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Prevention of pneumococcal disease among infants and children - Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine
... In 2010, although the Centre For Disease Control, Atlanta, confirmed the benefits of the new PCV7 vaccine in reducing both the resistance and carriage of pathologies due to Streptococcus pneumoniae serotypes contained in PCV7, it also expressed, however, a concern over the rise in the incidence of infections caused by the emerging strains not contained in the vaccine (serotypes 1, 19A, 3, 6A and 7F) [4]. Similar findings were to be reported, later, by other studies [5,6]. ...
... The earlier implementation of PCV7 vaccination had led to a tremendous reduction in severe pneumococcal infections worldwide [3][4][5][6][7]. In France, the 2007 EPIBAC study showed similar results after the introduction of PCV7 in national vaccination schedules [9]. ...
... The incidence of severe pneumococcal infections was reduced by 32% for acute meningitis and by 38% for bacteremia [9]. The same study additionally reported, however, a considerable rise in the incidence of both meningitis and severe bacteremia due to serotype 19A in toddlers, as reported by others [2,4,9,10]. ...
Key Clinical Message
We report a 13‐month‐old immune‐competent male child who was diagnosed with pneumococcal serotype 19A meningitis despite having received three PCV13 injections. Clinicians are reminded that bacterial meningitis can still occur, even in correctly vaccinated children. Investigations should include immune system screening along with abdominal ultrasound to exclude asplenia.
... In 2010, although the Centre For Disease Control, Atlanta, confirmed the benefits of the new PCV7 vaccine in reducing both the resistance and carriage of pathologies due to Streptococcus pneumoniae serotypes contained in PCV7, it also expressed, however, a concern over the rise in the incidence of infections caused by the emerging strains not contained in the vaccine (serotypes 1, 19A, 3, 6A and 7F) [4]. Similar findings were to be reported, later, by other studies [5,6]. ...
... The earlier implementation of PCV7 vaccination had led to a tremendous reduction in severe pneumococcal infections worldwide [3][4][5][6][7]. In France, the 2007 EPIBAC study showed similar results after the introduction of PCV7 in national vaccination schedules [9]. ...
... The incidence of severe pneumococcal infections was reduced by 32% for acute meningitis and by 38% for bacteremia [9]. The same study additionally reported, however, a considerable rise in the incidence of both meningitis and severe bacteremia due to serotype 19A in toddlers, as reported by others [2,4,9,10]. ...
... Use of the PCV vaccine at or after age 5 is dependent on the underlying chronic illness that is present. Those who are 6 to 18 years and adults 19 years and older should receive one PCV (if there is no previous PCV history) for cochlear implants, cerebrospinal fluid leakage, and immunosuppression due to HIV, asplenia (anatomic or function [i.e., sickle cell disease]), malignancy, and others (133)(134)(135). Use of PCV vaccine has lead to less invasive pneumococcal disease in children who are less than 5 years of age with 99 cases/100,000 persons in 1998-1999 dropping to 21 cases per 100,000 in 2008. ...
... Over the years many activities became focused in the south of Israel due to collaboration with various professionals at the FDA approval, 208 fear, 78,126,165,175,186,187,188,189,191,194,195 76,77,86,87,90,93,96,97,98,121,122,125,126,127,128,129,130,131,132,133,134,135,136,143,145,147,149,150,152,153,181,183,185,186,187,188,189,191,194,195,196,197,198,199,203,208,228,229,248 parotitis,211 participants,10,11,12,13,49,84,86,89,91,93,103,113,114,117,118,119,120,121,122,123,127,131,143,144,163,173,188,189,197 PCA,185,186,194,195,196,197 PCP,187,188,189,191,196 PCR,207 pediatrician,198, 51, 52, 55, 61, 64, 123, 148, 157, 158, 160, 161, 173 penalties, 188, 189, 191, 194, 195 perinatal, 6, 29, 30, 32, 33, 216 peripheral 43, 59, 148, 203, 227 preferential treatment, 52 pregnancy, 4, 5, 17, 18, 19, 20, 21, 22, 23, 25, 27, 29, 30, 31, 103, 106, 128, 131, 205, 210, 216, 217, 218, 220, 221, 224, 225, 226, 229, 235, 236 prejudice, 47 premature death, 76 premature infant, 29, 224 prematurity, 18, 29 preparedness, 220, 234 preschool, 38, 65, 113, 124, 147, 148, 149, 150, 151, 152, 153, 154, 155, 156 preschool children, 65 preschoolers, 156 preservative, 211 preventative care, 143 prevention, ix, 5, 17, 31, 75, 87, 88, 112, 123, 124, 132, 134, 138, 181, 183, 33, 55, 75, 89, 186, 194, 195, 196, 197, 200, 204, 205, 47, 48, 85, 112, 126, 199, 200, 231 researchers, 5, 9, 10, 11, 19, 81, 90, 96, 97, 112, 113, 116, 121, 148, 149, 153, 154, 195, 202, 210, 247 resilience, 164 resistance, 187, 195, 199 resources, 47, 49, 51, 52, 53, 54, 62, 63, 64, 98, 125, 126, 128, 129, 130, 154, 164, 174 respiratory syncytial virus, 223, 225, 227, 236, 237 ...
Children diagnosed with childhood apraxia of speech (CAS) often acquire sounds but have difficulties in putting them together and forming words. This case study deals with the therapeutic challenges and examines a technique called initial phoneme cue (IPC). A 10 year old girl with autism spectrum disorder (ASD) and CAS had word formation treatment for several years with no results. We compared the use of IPC technique versus regular imitation of CVCV structured words. Results: The use of IPC resulted in a 97- 100% success of word imitation while regular imitation had 0-20% success of word imitation. Conclusions: The results confirmed our speculation of the efficacy of IPC’s technique within this single treatment process.
... PCV10 was introduced in November 2009, while PCV13 in May 2010 and gradually replaced PCV7. The switch from PCV7 to PCV13 was completed following the recommendations of the Advisory Committee on Immunization Practices (ACIP) [20]. ...
... Childrens' PCV vaccination status was determined as non-vaccinated, fully vaccinated and partially vaccinated. Children were considered partially vaccinated for age if they had not completed the schedule for age according to the Center of Disease and Control guidelines [20]. ...
The objective of the study was to describe the incidence of pneumococcal nasopharyngeal carriage, serotype distribution and antibiotic resistance profile of pneumococcal nasopharyngeal isolates in healthy children aged 6 to 36 months following the implementation of conjugate vaccines. A nasopharyngeal swab was collected from 1105 healthy children following a stratified random sampling between September 2013 and April 2014. Demographics, vaccination status and data on possible risk factors were recorded. Isolates were serotyped and tested for antibiotic susceptibility. The nasopharyngeal carriage rate was 25.3%. Among 1105 children enrolled, 393 had received PCV13 and 685 PCV10. The prevailing isolated serotypes were: 23A (14.3%), 15A (8.9%), 6C (8.6%), 23B (7.5%), 19A (5.4%) and 15B (5%). The proportion of non-vaccine serotypes, PCV10 serotypes, PCV13 additional serotypes (3, 6A, 19A) was 76.8%, 2.1% and 10.4% respectively. Although children, who were fully or partially vaccinated with PCV13, were 63% less likely to be colonized with additional PCV13 serotypes compared to those vaccinated with PCV10, the difference is not significant (95%Cl = 0.14–1.02, p = 0.053). The highest antibiotic non-susceptible rates were found for erythromycin (28.2%) and penicillin (27.9%). The overall multidrug resistance rate was 13.2%, with serotypes 24F (4/6), 15A (14/25) and 19A (6/15) being the main contributors. Carriage rate was similar between children vaccinated with PCV10 or PCV13. The high incidence of 15A serotype which is also multidrug resistant should be underlined. Ongoing surveillance is needed to monitor the dynamics on nasopharyngeal carriage.
