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Sanford TC, Tweten RK, Abrahamsen HL. Bacterial cholesterol-dependent cytolysins and their interaction with the human immune response. Curr Opin Infect Dis 2024; 37:164-169. [PMID: 38527455 DOI: 10.1097/qco.0000000000001010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
PURPOSE OF REVIEW Many cholesterol-dependent cytolysin (CDC)-producing pathogens pose a significant threat to human health. Herein, we review the pore-dependent and -independent properties CDCs possess to assist pathogens in evading the host immune response. RECENT FINDINGS Within the last 5 years, exciting new research suggests CDCs can act to inhibit important immune functions, disrupt critical cell signaling pathways, and have tissue-specific effects. Additionally, recent studies have identified a key region of CDCs that generates robust immunity, providing resources for the development of CDC-based vaccines. SUMMARY This review provides new information on how CDCs alter host immune responses to aid bacteria in pathogenesis. These studies can assist in the design of more efficient vaccines and therapeutics against CDCs that will enhance the immune response to CDC-producing pathogens while mitigating the dampening effects CDCs have on the host immune response.
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Affiliation(s)
- Tristan C Sanford
- Department of Microbiology and Immunology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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Feemster K, Weaver J, Buchwald U, Banniettis N, Cox KS, McIntosh ED, Spoulou V. Pneumococcal Vaccine Breakthrough and Failure in Infants and Children: A Narrative Review. Vaccines (Basel) 2023; 11:1750. [PMID: 38140155 PMCID: PMC10747311 DOI: 10.3390/vaccines11121750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023] Open
Abstract
Globally, Streptococcus pneumoniae is a leading cause of vaccine-preventable morbidity and mortality in infants and children. In recent decades, large-scale pediatric immunization programs have substantially reduced the incidence of invasive pneumococcal disease. Despite this, residual vaccine-type pneumococcal disease remains in the form of vaccine breakthrough and vaccine failure. This targeted literature review aims to discuss aspects of vaccine breakthrough and failure in infants and children, including disease epidemiology, clinical presentation, risk factors, vaccination schedules, vaccine serotypes, correlates of protection, comorbidities, disease surveillance, and potential implications for future vaccine development.
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Affiliation(s)
- Kristen Feemster
- Merck & Co., Inc., Rahway, NJ 07065, USA; (J.W.); (U.B.); (N.B.); (K.S.C.)
| | - Jessica Weaver
- Merck & Co., Inc., Rahway, NJ 07065, USA; (J.W.); (U.B.); (N.B.); (K.S.C.)
| | - Ulrike Buchwald
- Merck & Co., Inc., Rahway, NJ 07065, USA; (J.W.); (U.B.); (N.B.); (K.S.C.)
| | - Natalie Banniettis
- Merck & Co., Inc., Rahway, NJ 07065, USA; (J.W.); (U.B.); (N.B.); (K.S.C.)
| | - Kara S. Cox
- Merck & Co., Inc., Rahway, NJ 07065, USA; (J.W.); (U.B.); (N.B.); (K.S.C.)
| | | | - Vana Spoulou
- Immunobiology and Vaccinology Research Laboratory, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece;
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CALABRÒ GIOVANNAELISA, VITALE FRANCESCO, RIZZO CATERINA, PUGLIESE ANDREA, BOCCALINI SARA, BECHINI ANGELA, PANATTO DONATELLA, AMICIZIA DANIELA, DOMNICH ALEXANDER, AMODIO EMANUELE, COSTANTINO CLAUDIO, DI PIETRO MARIALUISA, SALVATI CRISTINA, D’AMBROSIO FLORIANA, ORSINI FRANCESCA, MAIDA ADA, DOMINICI ANNA, CLEMENTE DANIA, CECCI MARINA, PELLACCHIA ANDREA, DI SERAFINO FRANCESCA, BAKKER KEVIN, MALIK TUFAILMOHAMMAD, SHAROMI OLUWASEUN, BELLUZZO MIRIAM, LEONFORTE FRANCESCO, ZAGRA LUIGI, LA GATTA EMANUELE, PETRELLA LUIGI, BONANNI PAOLO, DE WAURE CHIARA. [The new 15-valent pneumococcal conjugate vaccine for the prevention of S. pneumoniae infections in pediatric age: a Health Technology Assessment]. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2023; 64:E1-E160. [PMID: 37655211 PMCID: PMC10468156 DOI: 10.15167/2421-4248/jpmh2023.64.1s1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Affiliation(s)
- GIOVANNA ELISA CALABRÒ
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italia
- VIHTALI (Value In Health Technology and Academy for Leadership & Innovation), Spin-off dell’Università Cattolica del Sacro Cuore, Roma, Italia
| | - FRANCESCO VITALE
- Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro”, Università degli Studi di Palermo
