Childhood Pneumococcal Vaccination Research Articles

Antibody response to the pneumococcal vaccine in children with mitochondrial disease

Antibody response to the pneumococcal vaccine in children with mitochondrial disease

Cost-effectiveness of an in-development adult-formulated 21-valent pneumococcal conjugate vaccine in US adults aged 50 years or older

Indirect effects of childhood pneumococcal conjugate vaccines (PCV) have diminished the cost-effectiveness of current adult vaccine recommendations. An in-development adult-formulated 21-valent pneumococcal conjugate vaccine (PCV21) may play a critical role in reducing pneumococcal illness by targeting a larger number of serotypes responsible for adult pneumococcal infections. This study assesses the cost-effectiveness of PCV21 in US adults aged 50 years or older compared with currently recommended pneumococcal vaccines, from both the societal and healthcare perspectives. A Markov model evaluated the lifetime cost-effectiveness of PCV21 (given at age 50 years only, at ages 50/65 years, and risk-based at ages < 65 years plus age-based at age 65 years) compared to no vaccination and to currently recommended pneumococcal vaccines given either as currently recommended or routinely at ages 50/65 years. The analysis was conducted in hypothetical Black and non-Black cohorts aged 50 years or older, with and without considering childhood pneumococcal vaccination indirect effects. Model parameters were based on US data. Parameter uncertainty was assessed using 1-way and probabilistic sensitivity analyses.From the societal perspective, PCV21 at ages 50/65 years compared to PCV21 at age 50 years cost $7,410 per quality adjusted life year (QALY) gained in Black cohort analyses and $85,696/QALY gained in the non-Black cohort; PCV21 at ages 50/65 years had the most favorable public health outcomes. From the healthcare perspective, compared to no vaccination, PCV21 at age 50 years cost $46,213/QALY gained in the Black cohort and $86,629/QALY in non-Blacks. All other strategies were dominated in both cohorts and from both perspectives. When considering childhood pneumococcal vaccination indirect effects, costs of PCV21 at ages 50/65 years remained less than $140,000/QALY gained from the societal perspective in both populations. PCV21 is potentially cost-effective compared to currently approved pneumococcal vaccines in adults aged 50 years or older from both the societal and healthcare perspectives.

Tdap vaccine in pregnancy and immunogenicity of pertussis and pneumococcal vaccines in children: What is the impact of different immunization schedules?

BackgroundIn 2019, the 3 + 1 schedule for children’s vaccination (2–4–6–18 months old) was changed for a reduced 2 + 1 schedule (2–4–12 months old) in Quebec, Canada. We compared the post-booster anti-pertussis and anti-pneumococcus IgG antibody concentrations among children of Tdap-vaccinated and unvaccinated mothers for different vaccine schedules and vaccine formulations. MethodsWe conducted an observational cohort study. An invitation letter to potential participants was provided during a routine vaccination visit. Children’s blood samples were analyzed post-booster at 13 (2 + 1 schedule) or 19 (3 + 1 schedule) months of age for antibodies against pertussis antigens (pertussis toxin (PT), filamentous hemagglutinin (FHA) and pertactin (PRN)) and pneumococcal antigens (serotypes 4, 18C, 19A, and 19F). IgG concentrations among children of Tdap-vaccinated and unvaccinated mothers for each vaccination schedule were compared using geometric mean concentrations (GMCs) and GMC ratios (GMRs), adjusting for potentially immune-response-influencing factors (aGMR). Serotype-specific pneumococcal seroprotection rates were also compared. ResultsA total of 360 children were included for pertussis analysis and 248 for pneumococcal analysis. For the 2 + 1 schedule, 13-month-old children of Tdap-vaccinated mothers had lower GMCs against PT, FHA, and PRN, with aGMR (95 %CI) of 0.77 (0.65–0.90), 0.66 (0.55–0.79), 0.72 (0.52–0.99), respectively. For the 3 + 1 schedule, at 19 months old, the interference appeared to be attenuated (higher aGMR values). GMCs against PT were slightly higher in the 3 + 1 than the 2 + 1 schedule: 126.5 IU/ml vs 91.6 IU/ml; aGMR = 1.27. GMCs against PT, FHA and PRN were slightly higher among children who received Infanrix hexa® compared to those who received Pediacel® at 12 months old. For pneumococcal antibodies, at 13 months old, there was no strong evidence of immune interference in children of Tdap-vaccinated mothers. ConclusionInfant vaccination schedule may influence immune interference associated with maternal Tdap vaccination. More studies are needed to assess the clinical impact of this interference on children’s protection.