... Two more vaccines for pneumonia (a 23-valent polysaccharide for adults and a 7-valent protein-conjugated polysaccharide for children) have also been in use since in 1983 and 2000 respectively [10,30] despite substantial argument over their efficacy [30]. A new 13-valent pneumococcal polysaccharide-protein conjugate vaccine (PCV13 [Prevnar13]) was licensed in 2010 to cover for more serotype [20]. Studies show that pneumonia cases have been reduced by 20% when vaccination is used, however it is faced with a number of challenges of resistance that is always developed by the bacteria. ...
... A proportion of susceptible that moves to the vaccinated class when they receive a vaccine against the disease is . The vaccine is expected to protect an individual from getting infected by the bacteria, however there is a possibility of the vaccine to wane [20] at the rate (where 1 − is vaccine efficacy) exposing vaccinated individuals to infections. The susceptible can be infected by either carriers or by symptomatically infected individual with a force of infection . ...
Deterministic models have been used in the past to understand the epidemiology of infectious diseases, most importantly to estimate the basic reproduction number, R o by using disease parameters. However, the approach overlooks variation on the disease parameter(s) which are function of R o and can introduce random effect on R o. In this paper, we estimate the R o as a random variable by first developing and analyzing a deterministic model for transmission patterns of pneumonia, and then compute the probability distribution of R o using Monte Carlo Markov Chain (MCMC) simulation approach. A detailed analysis of the simulated transmission data, leads to probability distribution of R o as opposed to a single value in the convectional deterministic modeling approach. Results indicate that there is sufficient information generated when uncertainty is considered in the computation of R o and can be used to describe the effect of parameter change in deterministic models.
... Two more vaccines for pneumonia (a 23-valent polysaccharide for adults and a 7-valent protein-conjugated polysaccharide for children) have also been in use since in 1983 and 2000 respectively [10,30] despite substantial argument over their efficacy [30]. A new 13-valent pneumococcal polysaccharide-protein conjugate vaccine (PCV13 [Prevnar13]) was licensed in 2010 to cover for more serotype [20]. Studies show that pneumonia cases have been reduced by 20% when vaccination is used, however it is faced with a number of challenges of resistance that is always developed by the bacteria. ...
... A proportion of susceptible that moves to the vaccinated class when they receive a vaccine against the disease is . The vaccine is expected to protect an individual from getting infected by the bacteria, however there is a possibility of the vaccine to wane [20] at the rate (where 1 − is vaccine efficacy) exposing vaccinated individuals to infections. The susceptible can be infected by either carriers or by symptomatically infected individual with a force of infection . ...
Deterministic models have been used in the past to understand the epidemiology of infectious diseases, most importantly to estimate the basic reproduction number, R o by using disease parameters. However, the approach overlooks variation on the disease parameter(s) which are function of R o and can introduce random effect on R o. In this paper, we estimate the R o as a random variable by first developing and analyzing a deterministic model for transmission patterns of pneumonia, and then compute the probability distribution of R o using Monte Carlo Markov Chain (MCMC) simulation approach. A detailed analysis of the simulated transmission data, leads to probability distribution of R o as opposed to a single value in the convectional deterministic modeling approach. Results indicate that there is sufficient information generated when uncertainty is considered in the computation of R o and can be used to describe the effect of parameter change in deterministic models.
... ****La vacuna contra el VPH brinda el mayor beneficio cuando se administra antes de que una persona esté expuesta a cualquier VPH. γ Recomendaciones sugeridas por CDC/ACIP 2010[79]. ...
los pacientes con enfermedad renal son una población de alta complejidad porsus condiciones de multimorbilidad, riesgo cardiovascular y requerimiento de terapias inmuno-supresoras. La vacunación es una de las principales estrategias para mitigar el riesgo de infec-ciones, no obstante, la respuesta a las vacunas se ve afectada por la pérdida de la calidad de lafunción inmunológica, efecto que es mayor en la medida en que la enfermedad renal progresa ose requiere el uso de medicamentos inmunosupresores. Por ello, las prácticas de inmunizacióndeben ser incentivadas en los pacientes en estadios más precoces de su enfermedad. Desafortu-nadamente, existe un amplio desconocimiento por parte de los prestadores de atención respectode las mejores prácticas de inmunización, adicionalmente, en Colombia no existe cobertura deaseguramiento en el plan de beneficios de salud para muchos de los biológicos requeridos
... Women who develop intrapartum fever are more likely to receive antibiotics and neonates born to febrile mothers undergo increased rates of neonatal sepsis evaluation. [11,12] Fetal exposure to hyperthermia, inflammation, or both, is associated with several adverse neurologic outcomes. [5] Most of the studies are done in the developed world; the reason could be the high rate of labor epidural as vital statistic data suggest that approximately 68% of nulliparous patients in the USA receive labor epidural analgesia for vaginal birth, and are therefore at risk of developing fever [13] No studies are available from developing countries to show an association of labor epidural with maternal hyperthermia. ...
Background and Objective: There has been a concern regarding maternal hyperthermia with labor epidural in developed countries. This study aimed to determine the frequency of rise in maternal temperature after labor epidural placement in a tertiary care hospital of a developing country. Materials and Methods: After approval from the institutional ethics review committee and informed consent, this observational cohort study was conducted on 494 nulliparous women fulfilling the inclusion criteria and requesting labor epidural. Maternal temperature was recorded by a standardized method soon before institution of labor epidural (baseline temperature) and then hourly after its placement for up to 6 h maximum or till delivery. Neonatal outcome was observed by recording Apgar score at 1 and 5 min and intensive care admissions. Results: There was a steady rise of mean temperature from baseline (36.26 ± 0.31), each hour after institution of labor epidural. The percentage of patients showing a rise in temperature increased each hour from 45% in first hour to more than 56% in the sixth hour. The temperature of ≥37.5°C was considered as hyperthermia and was observed in four patients (0.81%). The median temperature difference was not statistically significant within time point (P > 0.05). Apgar scores of newborns born to mothers with hyperthermia were 8 at 1 min and 9 at 5 min with no intensive care admissions. Conclusion: Frequency of maternal hyperthermia was found to be low compared to the incidence reported from developed countries, most probably due to difference in obstetric practice and patients demographics.
... 3 Several studies have reported that serotypes 1, 4, 6A/B, 7F, 9V, 14, 15B/C, 18C, 19F, 19A, and 23F account for more than 80% of the IPD in children, especially in developing countries without any routine pneumococcal vaccination programs. [19][20][21][22] In the absence of such programs in Iran, we managed to identify the presence of serotypes 23F, 19A, 19F, 18C, 14, 1, and serogroups 6A/B, 15B/C, 9A/V, 15A/F, 7A/F, 11A/D/F, and 22A/F. In line with other studies, 1,4,[23][24][25][26] we found that the most prevalent serotypes in meningitis cases were 23F, 19A, 19F and 6A/B, which could be controlled with the PCV-13 vaccine. ...
