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Invasive Pneumococcal Disease in High-risk Children: A 10-Year Retrospective Study. Pediatr Infect Dis J 2023; 42:74-81. [PMID: 36450100 DOI: 10.1097/inf.0000000000003748] [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: 12/03/2022]
Abstract
BACKGROUND Despite the availability of conjugate pneumococcal vaccines, children with high-risk conditions remain vulnerable to invasive pneumococcal disease (IPD). This study sought to describe IPD prevalence, vaccination and outcomes among high-risk children. METHODS We used International Classification of Disease10 discharge and microbiology codes to identify patients hospitalized for IPD at a large pediatric hospital from January 1, 2009, to December 31, 2018. Patients were considered high-risk if they had: primary immunodeficiency, asplenia, transplant, active malignancy, sickle cell disease, cochlear implant, nephrotic syndrome, chronic lung disease, cerebrospinal fluid leak, HIV or used immunosuppressive therapy. RESULTS In total 94 high-risk patients were hospitalized for IPD. The most common high-risk conditions included malignancy (n = 33, 35%), solid-organ or bone marrow transplant (n = 17, 18%) and sickle cell disease (n = 14, 15%). Bacteremia was the most common presentation (n = 81, 86%) followed by pneumonia (n = 23, 25%) and meningitis (n = 9, 10%). No deaths occurred. Of 66 patients with known pneumococcal vaccination status, 15 (23%) were unvaccinated, and 51 (77%) received at least one dose of a pneumococcal vaccine; 20 received all four recommended pneumococcal conjugate vaccine (PCV) doses. Only three children received PPSV23. Of 20 children with no or partial (<3 doses) immunization, 70% (14) of IPD episodes were due to vaccine-preventable serotypes. Of 66 known IPD serotypes, 17% (n = 11) were covered by PCV13, 39% (n = 26) were covered by PPSV23 and 39% (n = 26) were nonvaccine serotype. CONCLUSIONS Despite the availability of effective pneumococcal vaccines, IPD persists among children with high-risk conditions. Improving PCV13 and PPSV23 vaccination could significantly reduce IPD; most episodes were due to vaccine-preventable serotypes in incompletely immunized patients.
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Streptococcus pneumoniae vaccination strategies and its expected impact on penicillin non-susceptibility in children under the age of five: Let's recap! Vaccine X 2022; 11:100170. [PMID: 35620569 PMCID: PMC9127579 DOI: 10.1016/j.jvacx.2022.100170] [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: 08/27/2021] [Revised: 12/23/2021] [Accepted: 05/09/2022] [Indexed: 11/22/2022] Open
Abstract
The efficacy of PCVs currently used in children under 5 years of age is threatened by the emergence of invasive and resistant non-vaccine serotypes worldwide. Resistant NVT strains are emerging in IPD in children < 5 years mainly serotypes 24F, 15A, 11A and 33F along with serotype 19A in PCV-10 settings. Continuous surveillance is necessary in IPD in children under five to monitor the long-term effect of PCV-10 and PCV-13 on penicillin resistance trends.
The impact of pneumococcal conjugate vaccines (PCVs) on invasive pneumococcal disease (IPD) burden has been extensively studied in children aged<5 years; however, a pooled estimation of the effect of PCVs on penicillin non-susceptible pneumococci (PNSP) has not yet been performed. We aimed to identify whether the introduction of PCV-10 and PCV-13 had led to the decrease of the overall PNSP rate in children < 5 years. We conducted a systematic review of published surveillance studies reporting the rate of PNSP rates in children < 5 in countries where PCV10/13 were introduced. The overall observed trend onwards the introduction of PCV-10 and PCV-13 is a decrease in PNSP among children < 5 years in surveillance sites located in PCV-13 countries. We identified an increase of PNSP rates (serotype 19A) in PCV-10 settings. Resistant NVT strains are emerging in IPD in children < 5 years mainly serotypes 24F, 15A, 11A and 33F along with serotype 19A in PCV-10 settings. Continuous surveillance is necessary in IPD in children under five to monitor the long-term effect of PCV-10 and PCV-13 on penicillin resistance trends.
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Krueger C, Mahant S, Begum N, Widjaja E, Science M, Parkin PC, Gill PJ. Changes in the Management of Severe Orbital Infections Over Seventeen Years. Hosp Pediatr 2021; 11:613-621. [PMID: 34031136 DOI: 10.1542/hpeds.2020-001818] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Periorbital and orbital cellulitis are common but serious infections in children. Management of these infections varies because of an absence of clinical guidelines, but it is unclear if management within institutions has changed over time. We compared the management and outcomes of children hospitalized with periorbital and orbital cellulitis in 2 eras. METHODS Data were extracted from records of children hospitalized at a tertiary care children's hospital with periorbital or orbital cellulitis from 2000 to 2005 and 2012 to 2016. Patient demographics, cross-sectional imaging, antibiotic and corticosteroid use, length of stay, and surgical rates were collected. Data from the eras were compared by using descriptive statistics, t tests, Mann-Whitney U tests, Fisher's exact tests, and χ2 tests. RESULTS There were 318 children included, 143 from 2000 to 2005 and 175 from 2012 to 2016. Compared with the first era, in the second era there were increased rates of MRI (5% vs 11%, P = .04), although rates of computed tomography scan use remained unchanged (60% vs 65%); increased number (1 vs 3, P < .01) and spectrum of antibiotics; increased use of intranasal corticosteroids (3% vs 49%, P < .01); and subspecialty consultation (89% vs 99%, P = .01). There were no differences in length of stay, readmission, or surgical rates between eras. CONCLUSIONS There has been considerable change in the management of hospitalized children with severe orbital infections at our institution, including the rates of MRI, number and spectrum of antibiotics used, use of adjunctive agents, and increased subspecialty involvement with no observed impact on clinical outcomes. Future research is needed to rationalize antimicrobial therapy and reduce low-value health care.
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Affiliation(s)
- Carsten Krueger
- Pediatric Outcomes Research Team, Divisions of Pediatric Medicine and
| | - Sanjay Mahant
- Pediatric Outcomes Research Team, Divisions of Pediatric Medicine and.,Departments of Pediatrics and.,Child Health Evaluative Sciences and.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; and
| | - Nurshad Begum
- Pediatric Outcomes Research Team, Divisions of Pediatric Medicine and
| | - Elysa Widjaja
- Neurosciences & Mental Health, SickKids Research Institute, Toronto, Canada.,Medical Imaging, Faculty of Medicine, and
| | - Michelle Science
- Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Patricia C Parkin
- Pediatric Outcomes Research Team, Divisions of Pediatric Medicine and.,Departments of Pediatrics and.,Child Health Evaluative Sciences and.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; and
| | - Peter J Gill
- Pediatric Outcomes Research Team, Divisions of Pediatric Medicine and .,Departments of Pediatrics and.,Child Health Evaluative Sciences and.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; and
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Pugh S, Wasserman M, Moffatt M, Marques S, Reyes JM, Prieto VA, Reijnders D, Rozenbaum MH, Laine J, Åhman H, Farkouh R. Estimating the Impact of Switching from a Lower to Higher Valent Pneumococcal Conjugate Vaccine in Colombia, Finland, and The Netherlands: A Cost-Effectiveness Analysis. Infect Dis Ther 2020; 9:305-324. [PMID: 32096144 PMCID: PMC7237584 DOI: 10.1007/s40121-020-00287-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Widespread use of ten-valent (Synflorix™, GSK) or 13-valent (Prevenar 13™; Pfizer) conjugate vaccination programs has effectively reduced invasive pneumococcal disease (IPD) globally. However, IPD caused by serotypes not contained within the respective vaccines continues to increase, notably serotypes 3, 6A, and 19A in countries using lower-valent vaccines. Our objective was to estimate the clinical and economic benefit of replacing PCV10 with PCV13 in Colombia, Finland, and The Netherlands. METHODS Country-specific databases, supplemented with published and unpublished data, informed the historical incidence of pneumococcal disease as well as direct and indirect medical costs. A decision-analytic forecasting model was applied, and both costs and outcomes were discounted. The observed invasive pneumococcal disease (IPD) trends from each country were used to forecast the future number of IPD cases given a PCV13 or PCV10 program. RESULTS Over a 5-year time horizon, a switch to a PCV13 program was estimated to reduce overall IPD among 0-2 year olds by an incremental - 37.6% in Colombia, - 32.9% in Finland, and - 26% in The Netherlands, respectively, over PCV10. Adults > 65 years experienced a comparable incremental decrease in overall IPD in Colombia (- 32.2%), Finland (- 15%), and The Netherlands (- 3.7%). Serotypes 3, 6A, and 19A drove the incremental decrease in disease for PCV13 over PCV10 in both age groups. A PCV13 program was dominant in Colombia and Finland and cost-effective in The Netherlands at 1 × GDP per capita (€34,054/QALY). CONCLUSION In Colombia, Finland, and The Netherlands, countries with diverse epidemiologic and population distributions, switching from a PCV10 to PCV13 program would significantly reduce the burden of IPD in all three countries in as few as 5 years.
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Fu J, Yi R, Jiang Y, Xu S, Qin P, Liang Z, Chen J. Serotype distribution and antimicrobial resistance of Streptococcus pneumoniae causing invasive diseases in China: a meta-analysis. BMC Pediatr 2019; 19:424. [PMID: 31711442 PMCID: PMC6844036 DOI: 10.1186/s12887-019-1722-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 09/12/2019] [Indexed: 12/13/2022] Open
Abstract
Background To summarize information about invasive pneumococcal disease (IPD) among children in mainland China. Methods Sixteen eligible studies were included in this systematic review and the random effect model was used to estimate the pool prevalence of IPD. Results The most predominant serotypes circulating in children were 19F (27.7, 95% confidence interval (95% CI): 17.7–37.6%), 19A (21.2%, 16.4–26.1%), 14 (16.5%, 12.8–20.1%), 6B (8.6%, 5.2–10.8%) and 23F (7.3%, 5.2–9.5%). The serotype coverage of the available pneumococcal conjugate vaccines PCV7, PCV10, and PCV13 was 60.8% (52.5–69.4%), 65.1% (57.7–72.4%), and 90.0% (87.1–92.8%), respectively. The pooled antibiotic resistance rates of Streptococcus pneumoniae revealed a resistance to penicillin prevalence rate of 32.0% (12.1–51.9%). Approximately 94.4% (90.7–98.1%) and 92.3% (87.4–97.3%) of isolates were resistant to erythromycin and clindamycin. eBURST analysis revealed great diversity among isolates, with 102 sequence types (STs) for 365 isolates. The major predominant clonal complexes (CCs) were CC271 (43.6%, 159/365), CC876 (13.4%, 49/365), CC81 (5.2%, 19/365), and CC90 (4.1%, 15/365). Long-term and regional surveillance of S. pneumoniae is necessary. Conclusions Based on our pooled results showing that PCV13 coverage of the reported serotypes was 90% and that most serotypes contributed to the distribution of antibiotic-resistant isolates, implementation of PCV13 into the Chinese Expanded Program on Immunizations (EPI) would achieve health benefits in Chinese children.
