Burden Of Pneumococcal Disease Research Articles

A population-based study on the burden of hospitalized pediatric pneumococcal disease in Taiwan before and after the introduction of 13-valent pneumococcal conjugate vaccine into the childhood immunization program in 2015

BackgroundTo estimate the burden of invasive pneumococcal disease, non-bacteremic pneumococcal pneumonia, and acute otitis media before and after inclusion of the 13-valent pneumococcal vaccine (PCV13) into Taiwan’s Childhood Immunization Program in 2015.MethodsEpisodes of eligible children aged < 18 years hospitalized with invasive pneumococcal disease, non-bacteremic pneumococcal pneumonia, or acute otitis media between 1 January 2011 and 31 December 2019 were identified from the National Health Insurance Research Database. Annual hospitalized incidence rate, case fatality rate, and healthcare resource utilization and costs were estimated. Incidence time trends were assessed with interrupted time series analyses.Results1,284 invasive pneumococcal disease episodes, 25,074 non-bacteremic pneumococcal pneumonia episodes, and 23,139 acute otitis media episodes were identified. The overall annual incidence rates of invasive pneumococcal disease, non-bacteremic pneumococcal pneumonia, and acute otitis media were 3.31, 64.61, and 59.62 episodes per 100,000 person-years, respectively. Interrupted time series analyses results showed a significantly lower baseline incidence rate (incidence rate ratio [IRR]:0.58, p-value = 0.001) for invasive pneumococcal disease, and significantly higher baseline incidence rate (IRR:1.17, p-value < 0.001) for non-bacteremic pneumococcal pneumonia in the post-PCV13 period. Baseline incidence rates between the two periods were comparable for acute otitis media. A significant increase in trend of incidence rate was observed for all three diseases. Case fatality rate was 1.79%, 0.09%, and 0.00% for invasive pneumococcal disease, non-bacteremic pneumococcal pneumonia, and acute otitis media, respectively. Median length of hospitalization per inpatient visit was comparable between the two periods for invasive pneumococcal disease and non-bacteremic pneumococcal pneumonia, but significantly shorter in the post-PCV13 period for acute otitis media. In the post-PCV13 period, average total costs per episode was lower for invasive pneumococcal disease and non-bacteremic pneumococcal pneumonia, but higher for acute otitis media.ConclusionsResidual clinical and economic burden of pneumococcal diseases remained substantial after PCV13 inclusion into Taiwan’s Childhood Immunization Program. To further reduce the disease burden among children, additional research to investigate the cause of increasing trends of hospitalized invasive pneumococcal disease, non-bacteremic pneumococcal pneumonia and acute otitis media in the post-PCV13 era will be required.

P-242. Disparities and inequities in the burden of pneumococcal disease in US adults

Abstract Background Understanding the impact of social determinants of health on pneumococcal disease (PD) is important. The purpose of this study was to conduct a targeted literature review (TLR) of the clinical and economic burden of PD in US adults with a focus on examining disparities and inequities by race, geography, urbanicity, income, education, and employment. Methods Original research studies reporting burden of PD in US adults published between 2012 and January 2024 were identified through a US focused TLR in Pubmed (vial Medline) and a review of surveillance data from the CDC website. The original search was supplemented with targeted searches via Google Scholar in areas for which data were not identified via Pubmed or the CDC website. Results Of 4,133 identified publications, 16 studies were identified: 10 described disparities by race, 7 by geography, 2 by urbanicity, 3 by income, 1 by education and 1 by employment. Black adults had the highest incidence and longest length of stay due to IPD and bacteremic community acquired pneumonia (CAP) and highest mortality rates from CAP compared to other racial groups across all adult age groups; Black adults living in poverty experienced a 2.1 times higher rate of PD compared to white adults. Pneumococcal disease also varied by geography and urbanicity. Lower urbanicity displayed higher mortality rates for PD. Incidence of all-cause CAP was higher in early retirees 18–64 years old and their adult dependents compared to their employed counterparts and their adult dependents. PD health care expenditures mirror the patterns observed for disease burden. Vaccination rates were lower in Black adults compared to white adults and in adults who resided in rural areas, were less educated and had a lower income. Conclusion This TLR confirms that disparities and inequities in the burden of PD among US adults exist with higher disease burden and lower pneumococcal vaccination in Black adults, those living in rural areas and with lower education and income. There is a paucity of studies examining inequities and social disparities of health in PD. Additional studies are needed to examine disparities and inequities in PD according to race, geography, urbanicity, income, education, and employment. Disclosures Salini Mohanty, DrPH, MPH, Merck &amp; Co., Inc.: Employee|Merck &amp; Co., Inc.: Stocks/Bonds (Public Company) Kelly D. Johnson, PhD, Merck &amp; Co., Inc.: Employee|Merck &amp; Co., Inc.: Stocks/Bonds (Public Company) Sheba Nellore, MBA, Merck: Advisor/Consultant Lindsay McNamee, BSc, Merck &amp; Co Inc.: Advisor/Consultant Hanane Khoury, PhD, Merck: Advisor/Consultant Laura De Benedetti, BSc, Merck &amp; Co, Inc: Advisor/Consultant Elmira Flem, MD, PhD, Merck: Stocks/Bonds (Private Company) Kristen A. Feemster, MD, MPH, MSHPR, FAAP, Merck &amp; Co., Inc., Rahway, NJ, USA: Grant/Research Support|Merck &amp; Co., Inc., Rahway, NJ, USA: Stocks/Bonds (Public Company) Nicole Cossrow, PhD, Merck: Stocks/Bonds (Public Company)