Background:
To date, more than 90 Streptococcus pneumoniae (S. pneumoniae) capsular serotypes are known. The prevalence of these serotypes varies according to the geographical area and the regional vaccination program. Due to the lack of regular vaccination programs for S. pneumoniae in developing countries, serotyping of the prevalent isolates is useful in selecting the correct vaccine. The present study aimed to evaluate common serotypes of pneumococcal meningitis in Bojnurd, Iran.
Methods:
All cerebrospinal fluid (CFS) samples suspected for bacterial meningitis were analyzed. The samples were collected during 2014-2018 in the Laboratory of Imam Reza Hospital (Bojnurd, Iran). Due to the high rate of false-negative cultures, polymerase chain reaction (PCR) was used for the detection of lytA and psaA genes of S. pneumoniae. In addition, the modified Marimon's PCR method was used for serotyping the bacteria. The data were analyzed using Pearson's Chi-square test.
Results:
Out of the 901 CSF samples, 106 cases tested positive for S. pneumoniae using the PCR method, while only 92 cases tested positive using the conventional methods. Based on the Marimon's PCR method, serotypes 23F, 19F, 19A, 1, 14, and serogroup 6A/B were the most common types. Serogroups 18C, 15A/F, 15B/C, 9A/V, 7A/F, 11A/D/F, and 22A/F were also detected in isolates. Note that 2.8% of the samples were non-typable (NT).
Conclusion:
The results showed that only 13 serotypes were responsible for all meningitis cases. Pneumococcal capsular vaccine-13 (PCV-13) is the preferred choice against common serotypes of S. pneumoniae in northeast Iran.The abstract was presented in Iran's 19th International Congress of Microbiology, as a poster and published in the congress abstracts book.
... En aquellos pacientes con IDC que requieran trasplante de médula ósea (TMO), la vacunación antineumocócica debe reiniciarse de 3 a 6 meses postrasplante con 3 dosis de PCV13 y, al año del trasplante, deben recibir una cuarta dosis de vacuna con PPVS23 (si tiene enfermedad injerto vs. huésped, no debe recibir PPVS23 y debe recibir una cuarta dosis con aplicación de PCV13) (Tabla 1.b). 3,[5][6][7][8]11,[47][48][49][50] ...
Primary immunodeficiencies (PIDs) are a group of hereditary diseases that affect the number and/or function of the various components of the immune system. Their prevalence is 1:1000-2000 births, and they include defects of adaptive immunity, defects of innate immunity, immunodeficiencies with
characteristic phenotypes, disorders of immune regulation, autoinflammatory syndromes, defects of phagocytes and complement system,
and defects considered phenocopies of PID.
Vaccination with inactivated vaccines is safe and may be effective in many immunodeficiencies, live attenuated vaccines may not be protective in certain PIDs or present as immunizationassociated vaccination disease, which leads to high morbidity and mortality. In order to update vaccine recommendations for patients with PID, the National Committee on Infectology and the Immunology Working Group worked on the vaccines that may be indicated for these patients, their closed contacts and health team workers.
... The age of enrollment was restricted to 2-5 years in the HIV-uninfected group because both vaccines are recommended as catch-up for healthy children till age 5 years. 5,10 The number of uninfected children recruited was determined by the number of HIV-infected 2-to 5-year-olds enrolled. ...
Background:
HIV infection increases risk of invasive disease from Streptococcus pneumoniae. Pneumococcal conjugate vaccines (PCV) prevent invasive disease and acquisition of vaccine type (VT) pneumococcus in the nasopharynx.
Objective:
To look at the safety and impact of one dose of PCV13 on acquisition of VT pneumococcal carriage in Indian children with HIV.
Method:
We conducted a cohort study in families of HIV-infected children (CLH) and families of HIV-uninfected children (HUC) in West Bengal. All children received one dose of PCV13. Nasopharyngeal swabs were collected from children and parents at baseline and two months after vaccination.
Result:
115 CLH and 47 HUC received one dose of PCV13. 58% of CLH were on antiretroviral therapy (ART), the median nadir CD4 count was 287. There were no significant adverse events in either group. HUC had more VT colonization than CLH-- 55% vs. 23% of all isolates. HIV infection doubled the risk of non-vaccine serotype colonization (NVT) (p=0.03). There was no difference in acquisition of VT isolates in CLH (4.4%) and HUC (4.5%) post PCV13, however older CLH (>5 years) had decreased clearance of VT strains. ART made no difference in pneumococcal colonization at baseline or after PCV13; however, CLH with higher nadir CD4 counts before starting ART were less likely to have VT colonization post-PCV13 (PR 0.2; 95%CI 0.1-0.5).
Conclusion:
While there was no difference in acquisition of VT nasopharyngeal carriage of pneumococcus in CLH and HUC after one dose of PCV13, earlier access to ART may impact response to PCV13 in CLH.
Clinical trial registry:
This study was registered with the Clinical Trial Registry-India hosted at National Institute of Medical Statistics, New Delhi (CTRI/2012/03/002515 and CTRI/2013/04/003535).
... We reviewed the publications and their references in order to identify non-indexed publications. We evaluated each in case the age, sex, associated infections, prognosis, therapeutic interventions defined as: "medical (only antibiotic treatment)" or "medical-surgical (antibiotic treatment + surgical debridement or percutaneous drainage)", relevant comorbidities according to the ones published by the Advisory Committee on Immunization Practices [11] with the goal to determine RF for invasive disease. The cases were grouped in two: those with known RF, and those with no evident or predisposing RF at the time of disease. ...
Celiac Disease is well known as a risk factor for severe infections caused by capsulated germs (i.e. Streptococcus pneumoniae). Among these infections there are some known by their extreme severity, such as pyomyositis. In this article we present the case of a 68 year old female patient with diagnosis of Celiac Disease and pyomyositis caused by Streptococcus pneumoniae and we review the literature
... 32,33 Given these facts, children with T1D require influenza vaccination yearly via injection and pneumococcal vaccination with 23-valent pneumococcal polysaccharide vaccine at ≥2 years of age, in addition to regular childhood vaccinations. 34 ...
... Al cabo de 5 años recibirán la segunda y última dosis de la VNP23. En otros niños no inmunodeprimidos ( fig. 2), pero con riesgo alto de presentar enfermedad neumocócica grave o frecuente, puede optarse por seguir o bien las mismas recomendaciones dirigidas a los pacientes de alto riesgo, o bien las recomendadas a los niños sanos de su propia comunidad autónoma, y se recomienda que reciban una única dosis de VNP23 a partir de los 2 años de edad, con un intervalo mínimo de 2 meses tras la última dosis recibida de VNC13 64 . ...
... Al cabo de 5 años recibirán la segunda y última dosis de la VNP23. En otros niños no inmunodeprimidos ( fig. 2), pero con riesgo alto de presentar enfermedad neumocócica grave o frecuente, puede optarse por seguir o bien las mismas recomendaciones dirigidas a los pacientes de alto riesgo, o bien las recomendadas a los niños sanos de su propia comunidad autónoma, y se recomienda que reciban una única dosis de VNP23 a partir de los 2 años de edad, con un intervalo mínimo de 2 meses tras la última dosis recibida de VNC13 64 . ...
... On March 12, 2010, the Advisory Committee for Immunization Practices recommended that PCV13 replace PCV7 for all children and that a supplemental dose of PCV13 be given to children aged 14 to 59 months who completed the PCV7 series. 7 The PCV13 contains the 7 serotypes included in PCV7, as well as an additional 6 serotypes, including serotype 19A. An estimated 64% of IPD cases in children younger than 5 years in 2007 were caused by serotypes contained in PCV13, with 42% of all IPD cases caused by serotype 19A. ...
