Prevalence Of Invasive Pneumococcal Disease Research Articles

Mortality of Invasive Pneumococcal Disease following Introduction of the 13-Valent Pneumococcal Conjugate Vaccine in Greenland.

Before the incorporation of the 13-valent pneumococcal conjugate vaccine (PCV13) into the childhood vaccination regimen in Greenland in 2010, Inuit populations experienced a substantial prevalence of invasive pneumococcal disease (IPD). The PCV13 introduction has been shown to markedly reduce the incidence of IPD. This current study estimated the impact of PCV13 introduction on IPD mortality in Greenland. This was a nationwide register-based study using all available data on IPD cases 1995-2020 in Greenland. Thirty-one-day IPD case fatality rates (CFR), and all-cause and mortality rates associated with IPD during the period before the introduction of PCV13 (January 1995 to September 2010) were compared with those observed in the post-PCV13 era (September 2010 to October 2020). Standardized mortality ratios (SMRs) expressed differences in mortality by sex, age, region, ethnicity, comorbidity, and serotype. IPD CFR decreased with 24.5% from the pre- to the post-PCV13 period. SMR in IPD patients decreased by 57% (95% CI, 36-75%), and a reduction occurred in all age groups. While SMR in IPD persons ≥60 years remained virtually unchanged, there were no IPD-related deaths in persons ≤39 years in the post-PCV13 period. In conclusion, IPD-related mortality has decreased in Greenland following PCV13 introduction in 2010 in the country.

The status of Streptococcus pneumoniae in Iran compared to the world: a systematic review

Introduction: Streptococcus pneumoniae is a leading cause of vaccine-preventable deaths worldwide. Sero-epidemiological data on S. pneumoniae is needed in each country to monitor the burden of this important pathogen in each population. The aim of this study was to evaluate the prevalence, antibiotic resistance, prevalent serotypes and virulence factors of S. pneumoniae in Iran, compared to other parts of the world. Methods: A search via Google Scholar, Scopus, PubMed, ISI, Iranmedex, Magiran, SID and ISC was conducted for original articles investigating S. pneumoniae in Iran. The search terms were ‘Streptococcus pneumoniae’, ‘S. pneumoniae’, ‘prevalence’, ‘antibiotic resistance’, ‘antimicrobial resistance’, ‘typing’, ‘serotyping’, ‘virulence factors’, ‘Iran’. Results: The overall prevalence of invasive pneumococcal disease had an increasing trend in Iran. The most common serotypes amongst Iranian population were 1, 19A, 6A/ 6B, 23F, 14,18C, 20, 19, 3, 6, 9 V, 11A and 19F. Resistance to penicillin and co-trimoxazole had significant decreasing trends whilst resistance to erythromycin was increasing although insignificantly. The most prevalent pneumococcal virulence genes were lytA and pspC. Conclusion: Since pneumococcal serotypes differ in invasiveness, virulence, and antibiotic resistance it is important to closely monitor the changes on evolving serotypes, antibiotic resistance and virulence factors of this pathogen to be able to implement suitable prevention and therapeutic strategies.

The Role of Streptococcus pneumoniae in Community-Acquired Pneumonia.