| | - CATERINA RIZZO
- Dipartimento di Ricerca Traslazionale e delle Nuove Tecnologie in Medicina e Chirurgia, Università degli Studi di Pisa, Pisa, Italia
| | - ANDREA PUGLIESE
- Dipartimento di Matematica, Università di Trento, Trento, Italia
| | - SARA BOCCALINI
- Dipartimento di Scienze della Salute, Università degli di Studi di Firenze, Firenze, Italia
| | - ANGELA BECHINI
- Dipartimento di Scienze della Salute, Università degli di Studi di Firenze, Firenze, Italia
| | - DONATELLA PANATTO
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Genova, Italia
- Centro Interuniversitario di Ricerca sull’Influenza e le altre Infezioni Trasmissibili (CIRI-IT), Genova, Italia
| | - DANIELA AMICIZIA
- Dipartimento di Scienze della Salute, Università degli Studi di Genova, Genova, Italia
- Centro Interuniversitario di Ricerca sull’Influenza e le altre Infezioni Trasmissibili (CIRI-IT), Genova, Italia
| | | | - EMANUELE AMODIO
- Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro”, Università degli Studi di Palermo
| | - CLAUDIO COSTANTINO
- Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro”, Università degli Studi di Palermo
| | - MARIA LUISA DI PIETRO
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italia
| | - CRISTINA SALVATI
- Dipartimento di Scienze della Salute, Università degli di Studi di Firenze, Firenze, Italia
| | - FLORIANA D’AMBROSIO
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italia
| | - FRANCESCA ORSINI
- Alta Scuola di Economia e Management dei Sistemi Sanitari (ALTEMS), Università Cattolica del Sacro Cuore, Roma, Italia
| | - ADA MAIDA
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italia
| | - ANNA DOMINICI
- Dipartimento di Medicina e Chirurgia, Università degli di Studi di Perugia, Italia
| | - DANIA CLEMENTE
- Dipartimento di Medicina e Chirurgia, Università degli di Studi di Perugia, Italia
| | - MARINA CECCI
- Dipartimento di Medicina e Chirurgia, Università degli di Studi di Perugia, Italia
| | - ANDREA PELLACCHIA
- Dipartimento di Medicina e Chirurgia, Università degli di Studi di Perugia, Italia
| | - FRANCESCA DI SERAFINO
- Dipartimento di Ricerca Traslazionale e delle Nuove Tecnologie in Medicina e Chirurgia, Università degli Studi di Pisa, Pisa, Italia
| | - KEVIN BAKKER
- Health Economic and Decision Sciences (HEDS), Biostatistics & Research Decision Sciences (BARDS), Merck Research Laboratories, West Point, Pennsylvania
| | - TUFAIL MOHAMMAD MALIK
- Health Economic and Decision Sciences (HEDS), Biostatistics & Research Decision Sciences (BARDS), Merck Research Laboratories, West Point, Pennsylvania
| | - OLUWASEUN SHAROMI
- Health Economic and Decision Sciences (HEDS), Biostatistics & Research Decision Sciences (BARDS), Merck Research Laboratories, West Point, Pennsylvania
| | - MIRIAM BELLUZZO
- Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro”, Università degli Studi di Palermo
| | - FRANCESCO LEONFORTE
- Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro”, Università degli Studi di Palermo
| | - LUIGI ZAGRA
- Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro”, Università degli Studi di Palermo
| | - EMANUELE LA GATTA
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italia
| | - LUIGI PETRELLA
- Sezione di Igiene, Dipartimento Universitario di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italia
| | - PAOLO BONANNI
- Dipartimento di Scienze della Salute, Università degli di Studi di Firenze, Firenze, Italia
| | - CHIARA DE WAURE
- Dipartimento di Medicina e Chirurgia, Università degli di Studi di Perugia, Italia
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Devarakonda Y, Reddy MVNJ, Neethu RS, Chandran A, Syal K. Multi epitope vaccine candidate design against Streptococcus pneumonia. J Biomol Struct Dyn 2023; 41:12654-12667. [PMID: 36636838 DOI: 10.1080/07391102.2023.2167123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 01/05/2023] [Indexed: 01/14/2023]
Abstract
Streptococcus pneumonia, the causative agent of sepsis, meningitis and pneumonia, is held responsible for causing invasive diseases predominantly in children along with adults from both developing and developed countries. The available vaccines coverage in the context of different serotypes is limited and emergence of non-vaccine serotypes could further emerge as a threat in future. Advanced immunoinformatics tools have been used for developing a multi epitope subunit vaccine. In the current study we have subjected these four surface antigenic proteins Ply, PsaA, PspA and PspK to construct vaccine designs. We have predicted different B-cell and T-cell epitopes by using NetCTL 1.2, IEDB (Immune