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Affiliation(s)
- Jinjian Fu
- Department of Laboratory Medicine, Liuzhou Maternity and Child Health Care Hospital, Liuzhou, 545001, Guangxi, China.,Department of Laboratory Medicine, Affiliated Rong'an of Liuzhou Maternity and Child Health Care Hospital, Liuzhou, 545001, Guangxi, China
| | - Rongsong Yi
- Department of Pediatric, Liuzhou Maternity and Child Health Care Hospital, Liuzhou, 545001, Guangxi, China
| | - Yongjiang Jiang
- Department of Neonatology, Liuzhou Maternity and Child Health Care Hospital, Liuzhou, 545001, Guangxi, China
| | - Shaolin Xu
- Department of Laboratory Medicine, Liuzhou Maternity and Child Health Care Hospital, Liuzhou, 545001, Guangxi, China
| | - Peixu Qin
- Department of Laboratory Medicine, Liuzhou Maternity and Child Health Care Hospital, Liuzhou, 545001, Guangxi, China
| | - Zhuoxin Liang
- Department of Pediatric Intensive Care Unit, Liuzhou Maternity and Child Health Care Hospital, Liuzhou, 545001, Guangxi, China. .,Department of Pediatric, Affiliated Rong'an of Liuzhou Maternity and Child Health Care Hospital, Liuzhou, 545001, Guangxi, China.
| | - Jichang Chen
- Department of Neonatology, Liuzhou Maternity and Child Health Care Hospital, Liuzhou, 545001, Guangxi, China.
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Resurgence of pneumococcal meningitis in Europe and Northern America. Clin Microbiol Infect 2019; 26:199-204. [PMID: 31100424 DOI: 10.1016/j.cmi.2019.04.032] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 04/24/2019] [Accepted: 04/27/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Streptococcus pneumoniae is the most common pathogen causing bacterial meningitis. The routine use of multivalent conjugate pneumococcal vaccines has led to a decline of invasive pneumococcal disease caused by serotypes included in the vaccine serotypes. Recently, several reports have described a concomitant rise in the incidence of non-vaccine serotypes, suggesting serotype replacement. OBJECTIVE We aim to review the effect of pneumococcal vaccination on the incidence of pneumococcal meningitis in Europe and northern America with a particular interest in serotype replacement. SOURCES Articles that include data on invasive pneumococcal disease incidence before and after the introduction of vaccination, or on invasive pneumococcal serotype, are discussed, with a focus on pneumococcal meningitis. CONTENT The introduction of pneumococcal conjugate vaccines has universally resulted in a decline in vaccine-serotype pneumococcal meningitis incidence throughout Europe and northern America. Serotype replacement by non-vaccine serotypes has however been reported following the introduction of the 7-, 10- and 13-valent pneumococcal conjugate vaccines, which in several regions abolished the overall effect of vaccination on pneumococcal meningitis incidence. IMPLICATIONS The promising decline in the incidence of pneumococcal meningitis following the introduction of vaccination seems to have been temporary. Replacement by non-vaccine serotypes illustrates that pneumococcal meningitis continues to pose a major challenge. We need new approaches to prevention, new vaccines and continued efforts to improve treatment for patients with pneumococcal meningitis.
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Abstract
PURPOSE OF REVIEW Pleural infection remains an important pulmonary disease, causing significant morbidity and mortality. There is a resurgence of disease burden despite introduction of antibiotics and pneumococcal vaccines. A revisit of the pathogenesis and update on intervention may improve the care of pleural infection. RECENT FINDINGS Recent studies have uncovered the prognostic implication of the presence of a pleural effusion in patients with pneumonia. Identifying where the bacteria lives may have diagnostic and therapeutic implications. Over-exaggerated pleural inflammation may underlie development of parapneumonic effusion as indirect evidence and a randomized study in children raised a role of corticosteroids in parapneumonic pleural effusions, but data are lacking for adults. Optimization of the delivery regimen of intrapleural fibrinolytic and deoxyribonuclease therapy is ongoing. SUMMARY The review aims to review the current practice and explore new directions of treatment on pleural infection.
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Demczuk WHB, Martin I, Desai S, Griffith A, Caron-Poulin L, Lefebvre B, McGeer A, Tyrrell GJ, Zhanel GG, Gubbay J, Hoang L, Levett PN, Van Caeseele P, Raafat Gad R, Haldane D, Zahariadis G, German G, Daley Bernier J, Strudwick L, Mulvey MR. Serotype distribution of invasive Streptococcus pneumoniae in adults 65 years of age and over after the introduction of childhood 13-valent pneumococcal conjugate vaccination programs in Canada, 2010-2016. Vaccine 2018; 36:4701-4707. [PMID: 29937245 DOI: 10.1016/j.vaccine.2018.06.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/24/2018] [Accepted: 06/06/2018] [Indexed: 01/22/2023]
Abstract
The 13-valent conjugate vaccine (PCV13) was recommended for childhood immunization programs in 2010 in Canada and has decreased the incidence of invasive pneumococcal disease (IPD) in children and changed the epidemiology of IPD in adults. This study investigated the epidemiology of IPD in adults 65 years of age and older in Canada. A total of 7282 invasive S. pneumoniae isolated from adults ≥65 years old were serotyped from 2010 to 2016 and antimicrobial susceptibility was performed on 2527 isolates. Serotyping was performed by Quellung reaction using commercial antisera and antimicrobial susceptibilities were determined by broth microdilution. PCV7 serotypes decreased non-significantly from 2010 to 2016 from 9.1% (n = 96) to 6.7% (n = 72) while the additional six PCV13 serotypes declined significantly from 39.5% (n = 418) to 18.6% (n = 201) (p < 0.05). The 23-valent pneumococcal polysaccharide vaccine (PPV23) and non-vaccine (NVT) serotypes increased from 26.3% (n = 278) to 36.2% (n = 393) (p < 0.05), and from 25.1% (n = 266) to 38.4% (n = 416) (p < 0.05), respectively. There were no significant changes in antimicrobial resistance rates from 2011 to 2016: 24.1% of the IPD from adults ≥65 years were resistant to clarithromycin (n = 609), 10.0% to doxycycline (n = 254), 11.8% to penicillin (n = 299), 5.2% to cefuroxime (n = 131), 6.6% to clindamycin (n = 168), 6.0% to trimethoprim-sulfamethoxazole (n = 152), and 0.5% (n = 12) to ceftriaxone. Although overall incidence of IPD in adults ≥65 years has remained relatively constant from 2010 to 2016, childhood PCV13 vaccination programs have been successful in indirectly reducing IPD caused by PCV13 serotypes in adults through herd immunity effects.
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Affiliation(s)
- Walter H B Demczuk
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Irene Martin
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Shalini Desai
- Vaccine Preventable Diseases Section, Surveillance and Epidemiology Division, Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Averil Griffith
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Laurence Caron-Poulin
- Vaccine Preventable Diseases Section, Surveillance and Epidemiology Division, Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Brigitte Lefebvre
- Laboratoire de santé publique du Québec, Ste-Anne-de-Bellevue, Québec, Canada
| | - Allison McGeer
- Toronto Invasive Bacterial Diseases Network (TIBDN), Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Gregory J Tyrrell
- The Provincial Laboratory for Public Health (Microbiology), Edmonton, Alberta, Canada
| | - George G Zhanel
- Department of Medical Microbiology and Infectious Diseases, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Linda Hoang
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Paul N Levett
- Saskatchewan Disease Control Laboratory, Regina, Saskatchewan, Canada
| | | | - Rita Raafat Gad
- New Brunswick, Office of the Chief Medical Officer of Health, New Brunswick Department of Health, Fredericton, New Brunswick, Canada
| | - David Haldane
- Queen Elizabeth II Health Science Centre, Halifax, Nova Scotia, Canada
| | - George Zahariadis
- Newfoundland Public Health Laboratory, St. John's, Newfoundland and Labrador, Canada
| | - Gregory German
- Queen Elizabeth Hospital, Charlottetown, Prince Edward Island, Canada
| | | | - Lori Strudwick
- Yukon Communicable Disease Control, Government of Yukon, Whitehorse, Yukon, Canada
| | - Michael R Mulvey
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada.
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Long-term impact of 10-valent pneumococcal conjugate vaccination on invasive pneumococcal disease among children in Finland. Vaccine 2018. [DOI: 10.1016/j.vaccine.2018.03.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Diaz A, Antonara S, Barton T. Prevention Strategies to Combat Antimicrobial Resistance in Children in Resource-Limited Settings. CURRENT TROPICAL MEDICINE REPORTS 2018. [DOI: 10.1007/s40475-018-0136-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Olwagen CP, Adrian PV, Nunes MC, Groome MJ, Cotton MF, Violari A, Madhi SA. Use of Multiplex Quantitative PCR To Evaluate the Impact of Pneumococcal Conjugate Vaccine on Nasopharyngeal Pneumococcal Colonization in African Children. mSphere 2017; 2:e00404-17. [PMID: 29134203 PMCID: PMC5677981 DOI: 10.1128/msphere.00404-17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 10/13/2017] [Indexed: 11/20/2022] Open
Abstract
Pneumococcal conjugate vaccine (PCV) immunization of children induces shifts in colonizing pneumococcal serotypes. This study evaluated the effect of infant vaccination with 7-valent PCV (PCV7) on vaccine serotype (VT) colonization and whether the increase in nonvaccine serotype (NVT) was due to either unmasking of previously low-density-colonizing serotypes or increase in acquisition of NVT. A multiplex quantitative PCR (qPCR) was used to evaluate VT and NVT nasopharyngeal colonization in archived swabs of PCV-vaccinated and PCV-unvaccinated African children at 9 and 15 to 16 months of age. Molecular qPCR clearly identified the vaccine effect typified by a decrease in VT colonization and an increase in NVT colonization. Serotype 19A was primarily responsible for the higher NVT carriage among PCV vaccinees at 9 months of age (53.4% difference; P = 0.021) and 16 months of age (70.7% difference; P < 0.001). Furthermore, the density of serotype 19A colonization was higher in PCV-vaccinated groups than in PCV-unvaccinated groups (3.76 versus 2.83 CFU/ml [P = 0.046], respectively, and 4.15 versus 3.04 CFU/ml [P = 0.013], respectively) at 9 and 16 months of age, respectively. Furthermore, serotype 19A was also more commonly reported as a primary isolate (by having the highest density among other cocolonizing serotypes identified in the sample) in PCV7-vaccinated children, while being equally a primary (46.2%) or nonprimary (53.8%) isolate in PCV-unvaccinated children. Molecular qPCR showed both serotype replacement and unmasking to be the cause for the increase in NVT colonization in PCV7-vaccinated children, as some serotypes were associated with an absolute increase in colonization (replacement), while others were associated with an increase in detection (unmasking). IMPORTANCE This study focused on evaluating the effect of infant vaccination with 7-valent pneumococcal conjugate vaccine (PCV7), using a multiplex qPCR method, on the density of serotype-specific nasopharyngeal colonization in order to delineate the relative role of serotype replacement versus unmasking as the cause for the increase in nonvaccine serotype colonization in PCV7-vaccinated children. This is pertinent in the context of the ongoing deployment of PCV immunization in children, with surveillance of colonization considered an early proxy for disease that might arise from nonvaccine serotypes, as well as the success of childhood vaccination on indirect effect in the community through the interruption of pneumococcal transmission from vaccinated young children.