With the notable exceptions of the United States and Canada in particular, the global burden of disease in adults due to invasive infection with the dangerous respiratory, bacterial pathogen, Streptococcus pneumoniae (pneumococcus) remains. This situation prevails despite the major successes of inclusion of polysaccharide conjugate vaccines (PCVs) in many national childhood immunization programs and associated herd protection in adults, as well as the availability of effective antimicrobial agents. Accurate assessment of the geographic variations in the prevalence of invasive pneumococcal disease (IPD) has, however, been somewhat impeded by the limitations imposed on the acquisition of reliable epidemiological data due to reliance on often insensitive, laboratory-based, pathogen identification procedures. This, in turn, may result in underestimation of the true burden of IPD and represents a primary focus of this review. Other priority topics include the role of PCVs in the changing epidemiology of IPD in adults worldwide, smoking as a risk factor not only in respect of increasing susceptibility for development of IPD, but also in promoting pneumococcal antibiotic resistance. The theme of pneumococcal antibiotic resistance has been expanded to include mechanisms of resistance to commonly used classes of antibiotics, specifically β-lactams, macrolides and fluoroquinolones, and, perhaps somewhat contentiously, the impact of resistance on treatment outcome. Finally, but no less importantly, the role of persistent antigenemia as a driver of a chronic, subclinical, systemic proinflammatory/procoagulant phenotype that may underpin the long-term sequelae and premature mortality of those adults who have recovered from an episode of IPD, is considered.

Emergence of Streptococcus pneumoniae serotype 19A (Spn19A) in the pediatric population in Bogotá, Colombia as the main cause of invasive pneumococcal disease after the introduction of PCV10

ABSTRACT Introduction: With the use of pneumococcal conjugate vaccines(PCV), the behavior of invasive pneumococcal disease(IPD) has changed relative to serotype distribution. The introduction of these vaccines in national immunization programs has reduced the incidence of IPD, with a marked decrease in the circulation of the serotypes included in the vaccine used in each country. However, the subsequent emergence of other serotypes not included in the vaccine, such 19A in case of PCV7 and PCV10, has been documented. Materials and methods: This was case series study (2008–2017) in pediatric patients admitted to 10 hospitals in Bogota who were diagnosed with IPD. It was conducted during the transitional period of implementing the PCV10 vaccine in Colombia in 2012. Cases of bacteremic pneumococcal pneumonia, meningitis, primary bacteremia and osteoarticular infection were included. A descriptive analysis of the demographic, clinical and laboratory variables of patients with IPD by Spn19A, its trend over time, profiles of antimicrobial susceptibility and clinical outcomes was performed. Results: There were 463 cases of IPD, 315(68%) with known serotypes. The prevalence of IPD by Spn19A was 17.7%(56 cases), tending to increase over time. During 2008–2011, the prevalence was 4.4%, and during 2014–2017, it was 32.4%, The most frequent diagnosis was pneumonia(80.4%). In nonmeningeal isolates, 39.6% were not susceptible to penicillin. An increase in the resistance was observed over time. Conclusion: Spn19A is a prevalent cause of IPD in the pediatric population of the analyzed cohort, with an increasing trend of this serotype during the surveillance period after the introduction of PCV10, being the most common serotype identified in recent years.

Streptococcus pneumoniae: Antimicrobial Resistance and Serotypes of Strains Carried by Children and Causing Invasive Disease in the Faroe Islands.

Knowledge about pneumococcal carriage, antibacterial resistance, serotype prevalence, and prevalence of invasive pneumococcal disease (IPD) after introduction of pneumococcal conjugate vaccines (PCVs) is lacking in the Faroe Islands. PCV-7 was introduced in 2008 and PCV-13 in 2010. The aim was to obtain knowledge on serotypes and antimicrobial resistance in pneumococci from carriage in children attending day-care centers (DCCs) and invasive isolates. Nasopharyngeal swabs were collected from 607 healthy children attending DCCs in the Faroe Islands in January to March in 2009, 2010, and 2011. Pneumococci were cultured selectively, tested for antibacterial susceptibility, and serotyped. Data from IPD isolates from 1974 to 2016 from the Department of Microbiology, National Hospital of the Faroe Islands, and typed and stored at Staten Serum Institute were also analyzed. Of the 607 screened children, 45% were pneumococcal carriers, 50% in 2009, 40% in 2010, and 42% in 2011. Antibiotic resistance in pneumococci was rare both in carriers and patients. Five penicillin nonsusceptible pneumococci were found in carriers (1.8%) and one among the invasive isolates (1.7%). The most common serotypes in carriage were 6B and 6A in 2009, serotype 3 and 6C in 2010, and serotype 11 and 6C in 2011. Serotype 6B was not found in 2011. The most common serotypes among IPD were 7F and 3. Pneumococcal carriage prevalence in healthy children attending DCCs in the Faroe Islands was low and antibacterial resistance was rare, compared with Iceland. The results suggest a possible serotype shift, reduction in antibacterial use, and PCV-7/13 serotype decrease in IPD after the introduction of pneumococcal vaccinations in children.