Invasive pneumococcal disease (IPD) is a leading cause of pneumonia, meningitis, and bacteremia in children. In March 2010, a 13-valent pneumococcal conjugate vaccine (PCV13) was introduced to the routine childhood immunization schedule. The PCV13 contains 6 serotypes not included in the previously recommended 7-valent pneumococcal conjugate vaccine, including serotype 19A, the predominant cause of IPD prior to the introduction of PCV13.
To describe changes in the epidemiology and incidence of IPD in children younger than 5 years in New York City (NYC) after the introduction of PCV13 and assess PCV13 coverage in NYC.
Retrospective analysis of population-based IPD surveillance data of the general population residing in NYC between January 1, 2007, and December 31, 2012. Invasive pneumococcal disease cases were identified by laboratory reporting of positive pneumococcal cultures from a normally sterile body site in NYC residents younger than 5 years. Isolates were serotyped. Participants included 468 cases younger than 5 years with IPD reported through routine surveillance to the NYC Department of Health and Mental Hygiene.
Absolute differences and percentage changes in IPD incidence before and after the introduction of PCV13 by serotype grouping, age, and race/ethnicity. The number of PCV13 doses administered to children younger than 5 years was calculated using the NYC immunization information system.
There were 468 IPD cases from 2007 to 2012. The incidence of IPD decreased by 69.6% (95% CI, -79.3% to -55.5%) from 21.0 cases per 100 000 (2007-2009 mean) pre-PCV13 to 6.4 cases per 100 000 (2011-2012 mean) post-PCV13. Estimates of disease caused by serotypes included in the PCV13 decreased by 82.5% (95% CI, -90.0% to -69.3%), including a 79.7% reduction in serotype 19A (95% CI, -89.0% to -62.4%). Reductions in IPD incidence were seen in all age groups, with the largest reduction in children younger than 12 months (80.4%; P = .005). Incidence decreased significantly in all racial/ethnic groups. The percentage of children younger than 5 years in NYC with 1 or more doses of PCV13 increased from 47.8% in 2010 to 89.8% in 2012.
The incidence of IPD in NYC children younger than 5 years and, particularly, the incidence of IPD caused by serotype 19A decreased dramatically following the introduction of PCV13, with reductions among all age and racial/ethnic groups. This represents a significant achievement for public health immunization programs and underscores the importance of achieving high immunization coverage.
Background
Adults aged ≥65 years, adults with certain underlying medical conditions, and persons experiencing homelessness are at increased risk for invasive pneumococcal disease (IPD). Two new pneumococcal conjugate vaccines, 15-valent pneumococcal conjugate vaccine (PCV15) and 20-valent pneumococcal conjugate vaccine (PCV20), were recently approved for use in U.S. adults. We described the epidemiology of IPD among Alaska adults and estimated the proportion of IPD cases potentially preventable by new vaccines.
Methods
We used statewide, laboratory-based surveillance data to calculate and compare IPD incidence rates and 95% confidence intervals (CI) among Alaska adults aged ≥18 years during 2011–2020 and estimate the proportion of IPD cases that were caused by serotypes in PCV15 and PCV20.
Results
During 2011–2020, 1,164 IPD cases were reported among Alaska adults for an average annual incidence of 21.3 cases per 100,000 adults per year (95% CI: 20.1–22.5). Incidence increased significantly during the study period (p<0.01). IPD incidence among Alaska Native adults was 4.7 times higher than among non-Alaska Native adults (95% CI: 4.2–5.2). Among adults experiencing homelessness in Anchorage, IPD incidence was 72 times higher than the general adult population (95% CI: 59–89). Overall, 1,032 (89%) Alaska adults with IPD had an indication for pneumococcal vaccine according to updated vaccination guidelines; 456 (39%) and 700 (60%) cases were caused by serotypes in PCV15 and PCV20, respectively.
Conclusions
Use of PCV15 and PCV20 could substantially reduce IPD among adults in Alaska, including Alaska Native adults and adults experiencing homelessness.
Objectives
Pneumococcal vaccine recommendations have become increasingly complex. This study aims to understand how national immunization technical advisory groups (NITAGs) and health technology assessment (HTA) agencies of 5 European countries and the United States formed their pneumococcal vaccine recommendations, by providing reviewed evidence and key drivers for new recommendations.
Methods
Centers for Disease Control and Prevention, European Centre for Disease Prevention and Control, and National Health Authorities Web sites were screened to capture the evolution of pneumococcal recommendations. A narrative review was conducted on NITAGs and HTA bodies’ Web sites. Assessments of pneumococcal vaccines published from 2009 to 2022 were included.
Results
Thirty-four records were identified including 21 assessments for risk groups, 17 for elderly, and 12 for children. Burden of disease and vaccine characteristics were almost systematically reviewed during assessments. All 6 countries recommended the use of higher-valent pneumococcal vaccine (PCV; i.e., PCV10 and PCV13) in childhood vaccination programs, given their broader serotype coverage and their comparable profile to PCV7. PCV13 was progressively added to the vaccine schedule (in addition to polysaccharide vaccine) in at least the high-risk group, given the high burden in this population and expected additional benefits of PCV13. For the elderly, unlike the United States, European countries issued negative recommendation for PCV13 routine use because of substantial herd effects from childhood vaccination program making PCV13 likely not cost-effective.
Conclusions
This research provides an overview of decision-making processes for higher-valent PCVs recommendations and could be of interest to anticipate the place of next generation of PCVs in the vaccination landscape.
Highlights
By describing evidence-based criteria for decision making, this study emphasizes the framework analysis of NITAGs and HTA bodies when assessing pneumococcal vaccines and demonstrates that variation exists between countries and also according to population evaluated. While the burden of disease and immunogenicity/efficacy data were almost systematically reviewed by national stakeholders, economic assessments were reported to a lesser extent but played a major role in the limited use of PCV13 in the adult population.
Although significant progress has been made in reducing the incidence of invasive pneumococcal disease (IPD) in children, IPD remains a continued threat. Since the introduction of pneumococcal conjugate vaccines (PCVs), rates of IPD and non-IPD have substantially decreased. However, serotype replacement reversed some of the benefits of PCV7 and, more recently, PCV13. Several replacement serotypes are antibiotic resistant, which is a cause of concern for providers. The introduction of the higher-valency conjugate vaccines PCV15 and PCV20 is expected to provide greater serotype coverage; unfortunately, these vaccines do not include some of the recently emerged serotypes. Recommendations for the use of the 23-valent polysaccharide vaccine in high-risk populations may be modified because of the effectiveness of the newer PCVs. Pediatricians must be aware of the new vaccine strategies for the prevention of IPD and the manifestations of IPD so that prompt empirical therapy can be initiated when treatment is required. [Pediatr Ann. 2023;52(3):e96-e101.].
Introduction/Objective
Historically, myringotomy, and the insertion of tympanostomy tubes has served as one of the initial surgical training experiences for residents. Resident experience with this procedure since the introduction of pneumococcal conjugate vaccines has not been well described in the literature. The objective of this study was to identify trends in resident training experience with chronic otitis media-related surgeries, such as myringotomy and tympanostomy tube placement. While multiple factors influence resident experience, we hypothesize that resident experience has decreased since the introduction of the pneumococcal 13-valent conjugate vaccine (PCV13).