P-624. Changes in Pneumoccocal serotypes in adults and children after 2 years of introduction of PCV13 in National Inmunization Plan in Colombia

Abstract Background Pneumococcal disease remains a significant public health concern globally, particularly affecting vulnerable populations such as children and adults. The introduction of pneumococcal conjugate vaccine 13 (PCV13) into national immunization plans has aimed to reduce the burden of pneumococcal disease by targeting specific serotypes. However, monitoring changes in pneumococcal serotypes following vaccine introduction is crucial for understanding vaccine effectiveness and potential serotype replacement. Distribution of Streptococcus pneumoniae serotype isolates by age in Colombia 2023 Distribution of Streptococcus pneumoniae serotype isolates by age in Colombia by age group, INS data as of December 2023. Methods In this study, data were extracted from the National Institute of Health for the Surveillance of Pneumococcus in Colombia. We conducted a comparison of proportions to analyze changes in pneumococcal serotypes among both adults and children after two years of PCV13 introduction. Serotype distribution was examined pre- and post-vaccine introduction to identify shifts in prevalence. Distribution of Streptococcus pneumoniae serotype isolates in children under 5 years of age, Colombia 2023 Distribution of Streptococcus pneumoniae serotype isolates in children under 5 years of age in Colombia by age group, INS data as of December 2023. Results Our analysis revealed a notable decrease in vaccine serotypes among both adults and children following the introduction of PCV13. However, an increase in non-vaccine serotypes was observed during the same period. Of particular significance, isolates of serotypes 19A, 3, and 6C continued to predominate, suggesting a persistent challenge in combating these serotypes despite vaccination efforts. Distribution of Streptococcus pneumoniae serotype isolates in persons over 60 years old, Colombia 2023 Conclusion The findings of this study underscore the complex dynamics of pneumococcal serotype distribution following the introduction of PCV13. While the vaccine has led to a reduction in vaccine-targeted serotypes, the emergence of non-vaccine serotypes presents a new challenge for pneumococcal disease prevention and control efforts. Continued surveillance and research are essential to monitor serotype trends and inform vaccine strategies to effectively combat pneumococcal disease in both children and adults. Disclosures Omar Huang Escobar Franco, MD, MSc, PhD., Pfizer: Honoraria

Burden of invasive pneumococcal disease, non-invasive all-cause pneumonia, and acute otitis media in hospitalized US children: a retrospective multi-center study from 2015 to 2020