The Impact of Pneumococcal Conjugate Vaccination

Pneumococcal conjugate vaccines (PCVs) have significantly reduced the prevalence of invasive pneumococcal disease in the U.S. (NEJM JW Pediatr Adolesc

Burden of Pneumococcal Disease in Cancer Patients: A 20 Year Single Center Study at Memorial Sloan-Kettering Cancer Center

Background: Streptococcus pneumoniae is a major cause of sepsis, pneumonia and meningitis leading to significant morbidity and mortality. Invasive pneumococcal disease (IPD) and mortality rates in cancer patients (pts) are higher than in the general population. Since the introduction of routine childhood immunization with the 7-valent pneumococcal conjugate vaccine (PREVNAR) in 2000, the overall rate of invasive pneumococcal disease (IPD) decreased in adults in the US. The impact of PREVNAR on rates of IPD in cancer pts is not well studied.Methods: Retrospective review of pts treated at Memorial Sloan-Kettering Cancer Center from 1991-2012. Unique patient visits per year were obtained from the hospital database. Prevalence was calculated as number of cases per 1000 patient-visits per year. Pts with positive culture(s) for S. pneumoniae were identified from microbiology records. Serotype data is available through 2001. IPD was defined as a positive S. pneumoniae culture from a sterile site such as blood, CSF, or pleural fluid culture. Pneumococcal pneumonia was defined as a positive S. pneumoniae culture from thelower respiratory tract or a positive upper respiratory culture with either radiographic evidence for pneumonia and/or ICD-9 code "pneumococcal pneumonia" or "pneumonia" associated with the positive culture for S. pneumoniae. Colonization was defined as positive culture for S. pneumoniae without IPD or pneumonia. We compared prevalence between "early" (prior to PREVNAR, 1992-2001) and "late" (2002-2012) periods, in those with diagnoses of solid tumors and hematologic malignancies, and between ages ≤21 and >21 years. Pneumococcal vaccination rates were calculated as the number of patients who received any pneumococcal vaccine divided by the number of patient-visits per year.Results: The mean number of patient-visits per year was 46,394 and 96,954, for the early and late period, respectively. Of 1,033 patients with ≥1 culture positive for S. pneumoniae during the study, 329 (32%) had IPD, 394 (38%) had pneumococcal pneumonia and 310 (30%) had colonization. S. pneumoniae type 6 accounted for 39 (22%) isolates where serotype data was available. The annual prevalence of IPD, pneumonia and colonization gradually declined over the course of the study (Figure 1). Compared to the early period, the prevalence of IPD, pneumonia and colonization were lower in the late period (Table 1). The highest prevalence of IPD was observed in pts ≤21 years of age (2.8 and 1.3 for early and late periods, respectively). The prevalence of IPD in pts with hematologic malignancies was 5-fold higher than pts with solid tumors in the early period (1.8 vs 0.39 respectively; P<0.001) and 3-fold higher in the late period (0.6 versus 0.2 respectively, P<0.001). Only 1% of all pts received pneumococcal vaccine during the late period.Conclusions: 1) Over a 20 year period we observed a decline in the prevalence of IPD, pneumococcal pneumonia and colonization in cancer patients at a tertiary cancer center in NYC. 2) The prevalence of IPD, pneumococcal pneumonia and colonization was significantly lower (P<0.001) in the late period compared to the early period for the overall population and in high risk groups (≤21 year of age and hematologic malignancies). 3) Rates of pneumococcal vaccination in cancer patients remained low during the study despite the availability of PREVNAR in the late period. 4) Continued efforts are needed to increase rates of vaccination against pneumococcus in cancer patients.Table 1Prevalence for IPD, Pneumonia and Colonization by PeriodPrevalencePeriodIPDPNAColonization1992-20010.360.480.482002-20120.160.160.08Prevalence ratio (Early/Late)2.253.06.095% CI2.0-2.72.6-3.44.8-7.7P value<0.001<0.001<0.001Abbreviations: IPD, invasive pneumococcal disease; PNA, pneumococcal pneumonia; CI, confidence interval [Display omitted] DisclosuresKaltsas:Pfizer: Research Funding.