Impacts of the COVID-19 pandemic on immunization with pneumococcal vaccines in children and older adults in Brazil

The COVID-19 pandemic has profoundly impacted individuals, resulting in long-lasting consequences. One of the effects has been a decline in vaccine adherence attributed to physical distancing measures, potentially contributing to the resurgence of preventable diseases, and posing diagnostic challenges. Consequently, monitoring immunization rates becomes crucial as an indicator for health promotion campaigns and to mitigate the strain on healthcare systems. This study aims to assess the effects of the COVID-19 pandemic on immunization with pneumococcal vaccines in children and older adults in Brazil from 2018 to 2021. Data was collected from the Department of Informatics of the Unified Health System, focusing on the number of doses administered and vaccination coverage with pneumococcal vaccines across the country. A total of 21,780,450 doses were administered, with a decline of 19.97% in vaccine coverage throughout the evaluation period. An overall negative trend was observed in the time series analysis for all states in Brazil. However, not all showed a statistically significant change associated with the pandemic. Therefore, it is essential for states that experienced a decline in vaccination rates during the COVID-19 pandemic to closely monitor changes in pneumococcal vaccination. Failure in the process may lead to an increase in pneumococcal infections and place an additional burden on the healthcare system.

Pneumococcal Vaccination in Adults: A Narrative Review of Considerations for Individualized Decision-Making.

Pneumococcal disease remains one of the major causes of severe disease in both children and adults. Severe disease may be prevented by pneumococcal polysaccharide and conjugate vaccines, which currently cover more than 20 serotypes. However, unlike routine pneumococcal vaccination in children, guidelines promote only limited pneumococcal vaccination in adults, and do not cater for decision-making for individual patients. In this narrative review, considerations for individualized decision-making are identified and discussed. This review identifies and discusses considerations for individualized decision-making, including the risk of severe disease, immunogenicity, clinical efficacy, mucosal immunity, herd immunity, concomitant administration with other vaccines, waning immunity, and replacement strains.

2183. Population-based Mortality Rate Trends of Potential Pneumococcal Pneumonia in Brazil from 2006-2019

Abstract Background Pneumococcal Disease is an important public health problem. In 2010, childhood pneumococcal vaccination with the 10-valent conjugate vaccine (PCV-10) was introduced in the Brazilian national immunization program. No public universal program is currently available for older adults; selected populations at risk are eligible to receive pneumococcal vaccine in few public centers across the country. The objective of this study was to assess trends in mortality rate (MR) due to potential pneumococcal pneumonia (PPP) from 2006-2019 in Brazil. Methods Death data were obtained from the Mortality Information System (SIM) and population data from the Brazilian Institute of Geography and Statistics (IBGE). ICD-10 codes included J13-J18. Yearly MR were calculated per 100,000 people. The percentage of change was calculated using average rate in the pre-(2006-2009) and post-PCV10 (2011-2019) vaccine introduction periods. Joinpoint regression was performed to assess changes in rates per 100,000 people and annual percentage changes (APCs) for each line segment and 95% confidence interval were estimated. Results During 2006-2019, 887,304 deaths by PPP occurred in all-age groups. Most cases were reported as unspecific pneumonia (99.8%). Mean MRs decreased in children &amp;lt; 5 years in post-PCV10 period, in contrast to increasing rates in adults ≥ 50 years (Table 1 and Figure 1). Among children less than 18 years, significant decreasing trends in MR by 5.5%, 2.9%, and 1.6% per year were observed in &amp;lt; 1year, 1-4 years, and 5-17 years, respectively, between 2006-2019 (Table 2). Although significantly decreasing trends were observed in 60-64 years and ≥65 years age groups during 2015-2019, the average APC increased by 1.0% (95%CI;0.3%;1.8%) and 1.4% (95%CI;0.5%;2.2%) in the post-PCV-10, respectively (Table 2). Table 1.Mean mortality rates by age groups for potential pneumococcal pneumonia in the pre-vaccination period (2006-2009) and post-vaccination period (2011-2019) , BrazilFigure 1.Mortality rate of pneumonia by age group in parallel with infant vaccination coverage, 2006-2019Table 2.Jointpoint analysis for mortality rate trends of potential pneumococcal pneumonia by age groups, Brazil, 2006-2019 Conclusion In post-PCV10 period, mortality rate of PPP declined mostly for infants. For older adults, the mortality trends have been consistently higher compared to &amp;lt; 18 age groups, being unable to demonstrate indirect effects of childhood vaccination. These findings inform decision makers about needs related to pneumococcal disease prevention and interventions among older adults. Disclosures Cintia I. Parellada, MD, PhD, MSD Brazil: Employee of MSD Brazil, a subsidiary of Merck &amp; Co., Inc.,|MSD Brazil: Stocks/Bonds Ana Luiza Bierrenbach, MD, PhD, Merck &amp; Co., Inc.: Advisor/Consultant Carolina Zampirolli, Msc, Merck &amp; Co., Inc.: Advisor/Consultant|Merck &amp; Co., Inc.: Employee of IQVIA who received funding to execute this study Ariane Abreu, Msc, Merck &amp; Co., Inc.: Advisor/Consultant|Merck &amp; Co., Inc.: Employee of IQVIA who received funding to execute this study Guilherme Julian, Msc, Merck &amp; Co., Inc.: Advisor/Consultant|Merck &amp; Co., Inc.: Employee of IQVIA who received funding to execute this study Thais Moreira, MD, MSc, MSD Brazil: Employee of MSD Brazil, a subsidiary of Merck &amp; Co., Inc.,|MSD Brazil: Stocks/Bonds Licieri Figueiredo, MD, Merck &amp; Co., Inc.: Employee of MSD Brazil, a subsidiary of Merck &amp; Co., Inc.,.

