children in Beijing, China. Children with confirmed IPD were retrospectively recruited from January 2014 to December 2019. Clinical data were gathered from medical records, and serotypes of Streptococcus pneumoniae isolates were detected. Clinical differences between deaths and survivors were also compared, and risk factors associated with death were determined. Of sixty-eight children diagnosed with IPD, 58 (85.3%) were < 5 years. 19F was the predominant serotype (23, 33.8%), followed by 19A (14, 20.6%), 14 (12, 17.6%), 23F (5, 7.4%), and non-vaccine serotype (NVT) 15A (3, 4.4%). The coverage rate of 13-valent pneumococcal conjugate vaccine (PCV) was 92.6% (63). After introduction of PCV-13, there was a significant increase of IPD due to NVTs (p = 0.047). Sixteen (23.5%) children died, and diagnoses of 11 (68.8%) were meningitis. Risk factors for death were < 2 years (odds ratio [OR] [95% confidence interval {CI}]: 6.64 [1.14-32.10]; p = 0.019), altered mental status (OR [95%CI]: 10.10 [2.11-48.31]; p = 0.004), and septic shock (OR [95%CI]: 6.61 [1.11-39.50]; p = 0.038). This study revealed that the case fatality rate of hospitalized IPD children was high in this hospital. Fatal cases were more likely to be children < 2 years, presented with changed mental status and septic shock. Notably, we found that NVTs increased after PCV13 availability in China.
Collapse
Affiliation(s)
- Yan Xu
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nan-Li-Shi Road, Beijing, 100045, China
| | - Qing Wang
- Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Kaihu Yao
- Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Fang Dong
- Bacteriology Laboratory, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Wenqi Song
- Bacteriology Laboratory, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Gang Liu
- Department of Infectious Diseases, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Baoping Xu
- Department of Respiratory, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Wei Shi
- Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Yue Li
- Key Laboratory of Major Diseases in Children, Ministry of Education, National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Kechun Li
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nan-Li-Shi Road, Beijing, 100045, China
| | - Yingchao Liu
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nan-Li-Shi Road, Beijing, 100045, China
| | - Suyun Qian
- Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nan-Li-Shi Road, Beijing, 100045, China.
| |
Collapse
|
21
|
Decreasing case fatality rate following invasive pneumococcal disease, North East England, 2006-2016. Epidemiol Infect 2020; 147:e175. [PMID: 31063115 PMCID: PMC6518772 DOI: 10.1017/s0950268819000657] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Declining mortality following invasive pneumococcal disease (IPD) has been observed concurrent with a reduced incidence due to effective pneumococcal conjugate vaccines. However, with IPD now increasing due to serotype replacement, we undertook a statistical analysis to estimate the trend in all-cause 30-day case fatality rate (CFR) in the North East of England (NEE) following IPD. Clinical, microbiological and demographic data were obtained for all laboratory-confirmed IPD cases (April 2006–March 2016) and the adjusted association between CFR and epidemiological year estimated using logistic regression. Of the 2510 episodes of IPD included in the analysis, 486 died within 30 days of IPD (CFR 19%). Increasing age, male sex, a diagnosis of septicaemia, being in ⩾1 clinical risk groups, alcohol abuse and individual serotypes were independently associated with increased CFR. A significant decline in CFR over time was observed following adjustment for these significant predictors (adjusted odds ratio 0.93, 95% confidence interval 0.89–0.98; P = 0.003). A small but significant decline in 30-day all-cause CFR following IPD has been observed in the NEE. Nonetheless, certain population groups remain at increased risk of dying following IPD. Despite the introduction of effective vaccines, further strategies to reduce the ongoing burden of mortality from IPD are needed.
