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A systems immunology approach to investigate cytokine responses to viruses and bacteria and their association with disease. Sci Rep 2022; 12:13463. [PMID: 35931775 PMCID: PMC9356009 DOI: 10.1038/s41598-022-16509-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 07/11/2022] [Indexed: 11/08/2022] Open
Abstract
Patterns of human immune responses to viruses and bacteria and how this impacts risk of infections or onset/exacerbation of chronic respiratory diseases are poorly understood. In a population-based birth cohort, we measured peripheral blood mononuclear cell responses (28 cytokines) to respiratory viruses and bacteria, Toll-like receptor ligands and phytohemagglutinin, in 307 children. Cytokine responses were highly variable with > 1000-fold differences between children. Machine learning revealed clear distinction between virus-associated and bacteria-associated stimuli. Cytokines clustered into three functional groups (anti-viral, pro-inflammatory and T-cell derived). To investigate mechanisms potentially explaining such variable responses, we investigated cytokine Quantitative Trait Loci (cQTLs) of IL-6 responses to bacteria and identified nine (eight novel) loci. Our integrative approach describing stimuli, cytokines and children as variables revealed robust immunologically and microbiologically plausible clustering, providing a framework for a greater understanding of host-responses to infection, including novel genetic associations with respiratory disease.
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Rybak A, Levy C, Angoulvant F, Auvrignon A, Gembara P, Danis K, Vaux S, Levy-Bruhl D, van der Werf S, Béchet S, Bonacorsi S, Assad Z, Lazzati A, Michel M, Kaguelidou F, Faye A, Cohen R, Varon E, Ouldali N. Association of Nonpharmaceutical Interventions During the COVID-19 Pandemic With Invasive Pneumococcal Disease, Pneumococcal Carriage, and Respiratory Viral Infections Among Children in France. JAMA Netw Open 2022; 5:e2218959. [PMID: 35763298 PMCID: PMC9240903 DOI: 10.1001/jamanetworkopen.2022.18959] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
IMPORTANCE An association between pneumococcal nasopharyngeal carriage and invasive pneumococcal disease (IPD) has been previously established. However, it is unclear whether the decrease in IPD incidence observed after implementation of nonpharmaceutical interventions (NPIs) during the COVID-19 pandemic was associated with concomitant changes in pneumococcal carriage and respiratory viral infections. OBJECTIVE To assess changes in IPD incidence after the implementation of NPIs during the COVID-19 pandemic and examine their temporal association with changes in pneumococcal carriage rate and respiratory viral infections (specifically respiratory syncytial virus [RSV] and influenza cases) among children in France. DESIGN, SETTING, AND PARTICIPANTS This cohort study used interrupted time series analysis of data from ambulatory and hospital-based national continuous surveillance systems of pneumococcal carriage, RSV and influenza-related diseases, and IPD between January 1, 2007, and March 31, 2021. Participants included 11 944 children younger than 15 years in France. EXPOSURES Implementation of NPIs during the COVID-19 pandemic. MAIN OUTCOMES AND MEASURES The estimated fraction of IPD change after implementation of NPIs and the association of this change with concomitant changes in pneumococcal carriage rate and RSV and influenza cases among children younger than 15 years. The estimated fraction of change was analyzed using a quasi-Poisson regression model. RESULTS During the study period, 5113 children (median [IQR] age, 1.0 [0.6-4.0] years; 2959 boys [57.9%]) had IPD, and 6831 healthy children (median [IQR] age, 1.5 [0.9-3.9] years; 3534 boys [51.7%]) received a swab test. Data on race and ethnicity were not collected. After NPI implementation, IPD incidence decreased by 63% (95% CI, -82% to -43%; P < .001) and was similar for non-13-valent pneumococcal conjugate vaccine serotypes with both high disease potential (-63%; 95% CI, -77% to -48%; P < .001) and low disease potential (-53%; 95% CI, -70% to -35%; P < .001). The overall pneumococcal carriage rate did not significantly change after NPI implementation (-12%; 95% CI, -37% to 12%; P = .32), nor did the carriage rate for non-PCV13 serotypes with high disease potential (-26%; 95% CI, -100% to 52%; P = .50) or low disease potential (-7%; 95% CI, -34% to 20%; P = .61). After NPI implementation, the estimated number of influenza cases decreased by 91% (95% CI, -74% to -97%; P < .001), and the estimated number of RSV cases decreased by 74% (95% CI, -55% to -85%; P < .001). Overall, the decrease in influenza and RSV cases accounted for 53% (95% CI, -28% to -78%; P < .001) and 40% (95% CI, -15% to -65%; P = .002) of the decrease in IPD incidence during the NPI period, respectively. The decrease in IPD incidence was not associated with pneumococcal carriage, with carriage accounting for only 4% (95% CI, -7% to 15%; P = .49) of the decrease. CONCLUSIONS AND RELEVANCE In this cohort study of data from multiple national continuous surveillance systems, a decrease in pediatric IPD incidence occurred after the implementation of NPIs in France; this decrease was associated with a decrease in viral infection cases rather than pneumococcal carriage rate. The association between pneumococcal carriage and IPD was potentially modified by changes in the number of RSV and influenza cases, suggesting that interventions targeting respiratory viruses, such as immunoprophylaxis or vaccines for RSV and influenza, may be able to prevent a large proportion of pediatric IPD cases.
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Affiliation(s)
- Alexis Rybak
- Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France
- Association Française de Pédiatrie Ambulatoire, Saint-Germain-en-Laye, France
- Assistance Publique–Hôpitaux de Paris, Service d'Accueil des Urgences Pédiatriques, Université de Paris, Paris, France
- Assistance Publique–Hôpitaux de Paris, Robert Debré University Hospital, Epidémiologie Clinique–Évaluation Économique Appliqué aux Populations Vulnérables, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1123, Université de Paris, Paris, France
| | - Corinne Levy
- Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France
- Association Française de Pédiatrie Ambulatoire, Saint-Germain-en-Laye, France
- Université Paris Est, Institut Mondor de Recherche Biomédicale, Groupe d'Etude de Maladies Infectieuses Néonatales et Infantiles, Créteil, France
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France
- Clinical Research Center, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - François Angoulvant
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France
- Institut National de la Santé et de la Recherche Médicale, Centre de Recherche des Cordeliers, Unité Mixte de Recherche Scientifique 1138, Université de Paris, Paris, France
- Assistance Publique–Hôpitaux de Paris, Service de Pédiatrie Générale, Robert Debré University Hospital, Université de Paris, Paris, France
| | - Anne Auvrignon
- Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France
| | - Piotr Gembara
- Association Française de Pédiatrie Ambulatoire, Saint-Germain-en-Laye, France
| | - Kostas Danis
- Direction des Maladies Infectieuses, Santé Publique France, Saint-Maurice, France
| | - Sophie Vaux
- Direction des Maladies Infectieuses, Santé Publique France, Saint-Maurice, France
| | - Daniel Levy-Bruhl
- Direction des Maladies Infectieuses, Santé Publique France, Saint-Maurice, France
| | - Sylvie van der Werf
- Centre National de Référence des Infections Respiratoires, Institut Pasteur, Paris, France
| | - Stéphane Béchet
- Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France
- Association Française de Pédiatrie Ambulatoire, Saint-Germain-en-Laye, France
| | - Stéphane Bonacorsi
- Assistance Publique–Hôpitaux de Paris, Service de Microbiologie, Robert Debré University Hospital, Université de Paris, Paris, France
- Infection Antimicrobials Modelling Evolution, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1137, Université de Paris, Paris, France
| | - Zein Assad
- Assistance Publique–Hôpitaux de Paris, Robert Debré University Hospital, Epidémiologie Clinique–Évaluation Économique Appliqué aux Populations Vulnérables, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1123, Université de Paris, Paris, France
- Assistance Publique–Hôpitaux de Paris, Service de Pédiatrie Générale, Robert Debré University Hospital, Université de Paris, Paris, France
- Service de Pédiatrie Médicale, Centre Hospitalier Universitaire Caen-Normandie, Caen, France
| | - Andréa Lazzati
- Chirurgie Générale, Digestive et de l'Obésité, Centre Hospitalier Intercommunal de Créteil, Créteil, France
- Institut National de la Santé et de la Recherche Médicale, L’Institut Mondor de Recherche Biomédicale, Unité 955, Université Paris-Est Créteil, Créteil, France
| | - Morgane Michel
- Assistance Publique–Hôpitaux de Paris, Robert Debré University Hospital, Epidémiologie Clinique–Évaluation Économique Appliqué aux Populations Vulnérables, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1123, Université de Paris, Paris, France
| | - Florentia Kaguelidou
- Assistance Publique–Hôpitaux de Paris, Robert Debré University Hospital, Epidémiologie Clinique–Évaluation Économique Appliqué aux Populations Vulnérables, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1123, Université de Paris, Paris, France
- Assistance Publique–Hôpitaux de Paris, Centre d’Investigation Clinique 1426, Robert Debré University Hospital, Université de Paris, Paris, France
| | - Albert Faye
- Assistance Publique–Hôpitaux de Paris, Robert Debré University Hospital, Epidémiologie Clinique–Évaluation Économique Appliqué aux Populations Vulnérables, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1123, Université de Paris, Paris, France
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France
- Assistance Publique–Hôpitaux de Paris, Service de Pédiatrie Générale, Robert Debré University Hospital, Université de Paris, Paris, France
| | - Robert Cohen
- Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France
- Association Française de Pédiatrie Ambulatoire, Saint-Germain-en-Laye, France
- Université Paris Est, Institut Mondor de Recherche Biomédicale, Groupe d'Etude de Maladies Infectieuses Néonatales et Infantiles, Créteil, France
- Groupe de Pathologie Infectieuse Pédiatrique, Paris, France
- Clinical Research Center, Centre Hospitalier Intercommunal de Créteil, Créteil, France
- Néonatalogie et Réanimation Néonatale, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Emmanuelle Varon
- Université Paris Est, Institut Mondor de Recherche Biomédicale, Groupe d'Etude de Maladies Infectieuses Néonatales et Infantiles, Créteil, France
- Microbiologie et Centre National de Référence du Pneumocoque, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Naïm Ouldali
- Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France
- Assistance Publique–Hôpitaux de Paris, Robert Debré University Hospital, Epidémiologie Clinique–Évaluation Économique Appliqué aux Populations Vulnérables, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1123, Université de Paris, Paris, France
- Assistance Publique–Hôpitaux de Paris, Service de Pédiatrie Générale, Robert Debré University Hospital, Université de Paris, Paris, France
- Service des Maladies Infectieuses Pédiatriques, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Québec, Canada
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Chan J, Mungun T, Batsaixan P, Ulziibayar M, Suuri B, Otgonbayar D, Luvsantseren D, Nguyen CD, Narangarel D, Dunne EM, Fox K, Hinds J, Nation ML, Pell CL, Mulholland EK, Satzke C, von Mollendorf C, Russell FM. Direct and indirect effects of 13-valent pneumococcal conjugate vaccine on pneumococcal carriage in children hospitalised with pneumonia from formal and informal settlements in Mongolia: an observational study. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2021; 15:100231. [PMID: 34528012 PMCID: PMC8342962 DOI: 10.1016/j.lanwpc.2021.100231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/07/2021] [Accepted: 07/12/2021] [Indexed: 11/24/2022]
Abstract
Background Within Ulaanbaatar, Mongolia, risk factors for pneumonia are concentrated among children living in informal settlements comprised of temporary shelters (gers). We used pneumococcal carriage surveillance among children from formal and informal settlements hospitalised with pneumonia to evaluate the direct and indirect effects of 13-valent pneumococcal conjugate vaccine (PCV13) against vaccine-type (VT) pneumococcal carriage following a phased introduction of PCV13. Methods We enrolled and collected nasopharyngeal swabs from children 2-59 months of age presenting to hospital. Pneumococci were detected using lytA qPCR and serotyped using microarray on a random monthly selection of swabs between November 2015 and March 2019 from two districts in Ulaanbaatar. PCV13 status was determined using written records. We quantified the associations between individual PCV13 status (direct effects) and district-level PCV13 coverage (indirect effects) and VT carriage using generalised estimating equations and explored interactions by settlement type. Findings A total of 1 292 swabs from 6 046 participants were tested for pneumococci. Receipt of PCV13 and increasing PCV13 coverage independently reduced the risk of VT carriage. For each percent increase in PCV13 coverage, the adjusted odds of VT carriage decreased by 1•0% (OR 95% CI 0•983-0•996; p=0•001), with a predicted decrease in VT carriage rate from 29•1% to 13•1% as coverage reached 100%. There was a trend towards a slower decline within informal settlements (p=0•100). Adjusted PCV13 vaccine effectiveness against VT carriage was 39•1% (95% CI 11•4-58•1%, p=0•009). Interpretation Substantial indirect effects were observed following PCV13 introduction, including among children living within informal settlements. Funding Bill & Melinda Gates Foundation; Gavi, the Vaccine Alliance.