Pneumococcal vaccination in general practice

The prevalence of invasive pneumococcal disease, which is depending on risk factors and comorbidities, is increasing over the age of 50 years. Most developed countries have recommendations but vaccination rates remain low. To assess the general practitioners' daily practice in relation to pneumococcal vaccination and analyse the effect of informing the subjects about the importance of pneumococcal vaccination on vaccination routine. Subjects over 50 years of age vaccinated against influenza during the 2012/2013 campaign were informed about the importance of pneumococcal vaccination and asked to fill in a questionnaire. Of the 4000 subjects, 576 asked for a prescription of pneumococcal vaccine (16.5% of females and 11.6% of males, OR 1.67 CI 95% 1.37-2.04, p<0.001) and 310 were vaccinated. The mean age of females and males was 70.95 and 69.8 years, respectively (OR 1.01; CI 95% 1.00-1.02; p<0.05). Information given by physicians resulted in 33,6% prescription rate, while in case it was 8% when nurses provided information (OR 6.33; CI 95% 5.23-7.67; p<0.001). As an effect of this study the vaccination rate was 6.3 times higher than in the previous year campaign (p<0.001). General practitioners are more effective in informing subjects about the importance of vaccination than nurses. Campaign can raise the vaccination rate significantly.

The association between asthma and invasive pneumococcal disease: a nationwide study in Korea.

The purpose of this study was to investigate the association between asthma and invasive pneumococcal disease (IPD) in Korea. A retrospective population-based cohort study was conducted using the Korean Health Insurance Review and Assessment database 2010-2011. The subjects included 935,106 (2010) and 952,295 (2011), of whom 398 (2010) and 428 (2011) patients with IPD were identified. There was significant difference in the prevalence of IPD in patients with and without asthma (0.07% vs. 0.02% in 2010 and 0.08% vs. 0.01% in 2011; P<0.001). After adjusting for age and gender, patients with asthma showed over a three-fold increased risk of IPD compared with patients without asthma (adjusted odds ratio [aOR] 3.90, 95% confidence interval [CI] 3.02-5.03 in 2010 / aOR, 5.44; 95% CI, 4.10-7.22 in 2011; P<0.001). These findings were also significant in children (aOR, 2.08; 95% CI, 1.25-3.45 in 2010; P=0.005 / aOR, 3.26; 95% CI, 1.74-6.11 in 2011; P<0.001). Although diabetes mellitus was also significantly associated with IPD, relatively low ORs compared with those of asthma were noted (aOR, 1.85; 95% CI, 1.35-2.54 in 2010 / aOR, 2.40; 95% CI, 1.78-3.24 in 2011; P<0.001). Both children and adults with asthma are at increased risk of developing IPD.