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Affiliation(s)
- Courtney P. Olwagen
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Peter V. Adrian
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Marta C. Nunes
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Michelle J. Groome
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Mark F. Cotton
- Children’s Infectious Diseases Clinical Research Unit, Stellenbosch University, Tygerberg, South Africa
| | - Avy Violari
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Shabir A. Madhi
- Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa
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Gaviria-Agudelo CL, Jordan-Villegas A, Garcia C, McCracken GH. The Effect of 13-Valent Pneumococcal Conjugate Vaccine on the Serotype Distribution and Antibiotic Resistance Profiles in Children With Invasive Pneumococcal Disease. J Pediatric Infect Dis Soc 2017; 6:253-259. [PMID: 26907814 PMCID: PMC7107452 DOI: 10.1093/jpids/piw005] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 01/19/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Invasive pneumococcal disease (IPD) continues to be a significant burden in children despite the implementation of two generations of conjugate vaccines. Serotype replacement by nonvaccine serotypes is reported in multiple areas around the world. This study is a continuation of previous studies and describes the incidence, serotype distribution, and antibiotic resistance pattern of Streptococcus pneumoniae serotypes causing IPD at Children's Medical Center Dallas after introduction of 13-valent pneumococcal conjugate vaccine (PCV13). METHODS Streptococcus pneumoniae isolates from normally sterile sites were collected from January 1, 1999 to June 30, 2014. Demographic and clinical information was extracted for analysis. Incidence of IPD was calculated using inpatient and emergency center admissions to Children's Medical Center of Dallas as the denominator. Isolates were serotyped and penicillin/cefotaxime susceptibilities were determined. Selected nontypeable isolates were further characterized by multilocus sequence typing. A χ2 test and the Cochran-Armitage Trend Test for trend analysis were used to evaluate change in serotype and antibiotic susceptibility patterns over time. RESULTS Comparison of the different study periods showed a significant reduction in the incidence of IPD in PCV13 era compared with prevaccine era and PCV7 era (P < .05). Children younger than 24 months showed the largest reduction of disease incidence. More than 40% of patients with IPD had a documented comorbidity. Cases of pneumonia continued to decrease in the PCV13 era (P < .002). The most common non-PCV13 serotypes after vaccine introduction were as follows: 23B, 6C, 23A, 9N/L, and 12. Penicillin resistance by meningitis breakpoint decreased significantly in the PCV13 era. CONCLUSIONS After introduction of PCV13 in Dallas, incidence of IPD caused by strains contained in the vaccine and penicillin resistance continued to decrease. Serotype replacement phenomena and persistence of PCV7 serotypes were documented. Patients with comorbidities represented a large percentage of patients with IPD. Concerns for geographic variation in serotype replacement phenomena arise from the present study.
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Affiliation(s)
- Claudia L Gaviria-Agudelo
- Department of Pediatric Infectious Diseases, University of Texas Southwestern, Dallas,,Correspondence: C. L. Gaviria-Agudelo, MD, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390–9063 ()
| | | | - Carla Garcia
- General Pediatrics, Questcare Pediatrics, Dallas, Texas
| | - George H McCracken
- Department of Pediatric Infectious Diseases, University of Texas Southwestern, Dallas,
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Abstract
INTRODUCTION The success of the vaccines available on the market has significantly increased interest in vaccine development. Areas covered: The main aim of this paper is to discuss the most important vaccines of pediatric interest that are currently being developed. New pneumococcal vaccines and vaccines against group B Streptococcus, Staphylococcus aureus and respiratory syncytial virus are analyzed in detail. Expert commentary: Advances in understanding human immunology, including human monoclonal antibody identification, sequencing technology, and the ability to solve atomic level structures of vaccine targets have provided tools to guide the rational design of future vaccines. It is likely that some of these vaccines will reach the market in the future and will thus partially contribute to the prevention of very severe diseases that significantly affect the morbidity and mortality of children. However, further studies in animals and several clinical trials in children must be performed before new vaccines become licensed.
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Affiliation(s)
- Susanna Esposito
- a Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation , Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - Nicola Principi
- a Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation , Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
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Baratali L, Lang PO. [Pneumococcal infections: Appraisal and perspectives in terms of adult vaccination]. Presse Med 2015; 44:1155-61. [PMID: 26363530 DOI: 10.1016/j.lpm.2015.04.038] [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] [Received: 03/04/2015] [Revised: 04/02/2015] [Accepted: 04/16/2015] [Indexed: 11/26/2022] Open
Abstract
Pneumococcal diseases are the first cause of bacterial infections in adult and in the aged adult. While its considerable morbi-mortality is potentially preventable through vaccination, the interest of anti-pneumococcal vaccination in these populations is still debated. Effectiveness appraisal of current anti-pneumococcal vaccines and the perspectives in terms of preventive strategies against Streptococcus pneumoniae infections in the adult population are presented.
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Affiliation(s)
- Laila Baratali
- CHUV, service de médecine interne, 46, rue du Bugnon, 1011 Lausanne, Suisse
| | - Pierre Olivier Lang
- CHUV, service de médecine interne, 46, rue du Bugnon, 1011 Lausanne, Suisse; CHUV, service de gériatrie et de réhabilitation gériatrique, Mont Paisible 16 (MP16/04/414), 1011 Lausanne, Suisse; Anglia Ruskin University, Health and wellbeing academy, Cambridge, Royaume-Uni.
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Impacts of the 13-Valent Pneumococcal Conjugate Vaccine in Children. J Immunol Res 2015; 2015:591580. [PMID: 26351648 PMCID: PMC4553318 DOI: 10.1155/2015/591580] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 01/06/2015] [Accepted: 01/10/2015] [Indexed: 11/25/2022] Open
Abstract
Applications of the heptavalent pneumococcal conjugate vaccine (PCV7) in the pediatric immunization schedule have dramatically reduced the incidence of pneumococcal diseases in both vaccinated children and unvaccinated individuals of all ages. However, increased infections caused by non-PCV7 serotypes have been reported by several groups. To overcome this problem, new vaccines covering more serotypes including the emerging serotypes have been developed. The 13-valent pneumococcal conjugate vaccine (PCV13) currently covers the 7 PCV7 serotypes (4, 6B, 9V, 14, 18C, 19F, and 23F) and 6 additional serotypes 1, 3, 5, 6A, 7F, and 19A. After the first year of PCV13 applications in the immunization schedule in young children, global evaluation studies demonstrated that PCV13 provided a wider coverage and more effective prevention than PCV7 against invasive pneumococcal diseases (IPDs), mucosal pneumococcal diseases, and pneumococcal carriage. We reviewed the effects of PCV13 in the control of pneumococcal diseases in children based on previous studies.
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Abstract
The age-associated increased susceptibility to infectious disease would suggest that vaccination should be a route to promote healthy aging and keep our seniors autonomous and independent. While vaccination represents a cost-effective and efficient strategy at community level, the ability of the immune system to mount a protective immune response is still unpredictable at the level of the individual. Thus, at a similar age, some individuals, including the elderly, might still be 'good' responders while some other, even younger, would definitely fail to mount a protective response. In this review, the current burden of vaccine-preventable diseases in the aging and aged population will be detailed with the aim to identify the ideal vaccine candidates over the age of 50 years. This article will conclude with potential strategies to reduce, as best as possible, this burden and the imperative need to overcome barriers in extending current vaccine coverage towards to a lifelong vaccine schedule.
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Affiliation(s)
- Pierre-Olivier Lang
- Translational Medicine Research group, Cranfield Health, Cranfield University, Cranfield, England,
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Fletcher MA, Schmitt HJ, Syrochkina M, Sylvester G. Pneumococcal empyema and complicated pneumonias: global trends in incidence, prevalence, and serotype epidemiology. Eur J Clin Microbiol Infect Dis 2014; 33:879-910. [PMID: 24563274 PMCID: PMC4110404 DOI: 10.1007/s10096-014-2062-6] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 01/15/2014] [Indexed: 12/23/2022]
Abstract
This review evaluates the serotype epidemiology of complicated pneumococcal pneumonia (CPP) during the period 1990–2012. PubMed and EMBASE were searched using the terms “empyema”, “complicated pneumonia”, “pleural infection”, “necrotizing pneumonia”, “pleural effusion”, “parapneumonic effusion”, “pneumatocele”, or “lung abscess”; “pneumococcal” or “Streptococcus pneumoniae”; and “serotype” for studies on the epidemiology of complicated pneumonias published from January 1, 1990 to October 1, 2013. Studies with data on incidence and serotypes were included; reviews, case reports, and conference abstracts were excluded. Of 152 papers, 84 fitted the inclusion criteria. A few pneumococcal serotypes were predominant causes of CPP, particularly serotypes 1, 19A, 3, 14, and 7F. CPP was a more common manifestation of pneumococcal disease among older (>2 years old) than younger children. The data support increases in both reported incidence rates and proportions of CPP in children and adults during the period 1990–2012; specific increases varied by geographic region. The proportions of serotype 3 and, particularly in Asia, serotype 19A CPP have increased, whereas most studies show declines in serotype 14. Serotype 1 has been a predominant cause of CPP since 1990, while antibiotic resistance was infrequent among serotype 1 isolates. The reported incidence and proportions of CPP among pneumonia cases steadily increased from 1990 to 2012. Several factors might account for these increases, including enhanced disease detection due to a higher index of suspicion, more sophisticated diagnostic assays, and changes in the prevalence of serotypes with capacity to invade the pleural space that were not targeted by the 7-valent pneumococcal conjugate vaccine (PCV7).