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Affiliation(s)
- Jocelyn Chan
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Tuya Mungun
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia.,National Centre for Communicable Diseases (NCCD), Ministry of Health, Ulaanbaatar, Mongolia
| | - Purevsuren Batsaixan
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia.,National Centre for Communicable Diseases (NCCD), Ministry of Health, Ulaanbaatar, Mongolia
| | - Mukhchuluun Ulziibayar
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia.,National Centre for Communicable Diseases (NCCD), Ministry of Health, Ulaanbaatar, Mongolia
| | - Bujinlkham Suuri
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia.,National Centre for Communicable Diseases (NCCD), Ministry of Health, Ulaanbaatar, Mongolia
| | - Dashpagam Otgonbayar
- National Centre for Communicable Diseases (NCCD), Ministry of Health, Ulaanbaatar, Mongolia
| | - Dashtseren Luvsantseren
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia.,National Centre for Communicable Diseases (NCCD), Ministry of Health, Ulaanbaatar, Mongolia
| | - Cattram D Nguyen
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Dorj Narangarel
- National Centre for Communicable Diseases (NCCD), Ministry of Health, Ulaanbaatar, Mongolia
| | - Eileen M Dunne
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia
| | - Kimberley Fox
- Regional Office for the Western Pacific, World Health Organization, Manila, Philippines
| | - Jason Hinds
- Institute for Infection and Immunity, St George's University of London, London, United Kingdom.,BUGS Bioscience, London Bioscience Innovation Centre, London, United Kingdom
| | - Monica L Nation
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia
| | - Casey L Pell
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia
| | - E Kim Mulholland
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Catherine Satzke
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia.,Department of Microbiology and Immunology, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Claire von Mollendorf
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Fiona M Russell
- Infection and Immunity, Murdoch Children's Research Institute (MCRI), Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
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Dunn MG, Lessa FC, Sánchez J, Cordero R, Feris-Iglesias J, Cedano D, Carvalho MDG, Fernández J, Feemster KA. Impact of 13-Valent Pneumococcal Conjugate Vaccine on Nasopharyngeal Carriage Rates of Streptococcus pneumoniae in a Rural Community in the Dominican Republic. J Infect Dis 2021; 224:S237-S247. [PMID: 34469551 PMCID: PMC8409531 DOI: 10.1093/infdis/jiab172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Invasive pneumococcal disease (IPD) leads to thousands of pediatric deaths annually. Pneumococcal colonization precedes IPD. In 2013, the Dominican Republic introduced the 13-valent pneumococcal conjugate vaccine (PCV13) into its routine infant immunization program, with doses at ages 2, 4, and 12 months. Prevalence of pneumococcal nasopharyngeal colonization was evaluated post–PCV13 introduction. Methods A prospective cohort study of 125 children aged 2–35 months was conducted in a rural Dominican Republic community November 2016 through July 2017. Nasopharyngeal swabs and clinical and vaccination data were collected at enrollment and 4–6 months later. Serotypes included in PCV13 were defined as vaccine-type. Colonization rates and serotype distribution were compared at baseline and follow-up, and the association between colonization and vaccination status among the entire cohort was evaluated at each time point. Results Of 125 children enrolled, 118 (94%) completed follow-up. Overall and vaccine-type pneumococcal colonization rates were 62% and 25%, respectively, at baseline and 60% and 28% at follow-up. Among children age-eligible for 3 doses, 50% and 51% were fully vaccinated at baseline and follow-up, respectively. At baseline assessment, children up-to-date for age for PCV13 were less likely to be colonized with vaccine-type pneumococci than children not up-to-date, and the same was found for fully vaccinated children (3 doses) compared to those not fully vaccinated (odds ratios [ORs], 0.38 [95% confidence interval {CI}, .18–.79], and 0.14 [95% CI, .04–.45], respectively). The same associations were not found at follow-up assessment. Conclusions Three years post -PCV13 introduction, vaccine-type colonization rates remained high. Low vaccination coverage for 3 PCV13 doses may have contributed. The protective effect of PCV13 on vaccine-type carriage suggests an increase in PCV13 coverage could lead to substantial declines in pneumococcal vaccine-type carriage.
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Affiliation(s)
- Maria G Dunn
- Department of Pediatrics, Global Health Center and Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Correspondence: Maria Dunn, DO, Children’s Hospital of Philadelphia Global Health Center, 2716 South St, Seventh Floor #7410, Philadelphia PA 19146, USA ()
| | - Fernanda C Lessa
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jacqueline Sánchez
- Hospital Infantil Dr Robert Reid Cabral, Santo Domingo, Dominican Republic
| | - Ramona Cordero
- Centro de Salud Divina Providencia, Consuelo, Dominican Republic
| | | | - Doraliza Cedano
- Hospital Infantil Dr Robert Reid Cabral, Santo Domingo, Dominican Republic
| | - Maria da Glória Carvalho
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Josefina Fernández
- Hospital Infantil Dr Robert Reid Cabral, Santo Domingo, Dominican Republic
| | - Kristen A Feemster
- Department of Pediatrics, Global Health Center and Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Li L, Cheng Y, Tu X, Yang J, Wang C, Zhang M, Lu Z. Association between asthma and invasive pneumococcal disease risk: a systematic review and meta-analysis. Allergy Asthma Clin Immunol 2020; 16:94. [PMID: 33292446 PMCID: PMC7653896 DOI: 10.1186/s13223-020-00492-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 10/26/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose Asthma has been shown to be related to an increased risk of invasive pneumococcal disease (IPD), although the results remain inconclusive. Therefore, we performed a meta-analysis to determine whether asthma increases the risk of IPD. This meta-analysis was performed to validate and strengthen the association between asthma and IPD. Methods PubMed, EMBASE, Web of Science, and the reference lists of all relevant articles and books were screened until May 2019. Two authors independently assessed eligibility and study quality and extracted data. A common odds ratio was estimated using a random-effects meta-analysis model of aggregated published data. Results A total of eight studies with 8877 IPD cases and 78,366 controls were included. Our meta-analysis showed that asthma was significantly associated with the increased risk of IPD (OR 2.44 [95% CI, 2.02–2.96]). The children with asthma (0–17 years old) (OR 2.86 [95% CI 1.80–4.55]) had a higher risk of IPD susceptibility compared with the adult patients (≥ 18 years old) (OR 2.45 [95% CI 1.98–3.03]). Conclusions Results of this meta-analysis indicated that the patients with asthma had a higher risk of IPD susceptibility, especially among the children with asthma.
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Affiliation(s)
- Lingling Li
- Department of Respiratory Medicine, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Yusheng Cheng
- Department of Respiratory Medicine, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Xiongwen Tu
- Department of Respiratory Medicine, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Jie Yang
- Department of Respiratory Medicine, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Chenghui Wang
- Department of Respiratory Medicine, Yijishan Hospital, Wannan Medical College, Wuhu, China
| | - Min Zhang
- Department of Emergency, Yijishan Hospital, Wannan Medical College, Wuhu, China.
| | - Zhiwei Lu
- Department of Respiratory Medicine, Yijishan Hospital, Wannan Medical College, Wuhu, China.
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Asner SA, Agyeman PKA, Gradoux E, Posfay-Barbe KM, Heininger U, Giannoni E, Crisinel PA, Stocker M, Bernhard-Stirnemann S, Niederer-Loher A, Kahlert CR, Hasters P, Relly C, Baer W, Aebi C, Schlapbach LJ, Berger C. Burden of Streptococcus pneumoniae Sepsis in Children After Introduction of Pneumococcal Conjugate Vaccines: A Prospective Population-based Cohort Study. Clin Infect Dis 2020; 69:1574-1580. [PMID: 30601988 DOI: 10.1093/cid/ciy1139] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 12/31/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Population-based studies assessing the impact of pneumococcal conjugate vaccines (PCV) on burden of pneumococcal sepsis in children are lacking. We aimed to assess this burden following introduction of PCV-13 in a nationwide cohort study. METHODS The Swiss Pediatric Sepsis Study (September 2011 to December 2015) prospectively recruited children <17 years of age with blood culture-proven sepsis due to Streptococcus pneumoniae, meeting criteria for systemic inflammatory response syndrome. Infection with vaccine serotype in children up to date with PCV immunization was defined as vaccine failure. Main outcomes were admission to pediatric intensive care unit (PICU) and length of hospital stay (LOS). RESULTS Children with pneumococcal sepsis (n = 117) accounted for a crude incidence of 2.0 per 100 000 children (95% confidence interval [CI] 1.7-2.4) and 25% of community-acquired sepsis episodes. Case fatality rate was 8%. Forty-two (36%) patients required PICU admission. Children with meningitis (29; 25%) were more often infected by serotypes not included in PCV (69% vs 31%; P < .001). Sixteen (26%) of 62 children up to date with PCV immunization presented with vaccine failure, including 11 infected with serotype 3. In multivariable analyses, children with meningitis (odds ratio [OR] 6.8; 95% CI 2.4-19.3; P < .001) or infected with serotype 3 (OR 2.8; 95% CI 1.1-7.3; P = .04) were more often admitted to PICU. Children infected with serotype 3 had longer LOS (β coefficient 0.2, 95% CI .1-1.1; P = .01). CONCLUSIONS The incidence of pneumococcal sepsis in children shortly after introduction of PCV-13 remained substantial. Meningitis mostly due to non-vaccine serotypes and disease caused by serotype 3 represented significant predictors of severity.
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Affiliation(s)
- Sandra A Asner
- Pediatric Infectious Diseases and Vaccinology Unit, Department Mother-Woman-Child, Switzerland.,Infectious Diseases Service, Department of Internal Medicine, Lausanne University Hospital, Switzerland
| | - Philipp K A Agyeman
- Department of Pediatrics, Inselspital, Bern University Hospital, Switzerland
| | - Eugénie Gradoux
- Pediatric Infectious Diseases and Vaccinology Unit, Department Mother-Woman-Child, Switzerland
| | - Klara M Posfay-Barbe
- Pediatric Infectious Diseases Unit, Children's Hospital of Geneva, University Hospitals of Geneva, Switzerland
| | - Ulrich Heininger
- Infectious Diseases and Vaccinology, University Children's Hospital Basel, Switzerland
| | - Eric Giannoni
- Infectious Diseases Service, Department of Internal Medicine, Lausanne University Hospital, Switzerland.,Clinic of Neonatology, Department Mother-Woman-Child, Lausanne University Hospital, Switzerland
| | - Pierre A Crisinel
- Pediatric Infectious Diseases and Vaccinology Unit, Department Mother-Woman-Child, Switzerland
| | - Martin Stocker
- Department of Pediatrics, Children's Hospital Lucerne, Switzerland
| | | | | | | | - Paul Hasters
- Department of Neonatology, University Hospital Zurich, Switzerland
| | - Christa Relly
- Division of Infectious Diseases and Children's Research Center, University Children's Hospital Zurich, Switzerland
| | | | - Christoph Aebi
- Department of Pediatrics, Inselspital, Bern University Hospital, Switzerland
| | - Luregn J Schlapbach
- Department of Pediatrics, Inselspital, Bern University Hospital, Switzerland.,Faculty of Medicine, Child Health Research Centre, The University of Queensland, Brisbane, Australia.,Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Brisbane, Australia.,Intensive Care Unit, Queensland Children's Hospital, Children's Health Queensland, Brisbane, Australia
| | - Christoph Berger
- Division of Infectious Diseases and Children's Research Center, University Children's Hospital Zurich, Switzerland
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Petousis-Harris H, Howe AS, Paynter J, Turner N, Griffin J. Pneumococcal Conjugate Vaccines Turning the Tide on Inequity: A Retrospective Cohort Study of New Zealand Children Born 2006-2015. Clin Infect Dis 2020; 68:818-826. [PMID: 30032236 DOI: 10.1093/cid/ciy570] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 07/18/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Hospitalization rates for infectious diseases in New Zealand (NZ) children have increased since 1989. The highest burden is among Māori and Pacific children, and the most socioeconomically deprived. New Zealand introduced pneumococcal conjugate vaccine (PCV)7 in June 2008, PCV10 in 2011, and PCV13 in 2014. METHODS A retrospective cohort study of NZ children aged <6 years between 2006 and 2015 was performed using administrative databases. Demographics and hospitalizations were linked to evaluate the impact of the PCV vaccination program on cases of invasive pneumococcal disease (IPD), all-cause pneumonia (ACP), and otitis media (OM), defined by ICD-10-AM codes, and to explore the effect by ethnicity and deprivation. RESULTS Between 2006 and 2015, there were 640 children hospitalized with IPD, 26589 for ACP, and 44545 for OM. IPD hospitalizations declined by 73% between 2005 and 2015 for children <6 years of age, whereas ACP and OM declined by 8% and 25%, respectively. The highest rates for all diseases were among Māori and Pacific children and those from high deprivation. However, the declines were highest among Māori and Pacific children and those from socioeconomically deprived areas. IPD hospitalizations declined by 79% and 67% for Māori and Pacific children, respectively, between 2006 and 2015. ACP declined by 12% in Māori and 21% in Pacific children. OM declined by 51% in Māori children. CONCLUSION In contrast to the increasing trend of hospitalization rates for infectious disease in New Zealand, the use of PCV appears associated with reductions in ethnic and socioeconomic disparities in hospitalization for IPD, ACP, and OM.
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Affiliation(s)
- Helen Petousis-Harris
- Department of General Practice and Primary Health Care, Faculty of Medicine and Health Science, University of Auckland, New Zealand
| | - Anna S Howe
- Department of General Practice and Primary Health Care, Faculty of Medicine and Health Science, University of Auckland, New Zealand
| | - Janine Paynter
- Department of General Practice and Primary Health Care, Faculty of Medicine and Health Science, University of Auckland, New Zealand
| | - Nikki Turner
- Department of General Practice and Primary Health Care, Faculty of Medicine and Health Science, University of Auckland, New Zealand
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8
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Changing Epidemiology and Predisposing Factors for Invasive Pneumococcal Disease at Two Australian Tertiary Hospitals. Pediatr Infect Dis J 2020; 39:1-6. [PMID: 31815835 DOI: 10.1097/inf.0000000000002489] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Invasive pneumococcal disease (IPD) is associated with significant morbidity and mortality in children. Universal pneumococcal conjugate vaccination has changed the epidemiology of IPD. In vaccinated children, IPD can be a marker of an underlying immunodeficiency. METHODS This is a retrospective audit of children younger than 18 years with IPD admitted to 2 tertiary pediatric hospitals in Australia between 2011 and 2017. Data on predisposing conditions, immunologic evaluation, pneumococcal serotype, antibiotic susceptibility and treatment were collected. RESULTS During the 7-year period, there were 131 presentations with IPD in 127 children; 3 children had recurrent IPD. Patients presented with sepsis (41%), empyema (29%), meningitis (18%), mastoiditis (12%), pneumonia (10%) and septic arthritis (4%). In 19 (15%) presentations, risk factors for IPD were present, including malignancy, hematologic disorder, chronic liver disease, chronic kidney disease and cochlear implant. Pneumococcal serotypes were determined in 78/131 (60%) of presentations: the most frequent serotypes were 19A (19%), 3 (13%), 7F (10%) and 19F (8%) and non-vaccine serotypes 22F (8%), 35B (6%), 15A (4%) and 38 (4%). Overall, 11% of isolates were non-susceptible to ceftriaxone. Only 36 patients (32%) had an immunologic evaluation, and 4 patients had proven or probable immunodeficiency. CONCLUSION Although pneumococcal conjugate vaccine serotypes 19A, 3, 19F and 7F remain frequent causes of IPD, non-vaccine serotypes are emerging. Our data support vancomycin treatment for children with pneumococcal meningitis given 11% of our isolates were not susceptible to ceftriaxone. It is important to consider underlying conditions predisposing to IPD in a population with high rates of pneumococcal vaccination.