The Risk of Invasive Pneumococcal Disease Differs between Risk Groups in Norway Following Widespread Use of the 13-Valent Pneumococcal Vaccine in Children.

The elderly and adults with medical risk conditions remain at high risk of invasive pneumococcal disease (IPD), highlighting the importance of adequate preventive efforts. In an observational population-based study in Norway (pop ≥ 5 years, 2009–2017) covering six years post-PCV13 implementation, we explored the incidence and risk of IPD associated with age and comorbidities. We obtained the data on 5535 IPD cases from the Norwegian Surveillance System for Communicable Diseases and the population data from Statistics Norway. To define comorbidities, we obtained ICD-10 codes from the Norwegian Patient Registry for the cases and the Norwegian population. The average annual decrease in PCV13 IPD incidence was significant in all risk groups and decreased post-PCV13 introduction by 16–20% per risk group, implying a nondifferential indirect protection from the childhood vaccination. The IPD incidence remained high in the medical risk groups. The relative importance of medical risk conditions was 2.8 to 6 times higher in those aged 5–64 versus ≥65 years for all types of IPD, since age itself is a risk factor for IPD. In groups without medical risk, the risk of IPD was eight times higher in those aged ≥65 compared to those 5–64 years (RR 8.3 (95% CI 7.3–9.5)). Our results underscore the need for age- and risk-group-based prevention strategies.

Maintenance of an Immunogenic Response to Pneumococcal Vaccination in Children With Sickle Cell Disease.

Patients with sickle cell disease (SCD) are at increased risk for invasive pneumococcal disease because of splenic dysfunction. To mitigate this risk, patients are protected with prophylactic penicillin until completion of pneumococcal vaccination series. The objective of this study was to assess the maintenance of a protective immune response to pneumococcal vaccination in children with SCD. A retrospective review was conducted between June 2019 and June 2020 of all patients with SCD patients for whom it had been 5±1 year since completion of PPSV23 vaccination series. A total of 41 patients were analyzed. The majority of children (68%) were able to maintain an adequate immune response. There was no identifiable disease characteristic associated with maintenance of an appropriate immunogenic response. This study finds that patients with SCD are able to maintain an adequate immune response at the 5±1 year time point from completion of PPSV23 vaccination series. Similarly, patients were not found to have an increased rate of invasive pneumococcal disease even if not meeting criteria for adequate pneumococcal serum titer levels. Maintenance of pneumococcal titers suggests that there may not be a need for revaccination at the 5-year time point in this patient population.

Pneumococcal and Influenza Vaccination Rates and Pneumococcal Invasive Disease Rates Set Geographical and Ethnic Population Susceptibility to Serious COVID-19 Cases and Deaths.