Methods and Materials
In a retrospective review of Accreditation Council for Graduate Medical Education (ACGME) National Data Reports, mean number of myringotomy and tympanostomy tube cases logged in the Resident Case Log System from 2006 to 2019 were collated and plotted against years to identify monotonic trends. Mann-Whitney U test was used to compare pre-PCV13 era and post-PCV13 era data.
Results
Since the introduction of PCV13, there is a national decreasing trend in the myringotomy and tympanostomy tube placement by otolaryngology residents ( P = .001).
Conclusions
Otologic surgeries are an important part of resident education and historically have served as one of the initial surgical training experiences for residents. There has been a significant reduction in the number of myringotomy and tympanostomy procedures performed by otolaryngology residents in the past decade. While multiple factors influence resident experience, it is possible that introduction of PCV13 has impacted resident exposure to myringotomy and tympanostomy tube placement. Resident proficiency with this procedure has likely not been affected by introduction of PCV13. Data should be reassessed in 5 years to determine if an impact of the PCV13 vaccine on resident training is evident.
Background:
Asplenic or splenectomized patients have a higher risk (ranging from 10 to 50-fold) than the general population of developing overwhelming post-splenectomy infection (OPSI). Thus, they should receive specific vaccinations to prevent bacterial infections (meningococcus, pneumococcus and Haemophilus influenzae type b) and influenza. The aim of this meta-analysis was to estimate vaccination coverage (VC) with the recommended vaccines among splenectomized patients; strategies recommended in those studies to improve VC worldwide are considered as well.
Research design and methods:
Scopus, MEDLINE/PubMed, Google Scholar and ISI Web of Knowledge databases were searched. Research papers, short reports, reviews and meta-analyses published between January 1, 2010 and July 18, 2020 were included; no geographic restrictions were included. Twenty-four studies were included in the meta-analysis.
Results:
For anti-pneumococcal vaccination, coverage was 55.1% (95%CI=41.0-69.2%), for anti-Hib 48.3% (95%CI=34.3-52.3%), for anti-meningococcal C/ACYW135 33.7% (95%CI=23.6-43.9%), for anti-meningococcal B 13.3% (95%CI=7.0-19.5%) and for anti-influenza 53.2% (95%CI=22.0-84.4%). Most studies determined a lack of adherence to international guidelines by healthcare workers and suggested the need to better educate health professionals in the management of post-splenectomy patients.
Conclusions:
The meta-analysis showed the suboptimal immunization coverage for the vaccines recommended for asplenic patients. Greater efforts must be made by public health professionals to increase VC in this group of patients at risk. Introducing specific prophylaxis protocols in the clinical routine seems to guarantee better immunization compliance in those patients.
Background
Subspecialty caseloads logged by otolaryngology residents over the last 15 years is currently unknown. This study examines the trends at the national level.
Methods
Otolaryngology case log data was collected from the Accreditation Council for Graduate Medical Education (ACGME) from 2005 to 2019. Data were categorized according to the following surgical subspecialties: pediatrics, rhinology/skull base, head and neck, facial plastics, otology, and laryngology. Linear regression analyses were performed for each procedure within each subspecialty, total subspecialty means, and total caseload means across all years.
Results
Overall surgical volume significantly increased between 2005 and 2019 ( P < .0001); however, there was a significant decline in pediatrics procedures ( R ² = 0.80, P < .0001). Rhinology/skull base procedures increased the most drastically ( R ² = 0.96, P < .0001).
Conclusion
While total mean resident case logs have steadily increased between 2005 and 2019, pediatric cases have declined substantially due to fewer tympanostomy tube insertions and adenotonsillectomies. Rhinology/skull base procedures have increased most significantly secondary to an increase in endoscopic sinus surgeries. Despite changes in case volume amongst specialties, the annual increase in resident case load suggests that otolaryngology residents are meeting the demands of their graduate medical training.
Vaccination has been one of the major revolutions in the history of human health. Vaccination programs have targeted entire populations such as infants or elderly subjects as a matter of being efficient with time and resources. These general populations are heterogeneous in terms of factors such as ethnicity, health status, and socio-economics. Thus, there have been variations in the safety and effectiveness profiles of certain vaccinations according to current population-wide strategies. As the concept of precision medicine has been raised in recent years, many researchers have suggested that vaccines could be administered more precisely in terms of particular target populations, vaccine formulations, regimens and dosage levels. This review addresses the concept and framework of precision immunization, summarizes recent and representative clinical trials of among specific populations, mentions important factors to be addressed in customizing vaccinations, and provides suggestions on the establishment of precision immunization with the goal of maximizing the effectiveness of vaccines in general.
To evaluate the safety and immunogenicity of a newly 23-valent pneumococcal polysaccharide vaccine (PPV23), a phase Ⅲ clinical trial was conducted in population aged ≥ 2 years. We conducted a randomized, double-blinded, active controlled trial, in which 1760 participants were randomly assigned in a 1:1 ratio to receive one dose of either the test vaccine or the control commercial vaccine. The surveillance period was 28 days. The 2-fold increase rate of anti-pneumococcal for 23 serotypes varied from 49.71% to 90.96% in the treatment group and from 44.52% to 88.24% in the control group. According to -10% non-inferiority margin and 95% confidence intervals of rate difference, all the 23 serotypes of the treatment group were non-inferiority to the control group. The 2-fold increase rate of anti-pneumococcal antibody were significantly higher in the treatment group for 11 serotypes including 1, 2, 3, 4, 10A, 11A, 14, 18C, 20, 22F, and 23F. Serious adverse events occurred in 2 in 879 (0.23%) participants in the treatment group and 2 in 880 (0.23%) participants in the control group, and all the adverse events were unrelated to the vaccination. The overall adverse reaction frequency showed no difference between the treatment (51.19%) and control group (47.95%), and most adverse reactions were mild or moderate in intensity. The newly PPV23 is immunologically non-inferior to the control commercial vaccine and well tolerated in healthy Chinese population aged ≥ 2 years.
Trial registration:
ClinicalTrial.gov identifier: NCT02451969.
Background:
Pneumococcal vaccination rates among high-risk patients (eg, diabetes, asthma, smoking) seen in 2 family medicine clinics are unknown.
Objectives:
To assess differences in pneumococcal polysaccharide vaccination rates and reasons for nonvaccination among patients with diabetes and asthma and patients who smoke.
Methods:
A chart review at 2 family medicine residency training clinics showed 425 patients with a medical indication for PPSV23 were seen between April 1, 2015, and April 30, 2015. One reviewer searched the electronic health records to assess reasons for nonvaccination.
Results:
Rates of nonvaccination were 29.8% in patients with diabetes, 58.7% in patients with asthma, and 62.5% in patients who smoke cigarettes. Patients were classified into 3 groups based on the reasons for nonvaccination: documented patient refusal, not being addressed by a provider, and being documented as low risk despite the presence of a medical indication.
Conclusion:
The 3 reasons for nonvaccination were vaccination not being addressed, misclassification of high-risk patients as low-risk patients for infection, and documented patient refusal. Providers overlooked vaccination more often in patients with asthma and cigarette use than in patients with diabetes. Patients seeing pharmacists were most likely to be vaccinated, whereas patients seeing physician assistants were least likely to be vaccinated. Pharmacists see patients to provide medication management and preventive care, whereas other providers treat more urgent conditions. Because indications are often overlooked and not addressed, pharmacists can play a larger role in identifying and vaccinating high-risk patients.