Collapse
|
22
|
Development of Next Generation Streptococcus pneumoniae Vaccines Conferring Broad Protection. Vaccines (Basel) 2020; 8:vaccines8010132. [PMID: 32192117 PMCID: PMC7157650 DOI: 10.3390/vaccines8010132] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/22/2020] [Accepted: 02/29/2020] [Indexed: 02/06/2023] Open
Abstract
Streptococcus pneumoniae is a major pathogen causing pneumonia with over 2 million deaths annually, especially in young children and the elderly. To date, at least 98 different pneumococcal capsular serotypes have been identified. Currently, the vaccines for prevention of S. pneumoniae infections are the 23-valent pneumococcal polysaccharide-based vaccine (PPV23) and the pneumococcal conjugate vaccines (PCV10 and PCV13). These vaccines only cover some pneumococcal serotypes and are unable to protect against non-vaccine serotypes and unencapsulated S. pneumoniae. This has led to a rapid increase in antibiotic-resistant non-vaccine serotypes. Hence, there is an urgent need to develop new, effective, and affordable pneumococcal vaccines, which could cover a wide range of serotypes. This review discusses the new approaches to develop effective vaccines with broad serotype coverage as well as recent development of promising pneumococcal vaccines in clinical trials. New vaccine candidates are the inactivated whole-cell vaccine strain (Δpep27ΔcomD mutant) constructed by mutations of specific genes and several protein-based S. pneumoniae vaccines using conserved pneumococcal antigens, such as lipoprotein and surface-exposed protein (PspA). Among the vaccines in Phase 3 clinical trials are the pneumococcal conjugate vaccines, PCV-15 (V114) and 20vPnC. The inactivated whole-cell and several protein-based vaccines are either in Phase 1 or 2 trials. Furthermore, the recent progress of nanoparticles that play important roles as delivery systems and adjuvants to improve the performance, as well as the immunogenicity of the nanovaccines, are reviewed.
Collapse
|
23
|
Prasil P, Ryskova L, Plisek S, Bostik P. A rare case of purulent meningitis caused by Capnocytophaga canimorsus in the Czech Republic - case report and review of the literature. BMC Infect Dis 2020; 20:100. [PMID: 32013874 PMCID: PMC6998360 DOI: 10.1186/s12879-020-4760-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 12/31/2019] [Indexed: 11/10/2022] Open
Abstract
Background Invasive infections caused by Capnocytophaga canimorsus are rare. Immunocompromised patients, who report being bitten by or having a close contact with an animal, represent a high-risk group for this infection. There are only few dozens of infections by this bacteria manifesting as purulent meningitis reported worldwide. The reported case is a first reported case of purulent meningitis caused by by Capnocytophaga canimorsus in Czech Republic with only a limited risk factor history. Case presentation The patient, a 74 years old man, was referred to the infectious diseases department of a teaching hospital with clear signs of developing purulent meningitis. His anamnestic data did not show any unusual findings. He was treated for compensated diabetes mellitus type II. The blood cultures were negative and the etiological agent did not grow from the cerebrospinal fluid (CSF) on common media. Eventually, it was identified by detecting pan-bacterial DNA and DNA sequencing. Subsequently, the pathogen was confirmed by anaerobic cultivation from CSF. Only after then the patient recalled being bitten by his German shepherd puppy during play. The patient was successfully treated intravenously by ceftriaxone. Conclusions Purulent meningitis caused by Capnocytophaga spp. is a rare disease, but it needs to be considered in patients at risk with pre-existing conditions, who report close contact with or being bitten by an animal. It is important to test for this microbe in cases with negative microbiological results for the more common agents.
Collapse
Affiliation(s)
- Petr Prasil
- Department of Infectious Diseases, Charles University School of Medicine and Faculty Hospital, Hradec Kralove, Czech Republic
| | - Lenka Ryskova
- Department of Clinical Microbiology, Charles University School of Medicine and Faculty Hospital, Hradec Kralove, Czech Republic
| | - Stanislav Plisek
- Department of Infectious Diseases, Charles University School of Medicine and Faculty Hospital, Hradec Kralove, Czech Republic
| | - Pavel Bostik
- Department of Infectious Diseases, Charles University School of Medicine and Faculty Hospital, Hradec Kralove, Czech Republic. .,Faculty of Military Health Sciences, University of Defense, Trebesska 1575, 50001, Hradec Kralove, Czech Republic.
| |
Collapse
|
24
|
Oligbu G, Collins S, Djennad A, Sheppard CL, Fry NK, Andrews NJ, Borrow R, Ramsay ME, Ladhani SN. Effect of Pneumococcal Conjugate Vaccines on Pneumococcal Meningitis, England and Wales, July 1, 2000-June 30, 2016. Emerg Infect Dis 2020; 25:1708-1718. [PMID: 31441745 PMCID: PMC6711218 DOI: 10.3201/eid2509.180747] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We describe the effects of the 7-valent (PCV7) and 13-valent (PCV13) pneumococcal conjugate vaccines on pneumococcal meningitis in England and Wales during July 1, 2000–June 30, 2016. Overall, 84,473 laboratory-confirmed invasive pneumococcal disease cases, including 4,160 (4.9%) cases with meningitis, occurred. PCV7 implementation in 2006 did not lower overall pneumococcal meningitis incidence because of replacement with non–PCV7-type meningitis incidence. Replacement with PCV13 in 2010, however, led to a 48% reduction in pneumococcal meningitis incidence by 2015–16. The overall case-fatality rate was 17.5%: 10.7% among patients <5 years of age, 17.3% among patients 5–64 years of age, and 31.9% among patients >65 years of age. Serotype 8 was associated with increased odds of death (adjusted odds ratio 2.9, 95% CI 1.8–4.7). In England and Wales, an effect on pneumococcal meningitis was observed only after PCV13 implementation. Further studies are needed to assess pneumococcal meningitis caused by the replacing serotypes.