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9
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Castro-Rodriguez JA, Abarca K, Forno E. Asthma and the Risk of Invasive Pneumococcal Disease: A Meta-analysis. Pediatrics 2020; 145:peds.2019-1200. [PMID: 31843863 PMCID: PMC6939845 DOI: 10.1542/peds.2019-1200] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/28/2019] [Indexed: 12/27/2022] Open
Abstract
CONTEXT Invasive pneumococcal disease (IPD) and pneumonia are a leading cause of morbidity and mortality throughout the world, and asthma is the most common chronic disease of childhood. OBJECTIVE To evaluate the risk of IPD or pneumonia among children with asthma after the introduction of pneumococcal conjugate vaccines (PCVs). DATA SOURCES Four electronic databases were searched. STUDY SELECTION We selected all cohorts or case-control studies of IPD and pneumonia in populations who already received PCV (largely 7-valent pneumococcal conjugate vaccine), but not 23-valent pneumococcal polysaccharide, in which authors reported data for children with asthma and in which healthy controls were included, without language restriction. DATA EXTRACTION Two reviewers independently reviewed all studies. Primary outcomes were occurrence of IPD and pneumonia. Secondary outcomes included mortality, hospital admissions, hospital length of stay, ICU admission, respiratory support, costs, and additional medication use. RESULTS Five studies met inclusion criteria; of those, 3 retrospective cohorts (∼26 million person-years) and 1 case-control study (N = 3294 children) qualified for the meta-analysis. Children with asthma had 90% higher odds of IPD than healthy controls (odds ratio = 1.90; 95% confidence interval = 1.63-2.11; I2 = 1.7%). Pneumonia was also more frequent among children with asthma than among controls, and 1 study reported that pneumonia-associated costs increased by asthma severity. LIMITATIONS None of the identified studies had information of asthma therapy or compliance. CONCLUSIONS Despite PCV vaccination, children with asthma continue to have a higher risk of IPD than children without asthma. Further research is needed to assess the need for supplemental 23-valent pneumococcal polysaccharide vaccination in children with asthma, regardless of their use of oral steroids.
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Affiliation(s)
| | - Katia Abarca
- Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; and
| | - Erick Forno
- Division of Pulmonary Medicine, Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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10
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Tan TQ. Asthma and Invasive Pneumococcal Disease in the Age of Pneumococcal Conjugate Vaccines. Pediatrics 2020; 145:peds.2019-3360. [PMID: 31843862 DOI: 10.1542/peds.2019-3360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- Tina Q Tan
- Infectious Diseases Division, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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11
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Long-term Vaccine Impact on Invasive Pneumococcal Disease Among Children With Significant Comorbidities in a Large Australian Birth Cohort. Pediatr Infect Dis J 2019; 38:967-973. [PMID: 31408056 DOI: 10.1097/inf.0000000000002407] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Little is known about long-term invasive pneumococcal disease (IPD) incidence in children with risk factors (RFs) in populations with high coverage pneumococcal conjugate vaccine (PCV) programs. We measured IPD burden and changes with PCV use in children by RF status. METHODS A retrospective cohort of all live births in 2001-2012 in New South Wales, Australia was linked to IPD, hospitalization and death data. RFs were identified from International Classification of Diseases codes in linked hospitalizations. For each RF adjusted hazard ratios (aHRs, using Cox models), population attributable fractions (PAFs) and changes post-PCV relative to baseline for IPD were calculated. RESULTS One-thousand two-hundred fifty-one IPD cases occurred in ~1.1 million children in 12-year study cohort. The 75,404 children (6.8% of cohort) with RFs accounted for 255 (20.4%) IPD cases [rate (per 100,000 person-years) of 61 compared with 14 in no RFs]. Asthma was most common RF (n = 41,074; 3.6%) but highest IPD risk was in 2452 children (0.2%) with immunosuppression, splenic dysfunction or breach in cerebrospinal fluid barrier (aHR~20; PAF 0.7-1.8%) versus asthma (aHR 5.3; PAF 14.8%). Compared with 2001-2004 birth cohort (baseline), IPD incidence in PCV-eligible 2009-2012 birth cohort was 78% (95% confidence interval: -72% to -82%) less in children without RFs. IPD declined nonsignificantly (13%; 95% confidence interval: -70% to +138%) in highest IPD risk group, but by 67% (-43% to -82%) in children with other RFs. CONCLUSIONS By 8 years of universal PCV, IPD incidence reduced significantly in all children except in the 0.2% at highest risk, for whom antibiotic prophylaxis and additional vaccine doses are recommended but compliance and effectiveness remain uncertain.
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12
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Vardanjani HM, Borna H, Ahmadi A. Effectiveness of pneumococcal conjugate vaccination against invasive pneumococcal disease among children with and those without HIV infection: a systematic review and meta-analysis. BMC Infect Dis 2019; 19:685. [PMID: 31382917 PMCID: PMC6683423 DOI: 10.1186/s12879-019-4325-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/26/2019] [Indexed: 01/11/2023] Open
Abstract
Background HIV-infected children are at a higher risk of Invasive Pneumococcal Disease (IPD) and its mortality, even in the era of antiretroviral therapy. Therefore, an effective vaccination strategy would be beneficial. To investigate the effectiveness of Pneumococcal Conjugate Vaccination (PCV) against IPD among HIV-Infected and HIV-Uninfected Children through a systematic review and meta-analysis. Methods Observational studies and randomized trials on 7 years old or older children were searched in the Cochrane Library, Web of Science core collection, Embase, Medline/PubMed, and Google Scholar. Critical appraisal was done using the Cochrane risk of bias tool and the Newcastle-Ottawa quality assessment form. Effectiveness and efficacy of at least one dose of PCV was investigated among children with and without HIV considering subgroups of pneumococcal serotypes. We meta-analyzed the effect sizes using random-effects modeling. Results Efficacy of PCV was estimated as 45.0% (31.2, 56.1) and 52.6% (25.7, 69.8) among HIV-infected and HIV-uninfected children, respectively. Effectiveness of PCV among HIV-infected children as − 6.2% (− 67.6, 32.7) was significantly lower than HIV-uninfected children 65.1% (47.3, 76.9). Effectiveness of PCV among HIV-infected children for IPDs caused by vaccine serotypes was estimated as 7.7(− 66.7, 48.9), and for IPDs caused by non-vaccine serotypes was estimated as − 402.8(− 1856, − 29.2). Conclusion Unlike the evidence on the efficacy of PCV against IPD among both of HIV-infected and HIV-uninfected children, its effectiveness against IPD among HIV-infected children is much less limited. Review registration The study protocol was registered at PROSPERO (registration ID: CRD42018108187). Electronic supplementary material The online version of this article (10.1186/s12879-019-4325-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hossein Molavi Vardanjani
- Molecular Biology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hodjat Borna
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ali Ahmadi
- Molecular Biology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.
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13
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McGirr A, Iqbal SM, Izurieta P, Talarico C, Luijken J, Redig J, Newson RS. A systematic literature review and network meta-analysis feasibility study to assess the comparative efficacy and comparative effectiveness of pneumococcal conjugate vaccines. Hum Vaccin Immunother 2019; 15:2713-2724. [PMID: 31216216 PMCID: PMC6930063 DOI: 10.1080/21645515.2019.1612667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: No head-to-head studies are currently available comparing pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) with 13-valent pneumococcal conjugate vaccine (PCV-13). This study explored the feasibility of using network meta-analysis (NMA) to conduct an indirect comparison of the relative efficacy or effectiveness of the two vaccines. Methods: A systematic literature search was conducted for published randomized controlled trials (RCTs) and non-RCT studies reporting data on vaccine efficacy or effectiveness against invasive pneumococcal disease in children aged <5 years receiving 7-valent pneumococcal conjugate vaccine (PCV-7), PHiD-CV or PCV-13. Study quality was evaluated using published scales. NMA feasibility was assessed by considering whether a connected network could be constructed by examining published studies for differences in study or patient characteristics that could act as potential treatment effect modifiers or confounding variables. Results: A total of 26 publications were included; 2 RCTs (4 publications), 7 indirect cohort studies, and 14 case-control studies (15 publications). Study quality was generally good. The RCTs could not be connected in a network as there was no common comparator. The studies differed considerably in design, dose number, administration schedules, and subgroups analyzed. Reporting of exposure status and subject characteristics was inconsistent. Conclusion: NMA to compare the relative efficacy or effectiveness of PHiD-CV and PCV-13 is not feasible on the current evidence base, due to the absence of a connected network across the two RCTs and major heterogeneity between studies. NMA may be possible in future if sufficient RCTs become available to construct a connected network.
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14
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Croucher NJ, Løchen A, Bentley SD. Pneumococcal Vaccines: Host Interactions, Population Dynamics, and Design Principles. Annu Rev Microbiol 2018; 72:521-549. [DOI: 10.1146/annurev-micro-090817-062338] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Streptococcus pneumoniae (the pneumococcus) is a nasopharyngeal commensal and respiratory pathogen. Most isolates express a capsule, the species-wide diversity of which has been immunologically classified into ∼100 serotypes. Capsule polysaccharides have been combined into multivalent vaccines widely used in adults, but the T cell independence of the antibody response means they are not protective in infants. Polysaccharide conjugate vaccines (PCVs) trigger a T cell–dependent response through attaching a carrier protein to capsular polysaccharides. The immune response stimulated by PCVs in infants inhibits carriage of vaccine serotypes (VTs), resulting in population-wide herd immunity. These were replaced in carriage by non-VTs. Nevertheless, PCVs drove reductions in infant pneumococcal disease, due to the lower mean invasiveness of the postvaccination bacterial population; age-varying serotype invasiveness resulted in a smaller reduction in adult disease. Alternative vaccines being tested in trials are designed to provide species-wide protection through stimulating innate and cellular immune responses, alongside antibodies to conserved antigens.
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Affiliation(s)
- Nicholas J. Croucher
- Department of Infectious Disease Epidemiology, Imperial College London, London W2 1PG, United Kingdom
| | - Alessandra Løchen
- Department of Infectious Disease Epidemiology, Imperial College London, London W2 1PG, United Kingdom
| | - Stephen D. Bentley
- Infection Genomics Programme, Wellcome Sanger Institute, Hinxton, Cambridge CB10 1SA, United Kingdom
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15
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Edwards MR, Saglani S, Schwarze J, Skevaki C, Smith JA, Ainsworth B, Almond M, Andreakos E, Belvisi MG, Chung KF, Cookson W, Cullinan P, Hawrylowicz C, Lommatzsch M, Jackson D, Lutter R, Marsland B, Moffatt M, Thomas M, Virchow JC, Xanthou G, Edwards J, Walker S, Johnston SL. Addressing unmet needs in understanding asthma mechanisms: From the European Asthma Research and Innovation Partnership (EARIP) Work Package (WP)2 collaborators. Eur Respir J 2017; 49:49/5/1602448. [PMID: 28461300 DOI: 10.1183/13993003.02448-2016] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 03/13/2017] [Indexed: 12/27/2022]
Abstract
Asthma is a heterogeneous, complex disease with clinical phenotypes that incorporate persistent symptoms and acute exacerbations. It affects many millions of Europeans throughout their education and working lives and puts a heavy cost on European productivity. There is a wide spectrum of disease severity and control. Therapeutic advances have been slow despite greater understanding of basic mechanisms and the lack of satisfactory preventative and disease modifying management for asthma constitutes a significant unmet clinical need. Preventing, treating and ultimately curing asthma requires co-ordinated research and innovation across Europe. The European Asthma Research and Innovation Partnership (EARIP) is an FP7-funded programme which has taken a co-ordinated and integrated approach to analysing the future of asthma research and development. This report aims to identify the mechanistic areas in which investment is required to bring about significant improvements in asthma outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Rene Lutter
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Benjamin Marsland
- University of Lausanne, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | | | | | - Georgina Xanthou
- Biomedical Research Foundation, Academy of Athens, Athens, Greece
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16
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Abstract
BACKGROUND Bacterial meningitis is a significant burden of disease and mortality in all age groups worldwide despite the development of effective conjugated vaccines. The pathogenesis of bacterial meningitis is based on complex and incompletely understood host-pathogen interactions. Some of these are pathogen-specific, while some are shared between different bacteria. METHODS We searched the database PubMed to identify host risk factors for bacterial meningitis caused by the pathogens Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae type b, because they are three most common causative bacteria beyond the neonatal period. RESULTS We describe a number of risk factors; including socioeconomic factors, age, genetic variation of the host and underlying medical conditions associated with increased susceptibility to invasive bacterial infections in both children and adults. CONCLUSIONS As conjugated vaccines are available for these infections, it is of utmost importance to identify high risk patients to be able to prevent invasive disease.
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Affiliation(s)
- Lene Fogt Lundbo
- a Department of Infectious Diseases , Copenhagen University Hospital , Hvidovre , Denmark.,b Clinical Research Centre , Copenhagen University Hospital , Hvidovre , Denmark.,c Faculty of Health and Medical Sciences , University of Copenhagen , København , Denmark
| | - Thomas Benfield
- a Department of Infectious Diseases , Copenhagen University Hospital , Hvidovre , Denmark.,b Clinical Research Centre , Copenhagen University Hospital , Hvidovre , Denmark.,c Faculty of Health and Medical Sciences , University of Copenhagen , København , Denmark
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17
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Rolfes MC, Juhn YJ, Wi CI, Sheen YH. Asthma and the Risk of Rheumatoid Arthritis: An Insight into the Heterogeneity and Phenotypes of Asthma. Tuberc Respir Dis (Seoul) 2017; 80:113-135. [PMID: 28416952 PMCID: PMC5392483 DOI: 10.4046/trd.2017.80.2.113] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 12/03/2016] [Accepted: 12/08/2016] [Indexed: 01/05/2023] Open
Abstract
Asthma is traditionally regarded as a chronic airway disease, and recent literature proves its heterogeneity, based on distinctive clusters or phenotypes of asthma. In defining such asthma clusters, the nature of comorbidity among patients with asthma is poorly understood, by assuming no causal relationship between asthma and other comorbid conditions, including both communicable and noncommunicable diseases. However, emerging evidence suggests that the status of asthma significantly affects the increased susceptibility of the patient to both communicable and noncommunicable diseases. Specifically, the impact of asthma on susceptibility to noncommunicable diseases such as chronic systemic inflammatory diseases (e.g., rheumatoid arthritis), may provide an important insight into asthma as a disease with systemic inflammatory features, a conceptual understanding between asthma and asthma-related comorbidity, and the potential implications on the therapeutic and preventive interventions for patients with asthma. This review discusses the currently under-recognized clinical and immunological phenotypes of asthma; specifically, a higher risk of developing a systemic inflammatory disease such as rheumatoid arthritis and their implications, on the conceptual understanding and management of asthma. Our discussion is divided into three parts: literature summary on the relationship between asthma and the risk of rheumatoid arthritis; potential mechanisms underlying the association; and implications on asthma management and research.