This study examines the relationship of pneumococcal vaccination rates, influenza, measles-mumps-rubella (MMR) diphtheria-tetanus-pertussis vaccinations (DTP), polio, Haemophilus influenzae type B (Hib), and Bacillus Calmette–Guerin (tuberculosis) vaccination rates to COVID-19 case and death rates for 51 nations that have high rates of COVID-19 testing and for which nearly complete childhood, at-risk adult and elderly pneumococcal vaccination data were available. The study is unique in a large number of nations examined, the range of vaccine controls, in testing effects of combinations of vaccinations, and in examining the relationship of COVID-19 and vaccination rates to invasive pneumococcal disease (IPD). Analysis of Italian regions and the states of the United States were also performed. Significant positive correlations were found between IPD (but not lower respiratory infections) and COVID-19 rates, while significant negative correlations were found between pneumococcal vaccination and COVID-19 rates. Influenza and MMR vaccination rates were negatively correlated with lower respiratory infection (LRI) rates and may synergize with pneumococcal vaccination rates to protect against COVID-19. Pneumococcal and influenza vaccination rates were independent of other vaccination rates. These results suggest that endemic rates of bacterial pneumonias, for which pneumococci are a sentinel, may set regional and national susceptibility to severe COVID-19 disease and death.

The incremental burden of invasive pneumococcal disease associated with a decline in childhood vaccination using a dynamic transmission model in Japan: A secondary impact of COVID-19

The coronavirus disease 2019 (COVID-19) pandemic has disrupted childhood vaccinations, including pneumococcal conjugate vaccine (PCV). Evaluating the possible impact on the invasive pneumococcal disease (IPD) incidence associated with a decline in childhood pneumococcal vaccination is important to advocate the PCV programs. Using a deterministic, dynamic transmission model, the differential incidence and burden of IPD in children younger than 5 years in Japan were estimated between the rapid vaccination recovery (January 2021) and the delayed vaccination recovery (April 2022) scenarios for the next 10 years. In our model, the IPD incidence was reduced from 11.9/100,000 in 2019 to 6.3/100,000 in 2020, caused by a reduced transmission rate due to the COVID-19 mitigation measures. Assuming a recovery in the transmission rate in 2022 April, the incidence of IPD was estimated to increase with maximal incidence of 12.1 and 13.1/100,000 children under 5 years in the rapid and the delayed vaccination recovery scenarios. The difference in the total IPD incidence between these two scenarios was primarily driven by vaccine serotypes IPD incidence. The difference of incidence was not observed between the two scenarios after 2025. The persistent decline in childhood pneumococcal vaccination rates due to the impact of COVID-19 might lead to an increased IPD incidence and an incremental disease burden.

Invasive pneumococcal disease among adults with hematological and solid organ malignancies: A population-based cohort study

ObjectivesTo determine the risk of invasive pneumococcal disease (IPD) in adult cancer patients stratified by type of underlying malignancy, age, and capsular serotype and to assess herd effects of childhood pneumococcal vaccination. MethodsAll adult IPD cases reported to the Dutch pneumococcal surveillance system between 2004 and 2016 were included in this study. IPD incidence rates (IR) stratified by subtype of malignancy were calculated per 100 000 patient-years of follow-up. Incidence rate ratios (IRR) were calculated to compare IRs between groups. ResultsA total of 7167 IPD cases were included, of which 1453 were in patients with malignancies. For patients with hematological malignancies (HM) and solid organ malignancies (SOM), IRs were 482/100 000 and 79/100 000, respectively, compared with 15/100 000 in controls. The highest incidence was observed among patients with multiple myeloma, non-Hodgkin lymphoma, chronic lymphocytic leukemia, pancreatic cancer, and lung cancer (3299/100 000, 2717/100 000, 538/100 000, 559/100 000, and 393/100 000, respectively), and in patients ≥50 years old. Among HM patients, the incidence of IPD declined significantly after the implementation of infant pneumococcal vaccination (IRR 0.65, 95% confidence interval 0.51–0.84); among SOM patients, the decline was not statistically significant (IRR 0.88, 95% confidence interval 0.72–1.07). ConclusionsThe IPD disease burden in cancer patients remains high. Large differences in IPD incidence between the different types of cancer demand tailored guidance regarding pneumococcal vaccination.

Effect of childhood pneumococcal vaccination and beta-lactam antibiotic use on the incidence of invasive pneumococcal disease in the adult population

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.