BackgroundDespite effective pneumococcal vaccines, pneumococcal disease (PD) exerts a substantial burden on children. This study explored the clinical and economic burden of invasive PD (IPD), non-invasive all-cause pneumonia (ACP), and acute otitis media (AOM) in hospitalized children.MethodsData from the BD Insights Research Database of hospitalized children (< 18 years, including infants and children) in the US were analyzed retrospectively. The study cohort included patients with an ICD10 code for IPD, ACP, or AOM and/or a positive culture for S. pneumoniae. Descriptive statistics and multivariable analyses evaluated the following outcomes: length of stay [LOS], hospital cost per admission, hospital margin per admission [costs – payments], and in-hospital mortality.ResultsThe study included 4575 pediatric patients with IPD (n = 36), ACP (n = 3,329), or AOM (n = 1,210) admitted to 57 US hospitals from October 2015 to February 2020. Approximately half (50.7%) were under 2 years of age. The in-hospital mortality rate was 0.6% (n = 28). The observed median (interquartile range) LOS was 4 (3, 5) days, cost per admission was $4,240 ($2,434, $8,311) US dollars, and hospital margin per admission was -$63 ($2,118, $2,025). LOS and costs were highly variable according to clinical characteristics and hospital variables. Key variables associated with poor outcomes were having a moderate- or high-risk condition (chronic or immunocompromising), intensive care unit admission, and prior 90-day admission.ConclusionsThe burden of PD among hospitalized pediatric patients in the US remains substantial. Our study highlights the burden of PD among young children (< 2 years) and children with underlying medical conditions that put them at greater risk for PD. The results support the need for ongoing prevention efforts including vaccination and antimicrobial stewardship programs to reduce the burden of PD in children.

Prevalence of nasopharyngeal Streptococcus Pneumoniae carriage in infants: A systematic review and meta-analysis of cohort studies and randomized controlled trials.

This study aims to examine the prevalence of nasopharyngeal Streptococcus pneumoniae carriage (NSPC) in infants during their first two years of life and to compare the carriage rates among different vaccine groups and country income-levels. This will be achieved through a systematic review of the published literature, specifically focusing on data from cohort studies and randomized controlled trials. A comprehensive search was conducted in four electronic databases: PubMed, Web of Science, ScienceDirect, and Scopus, using a predefined search strategy. Forty-nine articles met the inclusion criteria for this systematic review. According to the results obtained from the random effects model, the pooled mean prevalence of NSPC was 1.68% at birth (95% CI [0.50; 5.47]), 24.38% at 1 to 4 months (95% CI [19.06; 30.62]), 48.38% at 4 to 6 months (95% CI [41.68; 55.13]), 59.14% at 7 to 9 months (95% CI [50.88; 66.91]), 48.41% at 10 to 12 months (95% CI [41.54; 55.35]), 42.00% at 13 to 18 months (95% CI [37.01; 47.16]), and 48.34% at 19 to 24 months (95% CI [38.50; 58.31]). The highest NSPC rates were observed among children aged 4 to 6 months and 7 to 9 months across all vaccine groups. Low-income countries consistently demonstrated the highest NSPC rates across all age categories studied. This systematic review and meta-analysis provide robust evidence of the high prevalence of NSPC in infants aged 4 to 6 months and 7 to 9 months in all vaccine groups, with persistent regional disparities, especially among low-income countries. The study highlights the need for continuous monitoring of NSPC trends, particularly the emergence of non-vaccine serotypes. Policymakers and healthcare providers should leverage these findings to enhance vaccination strategies, aiming to minimize the overall burden of pneumococcal diseases in infants.

Economic evaluation of childhood pneumococcal conjugate vaccination programs in Qinghai and Hainan provinces, China

ABSTRACT Background The burden of pneumococcal disease varies regionally in China, particularly affecting children in Qinghai and Hainan. Nevertheless, absence of pneumococcal conjugate vaccine (PCV) in the National Immunization Program (NIP) or local programs presents limited coverage. This study evaluated the health and economic impact of including PCV in immunization programs in Qinghai and Hainan. Research design and methods A decision tree Markov model was constructed to simulate health outcomes and lifetime costs among children under different 13-valent PCV (PCV13) vaccination strategies compared to current practices, from societal and healthcare perspectives. Data on epidemiology, vaccine efficacy, cost, and utility were obtained from literature or open databases. Sensitivity analyses were conducted to explore parameter uncertainty. Results Including three-dose PCV13 in provincial programs at NIP coverage (98.91%) could avert 7100 episodes and 118 deaths in Qinghai, and 6200 episodes and 66 deaths in Hainan. It was cost-effective at the $68.2/dose in private market and cost-saving at the United Nations Children’s Fund (UNICEF) recommended $25/dose for both provinces. Increasing coverage to 50% or 75% was also cost-effective. Sensitivity analyses confirmed results robustness despite parameter uncertainty. Conclusions Prioritizing PCV13 in immunization programs in Qinghai and Hainan could effectively reduce disease burden, improve population health, and promote health equity.