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Affiliation(s)
| | - Young Jun Juhn
- Department of Pediatric and Adolescent Medicine/Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Chung-Il Wi
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Youn Ho Sheen
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Pediatrics, CHA Gangnam Medical Center, CHA University, Seoul, Korea
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18
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Chiu NC, Chi H, Peng CC, Chang HY, Huang DTN, Chang L, Lei WT, Lin CY. Retrospective study of prognostic factors in pediatric invasive pneumococcal disease. PeerJ 2017; 5:e2941. [PMID: 28149700 PMCID: PMC5270593 DOI: 10.7717/peerj.2941] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 12/26/2016] [Indexed: 12/27/2022] Open
Abstract
Streptococcus pneumoniae remains the leading causative pathogen in pediatric pneumonia and bacteremia throughout the world. The invasive pneumococcal disease (IPD) is known as isolation of S. pneumoniae from a normally sterile site (e.g., blood, cerebrospinal fluid, synovial fluid, pericardial fluid, pleural fluid, or peritoneal fluid). The aim of this study is to survey the clinical manifestations and laboratory results of IPD and identify the prognostic factors of mortality. From January 2001 to December 2006, a retrospective review of chart was performed in a teaching hospital in Taipei. The hospitalized pediatric patients with the diagnosis of pneumonia, arthritis, infectious endocarditis, meningitis or sepsis were recruited. Among them, 50 patients were pneumococcal infections proved by positive culture results or antigen tests. Clinical manifestations, laboratory data and hospitalization courses were analyzed. The median age was 3.5-year-old and there were 30 male patients (60%). Eight patients (16%) had underlying disease such as leukemia or congenital heart disease. Hemolytic uremic syndrome (HUS) was observed in ten patients and extracorporeal membrane oxygenation (ECMO) was performed in three patients. Leukocytosis, elevated C-reactive protein and AST level were noted in most of the patients. The overall mortality rate was 10%. We found that leukopenia, thrombocytopenia and high CRP level were significant predictors for mortality. In conclusion, S. pneumoniae remains an important health threat worldwide and IPD is life-threatening with high mortality rate. We found leukopenia, thrombocytopenia, and high CRP levels to be associated with mortality in pediatric IPD, and these factors are worthy of special attention at admission. Although we failed to identify a statistically significant prognostic factor in multivariate analysis due to relatively small sample size, we suggest an aggressive antibiotic treatment in patients with these factors at admission. Further large-scale studies are warranted.
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Affiliation(s)
- Nan-Chang Chiu
- Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan.,MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan.,MacKay Medical College, New Taipei, Taiwan
| | - Hsin Chi
- Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan.,MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan.,MacKay Medical College, New Taipei, Taiwan
| | - Chun-Chih Peng
- Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan.,MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan.,MacKay Medical College, New Taipei, Taiwan
| | - Hung-Yang Chang
- Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan.,Department of Medical Technology, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
| | - Daniel Tsung-Ning Huang
- Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan.,MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Lung Chang
- Department of Pediatrics, MacKay Children's Hospital, Taipei, Taiwan.,MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Wei-Te Lei
- Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
| | - Chien-Yu Lin
- Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan
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19
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Sterky E, Bennet R, Lindstrand A, Eriksson M, Nilsson A. The impact of pneumococcal conjugate vaccine on community-acquired pneumonia hospitalizations in children with comorbidity. Eur J Pediatr 2017; 176:337-342. [PMID: 28070670 PMCID: PMC5321702 DOI: 10.1007/s00431-016-2843-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 12/20/2016] [Accepted: 12/23/2016] [Indexed: 01/04/2023]
Abstract
UNLABELLED The burden of community-acquired pneumonia (CAP) in high-income countries is still significant. The introduction of pneumococcal conjugate vaccines (PCV) has reduced the overall need for hospitalization for CAP. However, it is not clear whether children with underlying disease also have benefitted from the PCV immunization programme. Children 0 to <5 years of age hospitalized with CAP and discharged with an ICD-10 code of J13-J18.9 between November 1, 2005, and April 30, 2007 (pre-vaccination period), and November 1, 2010, and April 30, 2012 (post-vaccination period), were eligible for this study. Data on hospitalization and discharge diagnoses were retrieved from the Hospital Registry. In addition, chart review was performed in 50% of the patients. Our result confirmed a decrease in hospitalization rate for CAP in the PCV13 period. Chart review revealed that half of the patients had underlying comorbidity and these children had more severe symptoms and required longer hospital stay. Intensive care was provided to less than 10% of the children and mostly for children with an underlying neurological disease. CONCLUSIONS We show that all children have benefitted from the reduction of CAP hospitalization after introduction of PCV. Our finding emphasizes the importance of children with chronic diseases receiving adequate vaccinations that may protect from lower respiratory diseases. What is known? • Community-acquired pneumonia is a leading infectious cause of hospitalizations and death among children <5 years of age globally • Pneumococcal conjugate vaccine reduces the hospitalizations of all-cause pneumonia What is new? • We show that also children with underlying comorbidities have benefitted from PCV immunization with a reduction of CAP hospitalization • We show that approximately half of all children hospitalized with CAP also have underlying comorbidities.
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Affiliation(s)
- Ellinor Sterky
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Ann Lindstrand
- Paediatric Infectious Diseases Unit, Paediatric Emergency Department, Astrid Lindgren’s Children Hospital, Stockholm, Sweden
| | | | - Anna Nilsson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden. .,Childhood Cancer Research Unit Q6:05, Astrid Lindgren Childrens Hospital, Stockholm, Sweden.
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20
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Link-Gelles R, Westreich D, Aiello AE, Shang N, Weber DJ, Holtzman C, Scherzinger K, Reingold A, Schaffner W, Harrison LH, Rosen JB, Petit S, Farley M, Thomas A, Eason J, Wigen C, Barnes M, Thomas O, Zansky S, Beall B, Whitney CG, Moore MR. Bias with respect to socioeconomic status: A closer look at zip code matching in a pneumococcal vaccine effectiveness study. SSM Popul Health 2016; 2:587-594. [PMID: 27668279 PMCID: PMC5033249 DOI: 10.1016/j.ssmph.2016.08.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
In 2010, 13-valent pneumococcal conjugate vaccine (PCV13) was introduced in the US for prevention of invasive pneumococcal disease in children. Individual-level socioeconomic status (SES) is a potential confounder of the estimated effectiveness of PCV13 and is often controlled for in observational studies using zip code as a proxy. We assessed the utility of zip code matching for control of SES in a post-licensure evaluation of the effectiveness of PCV13 (calculated as [1-matched odds ratio]*100). We used a directed acyclic graph to identify subsets of confounders and collected SES variables from birth certificates, geocoding, a parent interview, and follow-up with medical providers. Cases tended to be more affluent than eligible controls (for example, 48.3% of cases had private insurance vs. 44.6% of eligible controls), but less affluent than enrolled controls (52.9% of whom had private insurance). Control of confounding subsets, however, did not result in a meaningful change in estimated vaccine effectiveness (original estimate: 85.1%, 95% CI 74.8–91.9%; adjusted estimate: 82.5%, 95% CI 65.6–91.1%). In the context of a post-licensure vaccine effectiveness study, zip code appears to be an adequate, though not perfect, proxy for individual SES. Socioeconomic status (SES) may impact enrollment in vaccine effectiveness studies. We assessed zip code matching as a proxy for SES in a pneumococcal vaccine study. After zip code matching, we found differences in SES between cases and controls. Differences did not appear to substantially bias estimated vaccine effectiveness.
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Affiliation(s)
- Ruth Link-Gelles
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, MS C-25, Atlanta, GA 30329, USA; Department of Epidemiology, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27516, USA
| | - Daniel Westreich
- Department of Epidemiology, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27516, USA
| | - Allison E Aiello
- Department of Epidemiology, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27516, USA
| | - Nong Shang
- Department of Epidemiology, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27516, USA
| | - David J Weber
- Department of Epidemiology, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27516, USA
| | - Corinne Holtzman
- Minnesota Department of Health, P.O. Box 64975, St. Paul, MN 55164, USA
| | - Karen Scherzinger
- Institute for Public Health, University of New Mexico, Emerging Infections Program, 1601 Randolph SE, Suite 1005, Albuquerque, NM 87106, USA
| | - Arthur Reingold
- California Emerging Infections Program, 360 22nd Street, Suite 750, Oakland, CA 94612, USA
| | - William Schaffner
- Department of Preventive Medicine, Vanderbilt University School of Medicine, 1500 21st Avenue South, Suite 2600, Nashville, TN 37212, USA
| | - Lee H Harrison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 201 W. Preston Street, Baltimore, MD 21201, USA
| | - Jennifer B Rosen
- New York City Department of Health and Mental Hygiene, 125 Worth St, New York, NY 10013, USA
| | - Susan Petit
- Connecticut Department of Public Health, 410 Capitol Avenue, Hartford, CT 06134, USA
| | - Monica Farley
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA; Infection Disease Section, Medical Specialty Care Service Line, Atlanta VA Medical Center, 1670 Clairmont Road, Station 152, Decatur, GA 30033, USA
| | - Ann Thomas
- Oregon Public Health Division and Oregon Emerging Infections Program, 800 NE Oregon Street, Suite 772, Portland, OR 97232, USA
| | - Jeffrey Eason
- Bureau of Epidemiology, Utah Department of Health, 288 N 1460 W, Salt Lake City, UT 84116, USA
| | - Christine Wigen
- County of Los Angeles Department of Public Health, 313 N Figueroa St, Los Angeles, CA 90012, USA
| | - Meghan Barnes
- Colorado Emerging Infections Program, 4300 Cherry Creek Drive South, Denver, CO 80246, USA
| | - Ola Thomas
- County of Los Angeles Department of Public Health, 313 N Figueroa St, Los Angeles, CA 90012, USA
| | - Shelley Zansky
- New York State Department of Health, Corning Tower, Room 651, Empire State Plaza, Albany, NY 12237, USA
| | - Bernard Beall
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, MS C-25, Atlanta, GA 30329, USA
| | - Cynthia G Whitney
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, MS C-25, Atlanta, GA 30329, USA
| | - Matthew R Moore
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, MS C-25, Atlanta, GA 30329, USA
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21
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Johnston SL, Szigeti M, Cross M, Brightling C, Chaudhuri R, Harrison T, Mansur A, Robison L, Sattar Z, Jackson D, Mallia P, Wong E, Corrigan C, Higgins B, Ind P, Singh D, Thomson NC, Ashby D, Chauhan A. Azithromycin for Acute Exacerbations of Asthma : The AZALEA Randomized Clinical Trial. JAMA Intern Med 2016; 176:1630-1637. [PMID: 27653939 DOI: 10.1001/jamainternmed.2016.5664] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
IMPORTANCE Guidelines recommend against antibiotic use to treat asthma attacks. A study with telithromycin reported benefit, but adverse reactions limit its use. OBJECTIVE To determine whether azithromycin added to standard care for asthma attacks in adults results in clinical benefit. DESIGN, SETTING, AND PARTICIPANTS The Azithromycin Against Placebo in Exacerbations of Asthma (AZALEA) randomized, double-blind, placebo-controlled clinical trial, a United Kingdom-based multicenter study in adults requesting emergency care for acute asthma exacerbations, ran from September 2011 to April 2014. Adults with a history of asthma for more than 6 months were recruited within 48 hours of presentation to medical care with an acute deterioration in asthma control requiring a course of oral and/or systemic corticosteroids. INTERVENTIONS Azithromycin 500 mg daily or matched placebo for 3 days. MAIN OUTCOMES AND MEASURES The primary outcome was diary card symptom score 10 days after randomization, with a hypothesized treatment effect size of -0.3. Secondary outcomes were diary card symptom score, quality-of-life questionnaires, and lung function changes, all between exacerbation and day 10, and time to a 50% reduction in symptom score. RESULTS Of 4582 patients screened at 31 centers, 199 of a planned 380 were randomized within 48 hours of presentation. The major reason for nonrecruitment was receipt of antibiotics (2044 [44.6%] screened patients). Median time from presentation to drug administration was 22 hours (interquartile range, 14-28 hours). Exacerbation characteristics were well balanced across treatment arms and centers. The primary outcome asthma symptom scores were mean (SD), 4.14 (1.38) at exacerbation and 2.09 (1.71) at 10 days for the azithromycin group and 4.18 (1.48) and 2.20 (1.51) for the placebo group, respectively. Using multilevel modeling, there was no significant difference in symptom scores between azithromycin and placebo at day 10 (difference, -0.166; 95% CI, -0.670 to 0.337), nor on any day between exacerbation and day 10. No significant between-group differences were observed in quality-of-life questionnaires or lung function between exacerbation and day 10, or in time to 50% reduction in symptom score. CONCLUSIONS AND RELEVANCE In this randomized population, azithromycin treatment resulted in no statistically or clinically significant benefit. For each patient randomized, more than 10 were excluded because they had already received antibiotics. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01444469.
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Affiliation(s)
| | - Matyas Szigeti
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, England
| | - Mary Cross
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, England
| | | | - Rekha Chaudhuri
- Institute of Infection Immunity and Inflammation, University of Glasgow, Glasgow, Scotland.,Respiratory Medicine, NHS Greater Glasgow and Clyde, Glasgow, Scotland
| | - Timothy Harrison
- Nottingham Respiratory Research Unit, University of Nottingham, Nottingham, England
| | - Adel Mansur
- Respiratory Medicine, Heart of England Foundation Trust, Birmingham, England.,Severe and Brittle Asthma Unit, University of Birmingham, Birmingham, England
| | - Laura Robison
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, England
| | - Zahid Sattar
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, England
| | - David Jackson
- National Heart and Lung Institute, Imperial College London, London, England
| | - Patrick Mallia
- National Heart and Lung Institute, Imperial College London, London, England
| | - Ernie Wong
- National Heart and Lung Institute, Imperial College London, London, England
| | - Christopher Corrigan
- Respiratory Medicine and Allergy, King's College London School of Medicine, London, England.,Department of Asthma, Allergy and Respiratory Science, Guy's and St. Thomas' NHS Foundation Trust, London, England
| | - Bernard Higgins
- Respiratory Medicine, Newcastle University, Newcastle, England
| | - Philip Ind
- National Heart and Lung Institute, Imperial College London, London, England.,Respiratory Medicine, Imperial College Healthcare NHS Trust, London, England
| | - Dave Singh
- Centre for Respiratory Medicine and Allergy, Medicines Evaluation Unit, University of Manchester and University Hospital of South Manchester NHS Foundation Trust, Manchester, England
| | - Neil C Thomson
- Institute of Infection Immunity and Inflammation, University of Glasgow, Glasgow, Scotland
| | - Deborah Ashby
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, England
| | - Anoop Chauhan
- Respiratory Medicine, Portsmouth Hospitals NHS Trust, Portsmouth, England
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22
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Risk of underlying chronic medical conditions for invasive pneumococcal disease in adults. Vaccine 2016; 34:4293-7. [DOI: 10.1016/j.vaccine.2016.07.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 06/14/2016] [Accepted: 07/04/2016] [Indexed: 11/21/2022]
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23
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Hon KL, Tsang YCK, Chan LCN, Ng DKK, Miu TY, Chan JY, Lee A, Leung TF. A community-based cross-sectional immunisation survey in parents of primary school students. NPJ Prim Care Respir Med 2016; 26:16011. [PMID: 27053378 PMCID: PMC4823920 DOI: 10.1038/npjpcrm.2016.11] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 01/12/2016] [Accepted: 01/26/2016] [Indexed: 11/11/2022] Open
Abstract
Immunisation is a very important aspect of child health. Invasive pneumococcal and influenza diseases have been major vaccine-available communicable diseases. We surveyed demographics and attitudes of parents of primary school students who received pneumococcal conjugate vaccination (PCV) and compared them with those who did not receive pneumococcal vaccination. The survey was carried out in randomly selected primary schools in Hong Kong. Questionnaires were sent to nine primary schools between June and September 2014. Parents of 3,485 children were surveyed, and 3,479 (1,452 PCV immunised, 2,027 un-immunised) valid questionnaires were obtained. Demographic data were generally different between the two groups. PCV-immunised children were more likely to be female (57.0 vs. 52.2%, P=0.005), born in Hong Kong (94.2 vs. 92.3%, P=0.031), have a parent with tertiary education (49.2 vs. 31.8, P<0.0005), from the higher-income group (P=0.005), have suffered upper respiratory infections, pneumonia, otitis media or sinusitis (P=0.019), and have doctor visits in preceding 12 months (P=0.009). They were more likely to have received additional immunisations outside the Hong Kong Childhood Immunization Programme (64.0 vs. 30.6%, P<0.0005) at private practitioner clinics (91.1 vs. 83.5%, P<0.0005). Un-immunised children were more likely to live with senior relatives who had not received PCV. Their parents were less likely to be aware of public education programme on PCV and influenza immunisation, and children were less likely to have received influenza vaccination. The major reasons for PCV immunisations were parent awareness that pneumococcal disease could be severe and vaccines were efficacious in prevention. The major reasons for children not being immunised with PCV were concerns about vaccine side effects, cost, vaccine not efficacious or no recommendation by family doctor or government. In conclusion, PCV unimmunized children were prevalent during the study period. Reportedly, they were generally less likely to have received influenza and other childhood vaccines, and more likely to live with senior relatives who had not received PCV and influenza. These observations provide important demographic data for public health policy in childhood immunisation programme.