Community-acquired pneumonia (CAP) places a considerable burden on society. A substantial number of pediatric and adult CAP cases are due to Streptococcus pneumoniae, but fortunately there are effective vaccines available that have a significant impact on CAP-related medical, social, and economic problems. The main aim of this paper is to evaluate the published evidence concerning the impact of pneumococcal vaccines on the prevention of CAP in children and adults. Available data indicate that pneumococcal conjugate vaccines (PCVs) are effective in children, reducing all-cause CAP cases and bacteremic and nonbacteremic CAP cases. Moreover, at least for PCV7 and PCV13, vaccination of children is effective in reducing the incidence of CAP among adults. Recently use of PCV13 in adults alone or in combination with the pneumococcal polysaccharide vaccine has been suggested and further studies can better define its effectiveness in this group of subjects. The only relevant problem for PCV13 is the risk of a second replacement phenomenon, which might significantly reduce its real efficacy in clinical practice. Protein-based pneumococcal vaccines might be a possible solution to this problem.
The current national monitoring of routine wellness care and vaccine uptake does not provide data on health maintenance among pediatric populations with chronic medical conditions. In this case-control study that analyzes wellness visits and vaccine uptake among adolescents, ages 16 to 18 years, we identified 938 without (controls) and 74 with (cases) 1 of 12 specific chronic medical conditions. The PPSV23 (23-valent pneumococcal polysaccharide vaccine) is recommended by the Advisory Committee on Immunization Practices for these 12 conditions and served as a measure of uptake for medically indicated vaccines. Our controls were twice as likely as cases to have a documented well visit in the past year, and there was a significantly higher proportion of controls than cases vaccinated with Tdap (tetanus toxoid, reduced diphtheria toxoid, acellular pertussis), MCV-4 (quadrivalent meningococcal conjugate), and HPV (human papillomavirus), all P < .05. More than 60% of cases failed to receive PPSV23. Adolescents with chronic medical conditions are at high risk of neglecting routine health maintenance.
Background:
Parapneumonic empyema, a serious complication of pneumonia, started increasing among U.S. children before the introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) in 2000, and continued afterwards. This increase was due in part to pneumococcal serotypes not included in PCV7 that were included in the new 13-valent (PCV13) vaccine introduced in 2010. We assessed changes in the incidence of empyema hospitalizations among U.S. children after PCV13 introduction.
Methods:
We calculated annualized empyema hospitalization rates among U.S. children <18years using Nationwide Inpatient Sample and Census data (1997-2013) for four periods based on PCV7 and PCV13 introductions. Relative rates (RR) and 95% confidence intervals (CI) were calculated by age group and sex, comparing PCV7 [early-PCV7 (2001-2005) and late-PCV7 (2006-2009)] and PCV13 (2011-2013) periods with the pre-PCV7 period (1997-1999). Secondary analyses examined changes in pneumococcal, streptococcal, staphylococcal and unspecified empyema.
Results:
Among children <18years of age, annualized empyema hospitalization rates peaked at 3.6 per 100,000 in the late-PCV7 period compared with 2.1 per 100,000 in the pre-PCV7 period [RR: 1.70 (95% CI: 1.11-2.60)]. However, annualized rates in the post-PCV13 period declined to 2.0 per 100,000, similar to rates in the pre-PCV7 period. Empyema rates among children <2years were lower in the post-PCV13 period compared to the pre-PCV7 period [RR: 0.77 (95% CI: 0.61-0.96)], but rates in the two periods among children 2-4 and 5-17years were similar. Most empyema were of unspecified etiology. Pneumococcal and unspecified empyema declined after PCV13 introduction.
Conclusions:
Although empyema hospitalization rates among U.S. children peaked after PCV7 introduction, rates decreased substantially following the introduction of PCV13.
Patients with cochlear implants should receive all the recommended routine vaccinations appropriate for age according to the Centers for Disease Control and Prevention (CDC) annual immunization schedule. These patients are at greater risk for the development of meningitis and other infections with Streptococcus pneumoniae, Haemophilus influenzae type b, and influenza viruses and CDC guidelines stress the importance of vaccination against these agents in these patients. This is especially true for infections caused by Streptococcus pneumoniae. Vaccination with pneumococcal vaccines, both conjugate and polysaccharide, is critically important in the prevention of pneumococcal disease in cochlear implant patients.
Complex humanitarian emergencies affect 40–60 million people annually and are a growing public health concern worldwide. Despite efforts to provide medical and public health services to populations affected by complex emergencies, significant morbidity and mortality persist.
Measles is a major communicable disease threat, but through vaccination of broader target age groups beyond the traditional immunization schedule, measles-related mortality has been significantly reduced during crises. Yet, a limited number of vaccine-preventable diseases continue to contribute disproportionately to morbidity and mortality in complex emergencies.
The literature suggests that Streptococcus pneumoniae, Rotavirus, and Haemophilus influenzae type-b should be key targets for vaccination programs. Because of the significant contribution of these three pathogens to complex humanitarian emergencies in low and middle-income countries regardless of disaster type, geography, or population, their vaccines should be considered essential components of the standard emergency response effort. We discuss the barriers to vaccine distribution and provide evidence for strategies to improve distribution, including expanded target age-range and reduced dose schedules. Our review includes specific recommendations for the expanded use of these three vaccines in complex emergencies in low and middle-income countries as a way to guide future policy discussions.
Three duplex molecular beacon based real-time Nucleic Acid Sequence Based Amplification (NASBA) assays have been designed and experimentally validated targeting RNA transcripts for the detection and identification of Haemophilus influenzae, Neisseria meningitidis and Streptococcus pneumoniae respectively. Each real-time NASBA diagnostics assay includes an endogenous non-competitive Internal Amplification Control (IAC) to amplify the splice variant 1 mRNA of the Homo sapiens TBP gene from human total RNA. All three duplex real-time NASBA diagnostics assays were determined to be 100% specific for the target species tested for. Also the Limits of Detection (LOD) for the H. influenzae, N. meningitidis and S. pneumoniae duplex real-time NASBA assays were 55.36, 0.99, and 57.24 Cell Equivalents (CE) respectively. These robust duplex real-time NASBA diagnostics assays have the potential to be used in a clinical setting for the rapid (<60 min) specific detection and identification of the most prominent microorganisms associated with bacterial meningitis in humans.
This study was performed to measure early changes in the serotype distribution of pneumococci isolated from children with invasive disease during the 3-year period following the introduction of 10- and 13-valent pneumococcal conjugate vaccines (PCVs) in Korea. From January 2011 to December 2013 at 25 hospitals located throughout Korea, pneumococci were isolated among children who had invasive pneumococcal disease (IPD). Serotypes were determined using the Quellung reaction, and the change in serotype distribution was analyzed. Seventy-five cases of IPD were included. Eighty percent of patients were aged 3-59 months, and 32% had a comorbidity that increased the risk of pneumococcal infection. The most common serotypes were 19A (32.0%), 10A (8.0%), and 15C (6.7%). The PCV7 serotypes (4, 6B, 9V, 14, 18C, 19F, 23F, and 6A) accounted for 14.7% of the total isolates and the PCV13 minus PCV7 types (1, 3, 5, 7F and 19A) accounted for 32.0% of the total isolates. Serotype 19A was the only serotype in the PCV13 minus PCV7 group. The proportion of serotype 19A showed decreasing tendency from 37.5% in 2011 to 22.2% in 2013 (P = 0.309), while the proportion of non-PCV13 types showed increasing tendency from 45.8% in 2011 to 72.2% in 2013 (P = 0.108). Shortly after the introduction of extended-valent PCVs in Korea, serotype 19A continued to be the most common serotype causing IPD in children. Subsequently, the proportion of 19A decreased, and non-vaccine serotypes emerged as an important cause of IPD. The impact of extended-valent vaccines must be continuously monitored.