Epitope Databases) and ABCpred. An adjuvant (griselimycin) has been added to the vaccine construct sequence in order to improve its immunogenicity. The vaccine construct has been evaluated for its antigenicity, allergenicity, toxicity and different physio-chemical properties. The bioinformatic tools have been used for prediction, refinement and validation of the 3 D structure. Further, the vaccine structure has been docked with a toll-like receptor (TLR-4) by ClusPro 2.0. In conclusion, the proposed multi-epitope vaccine designs could potentially activate both humoral and cellular immune responses and has a potential to be a vaccine candidate against S.pneumoniae, and requires experimental validation for ensuring immunogenicity and safety profile.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Yogeshwar Devarakonda
- Department of Biological Sciences, Center for Genetics and Molecular Microbiology, Institute of Eminence, Birla Institute of Technology and Sciences-Pilani, Hyderabad, India
| | - M V N Janaradhan Reddy
- Department of Biological Sciences, Center for Genetics and Molecular Microbiology, Institute of Eminence, Birla Institute of Technology and Sciences-Pilani, Hyderabad, India
| | - R S Neethu
- Department of Biological Sciences, Center for Genetics and Molecular Microbiology, Institute of Eminence, Birla Institute of Technology and Sciences-Pilani, Hyderabad, India
| | - Aneesh Chandran
- Department of Biotechnology and Microbiology, Kannur University, Kannur, India
| | - Kirtimaan Syal
- Department of Biological Sciences, Center for Genetics and Molecular Microbiology, Institute of Eminence, Birla Institute of Technology and Sciences-Pilani, Hyderabad, India
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Silva-Costa C, Gomes-Silva J, Pinho MD, Friães A, Ramirez M, Melo-Cristino J. Continued Vaccine Breakthrough Cases of Serotype 3 Complicated Pneumonia in Vaccinated Children, Portugal (2016-2019). Microbiol Spectr 2022; 10:e0107722. [PMID: 35862941 PMCID: PMC9431508 DOI: 10.1128/spectrum.01077-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/07/2022] [Indexed: 11/20/2022] Open
Abstract
We previously reported that despite the use of pneumococcal conjugate vaccines (PCVs), vaccine serotypes remained important causes of pneumonia with pleural effusion and empyema (pediatric complicated pneumococcal pneumonia [PCPP]). We cultured and performed PCR on 174 pleural fluid samples recovered from pediatric patients in Portugal from 2016 to 2019 to identify and serotype Streptococcus pneumoniae. Most PCPP cases (n = 87/98) were identified by PCR only. Serotypes 3 (67%), 14, and 8 (5% each) were the most frequent. Vaccine breakthrough cases were seen among age-appropriately, 13-valent, PCV vaccinated children (median: 3 years, range: 17 months to 7 years), mostly with serotype 3 (n = 27) but also with serotypes 14 and 19A (n = 2 each). One breakthrough was seen with serotype 14 in an age-appropriately, 10-valent, PCV-vaccinated child and another with serotype 3 in a child to whom the 23-valent polysaccharide vaccine was administered. While the relative risk of serotype 1 PCPP decreased almost 10-fold from the period of 2010 to 2015 to the period of 2016 to 2019 (relative risk [RR] = 0.106), that of serotype 3 PCPP almost doubled (RR = 1.835). Our data highlight the importance of molecular diagnostics in identifying PCPP and document the continued importance of serotype 3 PCPP, even when PCV13 use with almost universal coverage could be expected to reduce exposure to this serotype. IMPORTANCE The use of conjugate vaccines against Streptococcus pneumoniae in children has led to substantial reductions in pneumococcal invasive disease. However, the reductions seen in each of the 13 serotypes currently included in the highest-valency vaccine approved for use in children (PCV13), were not the same. It is becoming clear that most vaccine breakthroughs worldwide involve serotype 3 and are frequently associated with complicated pneumonia cases, often with empyema or pleural effusion. Here, we show that despite almost universal PCV13 use, which would be expected to reduce vaccine serotype circulation and further reinforce vaccine direct protection, pneumococci and serotype 3 remain the major causes of pediatric complicated pneumonia. Molecular methods are essential to identify and serotype pneumococci in these cases, which frequently reflect vaccine breakthroughs. A broader use of molecular diagnostics will be essential to determine the role of this important serotype in the context of PCV13 use in different geographic regions.