Collapse
|
25
|
Choi YH, Andrews N, Miller E. Estimated impact of revising the 13-valent pneumococcal conjugate vaccine schedule from 2+1 to 1+1 in England and Wales: A modelling study. PLoS Med 2019; 16:e1002845. [PMID: 31269018 PMCID: PMC6608946 DOI: 10.1371/journal.pmed.1002845] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 05/30/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND In October 2017, the United Kingdom Joint Committee on Vaccination and Immunisation (JCVI) recommended removal of one primary dose of the 13-valent pneumococcal conjugate vaccine (PCV13) from the existing 2+1 schedule (2, 4, 12 months). We conducted a mathematical modelling study to investigate the potential impact of a 1+1 (3, 12 month) schedule on invasive pneumococcal disease (IPD) and pneumococcal community-acquired pneumonia (CAP). Our results and those from a 1+1 immunogenicity study formed the key evidence reviewed by JCVI. METHODS AND FINDINGS We developed age-structured, dynamic, deterministic models of pneumococcal transmission in England and Wales to describe the impact on IPD of 7-valent PCV (PCV7; introduced in 2006) and PCV13 (introduced in 2010). Key transmission and vaccine parameters were estimated by fitting to carriage data from 2001/2002 and post-PCV IPD data to 2015, using vaccine coverage, mixing patterns between ages, and population data. We considered various models to investigate potential reasons for the rapid increase in non-PCV13 (non-vaccine serotype [NVT]) IPD cases since 2014. After searching a large parameter space, 500 parameter sets were identified with a likelihood statistically close to the maximum and these used to predict future cases (median, prediction range from 500 parameter sets). Our findings indicated that the emergence of individual NVTs with higher virulence resulting from ongoing replacement was likely responsible; the NVT increase was predicted to plateau from 2020. Long-term simulation results suggest that changing to a 1+1 schedule would have little overall impact, as the small increase in vaccine-type IPD would be offset by a reduction in NVT IPD. Our results were robust to changes in vaccine assumptions in a sensitivity analysis. Under the base case scenario, a change to a 1+1 schedule in 2018 was predicted to produce 31 (6, 76) additional IPD cases over five years and 83 (-10, 242) additional pneumococcal-CAP cases, with together 8 (-2, 24) additional deaths, none in children under 15 years. Long-term continuation with the 2+1 schedule, or changing to a 1+1, was predicted to sustain current reductions in IPD cases in under-64-year-olds, but cases in 65+-year-olds would continue to increase because of the effects of an aging population. Limitations of our model include difficulty in fitting to past trends in NVT IPD in some age groups and inherent uncertainty about future NVT behaviour, sparse data for defining the mixing matrix in 65+-year-olds, and the methodological challenge of defining uncertainty on predictions. CONCLUSIONS Our findings suggest that, with the current mature status of the PCV programme in England and Wales, removing one primary dose in the first year of life would have little impact on IPD or pneumococcal CAP cases or associated deaths at any age. A reduction in the number of priming doses would improve programmatic efficiency and facilitate the introduction of new vaccines by reducing the number of coadministered vaccines given at 2 and 4 months of age in the current UK schedule. Our findings should not be applied to other settings with different pneumococcal epidemiology or with immature programmes and poor herd immunity.