Streptococcus pneumoniae (pneumococcus) is the leading cause of morbidity and mortality worldwide. Saudi Arabia is a host to millions of pilgrims who travel annually from all over the world for Umrah and the Hajj pilgrimages and are at risk of developing pneumococcal pneumonia or invasive pneumococcal disease (IPD). There is also the risk of transmission of S. pneumoniae including antibiotic resistant strains between pilgrims and their potential global spread upon their return. The country also has unique challenges posed by susceptible population to IPD due to people with hemoglobinopathies, younger age groups with chronic conditions, and growing problem of antibiotic resistance. Since the epidemiology of pneumococcal disease is constantly changing, with an increase in nonvaccine pneumococcal serotypes, vaccination policies on the effectiveness and usefulness of vaccines require regular revision. As part of the Saudi Thoracic Society (STS) commitment to promote the best practices in the field of respiratory diseases, we conducted a review of S. pneumoniae infections and the best evidence base available in the literature. The aim of the present study is to develop the STS pneumococcal vaccination guidelines for healthcare workers in Saudi Arabia. We recommend vaccination against pneumococcal infections for all children <5 years old, adults ≥50 years old, and people ≥6 years old with certain risk factors. These recommendations are based on the presence of a large number of comorbidities in Saudi Arabia population <50 years of age, many of whom have risk factors for contracting pneumococcal infections. A section for pneumococcal vaccination before the Umrah and Hajj pilgrimages is included as well.
Background:
23-Valent pneumococcal polysaccharide vaccine, trade name Pneumovax(®)23 (PPSV23), has been used for decades in the Unites States and has an extensive clinical record. However, limited post-licensure safety assessment has been conducted.
Objective:
To analyze reports submitted to the Vaccine Adverse Event Reporting System (VAERS) following PPSV23 from 1990 to 2013 in order to characterize its safety profile.
Methods:
We searched the VAERS database for US reports following PPSV23 for persons vaccinated from 1990 to 2013. We assessed safety through: automated analysis of VAERS data, crude adverse event (AE) reporting rates based on PPSV23 doses distributed in the US market, clinical review of death reports and reports involving vaccine administered to pregnant women, and empirical Bayesian data mining to assess for disproportional reporting.
Results:
During the study period, VAERS received 25,168 PPSV23 reports; 92% were non-serious, 67% were in females and 86% were in adults aged ≥19 years. When PPSV23 was administered alone, fever (43%), injection site erythema (28%) and injection site pain (25%) were the most commonly reported non-serious AEs in children. Injection site erythema (32%), injection site pain (27%) and injection site swelling (23%) were the most commonly reported non-serious AEs in adults. Of serious reports (2129, 8% of total), fever was most commonly reported in both children (69%) and adults (39%). There were 66 reports of death, four in children and 62 in adults. Clinical review of death reports did not reveal any concerning patterns that would suggest a causal association with PPSV23. No disproportional reporting of unexpected AEs was observed in empirical Bayesian data mining.
Conclusions:
We did not identify any new or unexpected safety concerns for PPSV23. The VAERS data are consistent with safety data from pre-licensure clinical trials and other post-licensure studies.
Objective:
To describe and compare the clinical characteristics, outcomes, and etiology of pneumonia among children hospitalized with community-acquired pneumonia (CAP) with neurologic disorders, non-neurologic underlying conditions, and no underlying conditions.
Study design:
Children <18 years old hospitalized with clinical and radiographic CAP were enrolled at 3 US children's hospitals. Neurologic disorders included cerebral palsy, developmental delay, Down syndrome, epilepsy, non-Down syndrome chromosomal abnormalities, and spinal cord abnormalities. We compared the epidemiology, etiology, and clinical outcomes of CAP in children with neurologic disorders with those with non-neurologic underlying conditions, and those with no underlying conditions using bivariate, age-stratified, and multivariate logistic regression analyses.
Results:
From January 2010-June 2012, 2358 children with radiographically confirmed CAP were enrolled; 280 (11.9%) had a neurologic disorder (52.1% of these individuals also had non-neurologic underlying conditions), 934 (39.6%) had non-neurologic underlying conditions only, and 1144 (48.5%) had no underlying conditions. Children with neurologic disorders were older and more likely to require intensive care unit (ICU) admission than children with non-neurologic underlying conditions and children with no underlying conditions; similar proportions were mechanically ventilated. In age-stratified analysis, children with neurologic disorders were less likely to have a pathogen detected than children with non-neurologic underlying conditions. In multivariate analysis, having a neurologic disorder was associated with ICU admission for children ≥2 years of age.
Conclusions:
Children with neurologic disorders hospitalized with CAP were less likely to have a pathogen detected and more likely to be admitted to the ICU than children without neurologic disorders.
Nasopharyngeal carriage studies provide insights into the local prevalence of circulating pneumococcal serotypes. These data are critical to vaccination monitoring, as they allow for the prediction and assessment of impact. Very little data are available on the carriage of pneumococcal serotypes in Morocco. Here, we describe the prevalence of Streptococcus pneumoniae carriage and serotype distribution among 697 pediatric patients with ages ranging from 2 to 59 months who were admitted to a Moroccan hospital with severe pneumonia, as well as 195 healthy infants and young children who were recruited at a vaccination clinic. Carriage rates were 40.5% (79/195) for healthy children and 22.8% (159/697) for sick children. The most commonly observed circulating serotypes included 6A, 6B and 19F, all of which are included in the current 13-valent anti-pneumococcal conjugate vaccine that was recently introduced in Morocco. Monitoring of circulating serotypes remains necessary after vaccine introduction to assess whether serotype replacement is occurring.
Background:
In 2010, 13-valent pneumococcal conjugate vaccine (PCV13) was licensed and recommended in the USA for prevention of invasive pneumococcal disease in children. Licensure was based on immunogenicity data comparing PCV13 with the earlier seven-valent formulation. Because clinical endpoints were not assessed for the new antigens, we did a postlicensure matched case-control study to assess vaccine effectiveness.
Methods:
Cases in children aged 2-59 months were identified through active surveillance in 13 sites. Controls were identified via birth registries and matched to cases by age and postal (zip) code. The primary objective was the vaccine effectiveness of at least one dose against the 13 serotypes included in PCV13. Secondary objectives included vaccine effectiveness against all-cause invasive pneumococcal disease, against antibiotic non-susceptible invasive pneumococcal disease, and among children with and without underlying conditions. Vaccine effectiveness was calculated as (1 - matched odds ratio) × 100%.
Findings:
We enrolled 722 children with invasive pneumococcal disease and 2991 controls; PCV13 serotype cases (217 [30%]) included most commonly serotypes 19A (128 [18%]), 7F (32 [4%]), and 3 (43 [6%]). Vaccine effectiveness against PCV13 serotypes was 86·0% (95% CI 75·5 to 92·3), driven by serotypes 19A and 7F, for which vaccine effectiveness was 85·6% (95% CI 70·6 to 93·5) and 96·5% (82·7 to 100), respectively. We also identified statistically significant effectiveness against serotype 3 (79·5%, 95% CI 30·3 to 94·8) and against antibiotic non-susceptible invasive pneumococcal disease (65·6%, 44·9 to 78·7). Vaccine effectiveness against all-cause invasive pneumococcal disease was 60·2% (95% CI 46·8 to 70·3). Vaccine effectiveness was similar among children with (81·4%, 95% CI 45·4 to 93·6) and without (85·8%, 74·9 to 91·9) underlying conditions.