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Affiliation(s)
- Catarina Silva-Costa
- Instituto de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Joana Gomes-Silva
- Instituto de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Marcos D. Pinho
- Instituto de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Ana Friães
- Instituto de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Mário Ramirez
- Instituto de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - José Melo-Cristino
- Instituto de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
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Athanasia X, Nektarios M, Theano G, Anastasia P, Stelmos S, Ioanna M, Andreas E, Vassiliki G, Anastasia AK, Efi S, Fani M, Athina A, Georgia V, Genovefa C, Anastasia P, Theodota L, Athanasios M, Vassiliki S, Evaggelia L, George P, Efthymia P, Elpis M, Emmanuel R, Manolis G, Vana P, Maria T, Tzanakaki G. Pneumococcal meningitis in Greece: A retrospective serotype surveillance study in the post-PCV13 era (2010-2020). Vaccine 2022; 40:5079-5087. [PMID: 35871868 DOI: 10.1016/j.vaccine.2022.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND As Greece is a country which has introduced the 13-valent pneumococcal conjugate vaccine (PCV13) both in the infant and in the adult immunization programs, the aim of the study was to investigate age-specific and serotype-specific trends of pneumococcal meningitis over an 11-year period (2010-2020). MATERIALS AND METHODS Data are reported from pneumococcal meningitis cases [notified to the National Public Health Organization (NPHO)], with clinical samples and bacterial isolates sent for pneumococcal identification and serotyping at the National Meningitis Reference Laboratory (NMRL). Pneumococcal identification was performed directly on clinical samples or bacterial isolates by multiplex PCR (mPCR) assay, while serotyping was carried out by application of the Capsular Sequence Typing (CST) method with the combination of single tube PCR assays. RESULTS A total of 427 pneumococcal meningitis cases were notified to the NPHO between 2010 and 2020. Among those, 405 (94.8%) were microbiologically confirmed, while samples from 273 patients were sent to the NMRL for identification and/or further typing. The annual notification rate peaked at 0.47/100,000 in 2016 and since then has been decreasing. The incidence was highest in infants and in older adults. Pneumococcal serotypes were identified in 260/273 (95.2%) cases, where clinical samples were sent to the NMRL. The most prevalent serotypes (≥5%) were 3, 19A, 23B, 15B/C, 11A/D, 23A, 22F. During the study period there has been a decrease of PCV13 serotypes combined with an increase of non-PCV13 serotypes (p = 0.0045). CONCLUSIONS This is the first study to report serotypes for pneumococcal meningitis across all ages in the post-PCV13 era in Greece. There is a need to enhance surveillance, by close monitoring of the emerging serotypes and the impact of vaccination programs. Higher-valency PCVs may help to improve the coverage of pneumococcal disease.
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Affiliation(s)
- Xirogianni Athanasia
- National Meningitis Reference Laboratory, Dept. of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece
| | - Marmaras Nektarios
- National Meningitis Reference Laboratory, Dept. of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece
| | - Georgakopoulou Theano
- Department of Vaccine Preventable Diseases, National Public Health Organization (NPHO), Athens, Greece
| | - Papandreou Anastasia
- National Meningitis Reference Laboratory, Dept. of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece
| | - Simantirakis Stelmos
- National Meningitis Reference Laboratory, Dept. of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece
| | - Magaziotou Ioanna
- Department of Vaccine Preventable Diseases, National Public Health Organization (NPHO), Athens, Greece
| | - Eliades Andreas
- Dept. of Paediatric Intensive Care Unit, University Hospital of Patras, Greece
| | - Getsi Vassiliki
- Dept. of Paediatrics, (")Hatzikosta" General Hospital, Ioannina, Greece
| | | | - Staikou Efi
- Dept. of Microbiology, "Pentelis" Children Hospital, Athens, Greece
| | - Markou Fani
- Dept. of Microbiology, Serres General Hopsital, Serres, Greece
| | - Argyrοpoulou Athina
- Dept. of Clinical Microbiology "Evangelismos" General Hospital, Athens, Greece
| | - Vlachaki Georgia
- Dept. of Paediatrics, "Venizeleion" General Hospital, Heraklion, Crete, Greece
| | | | | | | | - Michos Athanasios
- First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Spoulou Vassiliki
- First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens, Greece
| | | | - Panagiotakopoulos George
- Department of Vaccine Preventable Diseases, National Public Health Organization (NPHO), Athens, Greece
| | - Petinaki Efthymia
- Dept. of Microbiology, Dept. of Microbiology, Medical School, University of Thessaly, Larissa, Greece
| | - Mantadakis Elpis
- Dept. of Paediatrics, Faculty of Medicine, Democritus University of Thrace, University General Hospital, Alexandroupolis, Greece
| | - Roilides Emmanuel
- 3rd Dept. of Paediatrics, School of Medicine, Aristotle University, and Hippokration General Hospital, Thessaloniki, Greece
| | - Galanakis Manolis
- Paediatric Infectious Diseases Unit, Heraklion University Hospital, University of Crete, Heraklion, Greece
| | - Papaevangelou Vana
- Third Department of Pediatrics, National and Kapodistrian University of Athens, University General Hospital "ATTIKON", Athens, Greece
| | - Tsolia Maria
- Second Dept. of Pediatrics, Medical School, National and Kapodistrian University of Athens, "A&P Kyriakou" Children's Hospital, Athens, Greece
| | - Georgina Tzanakaki
- National Meningitis Reference Laboratory, Dept. of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece.