ИММУННЫЙ ОТВЕТ К КАПСУЛЬНЫМ ПОЛИСАХАРИДАМ STREPTOCOCCUS PNEUMONIAE У ДЕТЕЙ С ИЗБЫТОЧНОЙ МАССОЙ ТЕЛА, ПРИВИТЫХ 13-ВАЛЕНТНОЙ КОНЪЮГИРОВАННОЙ ВАКЦИНОЙ ПРОТИВ ПНЕВМОКОККОВОЙ ИНФЕКЦИИ

Objective of the research: to determine IgG antibodies (AB) to S. pneumoniae serotypes in overweight children after administration of a 13-valent pneumococcal conjugate vaccine (PCV13). Materials and methods: blood serum of 17 children with excess BW (main group) and 40 children with normal BW (control group) aged 3 to 7 years, vaccinated with PCV13 were examined. The method of solid phase ELISA was used for determination of IgG AB levels to a mixture of capsular polysaccharides (CPS) of pneumococcus contained in PCV13 and serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, 23F S. pneumoniae, after 6 months after vaccination with PCV13. Results: all children had post-vaccination specific AB to pneumococcal serotypes in the value higher than the negative control. In the main group, the mean values of IgG AB to 5 of 13 S. pneumoniae serotypes 7F, 9V, 18C, 19A, 23F and to the mixture of CPS in the vaccine were higher than in the control group, as well as the proportion of children with high (more than 100 cu) levels of IgG AB to the mixture of PCV13 CPS and to the pneumococcal serotype 18C in comparison with the control. Further study of the immune response to pneumococcal vaccination in children with metabolic disorders is needed.

Invasive pneumococcal disease in children with cancer: Incidence density, risk factors and isolated serotypes

BackgroundPediatric oncology patients (POP) have a high risk of infections due to impaired immunity. Invasive pneumococcal disease (IPD) is an important cause of severe infection in these patients and it is associated with high mortality. This study aimed to evaluate the incidence and risk factors associated with IPD at a Pediatric Oncology Center in Brazil. MethodsThis was a retrospective case-control study. All IPD cases in children with cancer from 2005 through 2016 were reviewed. Each case of IPD was matched with two controls from a cohort of patients matched for year of IPD, age and disease in order to assess risk factors. The incidence density was calculated as the number of IPD per 100,000 patients-year. ResultsA total of 51 episodes of IPD in 49 patients was identified. All pneumococci were isolated from blood cultures. The median age was five years and 67% were male; mortality rate was 7.8%. The IPD incidence density rate in POP was 311.21 per 100,000 patients-year, significantly higher than the rate in the general pediatric population. Severe neutropenia was the only risk factor associated with IPD, after multivariate conditional logistic regression analysis. ConclusionAlthough pneumococcal disease decreased after the introduction of 10-valent pneumococcal vaccine in the Brazilian national immunization schedule in 2010, there was no decrease in the IPD incidence rate in our cohort. A higher coverage rate of pneumococcal vaccination in children in the general population might be necessary to reduce the incidence rate in this high-risk population.

Serotype distribution of Streptococcus pneumoniae isolated from children hospitalized in Beijing children’s hospital (2013–2019)

BackgroundStreptococcus pneumoniae can cause many infectious diseases among children, and relevant vaccines have not been scheduled into the National Immunization Program in China. The serotype distribution of Streptococcus pneumoniae is essential information used to evaluate the value of pneumococcal vaccines and formulate immunization strategies. MethodsStreptococcus pneumoniae isolates, identified as the disease pathogens, were collected from children hospitalized in Beijing Children’s Hospital from 2013 to 2019. The serotype was detected by the Quellung reaction. ResultsA total of 903 isolates of Streptococcus pneumoniae were collected, among which 809 were from non-invasive infections and 94 were from invasive infections. The non-invasive isolates were mainly isolated from respiratory secretions (49.4%) and bronchoalveolar lavage fluid (38.9%), while invasive isolates were from venous blood (5.4%), cerebrospinal fluid (2.8%) and pleural effusion (2.8%). The leading serotypes were 19F (36.0%), 19A (13.6%), 23F (9.4%), 14 (8.9%), 6A (6.9%), and 6B (5.3%). The overall coverage rates of 10-, 13-, 15-, 20-valent pneumococcal conjugate vaccines (PCV10, PCV13, PCV15, PCV20) and 23-valent pneumococcal polysaccharide vaccine (PPV23) as well as Pneumosil (a 10-valent pneumococcal conjugate vaccine) were 61.6%, 83.2%, 83.4%, 88.0%, 82.4% and 81.6%, respectively. The coverage rates of PCV13, PCV15 and PPV23 in isolates from invasive infections were significantly higher than those from non-invasive infections. The coverage rates of Pneumosil, either on the whole or among different age groups or different infections, were significantly higher than those of PCV10. ConclusionsSerotypes 19F, 19A, 23F, 14, 6A and 6B were the most common types among the isolates. As for pneumococcal vaccines available now, the coverage rate of PCV13 was high, especially in isolates from invasive infections. The promotion of PCV13 or further high valent vaccines might be of greater benefit in preventing pneumococcal infections than other pneumococcal vaccines in children.