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Affiliation(s)
- M A Fletcher
- Pfizer, Inc., 23-25, avenue du Dr Lannelongue, 75668, Paris Cedex 14, France,
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18
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[Pleuropneumonia and septic shock due to multiresistant Streptococcus pneumoniae serotype 19A treated with linezolid]. An Pediatr (Barc) 2014; 81:e22-3. [PMID: 24534007 DOI: 10.1016/j.anpedi.2013.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 12/18/2013] [Accepted: 12/26/2013] [Indexed: 11/20/2022] Open
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Tan TQ. Serious and invasive pediatric pneumococcal disease: epidemiology and vaccine impact in the USA. Expert Rev Anti Infect Ther 2014; 8:117-25. [DOI: 10.1586/eri.09.132] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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20
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Fritzell B, Fletcher MA. Pneumococcal polysaccharide–protein (CRM197) conjugate vaccines, 7- or 9-valent, in the 2 + 1 schedule. Expert Rev Vaccines 2014; 10:263-90. [DOI: 10.1586/erv.11.11] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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21
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Zhao C, Zhang F, Chu Y, Liu Y, Cao B, Chen M, Yu Y, Liao K, Zhang L, Sun Z, Hu B, Lei J, Hu Z, Zhang X, Wang H. Phenotypic and genotypic characteristic of invasive pneumococcal isolates from both children and adult patients from a multicenter surveillance in China 2005-2011. PLoS One 2013; 8:e82361. [PMID: 24349263 PMCID: PMC3859574 DOI: 10.1371/journal.pone.0082361] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 10/23/2013] [Indexed: 11/21/2022] Open
Abstract
Streptococcus pneumoniae is an important pathogen in both children and the elderly, but previous studies in China have provided limited information about invasive pneumococcal disease (IPD). A total of 240 IPD S. pneumoniae strains (from 105 children and 135 adults) were collected from 12 cities in China in 2005–2011. Their phenotypes and genetic characteristics were analyzed. Streptococcus pneumoniae remained highly resistant to macrolides, tetracycline, and cotrimoxazole each year. Serotypes were assigned to the 240 isolates, and 19A (22.1%), 19F (21.7%), 14 (7.5%), 3 (7.1%), and 23F (5.4%) were the most prevalent, accounting for 63.8% of all strains. Serogroup 19 strains were significantly more common among children than among adults (58.7% vs 32.4%, respectively; P < 0.001). Serotypes 19F and 19A demonstrated higher resistance to β-lactams and cephalosporins than the other serotypes. The coverage of PCV13 was superior to that calculated for PCV7 and PCV10 (77.9% vs 40.8% and 47.1%, respectively), and coverage was higher in children than in adults (85.6% vs 72.1%, respectively; P = 0.012). A multilocus sequence typing analysis revealed great diversity, with nine clonal complexes and 83 singletons among all the strains. Specifically, CC271 was more common in children, whereas singletons were more prevalent in adults. Among the serogroup 19 strains, 84.7% were ST271, ST320, or ST236, belonging to CC271. The homogeneous genetic background of 19F and 19A, together with the high resistance of these strains, suggests that clonal spread is responsible for the high prevalence of serogroup 19 in IPD. This is the first large study to investigate IPD strains in both children and adults in China.
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Affiliation(s)
- Chunjiang Zhao
- Department of Clinical Laboratory, Peking University People’s Hospital, Beijing, China
| | - Feifei Zhang
- Department of Clinical Laboratory, Peking University People’s Hospital, Beijing, China
| | - Yunzhuo Chu
- Department of Clinical Laboratory, the First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yong Liu
- Department of Clinical Laboratory, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Bin Cao
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital of Capital Medical University, Beijing, China
| | - Minjun Chen
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Beijing, China
| | - Yunsong Yu
- The First Affiliated Hospital of Medical School of Hangzhou University, Hangzhou, Zhejiang, China
| | - Kang Liao
- Department of Clinical Laboratory, The First Affiliated Hospital of Sun Yatsen University, Guangzhou, Guangdong, China
| | - Liyan Zhang
- Department of Clinical Laboratory, Guangdong General Hospital, Guangzhou, Guangdong, China
| | - Ziyong Sun
- Tongji Hospital, Tongji Medical College Huazhong University of Science & Technology, Wuhan, Hubei, China
| | - Bijie Hu
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jin’e Lei
- Department of Clinical Laboratory, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Zhidong Hu
- Department of Clinical Laboratory, General Hospital, Tianjin Medical University, Tianjin, China
| | - Xiaobing Zhang
- Department of Clinical Laboratory, Southwest Hospital, Chongqing, China
| | - Hui Wang
- Department of Clinical Laboratory, Peking University People’s Hospital, Beijing, China
- * E-mail:
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Demczuk WH, Martin I, Griffith A, Lefebvre B, McGeer A, Lovgren M, Tyrrell GJ, Desai S, Sherrard L, Adam H, Gilmour M, Zhanel GG. Serotype distribution of invasive Streptococcus pneumoniae in Canada after the introduction of the 13-valent pneumococcal conjugate vaccine, 2010–2012. Can J Microbiol 2013; 59:778-88. [DOI: 10.1139/cjm-2013-0614] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The introduction of the 7-valent pneumococcal vaccine (PCV7) in Canada was very effective in reducing invasive pneumococcal disease (IPD) in children; however, increases of non-PCV7 serotypes have subsequently offset some of these reductions. A 13-valent pneumococcal vaccine (PCV13) targeting additional serotypes was implemented between 2010 and 2011, and in 2012 changes in the incidence of disease and the distribution of IPD serotypes began to emerge. The incidence of IPD in children <5 years of age declined from 18.0 to 14.2 cases per 100 000 population between 2010 and 2012; however, the incidence in ages ≥5 years remained relatively unchanged over the 3-year period, at about 9.7 cases per 100 000 population. From 2010 to 2012, PCV13 serotypes declined significantly from 66% (224/339) to 41% (101/244, p < 0.001) in children <5 years of age, and from 54% (1262/2360) to 43% (1006/2353, p < 0.001) in children ≥5 years of age. Serotypes 19A, 7F, 3, and 22F were the most common serotypes in 2012, with 19A decreasing from 19% (521/2727) to 14% (364/2620, p < 0.001), 7F decreasing from 14% (389/2727) to 12% (323/2620, p = 0.04), and 22F increasing from 7% (185/2727) to 11% (279/2620, p < 0.001) since 2010. Serotype 3 increased from 7% (23/339) to 10% (24/244) in <5-year-olds (p = 0.22) over the 3-year period. The highest rates of antimicrobial resistance were observed with clarithromycin (23%), penicillin using meningitis breakpoints (12%), clindamycin (8%), and trimethoprim–sulfamethoxazole (6%). Shifts in the distribution of IPD serotypes and reductions in the incidence of disease suggest that current immunization programs in Canada are effective in reducing the burden of IPD in children. While we acknowledge the limited data on the effectiveness of the PCV13 vaccine, to our knowledge, this study represents one of the first descriptions of the potential impact of the PCV13 vaccine in the Canadian population. Continued surveillance will be important to recognize replacement serotypes, to determine the extent of herd immunity effects in nonpaediatric populations, and to assess the overall effectiveness of PCV13 in reducing IPD in Canada.
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Affiliation(s)
- Walter H.B. Demczuk
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 Arlington Street, Winnipeg, MB R3E 3R2, Canada
| | - Irene Martin
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 Arlington Street, Winnipeg, MB R3E 3R2, Canada
| | - Averil Griffith
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 Arlington Street, Winnipeg, MB R3E 3R2, Canada
| | - Brigitte Lefebvre
- Laboratoire de santé publique du Québec, 20045 chemin Sainte-Marie, Ste-Anne-de-Bellevue, QC H9X 3R5, Canada
| | - Allison McGeer
- Department of Microbiology, Mount Sinai Hospital, 600 University Avenue, Room 210, Toronto, ON M5G 1X5, Canada
| | - Marguerite Lovgren
- The Provincial Laboratory for Public Health (Microbiology), Walter Mackenzie Health Sciences Centre, 8440 – 112 Street, Edmonton, AB T6G 2J2, Canada
| | - Gregory J. Tyrrell
- The Provincial Laboratory for Public Health (Microbiology), Walter Mackenzie Health Sciences Centre, 8440 – 112 Street, Edmonton, AB T6G 2J2, Canada
| | - Shalini Desai
- Vaccine Preventable Diseases Section, Surveillance and Outbreak Response Division, Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Room 273A, 2nd Floor, 130 Colonnade Road, AL 6502A, Ottawa, ON K1A 0K9, Canada
| | - Lindsey Sherrard
- Vaccine Preventable Diseases Section, Surveillance and Outbreak Response Division, Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Room 273A, 2nd Floor, 130 Colonnade Road, AL 6502A, Ottawa, ON K1A 0K9, Canada
| | - Heather Adam
- Department of Medical Microbiology and Infectious Diseases, Faculty of Medicine, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
- Diagnostic Services Manitoba, Health Sciences Centre, 820 Sherbrook Street, Winnipeg, MB R3A 1R9, Canada
| | - Matthew Gilmour
- Department of Medical Microbiology and Infectious Diseases, Faculty of Medicine, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
- Diagnostic Services Manitoba, Health Sciences Centre, 820 Sherbrook Street, Winnipeg, MB R3A 1R9, Canada
| | - George G. Zhanel
- Department of Medical Microbiology and Infectious Diseases, Faculty of Medicine, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
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Rudolph K, Bruce MG, Bulkow L, Zulz T, Reasonover A, Harker-Jones M, Hurlburt D, Hennessy TW. Molecular epidemiology of serotype 19A Streptococcus pneumoniae among invasive isolates from Alaska, 1986-2010. Int J Circumpolar Health 2013; 72:20854. [PMID: 23984273 PMCID: PMC3753058 DOI: 10.3402/ijch.v72i0.20854] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background After the introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) in Alaska, the incidence of invasive pneumococcal disease (IPD) due to non-vaccine serotypes, particularly serotype 19A, increased. The aim of this study was to describe the molecular epidemiology of IPD due to serotype 19A in Alaska. Methods IPD data were collected from 1986 to 2010 through population-based laboratory surveillance. Isolates were serotyped by the Quellung reaction and MICs determined by broth microdilution. Genotypes were assessed by multilocus sequence typing. Results Among 3,294 cases of laboratory-confirmed IPD, 2,926 (89%) isolates were available for serotyping, of which 233 (8%) were serotype 19A. Across all ages, the proportion of IPD caused by serotype 19A increased from 3.5% (63/1823) pre-PCV7 (1986–2000) to 15.4% (170/1103) post-PCV7 (2001–2010) (p<0.001); among children <5 years of age, the proportion increased from 5.0% (39/776) to 33.0% (76/230) (p<0.001). The annual incidence rate of IPD due to serotype 19A (all ages) increased from 0.73 cases pre-PCV7 to 2.56 cases/100,000 persons post-PCV7 (p<0.001); rates among children <5 years of age increased from 4.84 cases to 14.1 cases/100,000 persons (p<0.001). Among all IPD isolates with reduced susceptibility to penicillin, 17.8% (32/180) were serotype 19A pre-PCV7 and 64% (121/189) were serotype 19A post-PCV7 (p<0.001). Eighteen different sequence types (STs) were identified; ST199 or single locus variants of ST199 (n=150) and ST172 (n=59) accounted for the majority of isolates. Multidrug-resistant isolates were clustered in ST199 and ST320. Conclusion While PCV13 should significantly reduce the burden of disease due to 19A, these data highlight the need to continue surveillance for IPD to monitor the effects of vaccination on the expansion and emergence of non-PCV strains.