Navigating difficult dosing guidelines for PCV13 and PPSV23

At its June 2012 meeting, the Advisory Committee on Immunization Practices (ACIP) voted to recommend pneumococcal 13-valent protein conjugate vaccine (PCV13; Prevnar-13–Pfizer) in adults 19 years or older with specific immunocompromising conditions. The recommendations were posted on October 12, 2012. 1

Epidemiology of Invasive Pneumococcal Disease among Adult Patients in Barcelona Before and After Pediatric 7‐Valent Pneumococcal Conjugate Vaccine Introduction, 1997–2007

A dramatic decrease in the incidence of invasive pneumococcal disease (IPD) was observed among children and adults in the United States after the introduction of the 7-valent pneumococcal conjugate vaccine (PCV7). Little is known about the incidence of IPD after PCV7 licensure in Europe. The objective of this study was to examine changes in the prevalence of IPD among adults in the PCV7 era. We undertook a prospective study involving adults with IPD who required hospital admission in the southern area of Barcelona, Spain. Three periods were studied: the pre-PCV7 period (1997-2001), the early PCV7 period (2002-2004), and the late PCV7 period (2005-2007). A total of 1007 episodes of IPD were observed. Rates of IPD among adults increased from 13.9 to 14.6 episodes per 100,000 population between the pre-PCV7 period and the early PCV7 period (P = .6) and then to 19.55 episodes per 100,000 population in the late PCV7 period (P < .001). The rates of IPD among adults due to non-PCV7 serotypes increased from 8.4 to 9.7 episodes per 100,000 population between the pre-PCV7 period and the early PCV7 period (P = .15) and then to 15.3 episodes per 100,000 population in the late PCV7 period (P < .001); IPD due to PCV7 serotypes decreased from 5.6 to 4.9 episodes per 100,000 population between the pre-PCV7 period and the early PCV7 period (P = .3), then to 4.3 episodes per 100,000 population in the late PCV7 period (P = .056). Among people aged > or = 65 years, IPD due to PCV7 serotypes decreased from 19.5 to 14.6 episodes per 100,000 population between the pre-PCV7 period and the early PCV7 period (P = .13), then to 12.3 episodes per 100,000 population in the late PCV7 period (P = .02). A decrease in the prevalence of antibioticresistant pneumococci in the late PCV7 period was associated with a decrease in the prevalence of multidrugresistant PCV7 clones (Spain(23F)-ST81, Spain(6B)-ST90, and ST88(19F)) and an increase in the prevalence of non-PCV7 antibiotic-susceptible clones (ST306(1), ST191(7F), ST989(12F), and ST433(22F)). Rates of IPD among adults increased in Barcelona in the late PCV7 period, coinciding with a clonal expansion of non-PCV7 serotypes. In contrast, rates of IPD caused by PCV7 serotypes decreased among people aged > or = 65 years, which suggests the development of a herd immunity.

Antimicrobial resistance patterns and serotype distribution of invasive Streptococcus pneumoniae isolates from children in Taiwan from 1999 to 2004

Streptococcus pneumoniae causes substantial morbidity and mortality worldwide. Because only limited data are available for the antibiotic resistance patterns and seroepidemiology of invasive S. pneumoniae isolates in Taiwanese children, this national surveillance of invasive pneumococcal infections in children was conducted during a 5-year period. Invasive isolates of S. pneumoniae were obtained from sterile sites (yielding blood and cerebrospinal, pleural, and intra-articular fluids) in children (aged ≤14 years) at a total of 40 regional hospitals and medical centers distributed throughout Taiwan. The collection period was between July 1999 and June 2004, with a total of 286 isolates (including 30 cerebrospinal fluids) collected. All the samples were sent to the Center for Disease Control in Taipei for serotyping and susceptibility testing. Of the 286 S. pneumoniae isolates studied, the 5 most common serotypes were 14 (28.3%), 23F (21.0%), 6B (17.1%), 19F (13.6%), and 3 (4.9%). Intermediate- and high-level penicillin resistance was determined for 50.7% and 25.5% of the isolates, respectively. Isolate resistance was demonstrated to erythromycin (93%), tetracycline (82.2%), trimethoprim/sulfamethoxazole (79.4%), cefotaxime (11.2%), and levofloxacin (0.3%). Multiple drug resistance was found for each serotype, but mostly in types 14, 23F, 6B, and 19F. Overall, 85.0% of the serotypes, 90.8% of the penicillin-nonsusceptible S. pneumoniae (PNSSP), and 90.1% of the multiple drug-resistant (MDR) isolates were covered by the heptavalent pneumococcal conjugated vaccine (PCV7). In this study, we found a diverse pulse-field gel electrophoresis pattern among MDR isolates: a high prevalence of drug resistance and a continued increasing trend in penicillin resistance among nationwide pneumococcal isolates from children in Taiwan. The highest prevalence of invasive pneumococcal disease was in children aged 2 to 5 years, and the highest PNSSP prevalence and highest PCV7 coverage were in children aged <2 years. In terms of reducing the risk of invasive pneumococcal illness in Taiwan, the use of PCV7 is likely to have a beneficial effect similar to that obtained in countries that have used it.