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Mungall BA, Hoet B, Nieto Guevara J, Soumahoro L. A systematic review of invasive pneumococcal disease vaccine failures and breakthrough with higher-valency pneumococcal conjugate vaccines in children. Expert Rev Vaccines 2021; 21:201-214. [PMID: 34882050 DOI: 10.1080/14760584.2022.2012455] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION : The pneumococcal non-typeable Haemophilus influenzae protein D-conjugate vaccine (PHiD-CV or PCV10) and 13-valent pneumococcal conjugate vaccine (PCV13) protect against vaccine-serotype invasive pneumococcal disease (VT IPD). However, VT IPD can still occur in fully or partially vaccinated children (vaccine failure or breakthrough). We performed a systematic review of vaccine failures and breakthrough IPD with PCV10 and PCV13 in ≤5-year-olds. AREAS COVERED : We searched Scopus/Medline/EMBASE to retrieve articles/abstracts published between 1/2008-7/2019. We excluded reports from studies only including data from adults or children ≥6 years, exclusively assessing PCV7-vaccinated children or children with underlying comorbidities. Twenty-six reports (20 PCV13, 1 PCV10, 5 both), covering studies with various designs in six continents, using different schedules, were included. Collectively, these studies reported 469 VT IPD cases classified as vaccine failures and 403 as breakthrough. Vaccine failure and breakthrough rates were low: 8.4% and 9.3%, respectively, of all IPD in vaccinated children, consistent with the vaccines' high effectiveness. The main serotypes associated with vaccine failure or breakthrough were 19A, 3 and 19F in PCV13 studies and 14, 6B and vaccine-related 19A and 6A in PCV10 studies. EXPERT OPINION : As we move to vaccines with more serotypes, it is not only important to consider which serotypes are added, but also to monitor and address incomplete protection against specific serotypes.
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Pediatric Invasive Pneumococcal Disease Three Years after PCV13 Introduction in the National Immunization Plan-The Continued Importance of Serotype 3. Microorganisms 2021; 9:microorganisms9071428. [PMID: 34361864 PMCID: PMC8304318 DOI: 10.3390/microorganisms9071428] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 11/21/2022] Open
Abstract
The introduction of pneumococcal conjugate vaccines PCV7 and PCV13 led to decreases in incidence of pediatric invasive pneumococcal disease (pIPD) and changes in serotype distribution. We evaluated the consequences of higher vaccine uptake after the introduction of PCV13 in the National Immunization Plan (NIP) in 2015. Besides culture and conventional serotyping, the use of molecular methods to detect and serotype pneumococci in both pleural and cerebrospinal fluid samples contributed to 30% of all pIPD (n = 232) in 2015–2018. The most frequently detected serotypes were: 3 (n = 59, 26%), 10A (n = 17, 8%), 8 (n = 16, 7%) and 19A (n = 10, 4%). PCV13 serotypes still accounted for 46% of pIPD cases. Serotypes not included in any currently available conjugate vaccine (NVT) are becoming important causes of pIPD, with the increases in serotypes 8 and 33F being of particular concern given the importance of serotype 8 in adult IPD and the antimicrobial resistance of serotype 33F isolates. This study highlights the importance of using molecular methods in pIPD surveillance since these allowed a better case ascertainment and the identification of serotype 3 as the leading cause of pIPD. Even in a situation of vaccine uptake >95% for 3 years, PCV13 serotypes remain important causes of pIPD.