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Affiliation(s)
- Karen Rudolph
- Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Anchorage, Alaska 99508, USA.
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Ishimine P. Risk Stratification and Management of the Febrile Young Child. Emerg Med Clin North Am 2013; 31:601-26. [DOI: 10.1016/j.emc.2013.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Chappuy H, Keitel K, Gehri M, Tabin R, Robitaille L, Raymond F, Corbeil J, Maspoli V, Bouazza N, Alcoba G, Lacroix L, Manzano S, Galetto-Lacour A, Gervaix A. Nasopharyngeal carriage of individual Streptococcus pneumoniae serotypes during pediatric radiologically confirmed community acquired pneumonia following PCV7 introduction in Switzerland. BMC Infect Dis 2013; 13:357. [PMID: 23899390 PMCID: PMC3750295 DOI: 10.1186/1471-2334-13-357] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 07/19/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Community-acquired pneumonia (CAP) is a serious cause of morbidity among children in developed countries. The real impact of 7-valent pneumococcal conjugate vaccine (PCV7) on pneumococcal pneumonia is difficult to assess accurately. METHODS Children aged ≤16 years with clinical and radiological pneumonia were enrolled in a multicenter prospective study. Children aged ≤16 years admitted for a minor elective surgery was recruited as controls. Nasopharyngeal samples for PCR serotyping of S. pneumoniae were obtained in both groups. Informations on age, gender, PCV7 vaccination status, day care/school attendance, siblings, tobacco exposure were collected. RESULTS In children with CAP (n=236), 54% of the nasopharyngeal swabs were PCR-positive for S. pneumoniae compared to 32% in controls (n=105) (p=0.003). Serotype 19A was the most common pneumococcal serotype carried in children with CAP (13%) and in controls (15%). Most common serotypes were non-vaccine types (39.4% for CAP and 47.1% for controls) and serotypes included only in PCV13 (32.3% for CAP and 23.5% for controls). There was no significant difference in vaccine serotype distribution between the two groups. In fully vaccinated children with CAP, the proportion of serotypes carried only in PCV13 was higher (51.4%) than in partially vaccinated or non vaccinated children (27.6% and 28.6% respectively, p=0.037). CONCLUSIONS Two to 4 years following introduction of PCV7, predominant S. pneumoniae serotypes carried in children with CAP were non PCV7 serotypes, and the 6 new serotypes included in PCV13 accounted for 51.4% of carried serotypes in fully vaccinated children.
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Affiliation(s)
- Hélène Chappuy
- Child and Adolescent Department, University Hospital of Geneva, Geneva, Switzerland
- Hôpital Necker Enfants Malades, 149 rue de Sèvres 75743, Paris, Cedex 15, France
| | - Kristina Keitel
- Child and Adolescent Department, University Hospital of Geneva, Geneva, Switzerland
| | - Mario Gehri
- Hôpital de l’Enfance, CHUV, Lausanne, Switzerland
| | - René Tabin
- Hôpital du Valais, Centre Hospitalier du Centre Valais, Sion, Switzerland
| | - Lynda Robitaille
- Department of Molecular Medicine, Infectious Disease Research Center, CHUL Research Center and Laval University, Québec, Canada
| | - Frederic Raymond
- Department of Molecular Medicine, Infectious Disease Research Center, CHUL Research Center and Laval University, Québec, Canada
| | - Jacques Corbeil
- Department of Molecular Medicine, Infectious Disease Research Center, CHUL Research Center and Laval University, Québec, Canada
| | - Veronica Maspoli
- Child and Adolescent Department, University Hospital of Geneva, Geneva, Switzerland
| | - Naim Bouazza
- Unité de recherche clinique Necker Cochin, APHP, Paris, France
| | - Gabriel Alcoba
- Child and Adolescent Department, University Hospital of Geneva, Geneva, Switzerland
| | - Laurence Lacroix
- Child and Adolescent Department, University Hospital of Geneva, Geneva, Switzerland
| | - Sergio Manzano
- Child and Adolescent Department, University Hospital of Geneva, Geneva, Switzerland
| | | | - Alain Gervaix
- Child and Adolescent Department, University Hospital of Geneva, Geneva, Switzerland
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Abstract
BACKGROUND Hemolytic uremic syndrome (HUS) is usually associated with diarrheal illness but can also occur in children with Streptococcus pneumoniae infection (SpHUS), particularly those with complicated pneumonia. Based on recent reports that hospital discharges for complicated pneumococcal pneumonia are increasing in US children, we studied whether discharges for SpHUS might also be increasing. METHODS We used the Kids' Inpatient Database samples from 1997, 2000, 2003, 2006 and 2009 to estimate trends in US hospital discharges of children (0-18 years) for whom diagnosis codes indicated invasive pneumococcal disease, HUS, or both (SpHUS). Univariate and multivariate analyses were based on 2009 discharges. RESULTS During the 5 study years, annual numbers of US hospital discharges for SpHUS approximately doubled (P = 0.025 for linear trend) and cumulatively totaled an estimated 211 discharges. In 2009, SpHUS accounted for 4.6% (95% confidence interval [CI]: 3.0%-6.7%) of HUS discharges, 0.7% (95% CI: 0.5%-1.0%) of invasive pneumococcal disease discharges and 3.0% (95% CI: 2.0%-3.9%) of discharges for complicated pneumococcal pneumonia. Discharges for SpHUS were more likely than those for other invasive pneumococcal disease to occur in children <3 years of age and to incur longer length of stay and greater hospital charges. SpHUS was independently associated with pneumococcal sepsis/bacteremia (age-adjusted odds ratio 3.8; 95% CI: 1.9-7.8) and complicated pneumonia (odds ratio 9.2; 95% CI: 4.1-20.7). CONCLUSIONS SpHUS is an uncommon but severe illness that primarily affects young children and is strongly associated with complicated pneumococcal pneumonia. US hospital stays for SpHUS appear to be increasing along with those for complicated pneumococcal pneumonia.
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[Increase in the incidence of invasive pneumococcal disease caused by serotype 19A prior to the implementation of the expanded pneumococcal vaccines]. An Pediatr (Barc) 2013; 79:288-92. [PMID: 23587534 DOI: 10.1016/j.anpedi.2013.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Revised: 02/07/2013] [Accepted: 02/08/2013] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To describe the epidemiology, clinical syndromes and microbiological characteristics of serotype 19A as the main cause of invasive pneumococcal disease (IPD) in children admitted to a tertiary hospital in Spain. METHODS A retrospective (1998-2004) and prospective (2005-2009) study was conducted on children with IPD produced by serotype 19A. The study was divided into three periods (P): P1 (1998-2001) when PCV7 had not been commercialized; P2 (2002-2005) with 40% vaccine coverage among children; and P3 (2006-2009) when the vaccine was added to the Childhood Immunization Schedule in Madrid. RESULTS A total of 155 isolates of Streptococcus pneumoniae (SP) producing IPD were analysed, with 21 of them being serotype 19A (14%). An increased prevalence of serotype 19A was found: 2/45 cases (4.4%) in P1, 3/41 cases (7.3%) in P2 and 16/69 cases (23.2%) in P3. It occurred mostly in children younger than 2 years (16/21; 76%). This serotype was the main cause of meningitis (5/20; 25%), pleural empyema (3/22; 14%) and bacteraemic mastoiditis (2/4; 50%). Thirteen isolates (61.5%) had an MIC ≥ 0.12μ/ml for penicillin in extra-meningeal infections, and 3 of the 5 isolates causing meningitis (60%) had an MIC ≥ 1μ/ml for cefotaxime. CONCLUSIONS Serotype 19A was the main causal agent of IPD in the PCV7 era (P3), with high antibiotic resistance rates. This serotype was responsible for all types of IPD, being the main cause of meningitis.
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Pneumococcal serotypes causing acute otitis media among children in Barcelona (1992-2011): emergence of the multiresistant clone ST320 of serotype 19A. Pediatr Infect Dis J 2013. [PMID: 23190779 DOI: 10.1097/inf.0b013e31827c54dc] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is scarce information about changes in serotypes and clonal types of Streptococcus pneumoniae causing acute otitis media (AOM) in recent years, particularly in European countries. METHODS Pneumococcal serotypes and clones from S. pneumoniae strains isolated from children with AOM who were attended at Hospital Sant Joan de Déu, Barcelona (1992 to 2011), were studied. Heptavalent pneumococcal conjugate vaccine (PCV7) was introduced in June 2001. We defined 3 periods: prevaccine period 1992 to 2001, early vaccine period 2002 to 2006 and late vaccine period 2007 to 2011. RESULTS There were 376 pneumococcal strains causing AOM, and 373 (99.2%) of them were serotyped. AOM caused by PCV7 serotypes declined significantly: 161 of 245 (65.7%) episodes in 1992 to 2001 versus 22 of 67 (32.8%) in 2002 to 2006 versus 8 of 61 (13.1%) in 2007 to 2011 P < 0.001. In the last period (2007 to 2011), the potential serotype coverage for the PCV10 was 16.4% and for the PCV13 was 68.9% (P < 0.001). Serotype 19A increased from 5.7% in 1992 to 2001 to 42.6% in 2007 to 2011 (P < 0.001). Among strains with penicillin minimal inhibitory concentration ≥0.12 μg/mL (n = 241), serotype 19A rose from 2.3% in the first period to 57.9 % in the last period (P < 0.001). The clonal-type ST320 was initially detected in 2005, and in the period 2007 to 2011, the ST320 was found in 72.7% of nonsusceptible serotype 19A isolates. CONCLUSIONS Among children with AOM, a rapid expansion of the multiresistant clone ST320 expressing serotype 19A has been observed in Barcelona. The implementation of PCV13, which includes this serotype, may decrease the prevalence of AOM and reduce antimicrobial resistance.