Evaluating Sex Differences in Pneumococcal Disease Burden and Vaccination Effectiveness in Adults: A Population-Based Study.

Information concerning sex differences in pneumococcal vaccine effectiveness in adults is scarce. The main aim of this study is to compare the differences in clinical effectiveness of pneumococcal vaccination between male and female adults. Population-based cohort study involving 1,108,634 women and 951,011 men aged ≥50years in Catalonia, Spain. Baseline characteristics of cohort members (comorbidities/underlying conditions and PPsV23/PCV13 vaccination status) were established according to Institutional Research Database (SIDIAP) and pneumococcal disease-related hospitalizations (PDRH) captured from hospital discharge codes from 68 reference Catalonian hospitals, throughout 01/01/2017-31/12/2018. Cox regression models were used to estimate PPsV23/PCV13 effectiveness against PDRH by sex (adjusting for age and comorbidities/underlying risk conditions). Across the two-year follow-up 4,302 PDRH cases (1,878 women, 2,424 men) were observed, with incidences of 169.4/100,000 and 254.9/100,000 for women and men, respectively. Among women, nor PPsV23 ((hazard ratio [HR]:1.04; 95% CI:0.92- 1.18; p=0.540) neither PCV13 (HR:1.24; 95% CI:0.91-1.70; p=0.171)) altered PDRH risk. Among men, PCV13 was associated with significantly increased risk of PDRH (HR: 1.57; 95% CI: 1.07-2.31; p=0.021) whereas PPsV23 did not significantly alter this risk (HR:0.89; 95% CI:0.72-1.10; p=0.275). No reduced risk of death from PDRH was observed in vaccinated women or men. However, regarding all-cause death, PPsV23 showed slight reduction risk for women (HR:0.94; 95% CI:0.92-0.97; p<0.001). PPsV23/PCV13 vaccinations have not proven effective for either sex in preventing PDRH. PPsV23 appears associated with slight reduction risk of all-cause death in women, which could be related to better or longer-lasting vaccination effects in women compared to men.

EE633 Obesity Impact in the Economic Burden of Invasive Pneumococcal Disease in Hospitalised Adults in Portugal: The Sphere Study

EE633 Obesity Impact in the Economic Burden of Invasive Pneumococcal Disease in Hospitalised Adults in Portugal: The Sphere Study

Pneumococcal disease in children in the Middle East and Northern Africa: A systematic literature review of clinical burden, serotype distribution, and vaccination programs

ABSTRACT Bacterial diseases caused by S. pneumoniae are an important public health problem in Middle Eastern and North African countries. The burden of S. pneumoniae is poorly documented in these regions, local surveillance programs are lacking. This systematic review was conducted in Medline and Embase to obtain a comprehensive overview of the clinical burden of pneumococcal disease and pneumococcal vaccination status in the pediatric population in Middle East and Northern Africa. Overall, 255 articles and gray literature sources were included in the study, with the majority representing Israel (n = 82), Türkiye (n = 40), Iran (n = 27), and Saudi Arabia (n = 13). The incidence of pneumococcal disease varied based on time frame and country. The dominant IPD serotypes varied, with serotypes 19F and 14 the most prevalent in the Middle East region and serotypes 19F, 14, and 6B the most prevalent in North Africa. The PCV introduction status was identified in most countries of interest except Egypt, Jordan, and Syria. This review sheds light on the significant impact of PCV on the burden of S. pneumoniae-related diseases. Serotypes 19F, 14, and 6B are still prevalent in the countries of MENA region despite inclusion in licensed PCVs. Genomic analysis could elucidate what the drivers of this persistence are, and future work could be developed around this. Continuous monitoring of serotype epidemiology is important for policy decisions on pediatric pneumococcal vaccination recommendations.