The potential role of pneumococcal conjugate vaccine in reducing acute respiratory inflammation in community-acquired pneumococcal pneumonia

BackgroundPneumococcal conjugate vaccine (PCV) reduces both invasive pneumococcal disease (IPD) and other pneumococcal infections worldwide. We investigated the impact of stepwise implementation of childhood PCV programs on the prevalence of pneumococcal pneumonia, severity of acute inflammation, and associations between breakthrough pneumonia and pneumococcal serotypes in Taiwan.MethodsIn total, 983 children diagnosed with community-acquired pneumococcal pneumonia were enrolled between January 2010 and December 2015.ResultsProportions of pneumococcal vaccinations increased each year in age-stratified groups with PCV7 (32.2%) as the majority, followed by PCV13 (12.2%). The proportion of pneumococcal pneumonia decreased each year in age-stratified groups, especially in 2–5 year group. Serotype 19A is the leading serotype either in vaccinated (6.4%) or unvaccinated patients (5.2%). In particular, vaccinated patients had significantly higher lowest WBC, lower neutrophils, lower lymphocytes and lower CRP values than non-vaccinated patients (p < 0.05). After stratifying patients by breakthrough infection, those with breakthrough pneumococcal infection with vaccine coverage serotypes had more severe pneumonia disease (p < 0.05).ConclusionSystematic childhood pneumococcal vaccination reduced the prevalence of community-acquired pneumococcal pneumonia, especially in 2–5 year group. Serotype 19A was the major serotype for all vaccine types in patients with pneumococcal pneumonia and severity of acute inflammatory response was reduced in vaccinated patients.

Pneumococcal Vaccination for Children in Asian Countries: A Systematic Review of Economic Evaluation Studies.

Background: Evidence on costs and health benefits of pneumococcal conjugate vaccine (PCV) for children in Asian countries is limited but growing. As a region with a considerably high burden of pneumococcal disease, it is prominent to have a comprehensive overview on the cost-effectiveness of implementing and adopting a PCV vaccination program. Methods: We conducted a systematic review from Pubmed and Embase to identify economic evaluation studies of PCV for children in Asian countries up to May 2020. Data extraction included specific characteristics of the study, input parameters, cost elements, cost-effectiveness results, and key drivers of uncertainty. The Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) statement was followed for this systematic review. The reporting quality of the included studies was evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. Results: After the screening process on both the title and abstract and full text of 518 records, a total of 25 studies fulfilled the inclusion criteria, and were included in the review. The majority of included studies demonstrates that PCV for children is cost-effective in most of the Asian region, and even cost-saving in some countries. Most of the included studies implemented cost utility analysis (CUA) using either quality-adjusted life years (QALYs) or disability-adjusted life years (DALYs). Overall, the main drivers affecting the cost effectiveness were vaccine price, burden regarding pneumonia-related parameters, and the inclusion of herd effects. Conclusion: The children pneumococcal vaccination program appears to be a cost-effective intervention in Asia, and even cost-saving in certain conditions. Vaccine price, pneumonia-related disease burden, and the inclusion of the herd effect are observed as important key drivers in estimating cost-effectiveness in this region. Incorporating PCV in vaccination programs in this region was found to be highly favorable.

Assessment of Pneumococcal Vaccination in Children as a Basis of Shared Decision-Making for Adults.

Assessment of Pneumococcal Vaccination in Children as a Basis of Shared Decision-Making for Adults.