Collapse
Affiliation(s)
- Yoon Hong Choi
- Statistics, Modelling and Economics Department, Data and Analytical Sciences, National Infection Service, Public Health England, London, United Kingdom
| | - Nick Andrews
- Statistics, Modelling and Economics Department, Data and Analytical Sciences, National Infection Service, Public Health England, London, United Kingdom
| | - Elizabeth Miller
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, United Kingdom
| |
Collapse
|
26
|
Wang CY, Chen YH, Chen XJ, Xu HM, Jing CM, Deng JK, Zhao RZ, Deng HL, Cao SC, Yu H, Wang CQ, Wang AM, Lin AW, Wang SF, Cao Q, Wang X, Zhang T, Zhang H, Hao JH, Zhang CH. [Clinical characteristics and drug sensitivity in children with invasive pneumococcal disease: a multicenter study]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2019; 21:644-649. [PMID: 31315762 PMCID: PMC7389108 DOI: 10.7499/j.issn.1008-8830.2019.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 05/06/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To study the clinical characteristics, drug sensitivity of isolated strains, and risk factors of drug resistance in children with invasive pneumococcal disease (IPD). METHODS The clinical characteristics and drug sensitivity of the isolated strains of 246 hospitalized children with IPD in nine grade A tertiary children's hospitals from January 2016 to June 2018 were analyzed. RESULTS Of the 246 children with IPD, there were 122 males and 124 females. Their ages ranged from 1 day to 14 years, and among them, 68 (27.6%) patients were less than 1 year old, 54 (22.0%) patients were 1 to 2 years old, 97 (39.4%) patients were 2 to 5 years old, and 27 (11.0%) patients were 5 to 14 years old. Pneumonia with sepsis was the most common infection type (58.5%, 144/246), followed by bloodstream infection without focus (19.9%, 49/246) and meningitis (15.0%, 37/246). Forty-nine (19.9%) patients had underlying diseases, and 160 (65.0%) had various risk factors for drug resistance. The isolated Streptococcus pneumoniae strains were 100% sensitive to vancomycin, linezolid, moxifloxacin, and levofloxacin, 90% sensitive to ertapenem, ofloxacin, and ceftriaxone, but had a low sensitivity to erythromycin (4.2%), clindamycin (7.9%), and tetracycline (6.3%). CONCLUSIONS IPD is more common in children under 5 years old, especially in those under 2 years old. Some children with IPD have underlying diseases, and most of the patients have various risk factors for drug resistance. Pneumonia with sepsis is the most common infection type. The isolated Streptococcus pneumoniae strains are highly sensitive to vancomycin, linezolid, moxifloxacin, levofloxacin, ertapenem, and ceftriaxone in children with IPD.
Collapse
Affiliation(s)
- Cai-Yun Wang
- Department of Infectious Disease, Children's Hospital of Zhejiang University School of Medicine, Hangzhou 310052, China.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Ojal J, Griffiths U, Hammitt LL, Adetifa I, Akech D, Tabu C, Scott JAG, Flasche S. Sustaining pneumococcal vaccination after transitioning from Gavi support: a modelling and cost-effectiveness study in Kenya. Lancet Glob Health 2019; 7:e644-e654. [PMID: 31000132 PMCID: PMC6484775 DOI: 10.1016/s2214-109x(18)30562-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 12/03/2018] [Accepted: 12/06/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND In 2009, Gavi, the World Bank, and donors launched the pneumococcal Advance Market Commitment, which helped countries access more affordable pneumococcal vaccines. As many low-income countries begin to reach the threshold at which countries transition from Gavi support to self-financing (3-year average gross national income per capita of US$1580), they will need to consider whether to continue pneumococcal conjugate vaccine (PCV) use at full cost or to discontinue PCV in their childhood immunisation programmes. Using Kenya as a case study, we assessed the incremental cost-effectiveness of continuing PCV use. METHODS In this modelling and cost-effectiveness study, we fitted a dynamic compartmental model of pneumococcal carriage to annual carriage prevalence surveys and invasive pneumococcal disease (IPD) incidence in Kilifi, Kenya. We predicted disease incidence and related mortality for either continuing PCV use beyond 2022, the start of Kenya's transition from Gavi support, or its discontinuation. We calculated the costs per disability-adjusted life-year (DALY) averted and associated 95% prediction intervals (PI). FINDINGS We predicted that if PCV use is discontinued in Kenya in 2022, overall IPD incidence will increase from 8·5 per 100 000 in 2022, to 16·2 per 100 000 per year in 2032. Continuing vaccination would prevent 14 329 (95% PI 6130-25 256) deaths and 101 513 (4386-196 674) disease cases during that time. Continuing PCV after 2022 will require an estimated additional US$15·8 million annually compared with discontinuing vaccination. We predicted that the incremental cost per DALY averted of continuing PCV would be $153 (95% PI 70-411) in 2032. INTERPRETATION Continuing PCV use is essential to sustain its health gains. Based on the Kenyan GDP per capita of $1445, and in comparison to other vaccines, continued PCV use at full costs is cost-effective (on the basis of the assumption that any reduction in disease will translate to a reduction in mortality). Although affordability is likely to be a concern, our findings support an expansion of the vaccine budget in Kenya. FUNDING Wellcome Trust and Gavi, the Vaccine Alliance.