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Early trends for invasive pneumococcal infections in children after the introduction of the 13-valent pneumococcal conjugate vaccine. Pediatr Infect Dis J 2013; 32:203-7. [PMID: 23558320 DOI: 10.1097/inf.0b013e318275614b] [Citation(s) in RCA: 234] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The 13-valent pneumococcal conjugate vaccine (PCV13) was introduced for routine administration to infants and children in 2010 in the United States. We have monitored clinical and microbiologic features of invasive pneumococcal infections among children before and after PCV13 use. METHODS Infants and children cared for at 8 children hospitals in the United States with culture-proven invasive infections caused by S. pneumoniae were identified in an ongoing prospective surveillance study. Demographic and clinical data were recorded on a standard case report form. Serotype and antimicrobial susceptibilities of isolates were determined. RESULTS Since routine PCV13 immunization in 2010, invasive pneumococcal infections decreased 42% overall and 53% for children <24 months of age in 2011 compared with the average number of cases for 2007 to 2009. PCV13 serotype isolates decreased 57% during these same time periods; 19A, 7F and 3 decreased by 58%, 54% and 68%, respectively. The number of infections caused by serotypes 1 and 6C also decreased in 2011. The most common non-PCV13 serotypes encountered in 2010 and 2011 combined were 33F, 22F, 12, 15B, 15C, 23A and 11. Bacteremia, pneumonia and mastoiditis cases decreased more than meningitis cases. CONCLUSIONS After the introduction of PCV13, invasive pneumococcal infections decreased among 8 children hospitals compared with the 3 years before PCV13 use. Slight increases in some non-PCV13 serotype isolates were noted in 2011. Continued surveillance is necessary to determine the effectiveness of PCV13 including herd protection as well as any emerging invasive serotypes.
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Moran GJ, Rothman RE, Volturo GA. Emergency management of community-acquired bacterial pneumonia: what is new since the 2007 Infectious Diseases Society of America/American Thoracic Society guidelines. Am J Emerg Med 2013; 31:602-12. [PMID: 23380120 DOI: 10.1016/j.ajem.2012.12.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 11/30/2012] [Accepted: 12/02/2012] [Indexed: 01/02/2023] Open
Abstract
Community-acquired pneumonia (CAP) is a major health problem in the United States and is associated with substantial morbidity, mortality, and health care costs. Patients with CAP commonly present to emergency departments where physicians must make critical decisions regarding diagnosis and management of pneumonia in a timely fashion, with emphasis on efficient and cost-effective diagnostic choices, consideration of emerging antimicrobial resistance, timely initiation of antibiotics, and appropriate site-of-care decisions. In light of the burden that pneumonia places on health care systems and the emergency department in particular, this article reviews significant developments in the management of CAP in the United States 5 years since the publication of the 2007 Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of CAP in adults, focusing on recent studies and recommendations for managing CAP, the primary bacterial pathogens responsible for CAP, and trends in resistance, new diagnostic technologies, and newer antimicrobials approved for the treatment of CAP. These new data and additional guidelines pertaining to the treatment of CAP further our knowledge and understanding of this challenging infection. Furthermore, appreciation of the availability of new diagnostic testing and therapeutic options will help meet the demand for improved management of CAP.
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Affiliation(s)
- Gregory J Moran
- Olive View-UCLA Medical Center, North Annex, Sylmar, CA 91342, USA.
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Sharma D, Baughman W, Holst A, Thomas S, Jackson D, da Gloria Carvalho M, Beall B, Satola S, Jerris R, Jain S, Farley MM, Nuorti JP. Pneumococcal carriage and invasive disease in children before introduction of the 13-valent conjugate vaccine: comparison with the era before 7-valent conjugate vaccine. Pediatr Infect Dis J 2013; 32:e45-53. [PMID: 23080290 DOI: 10.1097/inf.0b013e3182788fdd] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Nasopharyngeal (NP) carriage and invasive pneumococcal disease (IPD) attributable to serotypes in the 7-valent pneumococcal conjugate vaccine (PCV7) declined dramatically after vaccine introduction, whereas non-PCV7 serotypes increased modestly. Characteristics of pneumococcal carriage and IPD among children in Atlanta, GA, were compared during 2 time periods: before PCV7 introduction and before 13-valent PCV (PCV13) introduction. METHODS NP swabs from 231 and 451 children 6-59 months old receiving outpatient medical care were obtained in 1995 and 2009, respectively. A total of 202 and 47 IPD cases were identified in children younger than 5 years of age in 1995 and in 2008 to 2009, respectively, through active, population-based surveillance in Atlanta. Isolates were serotyped, sequence-typed (ST) and tested for antimicrobial susceptibility. RESULTS Forty percent (93/231) of children in 1995 and 31% (139/451) in 2009 were colonized with Streptococcus pneumoniae; 60% and 0.7% were PCV7 serotypes, respectively. In 1995, PCV7 serotypes accounted for 83% and 19A accounted for 5% of IPD compared with no PCV7 serotypes and 19A accounting for 49% of IPD in 2009 (P < 0.001). In 2009, PCV13 serotypes accounted for 22% of carriage (mostly 19A) and 60% of invasive isolates (P < 0.001). ST320 accounted for 66% and 52% of 19A carriage and IPD isolates in 2009, respectively; all ST320 isolates were multidrug-resistant. No ST320 NP or IPD isolates were identified before PCV7. CONCLUSIONS Serotype distribution among NP and IPD isolates in Atlanta has shifted to non-PCV7 serotypes; 19A was the leading serotype for both. The multidrug-resistant ST320 strain was responsible for two-thirds of 19A carriage isolates and half of IPD isolates. The predominance of serotype 19A in carriage and IPD among children in Atlanta highlights the potential direct and indirect benefits anticipated by implementation of PCV13 in the community.
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Affiliation(s)
- Dolly Sharma
- Emory University School of Medicine, Atlanta, GA, USA
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Williams DJ, Shah SS. Community-Acquired Pneumonia in the Conjugate Vaccine Era. J Pediatric Infect Dis Soc 2012; 1:314-28. [PMID: 26619424 PMCID: PMC7107441 DOI: 10.1093/jpids/pis101] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 10/05/2012] [Indexed: 12/27/2022]
Abstract
Community-acquired pneumonia (CAP) remains one of the most common serious infections encountered among children worldwide. In this review, we highlight important literature and recent scientific discoveries that have contributed to our current understanding of pediatric CAP. We review the current epidemiology of childhood CAP in the developed world, appraise the state of diagnostic testing for etiology and prognosis, and discuss disease management and areas for future research in the context of recent national guidelines.
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Affiliation(s)
- Derek J. Williams
- Division of Hospital Medicine, The Monroe Carell Jr Children's Hospital at Vanderbilt, and,Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee; Divisions of,Corresponding Author: Derek J. Williams, MD, MPH, 1161 21st Ave. South, CCC 5311 Medical Center North, Nashville, TN 37232. E-mail: derek.
| | - Samir S. Shah
- Infectious Diseases and,Hospital Medicine, Cincinnati Children's Hospital Medical Center,Department of Pediatrics, University of Cincinnati College of Medicine, Ohio
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Pediatric invasive pneumococcal disease in the United States in the era of pneumococcal conjugate vaccines. Clin Microbiol Rev 2012; 25:409-19. [PMID: 22763632 DOI: 10.1128/cmr.00018-12] [Citation(s) in RCA: 136] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Invasive infections caused by Streptococcus pneumoniae continue to be a major cause of morbidity and mortality worldwide, especially in children under 5 years of age. In the United States, 90% of invasive pneumococcal infections in children are caused by 13 serotypes of S. pneumoniae. The licensure (in 2000) and subsequent widespread use of a heptavalent pneumococcal conjugate vaccine (PCV7) have had a significant impact on decreasing the incidence of serious invasive pneumococcal disease (IPD) in all age groups, especially in children under 2 years of age. However, the emergence of replacement non-PCV7 serotypes, especially serotype 19A, has resulted in an increase in the incidence of serious and invasive infections. In 2010, a 13-valent PCV was licensed in the United States. However, the impact that this vaccine will have on IPD remains to be seen. The objectives of this review are to discuss the epidemiology of serious and invasive pneumococcal infections in the United States in the PCV era and to review some of the pneumococcal vaccines that are in development.
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Genotype replacement within serotype 23FStreptococcus pneumoniaein Beijing, China: characterization of serotype 23F. Epidemiol Infect 2012; 141:1690-6. [DOI: 10.1017/s0950268812002269] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
SUMMARYWe investigated the genetic structure of 99 isolates of serotype 23FStreptococcus pneumoniaefrom children with acute respiratory infections collected over two periods from 1997 to 2006, and 2010. All isolates were susceptible to vancomycin and amoxicillin–clavulanic acid; 97 were resistant to erythromycin, 95 of which carried theermBgene and two carried bothmefA/EandermBgenes. Multidrug resistance to three or more classes of antibiotics was exhibited by 90 isolates. Sequence types ST342 and ST81 were the most frequent in 1997–2006 and 2010, respectively. All CC81 isolates were non-susceptible to β-lactam antibiotics and had higher minimum inhibitory concentration values for penicillin than other clone complexes and sequence types. The increased β-lactam antibiotic resistance may have resulted from the replacement of multidrug-resistant clones related to ST81. Long-term studies onS. pneumoniaeserotype 23F, especially the ST81 clone, should be conducted to better understand the epidemiological picture of this pathogen in China.
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Crowther-Gibson P, Cohen C, Klugman KP, de Gouveia L, von Gottberg A. Risk factors for multidrug-resistant invasive pneumococcal disease in South Africa, a setting with high HIV prevalence, in the prevaccine era from 2003 to 2008. Antimicrob Agents Chemother 2012; 56:5088-95. [PMID: 22802256 PMCID: PMC3457358 DOI: 10.1128/aac.06463-11] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 07/08/2012] [Indexed: 11/20/2022] Open
Abstract
The emergence of multidrug-resistant (MDR) Streptococcus pneumoniae complicates disease management. We aimed to determine risk factors associated with MDR invasive pneumococcal disease (IPD) in South Africa and evaluate the potential for vaccination to reduce disease burden. IPD data collected by laboratory-based surveillance from 2003 through 2008 were analyzed. Multidrug resistance was defined as nonsusceptibility to any three or more different antibiotic classes. Risk factors for multidrug resistance were evaluated using multivariable logistic regression. Of 20,100 cases of IPD identified, 3,708 (18%) had MDR isolates, with the proportion increasing from 16% (461/2,891) to 20% (648/3,326) (P < 0.001) over the study period. Serotypes included in the 13-valent pneumococcal conjugate vaccine (PCV13) accounted for 94% of MDR strains. Significant risk factors for MDR IPD included PCV13 (1,486/6,407; odds ratio [OR] of 6.3; 95% confidence interval [CI] of 5.0 to 7.9) and pediatric (3,382/9,980; OR of 12.8; 95% CI of 10.6 to 15.4) serotypes, age of <5 (802/3,110; OR of 2.0; 95% CI of 1.8 to 2.3) or ≥65 (39/239; OR of 1.5; 95% CI of 1.0 to 2.2) years versus age of 15 to 64 years, HIV infection (975/4,636; OR of 1.5; 95% CI of 1.2 to 1.8), previous antibiotic use (242/803; OR of 1.7; 95% CI of 1.4 to 2.1), previous hospital admissions (579/2,450; OR of 1.2; 95% CI of 1.03 to 1.4), urban location (883/4,375; OR of 2.0; 95% CI of 1.1 to 3.5), and tuberculosis treatment (246/1,021; OR of 1.2; 95% CI of 1.03 to 1.5). MDR IPD prevalence increased over the study period. The effect of many of the MDR risk factors could be reduced by more judicious use of antibiotics. Because PCV13 serotypes account for most MDR infections, pneumococcal vaccination may reduce the prevalence of multidrug resistance.