IAPSM’s Position Paper on Pneumococcal Vaccine (PCV) for Adult Immunization in India

Pneumococcal infection among adults is associated with invasive disease and poor outcomes. Pneumococcal vaccine (PCV) introduction has significantly reduced disease burden, invasive disease and reduced the rates of antimicrobial resistance. Of the various vaccines licensed, PCV 13 and PPSV 23 are available for use in India. Pneumococcal vaccination is suggested for people aged 19–64 years with immunosuppression, chronic cardiac, lung and hepatic disease, impaired splenic function, uncontrolled diabetes mellitus, current smokers, and those abusing alcohol. It is recommended that people &gt;65 years of age are vaccinated with PPSV23. The suggested regimen is to administer PCV13 followed by PPSV23 after one year. The vaccines have minimal side effects and tolerated well. Data on vaccine effectiveness from Indian studies is limited. Hence, documenting population demographics with surveillance on serotype specific pneumococcal disease burden in adults is needed. Following this, studies on safety, immunogenicity, and cost-effectiveness of the available vaccines need to be designed and implemented. It is suggested that in the initial phase, PCV needs to be made available for high-risk population followed by vaccination roll-out for adult population of India.

Incidence of pneumococcal disease in children in Germany, 2014–2019: a retrospective cohort study

BackgroundNovel, expanded valency pneumococcal conjugate vaccines (PCVs) are in development to reduce the burden of pneumococcal disease (PD) in children. To understand the potential value of new vaccines in Germany, this study estimated the residual burden of PD in children < 16 years old from 2014 to 2019, using administrative health data from a large German claims database.MethodsOutpatient and inpatient cases of all-cause pneumonia (ACP), pneumococcal pneumonia (PP) and invasive pneumococcal disease (IPD) were identified in the InGef database. Incidence rates (IRs) with 95% confidence intervals (CI) were calculated as number of episodes/person-years (PY) at risk. The Mann-Kendall test assessed time trends in incidence.ResultsThere were no significant trends in IRs of IPD or PP from 2014 to 2019. For ACP, IRs declined from 2014 to 2019; 2,213 (CI 2,176-2,250) to 1,503 (CI 1,472-1,534) per 100,000 PY (p = 0.017). IRs of ACP and PP were highest among children aged 12–23 months; 4,672 (CI 4,584-4,762) and 20.8 (CI 15.3–27.5) per 100,000 PY, respectively. For IPD, children 5–11 months-old had the highest IRs, at 14.7 (CI 9.0-22.7) per 100,000 PY.ConclusionsFrom 2014 to 2019 there were no discernible trends in the IRs of PP or IPD, but the IRs of ACP declined in children aged < 16 years. The highest IRs of ACP, PP and IPD were observed in children < 2 years of age, highlighting the importance of infant pneumococcal vaccination in the prevention of pediatric PD. The clinical burden of pediatric PD in Germany persists. Continued surveillance of changing pneumococcal burden, serotype distribution, antimicrobial resistance and vaccination status is critical to better understand the factors driving incidence of PD and to inform future vaccination strategies.

Uncovering the health system burden of pneumococcal infections in adult and elderly populations

Abstract Background Health system resources dedicated to vaccination and infectious disease prevention are often directed towards infants and children, through extensive childhood vaccination schedules. This focus has led to the near eradication of several preventable childhood diseases and had positive impacts on population health, but despite this track record of success, the ability of our health systems to make vaccinations accessible throughout the full life course has been less consistent. This project aims to address this issue by providing new data about the burden that pneumococcal infections, which are vaccine-preventable, have on adult and elderly populations. Methods This research aims to uncover the health system burden of invasive pneumococcal disease and pneumococcal pneumonia at all levels of the health system in 5 EU countries (Austria, Belgium, France, Italy &amp; Portugal). This involves a survey of managers and care providers working in hospitals, long-term care facilities, and primary care centres who may be affected by the health system impacts of pneumococcal infections. The survey covers several dimensions of health service delivery to collect a broad range of data on existing disruptions. The survey was translated into the study country languages and its formulation was further validated through interviews with experts in each study country to ensure that it can capture context-specific health system insights. The data collected through this survey will be further enhanced through a series of in-depth interviews before being synthesised, analysed and eventually published in a detailed report. Results Data collection begins as of 15 May 2024, and full results are expected to be published and available for the EPH Conference in November 2024. The results of this research will offer valuable evidence to public health professionals, health managers and policy-makers across Europe who are working to improve life-course access to pneumococcal vaccination. Key messages • Effective vaccination programmes for adult and elderly populations require expanding focus beyond childhood. • Data about the health system burden of pneumococcal infections in adult and elderly populations improves evidence-based decision-making and public health services.