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Affiliation(s)
- Kam Lun Hon
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.,Hong Kong Society of Paediatric Respirology and Allergy, Hong Kong
| | - Yin Ching K Tsang
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Lawrence C N Chan
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Daniel K K Ng
- Hong Kong Society of Paediatric Respirology and Allergy, Hong Kong.,Department of Paediatrics, Kwong Wah Hospital, Yau Ma Tei, Hong Kong
| | - Ting Yat Miu
- Hong Kong Society of Paediatric Respirology and Allergy, Hong Kong
| | - Johnny Y Chan
- Hong Kong Society of Paediatric Respirology and Allergy, Hong Kong.,Department of Paediatrics, Kwong Wah Hospital, Yau Ma Tei, Hong Kong
| | - Albert Lee
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ting Fan Leung
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.,Hong Kong Society of Paediatric Respirology and Allergy, Hong Kong
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24
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McLaughlin JM, Utt EA, Hill NM, Welch VL, Power E, Sylvester GC. A current and historical perspective on disparities in US childhood pneumococcal conjugate vaccine adherence and in rates of invasive pneumococcal disease: Considerations for the routinely-recommended, pediatric PCV dosing schedule in the United States. Hum Vaccin Immunother 2015; 12:206-12. [PMID: 26376039 PMCID: PMC4962742 DOI: 10.1080/21645515.2015.1069452] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Previous research has suggested that reducing the US 4-dose PCV13 schedule to a 3-dose schedule may provide cost savings, despite more childhood pneumococcal disease. The study also stressed that dose reduction should be coupled with improved PCV adherence, however, US PCV uptake has leveled-off since 2008. An estimated 24–36% of US children aged 5–19 months are already receiving a reduced PCV schedule (i.e., missing ≥1 dose). This raises a practical concern that, under a reduced, 3-dose schedule, a similar proportion of children may receive ≤2 doses. It is also unknown if a reduced, 3-dose PCV schedule in the United States will afford the same disease protection as 3-dose schedules used elsewhere, given lower US PCV adherence. Finally, more assurance is needed that, under a reduced schedule, racial, socioeconomic, and geographic disparities in PCV adherence will not correspond with disproportionately higher rates of pneumococcal disease among poor or minority children.
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Key Words
- pneumococcal conjugate vaccine (PCV), adherence, coverage, dosing schedule, disparities, race, minorities, socioeconomic status, pneumococcal disease, 2+1, 3+1
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25
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Usuf E, Badji H, Bojang A, Jarju S, Ikumapayi UN, Antonio M, Mackenzie G, Bottomley C. Pneumococcal carriage in rural Gambia prior to the introduction of pneumococcal conjugate vaccine: a population-based survey. Trop Med Int Health 2015; 20:871-9. [PMID: 25778937 DOI: 10.1111/tmi.12505] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate pneumococcal colonisation before and after the introduction of pneumococcal conjugate vaccine (PCV) in eastern Gambia. METHODS Population-based cross-sectional survey of pneumococcal carriage between May and August 2009 before the introduction of PCV into the Expanded Program on Immunization. Nasopharyngeal swabs were collected from all household members, but in selected households, only children aged 6-10 years were swabbed. This age group participated in an earlier trial of a nine-valent PCV between 2000 and 2004. RESULTS The prevalence of nasopharyngeal pneumococcal carriage in 2933 individuals was 72.0% in underfives (N = 515), 41.6% in children aged 5-17 (N = 1508) and 13.0% in adults ≥18 (N = 910) years. The age-specific prevalence of serotypes included in PCV7, PCV10 and PCV13 was 24.7%, 26.6% and 46.8% among children <5 years of age; 8.5%, 9.2% and 17.7% among children 5-17 years; and 2.5%, 3.3% and 5.5% among adults ≥18 years. The most common serotypes were 6A (13.1%), 23F (7.6%), 3 (7.3%), 19F (7.1%) and 34 (4.6%). There was no difference in the overall carriage of pneumococci between vaccinated and unvaccinated children 8 years after the primary vaccination with three doses of PCV (48.3% vs. 41.1%). CONCLUSION Before the introduction of PCV, serotypes included in PCV13 accounted for about half the pneumococcal serotypes in nasopharyngeal carriage. Thus, the potential impact of PCV13 on pneumococcal disease in the Gambia is substantial.
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Affiliation(s)
- Effua Usuf
- Medical Research Council Unit, Fajara, The Gambia
| | - Henry Badji
- Medical Research Council Unit, Fajara, The Gambia
| | | | - Sheikh Jarju
- Medical Research Council Unit, Fajara, The Gambia
| | | | - Martin Antonio
- Medical Research Council Unit, Fajara, The Gambia.,Microbiology and Infection Unit, University of Warwick, Coventry, UK.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Grant Mackenzie
- Medical Research Council Unit, Fajara, The Gambia.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Murdoch Children's Research Institute, Melbourne, Vic., Australia
| | - Christian Bottomley
- Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
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26
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Yildirim I, Shea KM, Little BA, Silverio AL, Pelton SI. Vaccination, underlying comorbidities, and risk of invasive pneumococcal disease. Pediatrics 2015; 135:495-503. [PMID: 25647674 DOI: 10.1542/peds.2014-2426] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Children with underlying conditions remain at increased risk for invasive pneumococcal diseases (IPD). This study describes the epidemiology, serotype distribution, clinical presentations, and outcomes of IPD in children with and without comorbidity. METHODS Cases of childhood IPD in Massachusetts were identified via enhanced surveillance from 2002 through 2014. Demographic and clinical data were collected via follow-up telephone interviews with parents and/or primary care providers. Underlying conditions were classified according to the 2012 Report of the Committee on Infectious Diseases and 2013 recommendations by the Advisory Committee on Immunization Practices. RESULTS Among 1052 IPD cases in Massachusetts children <18 years old, 22.1% had at least 1 comorbidity. Immunocompromising conditions (32.7%) and chronic respiratory diseases (22.4%) were most common. Children with comorbidities were older at the time of IPD diagnosis (median 54 vs 23 months, P < .001), had higher hospitalization (odds ratio 2.5; 95% confidence interval 1.7-3.6) and case-fatality rates (odds ratio 3.7; 95% confidence interval 1.5-8.9) compared with children without known underlying conditions after adjusting for age, gender, year of diagnosis, and pneumococcal vaccination status. During the last 2 years of the study, IPD among children with comorbidities was caused by non-pneumococcal conjugate vaccine 13 serotypes in 23-valent polysaccharide pneumococcal vaccine (6/12, 50%) or serotypes that are not included in any of the vaccines (6/12; 50%). CONCLUSIONS In children with comorbidity, IPD results in higher mortality, and a large proportion of disease is due to serotypes not included in current conjugate vaccines. Further research is needed, specifically to develop and evaluate additional strategies for prevention of IPD in the most vulnerable children.
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Affiliation(s)
- Inci Yildirim
- Section of Pediatric Infectious Diseases, Boston University Medical Center, Boston, Massachusetts; and Department of Epidemiology, Boston University, School of Public Health, Boston, Massachusetts
| | - Kimberly M Shea
- Section of Pediatric Infectious Diseases, Boston University Medical Center, Boston, Massachusetts; and Department of Epidemiology, Boston University, School of Public Health, Boston, Massachusetts
| | - Brent A Little
- Section of Pediatric Infectious Diseases, Boston University Medical Center, Boston, Massachusetts; and
| | - Amy L Silverio
- Section of Pediatric Infectious Diseases, Boston University Medical Center, Boston, Massachusetts; and
| | - Stephen I Pelton
- Section of Pediatric Infectious Diseases, Boston University Medical Center, Boston, Massachusetts; and Department of Epidemiology, Boston University, School of Public Health, Boston, Massachusetts
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27
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Kwak BO, Choung JT, Park YM. The association between asthma and invasive pneumococcal disease: a nationwide study in Korea. J Korean Med Sci 2015; 30:60-5. [PMID: 25552884 PMCID: PMC4278028 DOI: 10.3346/jkms.2015.30.1.60] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 09/04/2014] [Indexed: 12/28/2022] Open
Abstract
The purpose of this study was to investigate the association between asthma and invasive pneumococcal disease (IPD) in Korea. A retrospective population-based cohort study was conducted using the Korean Health Insurance Review and Assessment database 2010-2011. The subjects included 935,106 (2010) and 952,295 (2011), of whom 398 (2010) and 428 (2011) patients with IPD were identified. There was significant difference in the prevalence of IPD in patients with and without asthma (0.07% vs. 0.02% in 2010 and 0.08% vs. 0.01% in 2011; P<0.001). After adjusting for age and gender, patients with asthma showed over a three-fold increased risk of IPD compared with patients without asthma (adjusted odds ratio [aOR] 3.90, 95% confidence interval [CI] 3.02-5.03 in 2010 / aOR, 5.44; 95% CI, 4.10-7.22 in 2011; P<0.001). These findings were also significant in children (aOR, 2.08; 95% CI, 1.25-3.45 in 2010; P=0.005 / aOR, 3.26; 95% CI, 1.74-6.11 in 2011; P<0.001). Although diabetes mellitus was also significantly associated with IPD, relatively low ORs compared with those of asthma were noted (aOR, 1.85; 95% CI, 1.35-2.54 in 2010 / aOR, 2.40; 95% CI, 1.78-3.24 in 2011; P<0.001). Both children and adults with asthma are at increased risk of developing IPD.
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Affiliation(s)
- Byung Ok Kwak
- Department of Pediatrics, Konkuk University School of Medicine, Seoul, Korea
| | - Ji Tae Choung
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Yong Mean Park
- Department of Pediatrics, Konkuk University School of Medicine, Seoul, Korea
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28
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Risk factors for invasive pneumococcal disease among children less than 5 years of age in a high HIV prevalence setting, South Africa, 2010 to 2012. Pediatr Infect Dis J 2015; 34:27-34. [PMID: 24992122 DOI: 10.1097/inf.0000000000000484] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Invasive pneumococcal disease (IPD) causes significant disease burden, especially in developing countries, even in the era of pneumococcal conjugate vaccine and maternal-to-child HIV transmission prevention programs. We evaluated factors that might increase IPD risk in young children in a high HIV prevalence setting. METHODS We conducted a case-control study using IPD cases identified at 24 Group for Enteric, Respiratory and Meningeal disease Surveillance-South Africa program sites (2010-2012). At least 4 controls were matched by age, HIV status and hospital to each case. Potential risk factors were evaluated using multivariable conditional logistic regression. RESULTS In total, 486 age-eligible cases were enrolled. Factors associated with IPD in HIV-uninfected children (237 cases, 928 controls) included siblings <5 years [adjusted odds ratio (aOR) = 1.68, 95% confidence interval (CI): 1.16-2.46], underlying medical conditions (aOR = 1.99, CI 1.22-3.22), preceding upper respiratory tract infection (aOR = 1.79, CI 1.19-2.69), day-care attendance (aOR = 1.58, CI 1.01-2.47), perinatal HIV exposure (aOR = 1.62, CI 1.10-2.37), household car ownership (aOR = 0.45, CI 0.25-0.83) and ≥2 7-valent pneumococcal conjugate vaccine doses (aOR = 0.67, CI 0.46-0.99). Among HIV-infected children (124 cases, 394 controls), IPD-associated factors included malnutrition (aOR = 2.68, CI 1.40-5.14), upper respiratory tract infection (aOR = 3.49, CI 1.73-7.03), tuberculosis in the last 3 months (aOR = 5.12, CI 1.69-15.50) and current antiretroviral treatment (aOR = 0.13, CI 0.05-0.38). CONCLUSION Previously identified factors related to poverty, poor health and intense exposure continue to be risk factors for IPD in children. Ensuring delivery of pneumococcal conjugate vaccine and antiretroviral treatment are important for improving disease prevention.
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29
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Fleming-Dutra KE, Shapiro DJ, Hicks LA, Gerber JS, Hersh AL. Race, otitis media, and antibiotic selection. Pediatrics 2014; 134:1059-66. [PMID: 25404720 DOI: 10.1542/peds.2014-1781] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Previous research suggests that physicians may be less likely to diagnose otitis media (OM) and to prescribe broad-spectrum antibiotics for black versus nonblack children. Our objective was to determine whether race is associated with differences in OM diagnosis and antibiotic prescribing nationally. METHODS We examined OM visit rates during 2008 to 2010 for children ≤14 years old using the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. We compared OM visits between black and nonblack children, as percentages of all outpatient visits and visit rates per 1000. We compared antibiotic prescribing by race as the percentage of OM visits receiving narrow-spectrum (eg, amoxicillin) versus broader-spectrum antibiotics. We used multivariable logistic regression to examine whether race was independently associated with antibiotic selection for OM. RESULTS The percentage of all visits resulting in OM diagnosis was 30% lower in black children compared with others (7% vs 10%, P = .004). However, OM visits per 1000 population were not different between black and nonblack children (253 vs 321, P = .12). When diagnosed with OM during visits in which antibiotics were prescribed, black children were less likely to receive broad-spectrum antibiotics than nonblack children (42% vs 52%, P = .01). In multivariable analysis, black race was negatively associated with broad-spectrum antibiotic prescribing (adjusted odds ratio 0.59; 95% confidence interval, 0.40-0.86). CONCLUSIONS Differences in treatment choice for black children with OM may indicate race-based differences in physician practice patterns and parental preferences for children with OM.