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Izurieta P, Nieto Guevara J. Exploring the evidence behind the comparable impact of the pneumococcal conjugate vaccines PHiD-CV and PCV13 on overall pneumococcal disease. Hum Vaccin Immunother 2021; 18:1872341. [PMID: 33605846 PMCID: PMC8920200 DOI: 10.1080/21645515.2021.1872341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The worldwide implementation of pneumococcal conjugate vaccines (PCVs) in children has reduced the overall pneumococcal disease burden. Two PCVs are widely available for infant vaccination: the pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) and the 13-valent PCV (PCV13). While these PCVs differ in serotype composition (PCV13 includes polysaccharides of serotypes 3, 6A and 19A; PHiD-CV does not), their impact on the overall pneumococcal disease burden in children is comparable. This commentary summarizes the evidence of comparability between PHiD-CV and PCV13 and explores why differences in serotype composition may not necessarily translate into a differential clinical impact. Both vaccines confer similarly high protection against disease caused by vaccine serotypes and lead to a partial replacement by non-vaccine serotypes. PHiD-CV does not protect against serotype 3 disease (not included in the vaccine) and PCV13’s effect on this serotype has been inconsistent. PHiD-CV provides some cross-protection against disease caused by vaccine-related serotype 19A but neither vaccine has fully controlled 19A disease. While protection against 19A is higher for PCV13 than PHiD-CV, replacement by non-PCV13 serotypes in settings with a PCV13 program appears to compensate for this difference. This results in a similar residual overall disease burden with both vaccines.
What is the context?
The pneumococcus bacterium can cause infections of the meninges, blood, lung, middle ear and sinuses. Two vaccins, Synflorix (GSK) and Prevnar 13 (Pfizer Inc.), are widely used to protect young children against these infections. The vaccines’ compositions differ: Synflorix includes antigens from 10 pneumococcus strains (or “serotypes”) and Prevnar 13 from 13 serotypes. However, both have a similar effect on the total pneumococcal disease burden in children.
What does this commentary highlight?
This commentary summarizes the evidence beihnd the two vaccines’ comparable impact on pneumococcal disase. It also looks at why the vaccines have a similar effect on the total pneumococcal disease burden despite their different compositions.
What is the impact on current thinking?
Given that Synflorix and Prevnar 13 have a comparable impact on pneumococcal disease, a country’s choice between the two vaccines will depend on vaccine supply, cost, logistical factors (e.g., transport, storage, training requirements of health workers) and the local pneumococcal epidemiology.
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Hernández S, Navas E, Aznar-Lou I, Ciruela P, García-García JJ, Moraga-Llop F, Muñoz-Almagro C, Codina G, de Sevilla MF, González-Peris S, Esteva C, Planes AM, Izquierdo C, Martínez-Osorio J, Campins M, Uriona S, Salleras L, Serrano-Blanco A, Jané M, Domínguez Á. Impact of the 13-Valent Conjugated Pneumococcal Vaccine on the Direct Costs of Invasive Pneumococcal Disease Requiring Hospital Admission in Children Aged < 5 Years: A Prospective Study. Vaccines (Basel) 2020; 8:vaccines8030387. [PMID: 32679762 PMCID: PMC7564806 DOI: 10.3390/vaccines8030387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/05/2020] [Accepted: 07/13/2020] [Indexed: 11/16/2022] Open
Abstract
The lack of invasive pneumococcal disease (IPD) cost studies may underestimate the eect ofpneumococcal polysaccharide conjugated vaccines (PCV). The objective of this study was to estimatethe direct costs of hospitalized IPD cases. A prospective study was made in children aged <5 yearsdiagnosed with IPD in two high-tech hospitals in Catalonia (Spain) between 2007-2009 (PCV7 period)and 2012-2015 (PCV13 period). Costs were calculated according to 2014 Catalan Health Service ratesusing diagnostic-related groups. In total, 319 and 154 cases were collected, respectively. Pneumoniahad the highest cost (65.7% and 62.0%, respectively), followed by meningitis (25.8% and 26.1%,respectively). During 2007-2015, the costs associated with PCV7 serotypes (Pearson coecient (Pc) =?0.79; p = 0.036) and additional PCV13 serotypes (Pc = ?0.75; p = 0.05) decreased, but those of otherserotypes did not (Pc = 0.23 p = 0.62). The total mean cost of IPD increased in the PCV13 period by31.4% (¿3016.1 vs. ¿3963.9), mainly due to ICU stay (77.4%; ¿1051.4 vs. ¿1865.6). During the PCV13period, direct IPD costs decreased due to a reduction in the number of cases, but cases were more severe and had a higher mean cost. During 2015, IPD costs increased due to an increase in the costsassociated with non-PCV13 serotypes and serotype 3 and this requires further investigation.