Accelerating Evidence Synthesis in Observational Studies: Development of a Living Natural Language Processing-Assisted Intelligent Systematic Literature Review System.

Systematic literature review (SLR), a robust method to identify and summarize evidence from published sources, is considered to be a complex, time-consuming, labor-intensive, and expensive task. This study aimed to present a solution based on natural language processing (NLP) that accelerates and streamlines the SLR process for observational studies using real-world data. We followed an agile software development and iterative software engineering methodology to build a customized intelligent end-to-end living NLP-assisted solution for observational SLR tasks. Multiple machine learning-based NLP algorithms were adopted to automate article screening and data element extraction processes. The NLP prediction results can be further reviewed and verified by domain experts, following the human-in-the-loop design. The system integrates explainable articificial intelligence to provide evidence for NLP algorithms and add transparency to extracted literature data elements. The system was developed based on 3 existing SLR projects of observational studies, including the epidemiology studies of human papillomavirus-associated diseases, the disease burden of pneumococcal diseases, and cost-effectiveness studies on pneumococcal vaccines. Our Intelligent SLR Platform covers major SLR steps, including study protocol setting, literature retrieval, abstract screening, full-text screening, data element extraction from full-text articles, results summary, and data visualization. The NLP algorithms achieved accuracy scores of 0.86-0.90 on article screening tasks (framed as text classification tasks) and macroaverage F1 scores of 0.57-0.89 on data element extraction tasks (framed as named entity recognition tasks). Cutting-edge NLP algorithms expedite SLR for observational studies, thus allowing scientists to have more time to focus on the quality of data and the synthesis of evidence in observational studies. Aligning the living SLR concept, the system has the potential to update literature data and enable scientists to easily stay current with the literature related to observational studies prospectively and continuously.

Burden of Pneumococcal Disease in Young Children Due to Serotypes Contained in Different Pneumococcal Conjugate Vaccines in Eight Asian Countries and Territories.

Pneumococcal disease (PD) is a major cause of morbidity and mortality in young children in Asia and globally. Pneumococcal conjugate vaccines (PCVs) have significantly reduced the burden of PD when included in pediatric national immunization programs (NIPs). This study estimates the clinical and economic burden of PD due to serotypes contained in different PCVs in children aged < 5 years in eight Asian countries/territories. Based on published data, a cohort-based decision analytic model was used to estimate annual PD cases, deaths, and direct medical costs associated with serotypes contained in PCV10, PCV13, PCV15, and PCV20. PD incidence rates were lower in regions with PCV13 in their NIP than those without. Serotypes contained in higher but not lower valency PCVs resulted in a significant incremental clinical and economic burden, although the difference between PCV13 and PCV15 serotypes was generally small. Moving from PCV13 to PCV20 was estimated to result in greater clinical and economic burden reductions. This study demonstrates the remaining and incremental burden of PD from PCV10 to PCV20 serotypes in young children in selected Asian regions. Extending NIP access to higher-valency PCVs with broader serotype coverage and improving vaccine uptake will help prevent morbidity and deaths and save healthcare costs.

Prevalence, spatial distribution and determinants of complete childhood pneumococcal conjugate vaccination in Ethiopia: spatial and multilevel analyses