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Affiliation(s)
| | - Daniel J Shapiro
- School of Medicine, University of California, San Francisco, California
| | - Lauri A Hicks
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jeffrey S Gerber
- Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Adam L Hersh
- Pediatric Infectious Diseases, University of Utah, Salt Lake City, Utah
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30
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Abstract
Routine use of the pneumococcal conjugate vaccines (PCV7 and PCV13), beginning in 2000, has resulted in a dramatic reduction in the incidence of invasive pneumococcal disease (IPD) attributable to serotypes of Streptococcus pneumoniae contained in the vaccines. The Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention and the American Academy of Pediatrics recommend the expanded use of PCV13 in children 6 through 18 years of age with certain conditions that place them at elevated risk of IPD. This statement provides recommendations for the use of PCV13 in children 6 through 18 years. A single dose of PCV13 should be administered to certain children in this age group who are at elevated risk of IPD. Recommendations for the use of PCV13 in healthy children and for pneumococcal polysaccharide vaccine (PPSV23) remain unchanged.
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Allergic airway inflammation decreases lung bacterial burden following acute Klebsiella pneumoniae infection in a neutrophil- and CCL8-dependent manner. Infect Immun 2014; 82:3723-39. [PMID: 24958709 DOI: 10.1128/iai.00035-14] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The Th17 cytokines interleukin-17A (IL-17A), IL-17F, and IL-22 are critical for the lung immune response to a variety of bacterial pathogens, including Klebsiella pneumoniae. Th2 cytokine expression in the airways is a characteristic feature of asthma and allergic airway inflammation. The Th2 cytokines IL-4 and IL-13 diminish ex vivo and in vivo IL-17A protein expression by Th17 cells. To determine the effect of IL-4 and IL-13 on IL-17-dependent lung immune responses to acute bacterial infection, we developed a combined model in which allergic airway inflammation and lung IL-4 and IL-13 expression were induced by ovalbumin sensitization and challenge prior to acute lung infection with K. pneumoniae. We hypothesized that preexisting allergic airway inflammation decreases lung IL-17A expression and airway neutrophil recruitment in response to acute K. pneumoniae infection and thereby increases the lung K. pneumoniae burden. As hypothesized, we found that allergic airway inflammation decreased the number of K. pneumoniae-induced airway neutrophils and lung IL-17A, IL-17F, and IL-22 expression. Despite the marked reduction in postinfection airway neutrophilia and lung expression of Th17 cytokines, allergic airway inflammation significantly decreased the lung K. pneumoniae burden and postinfection mortality. We showed that the decreased lung K. pneumoniae burden was independent of IL-4, IL-5, and IL-17A and partially dependent on IL-13 and STAT6. Additionally, we demonstrated that the decreased lung K. pneumoniae burden associated with allergic airway inflammation was both neutrophil and CCL8 dependent. These findings suggest a novel role for CCL8 in lung antibacterial immunity against K. pneumoniae and suggest new mechanisms of orchestrating lung antibacterial immunity.
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Wortham JM, Zell ER, Pondo T, Harrison LH, Schaffner W, Lynfield R, Thomas A, Reingold A, Bennett NM, Petit S, Aragon D, Bareta J, Juni BA, Farley MM, Beall B, Moore MR. Racial Disparities in Invasive Streptococcus pneumoniae Infections, 1998-2009. Clin Infect Dis 2014; 58:1250-7. [DOI: 10.1093/cid/ciu108] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Weil-Olivier C, Gaillat J. Can the success of pneumococcal conjugate vaccines for the prevention of pneumococcal diseases in children be extrapolated to adults? Vaccine 2014; 32:2022-6. [PMID: 24565755 DOI: 10.1016/j.vaccine.2014.02.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 12/13/2013] [Accepted: 02/06/2014] [Indexed: 11/26/2022]
Abstract
Before conjugate pneumococcal vaccines (PCVs) were introduced it was estimated that Streptococcus pneumoniae caused 500,000 cases of pneumonia, 50,000 cases of bacteremia and 3000 cases of meningitis annually in the United States in both children and adults. After 10 years of routine use of the 7-valent pneumococcal conjugate vaccine (PCV7) the incidence of vaccine-type pneumococcal diseases (PDs) had significantly decreased in vaccinated children (direct effect) and unvaccinated subjects of all ages (indirect effect). Second generation, higher-valent PCVs, especially 13-valent (PCV13), routinely implemented since 2010, have reduced the incidence of PDs caused by the six additional non-PCV7 serotypes, in both vaccinated and unvaccinated subjects. The licence for this vaccine has recently been extended to include adults aged 18 to 49 in Europe. Although PCV13 has an indirect effect on IPD in adults, this will probably not achieve the same level of disease control in adults and the elderly (especially those at high risk) as that obtained in vaccinated children. As highlighted in this paper, differences exist between children and adults for PD manifestations (incidence, morbidity and mortality) and serotypes isolated in nasopharyngeal carriage and diseases, so benefits from adult vaccination must be considered in this light. PCV13 induces an immune response in adults that is non-inferior for all serotypes common with the 23-valent plain polysaccharide vaccine that is currently recommended for adults and even superior for many serotypes. Although there is no evidence that this immune response translates to clinical efficacy in adults as seen in children, the results from a randomised trial in The Netherlands, expected in 2014, should provide the missing evidence. This evidence and efficient surveillance systems should provide the necessary data, essential for policy makers in their decisions on adult pneumococcal vaccination policies.
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Affiliation(s)
- Catherine Weil-Olivier
- Department of Pediatrics, University Denis Diderot, 5 Rue Thomas Mann, 75013 Paris, France.
| | - Jacques Gaillat
- Department of Infectious Diseases, CH Annecy, 1 Avenue de l'Hôpital, Metz-Tessy BP 90074, 74374 Pringy Cedex, France.
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Rodrigo C, Bewick T, Sheppard C, Greenwood S, Trotter C, Slack M, George R, Lim WS. Clinical features of adults with seven-valent-conjugated-vaccine-serotype pneumococcal pneumonia. Vaccine 2014; 32:1460-5. [PMID: 24508039 DOI: 10.1016/j.vaccine.2014.01.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 12/06/2013] [Accepted: 01/14/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite the reduction in adult invasive pneumococcal disease through 'herd protection' consequent to the introduction of childhood pneumococcal conjugate vaccination (PCV), a significant proportion of adults continue to develop pneumococcal pneumonia caused by one of the seven serotypes included in the seven-valent conjugated pneumococcal vaccine (PCV7). The clinical features and outcomes of these adults have not been previously reported. METHODS Adults recruited over a three year period to a large prospective cohort study of community acquired pneumonia (CAP) were investigated for pneumococcal serotypes using a validated multiplex immunoassay (Bio-plex). The baseline characteristics and outcomes of adults with PCV7-serotype CAP in comparison to those with non-PCV7-serotype CAP were established. RESULTS Pneumococcal aetiology was identified in 415 of 1166 (35.6%) individuals, and a serotype determined in 287 (69.2%). Following exclusion of three individuals with both a PCV7 and non-PCV7 serotype, 77 of the remaining 284 (27.1%) adults had CAP due to PCV7 serotypes. Adults with PCV7-serotype CAP were older (median years (inter-quartile range) 73.3 (60.8-84.4) versus 65.0 (46.1-78.0); p=0.001) and were more likely to have a World Health Organisation performance status ≥1 (odds ratio (OR) 2.05, 95% confidence interval (CI) 1.21-3.50).The presence of stroke (adjusted OR 2.84, 95% CI 1.36-5.95) and dementia (adjusted OR 3.55, 95% CI 1.26-9.94) as underlying co-morbid illnesses were independently associated with PCV7-serotype CAP; 30-day mortality was significantly greater in adults with PCV7-serotype CAP (adjusted OR 4.38, 95% CI 1.85-10.34). CONCLUSION A significant proportion of adults continue to develop PCV7-serotype CAP in the era of childhood pneumococcal conjugate vaccination. These adults are more likely to have stroke and dementia as underlying co-morbid illnesses, and have a higher 30-day mortality. A combination of pneumococcal transmission factors, host factors and pneumococcal serotype specific characteristics are likely to explain these findings.
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Affiliation(s)
- Chamira Rodrigo
- Department of Respiratory Medicine, City Hospital Campus, Nottingham University Hospitals NHS Trust, Hucknall Road, Nottingham NG5 1PB, UK.
| | - Thomas Bewick
- Department of Respiratory Medicine, City Hospital Campus, Nottingham University Hospitals NHS Trust, Hucknall Road, Nottingham NG5 1PB, UK
| | - Carmen Sheppard
- Respiratory and Systemic Infection Laboratory, Public Health England, Microbiology Services Division, Colindale Avenue, London NW9 5EQ, UK
| | - Sonia Greenwood
- Department of Respiratory Medicine, City Hospital Campus, Nottingham University Hospitals NHS Trust, Hucknall Road, Nottingham NG5 1PB, UK
| | - Caroline Trotter
- Disease Dynamics Unit, Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK
| | - Mary Slack
- Respiratory and Systemic Infection Laboratory, Public Health England, Microbiology Services Division, Colindale Avenue, London NW9 5EQ, UK
| | - Robert George
- Respiratory and Systemic Infection Laboratory, Public Health England, Microbiology Services Division, Colindale Avenue, London NW9 5EQ, UK
| | - Wei Shen Lim
- Department of Respiratory Medicine, City Hospital Campus, Nottingham University Hospitals NHS Trust, Hucknall Road, Nottingham NG5 1PB, UK
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Rose MA, Christopoulou D, Myint TTH, de Schutter I. The burden of invasive pneumococcal disease in children with underlying risk factors in North America and Europe. Int J Clin Pract 2014; 68:8-19. [PMID: 23869711 PMCID: PMC4232238 DOI: 10.1111/ijcp.12234] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 06/19/2013] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Characterisation of risk groups who may benefit from pneumococcal vaccination is essential for the generation of recommendations and policy. METHODS We reviewed the literature to provide information on the incidence and risk of invasive pneumococcal disease (IPD) in at-risk children in Europe and North America. The PubMed database was searched using predefined search terms and inclusion/exclusion criteria for papers reporting European or North American data on the incidence or risk of IPD in children with underlying medical conditions. RESULTS Eighteen references were identified, 11 from North America and 7 from Europe, with heterogeneous study methods, periods and populations. The highest incidence was seen in US children positive for human immunodeficiency virus infection, peaking at 4167 per 100,000 patient-years in 2000. Studies investigating changes in incidence over time reported decreases in the incidence of IPD between the late 1990s and early 2000s. The highest risk of IPD was observed in children with haematological cancers or immunosuppression. Overall, data on IPD in at-risk children were limited, lacking incidence data for a wide range of predisposing conditions. There was, however, a clear decrease in the incidence of IPD in at-risk children after the introduction of 7-valent pneumococcal conjugate vaccine into immunisation programmes, as previously demonstrated in the general population. CONCLUSION Despite the heterogeneity of the studies identified, the available data show a substantial incidence of IPD in at-risk children, particularly those who are immunocompromised. Further research is needed to determine the true risk of IPD in at-risk children, particularly in the post-PCV period, and to understand the benefits of vaccination and optimal vaccination schedules.
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Affiliation(s)
- M A Rose
- Children's Hospital, Goethe University, Frankfurt, Germany
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36
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Ladhani SN, Andrews NJ, Waight P, Borrow R, Slack MPE, Miller E. Invasive Pneumococcal Disease, Comorbidities, and Polysaccharide Vaccine Use in Children Aged 5-15 Years in England and Wales. Clin Infect Dis 2013; 58:517-25. [DOI: 10.1093/cid/cit791] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Custovic A, Johnston SL, Pavord I, Gaga M, Fabbri L, Bel EH, Le Souëf P, Lötvall J, Demoly P, Akdis CA, Ryan D, Mäkelä MJ, Martinez F, Holloway JW, Saglani S, O'Byrne P, Papi A, Sergejeva S, Magnan A, Del Giacco S, Kalayci O, Hamelmann E, Papadopoulos NG. EAACI position statement on asthma exacerbations and severe asthma. Allergy 2013; 68:1520-31. [PMID: 24410781 PMCID: PMC7159478 DOI: 10.1111/all.12275] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2013] [Indexed: 02/02/2023]
Abstract
Asthma exacerbations and severe asthma are linked with high morbidity, significant mortality and high treatment costs. Recurrent asthma exacerbations cause a decline in lung function and, in childhood, are linked to development of persistent asthma. This position paper, from the European Academy of Allergy and Clinical Immunology, highlights the shortcomings of current treatment guidelines for patients suffering from frequent asthma exacerbations and those with difficult‐to‐treat asthma and severe treatment‐resistant asthma. It reviews current evidence that supports a call for increased awareness of (i) the seriousness of asthma exacerbations and (ii) the need for novel treatment strategies in specific forms of severe treatment‐resistant asthma. There is strong evidence linking asthma exacerbations with viral airway infection and underlying deficiencies in innate immunity and evidence of a synergism between viral infection and allergic mechanisms in increasing risk of exacerbations. Nonadherence to prescribed medication has been identified as a common clinical problem amongst adults and children with difficult‐to‐control asthma. Appropriate diagnosis, assessment of adherence and other potentially modifiable factors (such as passive or active smoking, ongoing allergen exposure, psychosocial factors) have to be a priority in clinical assessment of all patients with difficult‐to‐control asthma. Further studies with improved designs and new diagnostic tools are needed to properly characterize (i) the pathophysiology and risk of asthma exacerbations, and (ii) the clinical and pathophysiological heterogeneity of severe asthma.