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Affiliation(s)
- Sergi Hernández
- Public Health Agency of Catalonia, Generalitat de Catalunya, 08005 Barcelona, Spain; (E.N.); (P.C.); (M.J.); (C.I.)
- Correspondence:
| | - Encarna Navas
- Public Health Agency of Catalonia, Generalitat de Catalunya, 08005 Barcelona, Spain; (E.N.); (P.C.); (M.J.); (C.I.)
| | - Ignacio Aznar-Lou
- Teaching, Research & Innovation Unit, Institut de Recerca Sant Joan de Déu, Sant Boi de Llobregat, 08830 Barcelona, Spain;
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.J.G.-G.); (C.M.-A.); (C.E.); (L.S.); (A.S.-B.); (Á.D.)
| | - Pilar Ciruela
- Public Health Agency of Catalonia, Generalitat de Catalunya, 08005 Barcelona, Spain; (E.N.); (P.C.); (M.J.); (C.I.)
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.J.G.-G.); (C.M.-A.); (C.E.); (L.S.); (A.S.-B.); (Á.D.)
| | - Juan José García-García
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.J.G.-G.); (C.M.-A.); (C.E.); (L.S.); (A.S.-B.); (Á.D.)
- Hospital Sant Joan de Déu Barcelona, Universitat de Barcelona, Esplugues de Llobregat, 08950 Barcelona, Spain; (M.F.d.S.); (J.M.-O.)
- Malalties Prevenibles amb Vacunes, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, 08950 Barcelona, Spain
| | - Fernando Moraga-Llop
- Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (F.M.-L.); (G.C.); (S.G.-P.); (A.M.P.); (M.C.); (S.U.)
| | - Carmen Muñoz-Almagro
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.J.G.-G.); (C.M.-A.); (C.E.); (L.S.); (A.S.-B.); (Á.D.)
- Hospital Sant Joan de Déu Barcelona, Universitat de Barcelona, Esplugues de Llobregat, 08950 Barcelona, Spain; (M.F.d.S.); (J.M.-O.)
- Malalties Prevenibles amb Vacunes, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, 08950 Barcelona, Spain
- Departament de Medicina, Universitat Internacional de Catalunya, 08017 Barcelona, Spain
| | - Gemma Codina
- Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (F.M.-L.); (G.C.); (S.G.-P.); (A.M.P.); (M.C.); (S.U.)
| | - Mariona F. de Sevilla
- Hospital Sant Joan de Déu Barcelona, Universitat de Barcelona, Esplugues de Llobregat, 08950 Barcelona, Spain; (M.F.d.S.); (J.M.-O.)
- Malalties Prevenibles amb Vacunes, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, 08950 Barcelona, Spain
| | - Sebastià González-Peris
- Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (F.M.-L.); (G.C.); (S.G.-P.); (A.M.P.); (M.C.); (S.U.)
| | - Cristina Esteva
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.J.G.-G.); (C.M.-A.); (C.E.); (L.S.); (A.S.-B.); (Á.D.)
- Hospital Sant Joan de Déu Barcelona, Universitat de Barcelona, Esplugues de Llobregat, 08950 Barcelona, Spain; (M.F.d.S.); (J.M.-O.)
| | - Ana María Planes
- Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (F.M.-L.); (G.C.); (S.G.-P.); (A.M.P.); (M.C.); (S.U.)
| | - Conchita Izquierdo
- Public Health Agency of Catalonia, Generalitat de Catalunya, 08005 Barcelona, Spain; (E.N.); (P.C.); (M.J.); (C.I.)
| | - Johanna Martínez-Osorio
- Hospital Sant Joan de Déu Barcelona, Universitat de Barcelona, Esplugues de Llobregat, 08950 Barcelona, Spain; (M.F.d.S.); (J.M.-O.)
| | - Magda Campins
- Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (F.M.-L.); (G.C.); (S.G.-P.); (A.M.P.); (M.C.); (S.U.)
- Epidemiology and Public Health Research Group, Vall d’Hebron Institut de Recerca, 08035 Barcelona, Spain
| | - Sonia Uriona
- Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain; (F.M.-L.); (G.C.); (S.G.-P.); (A.M.P.); (M.C.); (S.U.)