IntroductionPneumococcal disease is a serious global public health concern. The primary causative agent of severe illnesses such as pneumonia, meningitis, acute otitis media, and bacteremia is the pneumococcus bacterium. The pneumococcal conjugate vaccine is a key strategy to reduce the burden of pneumococcal disease. Understanding the spatial distribution of complete childhood pneumococcal conjugate vaccine utilization and its associated factors is crucial for designing strategies to improve vaccination implementation. Therefore, this study aimed to determine the spatial distribution of complete childhood pneumococcal conjugate vaccination coverage and identify its determinants in Ethiopia.MethodA spatial and multilevel analysis was conducted using data from the 2019 Ethiopian Mini Demographic and Health Survey. The analysis included a total of 2,055 weighted children. The association between the outcome variable and the explanatory variables was determined by calculating adjusted odds ratios at a 95% confidence interval. Explanatory variables were considered significantly associated with the outcome if the p-value was less than 0.05.ResultThe prevalence of complete childhood pneumococcal conjugate vaccination in Ethiopia was 53.94% (95% CI: 51.77, 56.08). Higher complete childhood pneumococcal vaccination coverage was observed in the Addis Ababa, Tigray, Amhara, Benishangul-Gumuz, and Oromia regions, while lower coverage was seen in the Afar, Somali, and SNNPR regions of Ethiopia. Factors significantly associated with complete childhood pneumococcal conjugate vaccination included maternal age, antenatal care visits, place of delivery, region, community women’s literacy level, community poverty level, and community antenatal care utilization.ConclusionThe distribution of complete childhood pneumococcal conjugate vaccination exhibited spatial variability across Ethiopia. Approximately half of children aged twelve to thirty-five months received the full dose of the childhood pneumococcal conjugate vaccine in the country. Several factors were identified as statistically significant determinants of complete childhood pneumococcal conjugate vaccination, including maternal age, antenatal care visits, place of delivery, region, community women’s literacy level, community poverty level, and community ANC utilization. Therefore, policies and strategies aimed at combating pneumococcal disease should consider these determinants and address areas with low vaccination coverage.

Current and new vaccines against pneumococci

Pneumococcal vaccination plays acrucial role in the prevention of bacterial respiratory infections caused by Streptococcus pneumoniae. Pneumococci are responsible for diseases such as pneumonia, sinusitis and acute otitis media and can cause serious invasive infections such as meningitis and bacteraemia. Pneumococcal pneumonia leads to increased morbidity and mortality, particularly in patients with chronic lung diseases such as chronic obstructive pulmonary disease (COPD). The introduction of 13-valent conjugate vaccines (pneumococcal conjugate vaccine13 [PCV13]) has significantly reduced the burden of disease. However, infections caused by serotypes not covered by PCV13 continue to occur. Current vaccines such as the 20-valent conjugate vaccine (PCV20) provide extended serotype coverage and have shown arobust immune response in clinical trials. The recently updated recommendations of the German Standing Committee on Vaccination (Ständige Impfkommission, STIKO) include the use of PCV20 for all indication categories in adults, which represents asimplified and more effective vaccination strategy. Future developments include vaccines with even broader serotype coverage and improved immunological properties; these are expected to further reduce the burden of pneumococcal disease. Improving vaccination uptake and increasing vaccination rates, particularly among at-risk groups, remain key objectives to protect public health in the long term.

Experimental Human Pneumococcal Carriage using Streptococcus pneumoniae serotype 3 in Malawi: a dose ranging and reproducibility human infection study

Background Streptococcus pneumoniae is a major cause of morbidity and mortality from respiratory tract infections, pneumonia, meningitis, and sepsis. Nasopharyngeal carriage of pneumococcus is a prerequisite for pneumococcal disease and transmission. Since the global introduction of pneumococcal conjugated vaccines, rates of pneumococcal disease have declined for many vaccine type serotypes but serotype 3 (SPN3) continues to cause significant disease. The Experimental Human Pneumococcal Challenge (EHPC) model is a unique method of determining pneumococcal colonisation, understanding the impact of colonisation on acquired immunity and for testing pneumococcal vaccines. This study will develop a serotype 3 EHPC model to address some pertinent questions on the burden of pneumococcal disease in Malawi. Methods Healthy adults aged 18-50 years will be recruited, with a maximum target of 83 participants to complete all study visits. The study will consist of a dose ranging and safety study, followed by a reproducibility study. Sequential cohorts of 10 healthy participants will be challenged with escalating doses of SPN3 in the dose ranging study. Samples will be collected before inoculation and on days 2, 7, 13, 16, 21 and 28 following inoculations, for determination of carriage. A total of 33 participants will be enrolled in the reproducibility part and will use a dose that established ≥60% of carriage, and with a high safety profile. Samples will be collected for determination of both local and systemic immunological responses to pneumococcal challenge. Upon completion of study visits, participants will complete a questionnaire establish acceptability. Interpretations We expect to establish an optimal SPN3 dose required to establish nasopharyngeal colonisation in healthy adults in an EHPC model. The model can then be used to evaluate pneumococcal vaccines in both healthy and at-risk populations.

Expert panel opinion on adult pneumococcal vaccination in the post-COVID era (NAP- EXPO Recommendations-2024).