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Affiliation(s)
- A. Custovic
- Centre Lead for Respiratory Medicine; Institute of Inflammation & Repair; University of Manchester; University Hospital of South Manchester; Manchester UK
| | - S. L. Johnston
- Airway Disease Infection Section; National Heart & Lung Institute; Imperial College London; Norfolk Place London UK
| | - I. Pavord
- Department of Respiratory Medicine; Thoracic Surgery and Allergy University Hospitals of Leicester NHS Trust; Glenfield Hospital; Leicester UK
| | - M. Gaga
- 7th Respiratory Medicine Department and Asthma Centre; Athens Chest Hospital; Athens Greece
| | - L. Fabbri
- Department of Oncology Haematology and Respiratory Diseases; University of Modena & Reggio Emilia; Modena Italy
| | - E. H. Bel
- Department of Respiratory Medicine; Academic Medical Centre; University of Amsterdam; Amsterdam the Netherlands
| | - P. Le Souëf
- Department of Respiratory Medicine; University of Western Australia; Princess Margaret Hospital for Children; Perth WA Australia
| | - J. Lötvall
- Krefting Research Centre Sahlgrenska Academy; University of Gothenburg; Göteborg Sweden
| | - P. Demoly
- Allergology Unit; Département de Pneumologie-Addictologie; Hôpital de Villeneuve - Inserm U657; Montpellier France
| | - C. A. Akdis
- Swiss Institute of Allergy & Asthma Research (SIAF); University of Zurich; Davos
- Christine-Kühne Center for Allergy Research and Education (CK-CARE); Davos Switzerland
| | - D. Ryan
- Woodbrook Medical Centre; Loughborough UK
| | - M. J. Mäkelä
- Skin and Allergy Hospital; Helsinki University Central Hospital; HUS Finland
| | - F. Martinez
- University of Arizona; Arizona Health Sciences Center; Pediatric Pulmonary Center; Tucson AZ USA
| | - J. W. Holloway
- University of Southampton; Faculty of Medicine Southampton General Hospital; Southampton UK
| | - S. Saglani
- National Heart & Lung Institute; Imperial College London; London UK
| | - P. O'Byrne
- Department of Medicine; Michael G DeGroote School of Medicine; McMaster University Faculty of Health Sciences; Hamilton ON Canada
| | - A. Papi
- Research Center on Asthma and COPD; University of Ferrara; Ferrara Italy
| | - S. Sergejeva
- Institute of Technology; University of Tartu; Tartu Estonia
| | - A. Magnan
- INSERM UMR915; l'institut du thorax; Faculté de Médecine; & Université de Nantes; Nantes France
| | - S. Del Giacco
- Department of Medical Science; University of Cagliari; Cagliari Italy
| | - O. Kalayci
- Pediatric Allergy and Asthma Unit; Ihsan Dogramaci Children's Hospital; Hacettepe University School of Medicine; Ankara Turkey
| | - E. Hamelmann
- Department of Pediatric Pneumology & Immunology; Charité Universitäts Berlin; Berlin Germany
- Department of Pediatrics; Ruhr-University Bochum; Bochum Germany
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Bang DW, Yang HJ, Ryoo E, Al-Hasan MN, Lahr B, Baddour LM, Yawn BP, Juhn YJ. Asthma and risk of non-respiratory tract infection: a population-based case-control study. BMJ Open 2013; 3:e003857. [PMID: 24091424 PMCID: PMC3796274 DOI: 10.1136/bmjopen-2013-003857] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES Asthmatics have increased risks of airway-related infections. Little is known about whether this is true for non-airway-related serious infections such as Escherichia coli bloodstream infection (BSI). We assessed whether asthma is associated with a risk of developing community-acquired E coli BSI. DESIGN The study was designed as a population-based retrospective case-control study. SETTING This population-based study was conducted in Olmsted County, Minnesota. PARTICIPANTS The study included 259 all eligible community-acquired E coli BSI cases in Olmsted County, MN between 1998 and 2007 and 259 birthday-matched, gender-matched and residency-matched controls. PRIMARY AND SECONDARY OUTCOME MEASURES Only community-acquired E coli BSI cases as the primary outcome was included. Asthma status as an exposure was ascertained by predetermined criteria. An adjusted OR and 95% CI for the association between asthma and risk of community-acquired E coli BSI was calculated using conditional logistic regression. RESULTS Of 259 eligible cases, 179 (69%) were women and mean age was 61±22 years. Of the 259 cases 37 (14%) and 16 (6%) of 259 controls had a prior history of asthma (adjusted OR 2.74; 95% CI 1.11 to 6.76; p=0.029). The population attributable risk of asthma for community-acquired E coli BSI was 9%. Although not statistically significant, there was a borderline association between having a history of food allergy and increased risk of community-acquired E coli BSI (6% vs 2%; adjusted OR 3.51; 95% CI 0.94 to 13.11; p=0.062). CONCLUSIONS Based on the findings of the current population-based, case-control investigation, a history of asthma may be associated with risk of community-acquired E coli BSI. The impact of asthma on risk of microbial infections may go beyond airways.
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Affiliation(s)
- Duk Won Bang
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, South Korea
| | - Hyeon J Yang
- Department of Pediatrics, Soonchunhyang University Hospital, Seoul, South Korea
| | - Eell Ryoo
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Pediatrics, Gil Hospital, Gachon University School of Medicine, Inchon, South Korea
| | - Majdi N Al-Hasan
- Department of Medicine, University of Kentucky Medical Center, Lexington, Kentucky, USA
| | - Brian Lahr
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Larry M Baddour
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Barbara P Yawn
- Department of Research, Olmsted Medical Center, Rochester, Minnesota, USA
| | - Young J Juhn
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Boikos C, Quach C. Risk of invasive pneumococcal disease in children and adults with asthma: a systematic review. Vaccine 2013; 31:4820-6. [PMID: 23965221 DOI: 10.1016/j.vaccine.2013.07.079] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 07/18/2013] [Accepted: 07/30/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND The Advisory Committee on Immunization Practices (ACIP) recommended the inclusion of asthma as a high-risk condition that should warrant pneumococcal vaccination, but the National Advisory Committee on Immunization (NACI) in Canada has not yet done so. We aimed to determine the risk of invasive pneumococcal disease (IPD) in patients with asthma. METHODS We searched Ovid Medline, EMBASE, Classic EMBASE, PubMEd and Cochrane for articles published between January 1990 and February 2013, using the MeSH terms pneumococcal infections/or invasive pneumococcal disease and asthma. Google Scholar was used to retrieve articles citing the seminal article by Talbot et al. Articles were included if they were population-based studies that evaluated the relationship between IPD and asthma. Two authors independently assessed all titles and abstracts. All potentially relevant articles were retrieved as full text and assessed for inclusion. RESULTS The combined searches yielded 376 articles, which were reviewed by title and abstract. At this stage, 330 articles were excluded; 40 articles were excluded at the full article review stage - leaving 6 articles. Two additional articles were found through Google Scholar. The evidence reviewed consistently showed a positive association between asthma and risk of IPD. However, the magnitude of this effect was heterogeneous with adjusted odds ratios ranging from 6.7 (95% CI 1.6-27.3) in adults >18 years to 1.7 (95% CI 0.99-3.0) in individuals aged 2-49 with low-risk asthma. CONCLUSION The positive association between asthma and risk of IPD supports the addition of asthma as a high-risk condition warranting pneumococcal vaccination. Data on vaccine effectiveness in this population is needed.
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Affiliation(s)
- Constantina Boikos
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
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40
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Weil Olivier C. Ten years of experience with the pneumococcal conjugate 7-valent vaccine in children. Med Mal Infect 2013; 43:309-21. [DOI: 10.1016/j.medmal.2013.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Revised: 03/11/2013] [Accepted: 04/25/2013] [Indexed: 11/30/2022]
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Sykes A, Edwards MR, Macintyre J, del Rosario A, Gielen V, Haas J, Kon OM, McHale M, Johnston SL. TLR3, TLR4 and TLRs7-9 Induced Interferons Are Not Impaired in Airway and Blood Cells in Well Controlled Asthma. PLoS One 2013; 8:e65921. [PMID: 23824215 PMCID: PMC3688823 DOI: 10.1371/journal.pone.0065921] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 04/30/2013] [Indexed: 11/30/2022] Open
Abstract
Defective Rhinovirus induced interferon-β and interferon-λ production has been reported in bronchial epithelial cells from asthmatics but the mechanisms of defective interferon induction in asthma are unknown. Virus infection can induce interferon through Toll like Receptors (TLR)3, TLR7 and TLR8. The role of these TLRs in interferon induction in asthma is unclear. This objective of this study was to measure the type I and III interferon response to TLR in bronchial epithelial cells and peripheral blood cells from atopic asthmatics and non-atopic non-asthmatics. Bronchial epithelial cells and peripheral blood mononuclear cells from atopic asthmatic and non-atopic non-asthmatic subjects were stimulated with agonists to TLR3, TLR4 & TLRs7-9 and type I and III interferon and pro-inflammatory cytokine, interleukin(IL)-6 and IL-8, responses assessed. mRNA expression was analysed by qPCR. Interferon proteins were analysed by ELISA. Pro-inflammatory cytokines were induced by each TLR ligand in both cell types. Ligands to TLR3 and TLR7/8, but not other TLRs, induced interferon-β and interferon-λ in bronchial epithelial cells. The ligand to TLR7/8, but not those to other TLRs, induced only type I interferons in peripheral blood mononuclear cells. No difference was observed in TLR induced interferon or pro-inflammatory cytokine production between asthmatic and non-asthmatic subjects from either cell type. TLR3 and TLR7/8,, stimulation induced interferon in bronchial epithelial cells and peripheral blood mononuclear cells. Interferon induction to TLR agonists was not observed to be different in asthmatics and non-asthmatics.
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Affiliation(s)
- Annemarie Sykes
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
- MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
- Centre for Respiratory Infection, Imperial College London, London, United Kingdom
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Michael R. Edwards
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
- MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
- Centre for Respiratory Infection, Imperial College London, London, United Kingdom
| | - Jonathan Macintyre
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
- MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
- Centre for Respiratory Infection, Imperial College London, London, United Kingdom
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ajerico del Rosario
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
- MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
- Centre for Respiratory Infection, Imperial College London, London, United Kingdom
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Vera Gielen
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
- MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
- Centre for Respiratory Infection, Imperial College London, London, United Kingdom
| | - Jennifer Haas
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
- MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
- Centre for Respiratory Infection, Imperial College London, London, United Kingdom
| | - Onn Min Kon
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Mark McHale
- Respiratory and Inflammation Research Area, AstraZeneca R&D Charnwood, Loughborough, United Kingdom
| | - Sebastian L. Johnston
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
- MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
- Centre for Respiratory Infection, Imperial College London, London, United Kingdom
- Imperial College Healthcare NHS Trust, London, United Kingdom
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Ladhani SN, Slack MPE, Andrews NJ, Waight PA, Borrow R, Miller E. Invasive pneumococcal disease after routine pneumococcal conjugate vaccination in children, England and Wales. Emerg Infect Dis 2013; 19:61-8. [PMID: 23259937 PMCID: PMC3557991 DOI: 10.3201/eid1901.120741] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Nonvaccine serotypes occur more often among children with comorbid conditions. We assessed known risk factors, clinical presentation, and outcome of invasive pneumococcal disease (IPD) in children 3–59 months of age after introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) in England and Wales. During September 2006–March 2010, a total of 1,342 IPD episodes occurred in 1,332 children; 14.9% (198/1,332) had comorbidities. Compared with IPD caused by PCV7 serotypes (44/248; 17.7%), comorbidities were less common for the extra 3 serotypes in the 10-valent vaccine (15/299; 5.0%) but similar to the 3 additional PCV13 serotypes (45/336; 13.4%) and increased for the 11 extra serotypes in 23-valent polysaccharide vaccine (PPV23) (39/186; 21.0%) and non-PPV23 serotypes (38/138; 27.5%). Fifty-two (3.9%) cases resulted from PCV7 failure; 9 (0.7%) case-patients had recurrent IPD. Case-fatality rate was 4.4% (58/1,332) but higher for meningitis (11.0%) and children with comorbidities (9.1%). Thus, comorbidities were more prevalent in children with IPD caused by non-PCV13 serotypes and were associated with increased case fatality.
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Affiliation(s)
- Shamez N Ladhani
- Immunisation Department, Health Protection Agency Colindale, London, UK.
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Singleton R, Wenger J, Klejka JA, Bulkow LR, Thompson A, Sarkozy D, Emini EA, Gruber WC, Scott DA. The 13-valent pneumococcal conjugate vaccine for invasive pneumococcal disease in Alaska native children: results of a clinical trial. Pediatr Infect Dis J 2013; 32:257-63. [PMID: 23001026 DOI: 10.1097/inf.0b013e3182748ada] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND During 1996 to 2000, Alaska Native children aged <5 years from Yukon Kuskokwim Delta (YKD) had invasive pneumococcal disease (IPD) rates 10-fold higher than non-Alaska Native children (547/100,000/yr versus 56/100,000/yr). After 7-valent pneumococcal conjugate vaccine (PCV7) introduction, IPD rates decreased to 148 per 100,000 during 2001 to 2004, increasing to 426 per 100,000 during 2005 to 2007 due to non-vaccine serotype disease. In 2009, we evaluated safety, immunogenicity and impact of 13-valent PCV (PCV13) in YKD children. METHODS In a prelicensure open-label clinical trial, eligible YKD children aged <5 years were offered PCV13 as appropriate for age and prior PCV7 history. PCV13 impact was assessed using existing Alaska-wide IPD surveillance. Serotype-specific anti-pneumococcal IgG levels were measured postinfant series and posttoddler dose in a subset of subjects. Adverse events and serious adverse events were collected in all; local reactions and systemic events were collected in toddlers. All YKD children were offered licensed PCV13 when it became available. RESULTS Three hundred seventy-two subjects received PCV13 during the clinical trial and 3342 postlicensure (April 2010 to August 2011). Adverse events were typically mild, or generally consistent with common childhood illnesses. IgG levels following PCV13 were similar to other populations. In YKD children aged <5 years, 52 IPD cases (31 PCV13-serotype) occurred during 2005 to 2008 (399.0/100,000/yr) versus 9 (7 PCV13-serotype) during January 2009 to August 2011 (106.7/100,000/yr; P < 0.001). No PCV13-serotype cases occurred among PCV13 recipients (3680 person follow-up years). CONCLUSIONS PCV13-serotype IPD incidence declined significantly after PCV13 introduction. Although non-PCV13-serotype IPD also declined significantly, absence of PCV13-serotype IPD in children who received PCV13 suggests a protective vaccine effect.
