Early impact of PCV7/PCV13 sequential introduction to the national pediatric immunization plan,on adult invasive pneumococcal disease: A nationwide surveillance study |
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| Affiliation: | 1. Sheba Med Ctr., Ramat Gan, Israel;2. Tel-Aviv Med Ctr., Tel Aviv, Israel;3. Rabin Med Ctr., Petah Tikva, Israel;4. Rambam Med Ctr., Haifa, Israel;5. Meir Med Ctr., Kfar Saba, Israel;6. Barzilai Med Ctr., Ashkelon, Israel;7. Hillel Yaffe Med Ctr., Hadera, Israel;8. Assaf Harofe Med Ctr., Tsrifin, Israel;9. Rivka Ziv Med Ctr., Safed, Israel;10. Haddassah Med Ctr., Jerusalem, Israel;11. Soroka University Med Ctr., affiliated to the Ben-Gurion University of the Negev., Beersheba, Israel;1. Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Special Administrative Region, China;2. Centre for Paediatric Pharmacy Research Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom;3. Department of Primary Care & Health Services, Brighton and Sussex Medical School, Brighton, United Kingdom;4. School of Public Health Imperial College London and Chartfield Surgery, London, United Kingdom;5. Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, United Kingdom;6. Institute of Pharmaceutical Science & Department of Chemistry, King''s College London, London, United Kingdom;7. Paediatric Infectious Disease Research Group, St George''s University of London, London, United Kingdom;1. Department of Infectious Diseases, Istituto Superiore di Sanità, Rome;2. Italian Federation of General Practitioners (Federazione Italiana Medici di Medicina Generale, FIMMG), Rome, Italy;1. Immunisation, Hepatitis and Blood Safety Department, Public Health England, London NW9 5EQ, England, United Kingdom;2. Respiratory & Vaccine Preventable Bacteria Reference Unit, Public Health England, London NW9 5EQ, England, United Kingdom;1. Medical Research Council Unit, The Gambia, Fajara, The Gambia;2. Murdoch Childrens Research Institute, Melbourne, VIC, Australia;3. London School of Hygiene & Tropical Medicine, London, UK;4. Centre for International Health, University of Otago, Dunedin, New Zealand;5. The National Hospital, Abuja, Nigeria;6. Microbiology and Infection Unit, Warwick Medical School, Coventry, UK;7. Ministry of Health and Social Welfare, Gambia Government, Kotu, The Gambia;8. Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA;9. Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand;10. GlaxoSmithKline, Wavre, Belgium;1. Infectious Disease Center and Department of Clinical Research, National Hospital Organization Mie Hospital, Mie, Japan;2. National Institute of Infectious Diseases, Tokyo, Japan;3. Okinawa Prefectural Nanbu Medical Center & Children''s Medical Center, Okinawa, Japan;4. Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan;5. Section of Pediatrics, Department of Medicine, Division of Oral and Medical Management, Fukuoka Dental College, Fukuoka, Japan;6. Kochi University, Kochi, Japan;7. Department of Pediatrics, Kochi Prefectural Hata-Kenmin Hospital, Kochi, Japan;8. Okayama University Graduate School of Health Sciences, Okayama, Japan;9. Department of Infectious Diseases, Medical Mycology Research Center, Chiba University, Chiba, Japan;10. Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan;11. Department of Pediatrics, Fukushima Medical University School of Medicine, Fukushima, Japan;12. Sapporo City University School of Nursing, Hokkaido, Japan |
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| Abstract: | BackgroundPCV7 was introduced as a universal childhood vaccination in Israel on July 2009 and was gradually replaced by PCV13 from November 2010. We report data on adult invasive pneumococcal disease (IPD), two years post PCV13 implementation.MethodsAn ongoing nationwide active surveillance (all 27 laboratories performing blood/CSF cultures nationwide), initiated in 2009, providing all blood/CSF Streptococcus pneumoniae isolated from persons ≥18 years. Capture-recapture method assured reporting of >95% cases. All isolates were serotyped in one central laboratory. Medical history and outcomes were recorded in ∼90%.ResultsOf 1809 IPD episodes, S. pneumoniae was isolated from the blood in 95% and most cases had pneumonia. Predisposing comorbidities were present in >70%. During the four study years, overall IPD incidence decreased from 9.2 to 7.2/100,000, incidence of pneumonia and particularly severe pneumonia cases decreased significantly from 6.6 to 4.7/100,000, (p = 0.029). Vaccine type (VT7/VT13) serotypes decreased by 70%/57% within 4 years. This was accompanied by a 52% increase in non-VT13 strains. These changes were most apparent in winter. PCV impact was most pronounced in younger adults (39% decrease in overall IPD with only a non-significant increase in non-VT13 cases) while in those >65 years a non-significant decrease in overall IPD was observed with a 64% increase in non-VT13 cases. Non-VT13 serotypes that increased significantly were 12F, 15A 10A and 6 C. A continuous reduction in isolates with penicillin MIC > 0.06 μg/ml was observed (26% to 11%, p < 0.001).ConclusionsFour years after PCV7 and 2.5 years after PCV13 universal implementation in children, incidence of adult IPD caused by VT7 and VT13 decreased in all ages, mainly in younger adults. Despite increase in non-VT13 IPD, overall IPD decreased. Additional follow-up is needed to determine the long-term impact of PCV13. |
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| Keywords: | Adult invasive pneumococcal disease PCV7 PCV13 impact Herd effect Nationwide active surveillance |
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