Pneumococcal diseases pose a significant public health concern in India, with substantial morbidity and mortality, with the elderly and those with coexisting medical conditions being most at risk. Pneumococcus was also seen to be one of the main reasons for co-infection, pneumonia and complications in COVID. Current guidelines recommend vaccination for specific adult populations, but there is a lack of uniformity and guidance on risk stratification, prioritisation and optimal timing. Nation Against Pneumococcal Infections - Expert Panel Opinion (NAP-EXPO) is a panel convened to review and update recommendations for adult pneumococcal vaccination in India. The panel of 23 experts from various medical specialties engaged in discussions and evidence-based reviews, discussed appropriate age for vaccination, risk stratification for COPD and asthma patients, vaccination strategies for post-COVID patients, smokers and diabetics, as well as methods to improve vaccine awareness and uptake. The NAP-EXPO recommends the following for adults: All healthy individuals 60 years of age and above should receive the pneumococcal vaccine; all COPD patients, regardless of severity, high-risk asthma patients, post-COVID cases with lung fibrosis or significant lung damage, should be vaccinated with the pneumococcal vaccine; all current smokers and passive smokers should be educated and offered the pneumococcal vaccine, regardless of their age or health condition; all diabetic individuals should receive the pneumococcal vaccine, irrespective of their diabetes control. Strategies to improve vaccine awareness and uptake should involve general practitioners (GPs), primary health physicians (PHPs) and physicians treating patients at high risk of pneumococcal disease. Advocacy campaigns should involve media, including social media platforms. These recommendations aim to enhance pneumococcal vaccination coverage among high-risk populations in India in order to ensure a reduction in the burden of pneumococcal diseases, in the post-COVID era. There is a need to create more evidence and data to support the recommendations that the vaccine will be useful to a wider range of populations, as suggested in our consensus.

Lifetime Health and Economic Burden of Invasive Pneumococcal Diseases Attributable to V116 Serotypes Among Adults in the United States.

This study aimed to estimate and compare the lifetime clinical and economic burden of invasive pneumococcal diseases (IPD) attributable to the serotypes contained in a new 21-valent pneumococcal conjugate vaccine (V116) vs. the 20-valent pneumococcal conjugate vaccine (PCV20) among adults aged 18years and above in the USA. A state-transition Markov model was used to track IPD cases and deaths as well as the associated direct medical costs (in 2023 US dollars) from a US healthcare payer perspective at 3% annual discount rate. The results were summarized for V116, PCV20, and eight unique serotypes contained in V116. A sensitivity analysis was conducted to determine the most influential inputs on the overall total direct lifetime cost. For the total population of US adults aged 18years and above in 2021 (approx. 258million residents), the estimated lifetime numbers of cases of IPD, post-meningitis sequelae (PMS), and IPD-related deaths attributable to the serotypes contained in V116 were approximately 1.4million, 17,608, and 186,200, respectively, with a total discounted lifetime direct cost of $32.6billion. A substantial proportion (approx. 31%) of those were attributable to the unique eight serotypes. The corresponding estimates for PCV20 were approximately 35% lower-934,000, 11,500, and 120,000, respectively-with a total discounted direct lifetime cost of $21.9billion. These results show that V116 serotypes (compared to PCV20) are associated with substantially higher clinical and economic burden of IPD. The addition of V116 to vaccination recommendations can help to reduce the residual burden of IPD in US adults.

Immunogenicity of Current and Next-Generation Pneumococcal Conjugate Vaccines in Children: Current Challenges and Upcoming Opportunities.

Global use of pneumococcal conjugate vaccines (PCVs) with increasingly broader serotype coverage has helped to reduce the burden of pneumococcal disease in children and adults. In clinical studies comparing PCVs, higher-valency PCVs have met noninferiority criteria (based on immunoglobulin G geometric mean concentrations and response rates) for most shared serotypes. A numeric trend of declining immunogenicity against shared serotypes with higher-valency PCVs has also been observed; however, the clinical relevance is uncertain, warranting additional research to evaluate the effectiveness of new vaccines. Novel conjugation processes, carriers, adjuvants, and vaccine platforms are approaches that could help maintain or improve immunogenicity and subsequent vaccine effectiveness while achieving broader protection with increasing valency in pneumococcal vaccines.