Nasopharyngeal carriage of Streptococcus pneumoniae in children from day-care centers in Smolensk

Objective. To investigate a nasopharyngeal carriage and serotypes of S. pneumoniae in children aged 3 to 6 years from day-care centers in Smolensk. Materials and Methods. A total of 245 isolates of S. pneumoniae from 1027 nasopharyngeal swabs from healthy children attending day-care centers was tested. Identification of S. pneumoniae was performed according morphological, cultural and antigenic characteristics (Slidex pneumo-Kit, bioMeriеux, France), susceptibility to optohin and bile. Extraction of S. pneumoniae DNA (338) from nasopharyngeal specimens and cultures was performed using nucleic acids extraction kit AmpliSens® DNA-sorb-В (Interlabservice, Russia). Molecular typing was performed using CDC-recommended PCR method with 22 pairs of primers. Results. Children without signs of infection diseases from 14 day-care centers were examined, whose parents have signed an informed consent. There were 245 (24.0%) isolates of S. pneumoniae from 1027 specimens of nasopharynx’s swabs. The partly vaccinated with PCV13 were children aged 3–4 years – 311 (30.3%), in 95 children were healthy carriage (38.2%) of S. pneumoniae. The majority of children under 4 years (716⁄69.7%) were non vaccinated, healthy carriage of S. pneumoniae were 216 (29.3%). The predominant serotypes of S. pneumoniae in partly vaccinated children were: 3 (9.8%), 6AB (17.9%), 19F (13.8%), 11AD (12.2%), 23F (5.3%), 19A (2%), 18ABCF (1.6%), 14 (2%), 9AV (1.2%), 6CD (0.8%). The coincidence of S. pneumoniae serotypes in vaccinated children and included in PCV13 were 54%. The most common serotypes of S. pneumoniae in non-vaccinated children were: 11AD (12.2%), 15A/F (2%), 23A (2%), 22AF (0.4%), 19A (1.3%), 33FA/37 (1.6%) and non-typeable serotypes (27.8%). Conclusions. The low coverage of pneumococcal vaccine in children under 6 years shows the initial process of its implementation in Health Care. We detect the reduction of vaccine serotypes in children with incomplete immunization (54%) and notable increase in non-typeable serotypes (27.8%) in nonvaccinated children.

Influence of Older Age and Other Risk Factors on Pneumonia Hospitalization in Switzerland in the Pneumococcal Vaccine Era.

Background: Pneumococcal pneumonia is a disease of the extremes of age. However, as other traditional risk factors for pneumococcal pneumonia also increase with older age, it is unclear if older age itself should be an indication for pneumococcal vaccination. Therefore, we assessed the effect of age on risk for hospitalization for pneumonia and for pneumococcal pneumonia.Methods: Using a national hospitalization dataset, all patients ≥16 years hospitalized in a Swiss hospital with a diagnosis of pneumonia or pneumococcal pneumonia between 2002 and 2015 were included. Multivariable logistic regression analysis was used to test the association between age (≥50 or ≥65 years) and hospitalization for pneumonia or pneumococcal pneumonia after adjusting for pneumococcal vaccine indications. Similar analyses were performed for effect of age on length of stay (LOS) and mortality.Results: Among a total of 17,619,016 hospitalizations a diagnosis of pneumonia was present in 421,760 (2.4%) and a diagnosis of pneumococcal pneumonia in 21,610 (0.12%). Age ≥50 years (OR: 3.52 and 2.12, respectively; p for both <0.001) and age ≥65 years (OR: 2.98 and 1.80, respectively; p for both <0.001) as well as most Swiss pneumococcal vaccine indications were independent predictors of hospitalization with a pneumonia and pneumococcal pneumonia diagnosis, respectively. Older age with both age cut-offs were associated with increased LOS (≥50 years: aRR: 1.19 and 1.24, respectively; age ≥65 years: aRR: 1.60 and 1.20, respectively; p < 0.001 for all) and mortality (≥50 years: aOR: 4.73 and 2.84, respectively; age ≥65 years: aOR: 2.38 and 2.69, respectively, p < 0.001 for all) in patients with a pneumonia and pneumococcal pneumonia diagnosis, respectively. The effects of pneumococcal vaccine indications decreased with older age. The incidences of hospitalizations with a pneumonia diagnosis and a pneumococcal pneumonia diagnosis increased significantly from the pre-vaccine era to the PCV7 era and the PCV13 era (p for trend for both analyses <0.001).Conclusion: This study confirms the Swiss indications for pneumococcal vaccination as independent risk factors for pneumonia hospitalizations. Older age itself should be considered as an additional vaccine indication. Pneumonia and pneumococcal pneumonia in adults have increased despite pneumococcal vaccination in children.