- Epidemiology and Public Health Research Group, Vall d’Hebron Institut de Recerca, 08035 Barcelona, Spain
| | - Luis Salleras
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.J.G.-G.); (C.M.-A.); (C.E.); (L.S.); (A.S.-B.); (Á.D.)
- Departament de Medicina, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Antoni Serrano-Blanco
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.J.G.-G.); (C.M.-A.); (C.E.); (L.S.); (A.S.-B.); (Á.D.)
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, 08830 Barcelona, Spain
| | - Mireia Jané
- Public Health Agency of Catalonia, Generalitat de Catalunya, 08005 Barcelona, Spain; (E.N.); (P.C.); (M.J.); (C.I.)
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.J.G.-G.); (C.M.-A.); (C.E.); (L.S.); (A.S.-B.); (Á.D.)
| | - Ángela Domínguez
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, 28029 Madrid, Spain; (J.J.G.-G.); (C.M.-A.); (C.E.); (L.S.); (A.S.-B.); (Á.D.)
- Departament de Medicina, Universitat de Barcelona, 08036 Barcelona, Spain
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Valdivielso Martínez AI, Ramos Fernández JM, Pérez Frías J, Moreno Pérez D. Influence of pneumococcal vaccination on the hospitalization of healthy pediatric patients due to typical Community-Acquired Pneumonia. Int J Infect Dis 2020; 98:194-199. [PMID: 32553718 DOI: 10.1016/j.ijid.2020.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION Community-Acquired Pneumonia (CAP) is one of the most frequent causes of hospital admission in children. Our objective is to measure the impact of the introduction of pneumococcal conjugate vaccines on the hospitalization of previously healthy children due to CAP. METHOD From 2011 to 2016, a partially retrospective, prospective, and descriptive study was carried out on healthy pediatric patients (3 months-14 years old) with CAP, who required hospital admission. Clinical, epidemiological, and demographic characteristics were collected, and vaccination status was obtained from medical records. RESULTS A total of 292 cases were included, with a mean age of 33.4 months, 54% males. There was a progressive and significant 42% decrease in the number of admissions each year, without significant changes in the annual percentage of parapneumonic pleural effusion (PPE). Fifty-six percent of patients were immunized with a pneumococcal conjugate vaccine (PCV). The percentage of children who were not vaccinated decreased by 14%, and the coverage with PCV-13 increased by 46%. This revealed a significant increase of PPE in vaccinated patients with PCV-7 (63%) compared with unvaccinated (45%) and with PCV-13 (57%), without association with the presence of severe PPE. Moreover, no significant differences in severity or hospital stay were observed in unvaccinated patients, compared to those who were vaccinated. In >2-year-olds, we observed a significant increase in PPE (59%) compared to 45% in younger children. CONCLUSIONS The increase in vaccination coverage with PCV-13 resulted in a decrease in hospitalizations due to CAP and PPE. Vaccination with PCV-7 is associated in our sample with an increase in PPE but not with severe PPE nor an increase in the hospital stay. There was an epidemiological shift of severe forms of pneumonia and empyema at later ages (>2 years).
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Affiliation(s)
- Ana Isabel Valdivielso Martínez
- Pediatría Distrito Sanitario Málaga-Guadalhorce, Pediatría Hospital Regional Universitario de Málaga, Programa del Doctorado de Universidad de Ciencias de la Salud.
| | - Jose Miguel Ramos Fernández
- Facultativo Especialista de Área de Neuropediatría, Pediatría Hospital Materno-Infantil Regional Universitario de Málaga, Grupo de Investigación IBIMA; Departamento de Pediatría y Farmacología, Facultad de Medicina, Universidad de Málaga
| | - Javier Pérez Frías
- Facultativo Especialista de Área de Neumología pediátrica, Pediatría Hospital Materno-Infantil Regional Universitario de Málaga, Grupo de Investigación IBIMA; Profesor Catedrático del Departamento de Pediatría y Farmacología, Facultad de Medicina, Universidad de Málaga
| | - David Moreno Pérez
- Departamento de Pediatría y Farmacología, Facultad de Medicina, Universidad de Málaga; Infectología Pediátrica e Inmunodeficiencias, UGC Pediatría, Hospital Materno-Infantil, Hospital Regional Universitario de Málaga, Málaga, Spain; Grupo de Investigación IBIMA; Red de Investigación Translacional en Infectología Pediátrica (RITIP)
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