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Ciruela P, Soldevila N, Selva L, Hernández S, Garcia-Garcia JJ, Moraga F, de Sevilla MF, Codina G, Planes AM, Esteva C, Coll F, Cardeñosa N, Jordan I, Batalla J, Salleras L, Muñoz-Almagro C, Domínguez A. Are risk factors associated with invasive pneumococcal disease according to different serotypes? Hum Vaccin Immunother 2013; 9:712-9. [PMID: 23295982 DOI: 10.4161/hv.23270] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The aim of this study was to investigate risk factors for the most common serotypes of invasive pneumococcal disease (IPD). A total of 293 IPD cases were analyzed in children aged 3-59 mo in a community with intermediate vaccination coverage with the 7-valent pneumococcal vaccine (PCV7). IPD cases were reviewed during 2007-2009 in two pediatric hospitals in Catalonia (Spain). A multivariate analysis using unconditional logistic regression was performed to estimate the adjusted odds ratio. PCV7 coverage was 45.4%. Pneumonia with empyema (64.5%) was the most frequent clinical manifestation. The most common serotypes were: serotype 1 (21.2%), 19A (16.0%), 3 (12.6%) and 7F/A (6.8%). 70.0% of serotypes found were included in the 13-valent conjugate vaccine (PCV13), 39.2% in the 10-valent conjugate vaccine and 8.1% in the PCV7. PCV7 was protective in IPD cases due to PCV7-serotypes (aOR: 0.15, 95% CI:0.04-0.55). Serotype 1 was positively associated with attending day care or school (aOR: 3.55, 95% CI: 1.21-10.38) and age 24-59 mo (aOR: 7.70, 95% CI:2.70-21.98). Serotype 19A was positively associated with respiratory infection in the previous month (aOR: 2.26, 95% CI: 1.03-4.94), non-penicillin susceptible IPD (aOR: 1.89, 95% CI:1.13-3.16) and negatively associated with age 24-59 mo (aOR: 0.19, 95% CI:0.09-0.41). Serotype 3 was positively associated with vaccination (aOR: 4.87, 95% CI:2.05-11.59). No factors were associated with serotype 7F/A. Vaccination with pneumococcal vaccines including more serotypes may reduce the risk of disease in our setting.
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Feikin DR, Kagucia EW, Loo JD, Link-Gelles R, Puhan MA, Cherian T, Levine OS, Whitney CG, O’Brien KL, Moore MR. Serotype-specific changes in invasive pneumococcal disease after pneumococcal conjugate vaccine introduction: a pooled analysis of multiple surveillance sites. PLoS Med 2013; 10:e1001517. [PMID: 24086113 PMCID: PMC3782411 DOI: 10.1371/journal.pmed.1001517] [Citation(s) in RCA: 349] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 08/12/2013] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Vaccine-serotype (VT) invasive pneumococcal disease (IPD) rates declined substantially following introduction of 7-valent pneumococcal conjugate vaccine (PCV7) into national immunization programs. Increases in non-vaccine-serotype (NVT) IPD rates occurred in some sites, presumably representing serotype replacement. We used a standardized approach to describe serotype-specific IPD changes among multiple sites after PCV7 introduction. METHODS AND FINDINGS Of 32 IPD surveillance datasets received, we identified 21 eligible databases with rate data ≥ 2 years before and ≥ 1 year after PCV7 introduction. Expected annual rates of IPD absent PCV7 introduction were estimated by extrapolation using either Poisson regression modeling of pre-PCV7 rates or averaging pre-PCV7 rates. To estimate whether changes in rates had occurred following PCV7 introduction, we calculated site specific rate ratios by dividing observed by expected IPD rates for each post-PCV7 year. We calculated summary rate ratios (RRs) using random effects meta-analysis. For children <5 years old, overall IPD decreased by year 1 post-PCV7 (RR 0.55, 95% CI 0.46-0.65) and remained relatively stable through year 7 (RR 0.49, 95% CI 0.35-0.68). Point estimates for VT IPD decreased annually through year 7 (RR 0.03, 95% CI 0.01-0.10), while NVT IPD increased (year 7 RR 2.81, 95% CI 2.12-3.71). Among adults, decreases in overall IPD also occurred but were smaller and more variable by site than among children. At year 7 after introduction, significant reductions were observed (18-49 year-olds [RR 0.52, 95% CI 0.29-0.91], 50-64 year-olds [RR 0.84, 95% CI 0.77-0.93], and ≥ 65 year-olds [RR 0.74, 95% CI 0.58-0.95]). CONCLUSIONS Consistent and significant decreases in both overall and VT IPD in children occurred quickly and were sustained for 7 years after PCV7 introduction, supporting use of PCVs. Increases in NVT IPD occurred in most sites, with variable magnitude. These findings may not represent the experience in low-income countries or the effects after introduction of higher valency PCVs. High-quality, population-based surveillance of serotype-specific IPD rates is needed to monitor vaccine impact as more countries, including low-income countries, introduce PCVs and as higher valency PCVs are used. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Daniel R. Feikin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- National Center for Emerging and Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Eunice W. Kagucia
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Jennifer D. Loo
- Respiratory Disease Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ruth Link-Gelles
- Respiratory Disease Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Milo A. Puhan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Thomas Cherian
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Orin S. Levine
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Cynthia G. Whitney
- Respiratory Disease Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Katherine L. O’Brien
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Matthew R. Moore
- Respiratory Disease Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Ciruela P, Soldevila N, Hernández S, Selva L, de Sevilla MF, García-García JJ, Moraga F, Planes AM, Muñoz-Almagro C, Domínguez A. Risk factors for invasive pneumococcal disease in a community with a high proportion of non vaccine serotypes. Vaccine 2012; 31:960-6. [PMID: 23261046 DOI: 10.1016/j.vaccine.2012.11.102] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 11/23/2012] [Accepted: 11/30/2012] [Indexed: 11/28/2022]
Abstract
The aim of this study was to investigate factors associated with vaccination with 7-pneumococcal conjugate vaccine (PCV7) and risk factors for invasive pneumococcal disease (IPD) and for penicillin-nonsusceptible strains in a community with intermediate vaccination coverage. We conducted a prospective, matched case-control study in children aged 3-59 months with IPD admitted to two hospitals in Catalonia. Three controls matched by hospital, age, sex, date of hospitalization and risk medical conditions were selected for each case. We calculated odds ratios for potential risk factors using logistic regression. Of the 1075 children included, 46.6% were considered fully vaccinated by age. 91.1% of cases were caused by non-PCV7 serotypes. Vaccination with PCV7 was positively associated with attending day care or school and negatively associated with age 24-59 months, >4 cohabitants and low social class. Attending day care or school and >4 cohabitants were risk factors for IPD. Previous antibiotic treatment in children aged 24-59 months was a protective factor for IPD; however, antibiotic use in the previous month and age <24 months were associated with penicillin-nonsusceptible IPD. In a community where IPD in children aged <5 years is caused mainly by non-PCV7 Streptococcus pneumoniae serotypes and where vaccine coverage is only intermediate, attending day care or school, age <24 months, >4 cohabitants and social class were associated with vaccination. Attending day care or school was a strong risk factor for IPD, while vaccination was protective in children aged <24 months. Age and antibiotic use in the previous month were associated with penicillin-nonsusceptible IPD.
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Affiliation(s)
- Pilar Ciruela
- Agència de Salut Pública de Catalunya, Generalitat of Catalonia, Barcelona, Spain.
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Murray RL, Britton J, Leonardi-Bee J. Second hand smoke exposure and the risk of invasive meningococcal disease in children: systematic review and meta-analysis. BMC Public Health 2012; 12:1062. [PMID: 23228219 PMCID: PMC3534009 DOI: 10.1186/1471-2458-12-1062] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 11/22/2012] [Indexed: 11/30/2022] Open
Abstract
Background Invasive meningococcal disease remains an important cause of serious morbidity and mortality in children and young people. There is a growing body of literature to suggest that exposure to passive smoke may play a role in the development of the disease, therefore we have performed a systematic review to provide a comprehensive estimate of the magnitude of this effect for smoking by any household member, by individual family members, and of maternal smoking before and after birth. Methods Four databases (Medline, Embase, PsychINFO and CAB Abstracts database) were searched to identify studies (to June 2012) and reference lists scanned for further studies. Titles, abstracts and full texts were checked for eligibility independently by two authors. Quality of included studies was assessed using the Newcastle-Ottawa Scale. Pooled odds ratios (OR) with 95% confidence intervals (CI) were estimated using random effect models, with heterogeneity quantified using I2. Results We identified 18 studies which assessed the effects of SHS on the risk of invasive meningococcal disease in children. SHS in the home doubled the risk of invasive meningococcal disease (OR 2.18, 95% CI 1.63 to 2.92, I2 = 72%), with some evidence of an exposure-response gradient. The strongest effect was seen in children under 5 years (OR 2.48, 95% CI 1.51 to 4.09, I2 = 47%). Maternal smoking significantly increased the risk of invasive meningococcal disease by 3 times during pregnancy (OR 2.93, 95% CI 1.52-5.66) and by 2 times after birth (OR 2.26, 95% CI 1.54-3.31). Conclusions SHS exposure, and particularly passive foetal exposure to maternal smoking during pregnancy, significantly increases the risk of childhood invasive meningococcal disease. It is likely that an extra 630 cases of invasive meningococcal disease annually in children under 16 are directly attributable to SHS exposure in UK homes.
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Affiliation(s)
- Rachael L Murray
- Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building Phase 2, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK.
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Baraldo S, Contoli M, Bazzan E, Turato G, Padovani A, Marku B, Calabrese F, Caramori G, Ballarin A, Snijders D, Barbato A, Saetta M, Papi A. Deficient antiviral immune responses in childhood: distinct roles of atopy and asthma. J Allergy Clin Immunol 2012; 130:1307-14. [PMID: 22981791 DOI: 10.1016/j.jaci.2012.08.005] [Citation(s) in RCA: 146] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 08/01/2012] [Accepted: 08/02/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Impaired immune response to viral infections in atopic asthmatic patients has been recently reported and debated. Whether this condition is present in childhood and whether it is affected by atopy per se deserves further investigation. OBJECTIVE We sought to investigate airway interferon production in response to rhinovirus infection in children who are asthmatic, atopic, or both and its correlation with the airway inflammatory profile. METHODS Bronchial biopsy specimens and epithelial cells were obtained from 47 children (mean age, 5 ± 0.5 years) undergoing bronchoscopy. The study population included asthmatic children who were either atopic or nonatopic, atopic children without asthma, and children without atopy or asthma. Rhinovirus type 16 induction of IFN-λ and IFN-β mRNA and protein levels was assessed in bronchial epithelial cell cultures. The immunoinflammatory profile was evaluated by means of immunohistochemistry in bronchial biopsy specimens. RESULTS Rhinovirus type 16-induced interferon production was significantly reduced in atopic asthmatic, nonatopic asthmatic, and atopic nonasthmatic children compared with that seen in nonatopic nonasthmatic children (all P < .05). Increased rhinovirus viral RNA levels paralleled this deficient interferon induction. Additionally, IFN-λ and IFN-β induction correlated inversely with the airway T(H)2 immunopathologic profile (eosinophilia and IL-4 positivity: P < .05 and r = -0.38 and P < .05 and r = -0.58, respectively) and with epithelial damage (P < .05 and r = -0.55). Furthermore, total serum IgE levels correlated negatively with rhinovirus-induced IFN-λ mRNA levels (P < .05 and r = -0.41) and positively with rhinovirus viral RNA levels (P < .05 and r = 0.44). CONCLUSIONS Deficient interferon responses to rhinovirus infection are present in childhood in asthmatic subjects irrespective of their atopic status and in atopic patients without asthma. These findings suggest that deficient immune responses to viral infections are not limited to patients with atopic asthma but are present in those with other T(H)2-oriented conditions.
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Affiliation(s)
- Simonetta Baraldo
- Department of Cardiac, Thoracic and Vascular Sciences, Section of Respiratory Diseases, University of Padova, Padua, Italy
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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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Weil-Olivier C, van der Linden M, de Schutter I, Dagan R, Mantovani L. Prevention of pneumococcal diseases in the post-seven valent vaccine era: a European perspective. BMC Infect Dis 2012; 12:207. [PMID: 22954038 PMCID: PMC3462147 DOI: 10.1186/1471-2334-12-207] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Accepted: 08/31/2012] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The burden of invasive pneumococcal disease in young children decreased dramatically following introduction of the 7-valent pneumococcal conjugate vaccine (PCV7). The epidemiology of S. pneumoniae now reflects infections caused by serotypes not included in PCV7. Recently introduced higher valency pneumococcal vaccines target the residual burden of invasive and non-invasive infections, including those caused by serotypes not included in PCV7. This review is based on presentations made at the European Society of Pediatric Infectious Diseases in June 2011. DISCUSSION Surveillance data show increased circulation of the non-PCV7 vaccine serotypes 1, 3, 6A, 6C, 7 F and 19A in countries with routine vaccination. Preliminary evidence suggests that broadened serotype coverage offered by higher valency vaccines may be having an effect on invasive disease caused by some of those serotypes, including 19A, 7 F and 6C. Aetiology of community acquired pneumonia remains a difficult clinical diagnosis. However, recent reports indicate that pneumococcal vaccination has reduced hospitalisations of children for vaccine serotype pneumonia. Variations in serotype circulation and occurrence of complicated and non-complicated pneumonia caused by non-PCV7 serotypes highlight the potential of higher valency vaccines to decrease the remaining burden. PCVs reduce nasopharyngeal carriage and acute otitis media (AOM) caused by vaccine serotypes. Recent investigations of the interaction between S. pneumoniae and non-typeable H. influenzae suggest that considerable reduction in severe, complicated AOM infections may be achieved by prevention of early pneumococcal carriage and AOM infections. Extension of the vaccine serotype spectrum beyond PCV7 may provide additional benefit in preventing the evolution of AOM. The direct and indirect costs associated with pneumococcal disease are high, thus herd protection and infections caused by non-vaccine serotypes both have strong effects on the cost effectiveness of pneumococcal vaccination. Recent evaluations highlight the public health significance of indirect benefits, prevention of pneumonia and AOM and coverage of non-PCV7 serotypes by higher valency vaccines. SUMMARY Routine vaccination has greatly reduced the burden of pneumococcal diseases in children. The pneumococcal serotypes present in the 7-valent vaccine have greatly diminished among disease isolates. The prevalence of some non-vaccine serotypes (e.g. 1, 7 F and 19A) has increased. Pneumococcal vaccines with broadened serotype coverage are likely to continue decreasing the burden of invasive disease, and community acquired pneumonia in children. Further reductions in pneumococcal carriage and increased prevention of early AOM infections may prevent the evolution of severe, complicated AOM. Evaluation of the public health benefits of pneumococcal conjugate vaccines should include consideration of non-invasive pneumococcal infections, indirect effects of vaccination and broadened serotype coverage.
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Affiliation(s)
| | - Mark van der Linden
- Department of Medical Microbiology, National Reference Center for Streptococci, University Hospital RWTH Aachen, Aachen, Germany
| | - Iris de Schutter
- Department. of Pediatric Pneumology, Cystic Fibrosis Clinic and Pediatric Infectious Diseases, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Ron Dagan
- Pediatric Infectious Disease Unit, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
| | - Lorenzo Mantovani
- CIRFF/Center of Pharmacoeconomics, Faculty of Pharmacy, University of Naples, Naples, Italy
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