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Affiliation(s)
- Penny Crowther-Gibson
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa.
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Presentation and management of pediatric orbital cellulitis. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2012; 22:97-100. [PMID: 22942886 DOI: 10.1155/2011/626809] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Orbital cellulitis is a serious, vision-threatening infection. OBJECTIVE To review the epidemiology and clinical data of pediatric orbital cellulitis in Manitoba. METHODS A 12-year retrospective review was conducted of all children (younger than 18 years of age) with orbital cellulitis admitted to Manitoba's only tertiary pediatric centre. Admission rates for orbital cellulitis were compared over three distinct time periods, based on licensure and funding levels of the heptavalent pneumococcal conjugate vaccine (PCV7) in Manitoba. RESULTS Thirty-eight patients with orbital cellulitis were identified. Of these, 11% were of Aboriginal ethnicity in contrast with 30% to 40% of children who were admitted for other respiratory illnesses. Subperiosteal abscesses occurred in 31.5%. Only eight patients (21%) required surgery. Follow-up imaging after presentation usually did not indicate a need for subsequent surgical drainage. The mean number of orbital cellulitis cases per 1000 admissions for the following periods - before PCV7 licensure, after licensure and before full provincial funding, and after licensure and full funding - were 0.39, 0.53 and 0.90, respectively. No significant difference was noted among any of the periods as PCV7 coverage increased. CONCLUSIONS The rate of subperiosteal abscesses was lower than other reports. This may be due to the median age at presentation. In contrast to admissions for most other respiratory infections at the Winnipeg Children's Hospital (Winnipeg, Manitoba), Aboriginal ethnicity was uncommon. Surprisingly, rates of admissions for orbital cellulitis appeared to show an increasing trend with increasing access to PCV7 in Manitoba, although overall the number of cases was very small. Studies into the changing microbiology of orbital cellulitis and sinusitis are warranted.
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Gruber WC, Scott DA, Emini EA. Development and clinical evaluation of Prevnar 13, a 13-valent pneumocococcal CRM197 conjugate vaccine. Ann N Y Acad Sci 2012; 1263:15-26. [PMID: 22830997 DOI: 10.1111/j.1749-6632.2012.06673.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Pneumococcus is the leading cause of bacterial illness in children worldwide. The development, clinical evaluation, and postlicensure impact of the pneumococcal CRM(197) protein conjugate vaccine, PCV13, (Prevnar 13®) builds upon the excellent safety and substantial effectiveness of PCV7 (Prevnar®) in preventing pneumococcal disease in children. PCV13 adds pneumococcal serotypes 1, 3, 5, 6A, 7F, and 19A to serotypes 4, 6B, 9V, 14, 18C, 19F, 23F in PCV7 to provide comprehensive coverage for over 85% of epidemiologically important pneumococcal serotypes in the United States and throughout the world. PCV13 development required demonstration of immunologic responses to the 13 serotypes contained in the vaccine that were noninferior to the responses elicited by PCV7, and demonstration of a satisfactory safety profile. Studies were also performed to demonstrate compatibility with other childhood vaccines. Now licensed in many countries worldwide, PCV13 shows significant promise for expanded protection against pneumococcal disease in children.
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Lang PO, Aspinall R. Immunosenescence and herd immunity: with an ever-increasing aging population do we need to rethink vaccine schedules? Expert Rev Vaccines 2012; 11:167-76. [PMID: 22309666 DOI: 10.1586/erv.11.187] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Vaccination is a powerful public health tool that has been of tremendous benefit in protecting vulnerable populations from specific infections. Moreover, in addition to the direct benefits to vaccinated individuals, the indirect effects of protection at the community level have also been demonstrated and termed 'herd immunity'. The predicted demographic shift in the population landscape towards an ever-increasing aging population and the evidence suggesting that older individuals produce less-than-optimal vaccine responses have raised the question of rethinking vaccine schedules. This article provides evidence that even if herd immunity might be an option to indirectly protect the aging and aged adult population, the highest priorities for the near future must be to understand how vaccine responses in older individuals can be improved, to break down the public, cultural, societal and political barriers to vaccination and to counter the antivaccination movement that inhibits the worldwide spread of lifelong immunization programs.
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Affiliation(s)
- Pierre Olivier Lang
- Department of Internal Medicine, Rehabilitation & Geriatrics, Medical School & University Hospitals of Geneva, Hospital of Trois-Chêne, Chemin du Pont-Bochet 3, CH-1226 Thônex-Geneva, Geneva, Switzerland.
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Lemaître C, Ferroni A, Doit C, Vu-Thien H, Glorion C, Raymond J, Mary P, Wicart P, Bingen E, Ilharreborde B, Lorrot M. Pediatric osteoarticular infections caused by Streptococcus pneumoniae before and after the introduction of the heptavalent pneumococcal conjugate vaccine. Eur J Clin Microbiol Infect Dis 2012; 31:2773-81. [DOI: 10.1007/s10096-012-1627-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 04/10/2012] [Indexed: 10/28/2022]
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40
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Seale J, Flanagan P. Fulminant fatal Streptococcus pneumoniae serotype 6C infection in two HIV infected individuals. J Infect 2012; 64:529-30. [DOI: 10.1016/j.jinf.2012.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 01/08/2012] [Indexed: 10/14/2022]
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De Serres G, Pilishvili T, Link-Gelles R, Reingold A, Gershman K, Petit S, Farley MM, Harrison LH, Lynfield R, Bennett NM, Baumbach J, Thomas A, Schaffner W, Beall B, Whitney C, Moore M. Use of surveillance data to estimate the effectiveness of the 7-valent conjugate pneumococcal vaccine in children less than 5 years of age over a 9 year period. Vaccine 2012; 30:4067-72. [PMID: 22525797 DOI: 10.1016/j.vaccine.2012.04.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 03/29/2012] [Accepted: 04/04/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Case-control studies evaluating post-licensure effectiveness of conjugate vaccines can be laborious and costly. We applied an indirect cohort method to evaluate the effectiveness of seven-valent pneumococcal conjugate vaccine (PCV7) against invasive pneumococcal disease (IPD) and compared the results to the effectiveness measured using a standard case-control study conducted during the same time period. METHODS IPD cases among children 2-59 months old were identified through the Active Bacterial Core surveillance system during 2001-2009. We used logistic regression to calculate the odds ratio of vaccination (versus no vaccination) among cases (PCV7-type IPD cases) and non-cases (non-PCV7-type IPD cases), controlling for the presence of underlying conditions. Vaccine effectiveness (VE) was calculated as one minus the adjusted odds ratio. RESULTS Among 4225 IPD cases reported during 2001-2009, 2680 (63%) had serotype information and vaccine history. Effectiveness of ≥ 1 dose of PCV7 against PCV7-types was 88% (95% confidence interval (CI) 78-94%) among children with comorbid conditions and 97% (95% CI 92-98%) among healthy children. Among healthy children, VE was higher in 2001-2003 (97%, 95% CI 95-98%) compared to 2004-2009 (81%, 95% CI 64-90%). The annual estimates of VE in 2004-2009 showed great variability and wide confidence intervals due to the small number of PCV7-type cases. CONCLUSIONS An indirect cohort design using IPD surveillance data confirms the findings of the case-control study and, therefore, appears suitable for estimating PCV7 effectiveness. This method would be most useful shortly after vaccine introduction, and less useful in a setting of very high vaccine coverage and fewer vaccine-type cases.
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Affiliation(s)
- Gaston De Serres
- Institut National de Santé Publique du Québec and Laval University, Québec, Canada
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Song JH, Dagan R, Klugman KP, Fritzell B. The relationship between pneumococcal serotypes and antibiotic resistance. Vaccine 2012; 30:2728-37. [DOI: 10.1016/j.vaccine.2012.01.091] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 01/31/2012] [Accepted: 01/31/2012] [Indexed: 10/28/2022]
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Abstract
Vaccination with heptavalent pneumococcal conjugate vaccine (PCV7) has significantly reduced the burden of pneumococcal disease and has had an important public health benefit. Because this vaccine targets only seven of the more than 92 pneumococcal serotypes, concerns have been raised that non-vaccine serotypes (NVTs) could increase in prevalence and reduce the benefits of vaccination. Indeed, among asymptomatic carriers, the prevalence of NVTs has increased substantially, and consequently, there has been little or no net change in the bacterial carriage prevalence. In many populations, pneumococcal disease caused by NVT has increased, but in most cases this increase has been less than the increase in NVT carriage. We review the evidence for serotype replacement in carriage and disease, and address the surveillance biases that might affect these findings. We then discuss possible reasons for the discrepancy between near-complete replacement in carriage and partial replacement for disease, including differences in invasiveness between vaccine serotypes. We contend that the magnitude of serotype replacement in disease can be attributed, in part, to a combination of lower invasiveness of the replacing serotypes, biases in the pre-vaccine carriage data (unmasking), and biases in the disease surveillance systems that could underestimate the true amount of replacement. We conclude by discussing the future potential for serotype replacement in disease and the need for continuing surveillance.
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Affiliation(s)
- Daniel M Weinberger
- Department of Immunology and Infectious Diseases, Harvard School of Public Health, Boston, MA, USA.
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Andrews N, Waight PA, Borrow R, Ladhani S, George RC, Slack MPE, Miller E. Using the indirect cohort design to estimate the effectiveness of the seven valent pneumococcal conjugate vaccine in England and Wales. PLoS One 2011; 6:e28435. [PMID: 22164292 PMCID: PMC3229580 DOI: 10.1371/journal.pone.0028435] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 11/08/2011] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The 7-valent pneumococcal conjugate vaccine (PCV-7) was introduced in the United Kingdom in 2006 with a 2, 3 and 13 month schedule, and has led to large decreases in invasive pneumococcal disease (IPD) caused by the vaccine serotypes in both vaccinated and unvaccinated cohorts. We estimated the effectiveness of PCV-7 against IPD. METHODS AND FINDINGS We used enhanced surveillance data, collated at the Health Protection Agency, on vaccine type (n = 153) and non vaccine type (n = 919) IPD cases eligible for PCV-7. The indirect cohort method, a case-control type design which uses non vaccine type cases as controls, was used to estimate effectiveness of various numbers of doses as well as for each vaccine serotype. Possible bias with this design, caused by differential serotype replacement in vaccinated and unvaccinated individuals, was estimated after deriving formulae to quantify the bias. The results showed good effectiveness, increasing from 56% (95% confidence interval (CI): -7-82) for a single dose given under one year of age to 93% (95% CI: 70-98) for two doses under one year of age plus a booster dose in the second year of life. Serotype specific estimates indicated higher effectiveness against serotypes 4, 14 and 18C and lower effectiveness against 6B. Under the assumption of complete serotype replacement by non vaccine serotypes in carriage, we estimated that effectiveness estimates may be overestimated by about 2 to 5%. CONCLUSIONS This study shows high effectiveness of PCV-7 under the reduced schedule used in the UK. This finding agrees with the large reductions seen in vaccine type IPD in recent years in England and Wales. The formulae derived to assess the bias of the indirect cohort method for PCV-7 can also be used when using the design for other vaccines that affect carriage such as the recently introduced 13 valent pneumococcal conjugate vaccine.