Collapse
Affiliation(s)
- John Ojal
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine-Coast, Kilifi, Kenya; Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
| | - Ulla Griffiths
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK; UNICEF Health Section, Programme Division, New York, NY, USA
| | - Laura L Hammitt
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine-Coast, Kilifi, Kenya; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ifedayo Adetifa
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine-Coast, Kilifi, Kenya; Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Donald Akech
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine-Coast, Kilifi, Kenya
| | | | - J Anthony G Scott
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine-Coast, Kilifi, Kenya; Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Stefan Flasche
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
28
|
Abstract
Streptococcus pneumoniae is one of the commonest bacteria that cause morbidity and mortality in children and the elderly. The two extremes of age and individuals with underlying disease are particularly at risk of developing pneumococcal disease. The pneumococcus is responsible for a wide range of infectious diseases, ranging from mild, non-invasive infections such as otitis media and sinusitis, to more severe infections including pneumonia, septicemia, and meningitis. Despite the licensure of highly effective pneumococcal conjugate vaccines, the control of pneumococcal disease is still challenging. Here we describe the critical role of Streptococcus pneumoniae in public health.
Collapse
Affiliation(s)
- Godwin Oligbu
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George's, University of London, London, UK. .,Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK.
| | - Norman K Fry
- Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK.,Respiratory and Vaccine Preventable Bacterial Reference Unit (RVPBRU), National Infection Service Laboratories, Public Health England, London, UK
| | - Shamez N Ladhani
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St. George's, University of London, London, UK.,Immunisation and Countermeasures Division, National Infection Service, Public Health England, London, UK
| |
Collapse
|
29
|
Wang Y, Li J, Wang Y, Gu W, Zhu F. Effectiveness and practical uses of 23-valent pneumococcal polysaccharide vaccine in healthy and special populations. Hum Vaccin Immunother 2017; 14:1003-1012. [PMID: 29261406 PMCID: PMC5893217 DOI: 10.1080/21645515.2017.1409316] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Streptococcus pneumonia (S. pneumoniae) is responsible for significant morbidity and mortality throughout the world. The 23-valent pneumococcal polysaccharide vaccines (PPV23) have been widely used for many years, but challenges are remaining in some respects, especially for its effectiveness among high-risk populations and older adults. This review aims to summarize recent clinical trials and studies of PPV23 vaccination among healthy people ≥ 2 years of age and those with high-risk conditions such as pregnant women, individuals with immunocompromising diseases and other chronic conditions, and provide health officials in China and other developing countries a comprehensive understanding of the current vaccination strategies for PPV23 and for the combined use of PPV23 and pneumococcal conjugate vaccines (PCVs) in adults.
Collapse
Affiliation(s)
- Yang Wang
- a School of Public Health, Southeast University , Nanjing , PR China
| | - Jingxin Li
- b Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , PR China
| | - Yuxiao Wang
- a School of Public Health, Southeast University , Nanjing , PR China
| | - Wei Gu
- c School of Public Health, Nanjing Medical University , Nanjing , PR China
| | - Fengcai Zhu
- b Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , PR China
| |
Collapse
|
30
|
Invasive pneumococcal disease in children under 16 years of age: Incomplete rebound in incidence after the maximum effect of PCV13 in 2012/13 in Germany. Vaccine 2017; 36:572-577. [PMID: 29258705 DOI: 10.1016/j.vaccine.2017.11.085] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 11/21/2017] [Accepted: 11/26/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To identify a potential nadir of the impact of pneumococcal conjugate vaccination (PCV) in infancy on invasive pneumococcal diseases (IPD) in children under 16 in Germany. METHODS Active surveillance on IPD based on two independent data sources with capture-recapture correction for underreporting. Annual incidence rates by age group, serotypes, site of infection, and relative incidence reduction compared to pre-vaccination period (1997-2001) at nadir and for the most recent season are reported. We calculated vaccine coverage at the age of 24 months using health insurance claims data. RESULTS 96-97% of children had received at least two doses of PCV since 2009. The maximum impact on overall IPD incidence was achieved in 2012/13 (-48% [95% CI: -55%; -39%]) with a rebound to -26% [95% CI: -36%; -16%] in 2015/16. Non-PCV13 serotypes accounted for 84.1% of the IPD cases in 2015/16. The most frequent non-PCV serotypes in IPD in 2014/15 and 2015/16 were 10A, 24F, 15C, 12F, 38, 22F, 23B, and 15B. The impact at nadir was highest in children 0-1 years of age both in meningitis and non-meningitis cases, whereas the impact for other age groups was higher for meningitis cases. The rebound mainly pertained to non-meningitis cases. CONCLUSION The maximum impact of pneumococcal conjugate vaccination has been attained and signs of a rebound are apparent. Sustained surveillance for IPD in children is warranted to assess whether these trends will continue. There may be a need for vaccines using antigens common to all serotypes.
Collapse
|