Pneumococcal vaccines: do they prevent infection and how?

The purpose of this review is to update and summarize information concerning the epidemiology of infections due to Streptococcus pneumoniae and the early results of effectiveness studies of the heptavalent pneumococcal conjugate vaccine. This vaccine was licensed in the US in 2000, and has been used increasingly since that time. Several studies have documented a dramatic decline in the rate of invasive infections due to S. pneumoniae in children under 5 years of age. There has been a simultaneous decrease in serious infections in persons over 20 years of age, presumably because of a decrease in transmission of S. pneumoniae to unvaccinated individuals. Three different studies have shown a modest reduction in the overall number of cases of acute otitis media in children who have received the vaccine. Although the overall number of cases has decreased there has been an increase in the number of cases of acute otitis media caused by serotypes of S. pneumoniae not contained in the vaccine. Worldwide, many studies have appeared that examine the prevalence of different pneumococcal serotypes/serogroups as a cause of invasive and respiratory disease, to assess the likelihood that the vaccine will be effective in particular geographic areas. Use of the heptavalent pneumococcal conjugate vaccine has led to a major decline in the prevalence of invasive pneumococcal disease (bacteremia, meningitis) and a more modest decrease in respiratory tract infections (acute otitis media, pneumonia). Continued surveillance is essential to document future trends in the occurrence of pneumococcal infections and the enduring protectiveness of the heptavalent pneumococcal conjugate vaccine.

Treatment of severe infections caused by penicillin-resistant pneumococci. Role of third generation cephalosporins.

Penicillin resistance occurred soon after the discovery of penicillin, first in the test tube and subsequently in patients. The prevalence of invasive pneumococcal disease has been estimated to be as high as 15-18/100,000 in the elderly population and even higher in AIDS patients, children and the very old. While prevention with pneumococcal vaccine seems the most reasonable solution, under-utilization of the vaccine and an increase in the number of immuno-compromised individuals has limited the success of this approach. Streptococcus pneumoniae is conventionally classified as penicillin-susceptible (MIC < 0.125 mg/l), penicillin-intermediate (MIC 0.125-1.0 mg/l) and penicillin-resistant (MIC > or = 2 mg/l). In many countries, penicillin resistance in pneumococci is on the increase and in some areas penicillin intermediate and resistant isolates reach 60%. As a consequence, a switch of therapy from penicillin to other agents is mandatory in infections caused by penicillin-resistant strains. Benzyl-penicillin, however, can be used for most infections caused by penicillin-intermediate and all infections caused by penicillin-sensitive strains. Third generation cephalosporins, and in particular cefotaxime, are an optional alternative, particularly in view of their low MICs against penicillin-susceptible and -intermediate and some penicillin-resistant strains, and the easily achievable therapeutic concentrations in serum, pulmonary tissues and other compartments in which pneumococcal infections occur. Third generation cephalosporins have a high safety record and can be administered to children, pregnant women and the elderly.(ABSTRACT TRUNCATED AT 250 WORDS)