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Affiliation(s)
- Nick Andrews
- Statistics, Modelling and Economics Department, Health Protection Services, Health Protection Agency, London, United Kingdom.
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Scott JR, Millar EV, Lipsitch M, Moulton LH, Weatherholtz R, Perilla MJ, Jackson DM, Beall B, Craig MJ, Reid R, Santosham M, O'Brien KL. Impact of more than a decade of pneumococcal conjugate vaccine use on carriage and invasive potential in Native American communities. J Infect Dis 2011; 205:280-8. [PMID: 22128315 DOI: 10.1093/infdis/jir730] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We assessed the impact of 12 years of pneumococcal conjugate vaccine (PCV7) use on pneumococcal nasopharyngeal carriage and serotype-specific invasive disease potential among Native Americans. METHODS Families were enrolled in a carriage study from 2006 to 2008; nasopharyngeal specimens and risk factor information were collected monthly for 7 visits. Pneumococcal carriage prevalence was compared with that before (1998-2000) and during (2001-2002) PCV7 introduction. We compared invasive disease incidence and carriage prevalence before and after PCV7 introduction to estimate changes in serotype-specific invasive potential. RESULTS We enrolled 1077 subjects from 302 households. There was an absolute reduction in carriage prevalence of 8.0% (95% confidence interval [CI], 4.5%-11.4%) in children aged <5 years and 3.1% (95% CI, 1.1%-5.1%) in adults. In children aged <5 years, vaccine-serotype carriage prevalence decreased by 22.8% (95% CI, 20.1%-25.3%), and nonvaccine serotype (NVT) increased by 15.9% (95% CI, 12.4%-19.3%). No significant change was detected in serotype-specific invasive potential after PCV7 introduction. CONCLUSIONS Pneumococcal carriage prevalence decreased in all ages since PCV7 introduction; vaccine-serotype carriage has been nearly eliminated, whereas the prevalence of NVT carriage has increased. The increase in the NVT invasive disease rate seems to be proportional to the increase in colonization prevalence.
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Affiliation(s)
- Jennifer R Scott
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA
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Rosen JB, Thomas AR, Lexau CA, Reingold A, Hadler JL, Harrison LH, Bennett NM, Schaffner W, Farley MM, Beall BW, Moore MR. Geographic variation in invasive pneumococcal disease following pneumococcal conjugate vaccine introduction in the United States. Clin Infect Dis 2011; 53:137-43. [PMID: 21690620 DOI: 10.1093/cid/cir326] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Rates of invasive pneumococcal disease (IPD) varied among the United States before pneumococcal conjugate vaccine (PCV7) introduction. We compared trends in IPD rates among diverse US sites over 10 years since PCV7 introduction. METHODS Patients with IPD of all ages were identified through active population and laboratory-based surveillance in 8 geographic areas under continuous surveillance during 1998-2009. Isolates were serotyped. IPD incidence rates and percent changes were calculated by site, serotype group, age, and year. RESULTS Reductions in rates of IPD ranged, by site, from 19 to 29.9 cases per 100,000 population during 1998-1999 to 11.2-18.0 cases per 100,000 population during 2009 (rate reduction, 5.1-15.3 cases per 100,000 population). Reductions in IPD rates among children aged <5 years ranged from 35.7 to 117.2 cases per 100,000 population across the sites. Reductions in rates of IPD due to PCV7 serotypes were seen in all age groups at all sites, ranging from 12 to 21.4 cases per 100,000 population during 1998-1999 to <2 cases per 100,000 population during 2009 (92%-98% reductions). Serotype 19A rates ranged from 0.4 to 1.5 cases per 100,000 population during 1998-1999 to 1.3 to 3.4 cases per 100,000 population during 2009 (rate difference, 0.9-2.8 cases per 100,000 population); modest increases were observed for most age groups across the sites. Rates of IPD due to all other serotypes ranged from 6.3 to 10.3 cases per 100,000 population during 1998-1999 to 8.3-13.6 cases per 100,000 population during 2009 (rate difference, -0.4 to 5.7 cases per 100,000 population). Across the sites, the greatest rate increases were seen in the 50-64 and >65 year age groups. CONCLUSIONS Reductions in IPD due to vaccine serotypes were consistent across sites. Changes in serotype 19A and all other serotypes were variable. Although relative increases in non-vaccine type serotypes were large in some sites, absolute rate increases were small.
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Affiliation(s)
- Jennifer B Rosen
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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48
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Silberbauer EJ, Ismail N, von Gottberg A, Hoosen AA. Serotype and antimicrobial profile distribution of invasive pneumococcal isolates in the pre-vaccine introduction era in Pretoria, South Africa, 2005 through 2009. Diagn Microbiol Infect Dis 2011; 71:309-11. [PMID: 21907527 DOI: 10.1016/j.diagmicrobio.2011.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 07/13/2011] [Accepted: 07/21/2011] [Indexed: 10/17/2022]
Abstract
A description of invasive Streptococcus pneumoniae isolates over a 5-year period from blood culture and cerebrospinal fluid culture follows, in Pretoria South Africa January 2005 through December 2009. Isolates were identified using standard microbiological techniques, serotyped, and a MIC determined for penicillin and cefotaxime. A total of 177 isolates were included in the analysis. Eighty percent of patients in the 18- to 45-year age group tested positive for HIV. In children <5 years of age, 66% (n = 49) of serotypes were those present in the heptavalent pneumococcal conjugate vaccine (PCV-7). Fifty-nine percent (n = 29) were from PCV-7 serotypes in the <1-year-old age group. An additional peak of invasive disease was also seen in the 18- to 45-year age group. Only 1 of 177 isolates had resistance to penicillin (MIC ≥2 μg/mL); none was resistant to cefotaxime. The introduction of the PCV-7 vaccine in South Africa will decrease invasive pneumococcal disease caused by vaccine serotypes.
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Affiliation(s)
- Eduard Johan Silberbauer
- Department of Medical Microbiology, University of Pretoria and National Health Laboratory Services, Tshwane Academic Division, South Africa.
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49
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Antimicrobial susceptibility of invasive and lower respiratory tract isolates of Streptococcus pneumoniae, 1998 to 2007. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2011; 20:e139-44. [PMID: 21119791 DOI: 10.1155/2009/413749] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Previous surveys of antimicrobial resistance in Streptococcus pneumoniae have found differences depending on source of isolate (eg, higher resistance in lower respiratory tract [LRT] versus invasive isolate) and age (higher resistance in children versus adults). Susceptibility profiles in the Calgary Health Region (approximately 1.25 million population) over a 10-year period were studied. Prospective laboratory-based population surveillance for S pneumoniae disease has been conducted since 1998. Patient demographics and susceptibility testing were analyzed. In total, 2382 patient isolates were available for analysis from 1998 to 2007. Of these, 1170 isolates were invasive while 496 were LRT. Patient age distribution was: younger than five years, 14%; five to 17 years, 6%; 18 to 64 years, 56%; and 65 years or older, 24%. Mean patient age was 44.8 years and 60.0% were male. The overall incidence of nonsusceptibility was: penicillin, 8.2%; amoxicillin, 0.3%; cefuroxime, 6.2%; ceftriaxone, 1.7%; erythromycin, 8.8%; trimethoprim-sulfamethoxazole (TMP-SMX), 25.6%; clindamycin, 2.3%; and levofloxacin, 0.2%. Overall resistance rates were stable, except for increasing erythromycin resistance from 5.4% (1998) to a high of 14.2% (2004) (P=0.007). Isolates that were nonsusceptible to penicillin or TMP-SMX were more likely to be multidrug resistant (P<0.001) compared with penicillin- or TMP-SMX-susceptible isolates. Compared with invasive isolates, LRT isolates showed more resistance to penicillin, TMP-SMX, cefuroxime and erythromycin, and were more likely to be multidrug resistant. Isolates from children younger than five years of age are more likely to be multidrug resistant and resistant to erythromycin and cefotaxime. Ongoing surveillance of S pneumoniae isolates is important because resistance rates vary by source and patient age among health care regions.
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50
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Yasin RMD, Zin NM, Hussin A, Nawi SH, Hanapiah SMD, Wahab ZA, Raj G, Shafie N, Peng NP, Chu KK, Aziz MN, Maning N, Mohamad JS, Benjamin A, Salleh MABM, Zahari SS, Francis A, Ahmad N, Karunakaran R. Current trend of pneumococcal serotypes distribution and antibiotic susceptibility pattern in Malaysian hospitals. Vaccine 2011; 29:5688-93. [PMID: 21723357 DOI: 10.1016/j.vaccine.2011.06.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Revised: 03/15/2011] [Accepted: 06/05/2011] [Indexed: 11/15/2022]
Abstract
From January 2008 to December 2009, 433 Streptococcus pneumoniae strains were examined to determine the serotype distribution and susceptibility to selected antibiotics. About 50% of them were invasive isolates. The strains were isolated from patients of all age groups and 33.55% were isolated from children below 5 years. The majority was isolated from blood (48.53%) and other sterile specimens (6.30%). Community acquired pneumonia (41.70%) is the most common diagnosis followed by sepsis (9.54%). Serotyping was done using Pneumotest Plus-Kit and antibiotic susceptibility pattern was determined by modified Kirby-Bauer disk diffusion method and measurement of minimum inhibitory concentration (MIC) using E-test strip. Ten most common serotypes were 19F (15.02%), 6B (10.62%), 19A (6.93%), 14 (6.70%), 1 (5.08%), 6A (5.08%), 23F (4.85%), 18C (3.93%), 3 (2.08%) and 5 (1.85%). Penicillin MIC ranged between ≤ 0.012-4 μg/ml with MIC₉₀ of 1 μg/ml. Penicillin resistant rate is 31.78%. The majority of penicillin less-susceptible strains belonged to serotype 19F followed by 19A and 6B. Based on the serotypes distribution 22 (44.00%), 28 (56.00%) and 39 (78.00%) of the invasive isolates from children ≤ 2 years were belonged to serotypes included in the PCV7, PCV10 and PCV13, respectively.
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Affiliation(s)
- Rohani M D Yasin
- Specialised Diagnostic Centre, Institute for Medical Research, Kuala Lumpur, Malaysia.
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