Interpretation:
PCV13 appears highly effective against invasive pneumococcal disease among children in the USA in the context of routine and catch-up schedules, although some new vaccine antigens could not be assessed. PCV13 immunisation provides a robust strategy for combating pneumococcal antimicrobial resistance.
Funding:
Centers for Disease Control and Prevention.
Introduction:
A number of pneumococcal vaccines have long been available and have been used to reduce the medical, social, and economic problems associated with Streptococcus pneumoniae-related diseases. Areas covered: The main purpose of this review was to analyze what has been, until recently, the established doctrine regarding the safety and tolerability of pneumococcal vaccines that have been used in the past and are currently being used in children. Expert opinion: Pneumococcal vaccines available on the market are all safe and are highly recommended in clinical practice. In children, pneumococcal conjugate vaccines (PCVs) are considered the preparations of choice because of their enhanced immunogenicity and superior ability to impact nasopharyngeal carriage. All PCVs are considered safe because the incidence of severe adverse events (AEs) is marginal. Nonetheless, evidence has emerged from post-marketing surveillance regarding the occurrence of very rare but significant potential AEs following PCV administration. Therefore, post-marketing surveillance should be maintained to confirm the existence of these AEs. Over the next few years, other pneumococcal vaccines will be developed. When these new products are licensed and reach the market, new technologies and innovative epidemiological methods will permit a more rapid and more effective evaluation of AEs.
This Policy Statement was retired July 2018
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.
Universal immunization of infants and toddlers with pneumococcal conjugate vaccines over the last 15 years has dramatically altered the landscape of pneumococcal disease. Decreases in invasive pneumococcal disease, all-cause pneumonia, empyema, mastoiditis, acute otitis media, and complicated otitis media have been reported from multiple countries in which universal immunization has been implemented. Children with comorbid conditions have higher rates of pneumococcal disease and increased case fatality rates compared with otherwise healthy children, and protection for the most vulnerable pediatric patients will require new strategies to address the underlying host susceptibility and the expanded spectrum of serotypes observed.
Primary Ciliary Dyskinesia (PCD) is a rare heterogenic disorder leading to significant respiratory morbidity. Health-care providers who treat PCD must familiarize themselves with recommended treatment strategies. However, most of the treatments recommended in PCD have been extrapolated from cystic fibrosis (CF) and non-CF bronchiectasis literature. Mainstays of therapy are reviewed in detail, and should include at a minimum: regular airway clearance, routine microbiological surveillance, antibiotic treatment for pulmonary exacerbation, and health vaccinations. This review summarizes both medical and surgical pulmonary treatment considerations, as well as recommendations for the integration of non-pulmonary subspecialty care in the management of PCD.
Streptococcus pneumoniae is one of the main causative bacteria in patients with pneumonia; however, there are no data regarding serotype changes in adult patients with pneumonia after the introduction of the pneumococcal vaccine (PCV7) for childhood immunization in Japan. We herein evaluated the serotype distribution in adult patients with pneumonia.
This retrospective epidemiological study was performed at the University of Occupational and Environmental Health, Japan from January 2011 to December 2013. The serotypes of pneumococcal isolates obtained from patients with pneumonia were evaluated along with the patients' clinical information.
A total of 81 patients with pneumococcal pneumonia (89 episodes) from whom S. pneumoniae was isolated were included. The numbers (percentages) of sample types were as follows: sputum 55 (61.8%), intratracheal tube suction 15 (16.9%), intrabronchial sampling 5 (5.6%) and bronchoalveolar lavage fluid 14 (15.7%). The PCV7 serotypes decreased significantly among the patients with pneumococcal pneumonia from 46.4% in 2011 to 20.0% in 2013 (p < 0.05). Conversely, PCV13 and 23-valent pneumococcal polysaccharide vaccination (PPSV23) serotypes other than PCV7 serotypes mildly increased during this period. In addition, the frequency of serotypes 19F, 23F and 4 (which are covered by PCV7) decreased annually; however, the changes in the frequencies of the other serotypes were not significant.
This study demonstrated the yearly decrease of PCV7 serotypes in adult pneumococcal pneumonia patients after introducing PCV7 into the childhood immunization schedule in Japan. Continued surveillance of pneumococcal serotype changes is important for the proper use of different pneumococcal vaccines.
Copyright © 2015 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
Background:
Vaccination can reduce the incidence and mortality of an infectious disease and thus increase the years of life and productivity for the entire society. But when determining the vaccination coverage rate, its economic burden is usually not taken into account.
Objective:
This article aimed to use a dynamic transmission modeling (DTM), which is based on a susceptible-infectious-recovered model and is a system of differential equations, to find the optimal vaccination coverage rate based on the economic burden of an infectious disease.
Methods:
Vaccination for pneumococcal diseases was used as an example to demonstrate the main purpose. 23-Valent pneumococcal polysaccharide vaccines (PPV23) and 13-valent pneumococcal conjugate vaccines (PCV13) have shown their cost-effectiveness in elderly and children, respectively. Scenarios analysis of PPV23 to elderly aged 65+ years and of PCV13 to children aged 0 to 4 years was applied to assess the optimal vaccination coverage rate based on the 5-year economic burden. Model parameters were derived from Taiwan's National Health Insurance Research Database, government data, and published literature. Various vaccination coverage rates, the vaccine efficacy, and all epidemiologic parameters were substituted into DTM, and all differential equations were solved in R Statistical Software.
Results:
If the coverage rate of PPV23 for the elderly and of PCV13 for the children both reach 50%, the economic burden due to pneumococcal disease will be acceptable.
Conclusions:
This article provided an alternative perspective from the economic burden of diseases to obtain a vaccination coverage rate using the DTM. This will provide valuable information for vaccination policy decision makers.
Invasive pneumococcal disease (IPD) and pneumonia are the major causes of morbidity and deaths in children in the world. The management of IPD and pneumonia is an important economic burden on healthcare systems and families. The aim of this study was to assess the economic burden of IPD and pneumonia among younger children in Taiwan. We used a cost-illness approach to identify the cost categories for analysis in this study according to various perspectives. We obtained data of admission, outpatient, and emergency department visit data from the National Health Insurance Research (NHIR) database for children <5 years of age between January 2008 and December 2008. A prospective survey was administered to the families of patients to obtain detailed personal costs. All costs are presented in US dollars and were estimated by extrapolating 2008 cost data to 2013 price levels. We estimated the number of pneumococcal disease cases that were averted if the PCV-13 vaccine had been available in 2008. The total annual social and hospital costs for IPD were US $4.3 million and US $926,000, respectively. The total annual social and hospital costs for pneumonia were US $150 million and US $170 million, respectively. On average, families spent US $653 or US $218 when their child was diagnosed with IPD or pneumonia, respectively. This cost is approximately 27%-81% of the monthly salary of an unskilled worker. In conclusion, a safe and effective pediatric pneumococcal vaccine is needed to reduce the economic burden caused by pneumococcal infection.
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