Abstract

Describe the incidence of invasive pneumococcal disease (IPD) in serotypes with reduced antibiotic sensitivity to penicillin (RAS-Pen) in adults over 59 years of age and its association with childhood anti-pneumococcal vaccination coverage (CVC) and community consumption of beta-lactam. We selected IPD cases in adults over 59 years of age reported in the Community of Madrid between 2007 and 2016. We estimated the incidence of cases caused by serotypes included in the 13-valent pneumococcal conjugate vaccine (PCV13), those not included (non-PCV13) and the six serotypes additional to the 7-valent (PCV13-no7). We compared the incidences of serotypes from the pre-vaccine period (2007–2009) and the vaccine period (2011–2016) by analysing the incidence trend (JointPoint Trend Analysis) and its association with the CVC and community consumption of beta-lactam (Poisson model). We identified 1936 cases of IPD, 29.2% (n = 565) in serotypes with RAS-Pen. The incidence decreased for PCV13 cases (annual percentage of change, APC: -12.2, p < 0.05) and increased for non-PCV13 (APC: 15.4, p < 0.05). The incidence of IPD due to non-PCV13 was associated with community beta-lactam consumption (IRR 1.156; CI95% 1.025–1.304) and that of cases of PCV13-no7 with CVC (IRR 0.574; 95% CI95% 0.413–0.797). The non-PCV13 strains that increased the most at the end of the period were 6C, 11A and 15A. The incidence of IPD due to PCV13 with RAS-Pen at > 59 years was decreasing and was associated with CVC. The incidence of cases due to non-PCV13 was increasing and was associated with community consumption of beta-lactam.

Highlights

  • Ramón y Cajal, IRYCIS, CIBER of Epidemiology and Public Health (CIBERESP), Madrid, SpainIn recent decades, a significant worldwide increase in antimicrobial resistance to Streptococcus pneumoniae (SP) has been observed [1]

  • The indirect effect of childhood vaccine coverage has had an important role in the decrease of reduced antibiotic sensitivity to penicillin (RAS-Pen) serotype-based invasive pneumococcal disease (IPD) in people over 59 years of age [5, 16]

  • The direct effect of PCV13 vaccine coverage on adults in the Community of Madrid (CM) has not been analysed because the vaccine has not been on the adult immunisation schedule for the entire period studied

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Summary

Introduction

A significant worldwide increase in antimicrobial resistance to Streptococcus pneumoniae (SP) has been observed [1]. There appears to be numerous factors involved in the evolution of this resistance. Age, vaccination coverage and community antibiotic consumption appear to be the most relevant population-based factors [2]. Adults aged over 59 years are at higher risk of invasive pneumococcal disease (IPD) caused by serotypes with lower antibiotic sensitivity (RAS) because of greater comorbidity, predisposition to infection and high antibiotic consumption [3]. The likelihood of contracting pneumococcal pneumonia or IPD is four times higher in persons over 60 years of age compared to those aged 18 to 49 years [4]. In 2000, the USA became the first country to introduce the first pneumococcal conjugate vaccine in the childhood

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