Comparative incidence dynamics and serotypes of meningitis,bacteremic pneumonia and other-IPD in young children in the PCV era: Insights from Israeli surveillance studies |
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| Institution: | 1. The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel;2. Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel;3. Pediatric Infectious Disease Unit, Dana Children''s Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel;4. Pediatric Department and Infectious Diseases Unit, Shaare Zedek Medical Center Affiliated with Hebrew University-Hadassah School of Medicine, Jerusalem, Israel;1. Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia;2. Pediatric Highly Intensive Care Unit, University of Milan, Milan, Italy;3. Immunization Action Coalition, St Paul, MN, USA;1. Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa;2. Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa;3. National Institute for Communicable Diseases: A Division of National Health Laboratory Service, Centre for Vaccines and Immunology, Johannesburg, South Africa;1. Institute of Medical Microbiology, Semmelweis University, Nagyvárad tér 4, H-1089 Budapest, Hungary;2. Institute of Laboratory Medicine, Semmelweis University, Üll?i út 78/a, H-1082 Budapest, Hungary;3. German National Reference Center for Streptococci, Department of Medical Microbiology, University Hospital RWTH Aachen, Pauwelsstrasse 30, D-52074 Aachen, Germany;4. National Public Health Institute, Albert Flórián út 2-6, H-1097 Budapest, Hungary;1. Marmara University, Faculty of Medicine, Division of Pediatric Infectious Diseases, Istanbul, Turkey;2. Marmara University, Faculty of Medicine, Department of Pediatrics, Istanbul, Turkey;3. Marmara University, Faculty of Medicine, Department of Microbiology, Istanbul, Turkey;1. Division of Epidemiology, Institute of Social Paediatrics and Adolescent Medicine, Ludwig-Maximilians-University Munich, Munich, Germany;2. National Reference Centre for Streptococci, Institute of Medical Microbiology, University Hospital RWTH Aachen, Germany;3. Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany;4. Charité – University Medicine Berlin, Berlin, Germany;1. Institute for Disease Modeling, Bellevue, WA, United States;2. Information School, University of Washington, Seattle, WA, United States;3. Department of Biology, New Mexico State University, Las Cruces, NM, United States;4. Pediatric Infectious Diseases Unit, Soroka University Medical Center, Beer Sheva, Israel;5. Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel;1. Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel;2. Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel |
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| Abstract: | IntroductionWidespread introduction of pneumococcal conjugated vaccines (PCVs) impacted on invasive pneumococcal disease (IPD). However, IPD reduction may not be similar in all outcomes within IPD.We assessed PCV7/PCV13 impact on pneumococcal meningitis, bacteremic pneumonia (BP) and other (non-meningitis, non-pneumonia) IPD episodes in children <5 years in Israel.MethodsA prospective, population-based, active nationwide surveillance.All pneumococcal invasive episodes with positive blood/CSF cultures, July 2000 through June 2016, were included. Three sub-periods were defined: pre-PCV (2000–2008), PCV7 (2009–2011) and PCV13 (2014–2016). Incidence rate ratios (IRRs) were calculated.ResultsOverall, 4321 episodes were recorded; 456 (10.6%) meningitis, 1478 (34.2%) pneumonia and 2387 (55.2%) other-IPD.In the pre-PCV period, proportion of serotypes in PCV13, but not in PCV7 (mainly serotypes 1, 5 and 19A) was higher in BP (43.3%) compared with other-IPD episodes (32.8%, p < 0.001) and similar to that of meningitis (37.6%, p = 0.1). The proportion of episodes in children <12 months was higher in meningitis (52.1%) compared with pneumonia (23.2%) and other-IPD episodes (39.5%; p < 0.001 for both).The declines of the 3 entities were not similar; Meningitis rate non-significantly declined by 24% (IRR = 0.76; 95% CI 0.57–1.01), while BP and other-IPD rates significantly declined by 57% and 70%, respectively. In contrast to other entities, BP did not decline significantly after PCV7 introduction but started to decline only after PCV13 introduction.Rates of meningitis, pneumonia and other-IPD caused by PCV13-serotypes (VT13) substantially declined by 88%, 95% and 97%, respectively, comparing PCV13 and the pre-PCV periods. However, diseases caused by non-VT13 increased by 256%, 302% in meningitis and pneumonia, respectively, but only 116% in other-IPD.ConclusionsFollowing PCV7/PCV13 introduction, rates of episodes caused by VT13 were substantially reduced in all 3 groups. However, differences in age distribution, serotype replacement and specific serotype decrease suggest different pathogenesis and host susceptibility between the 3 entities. |
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| Keywords: | Pneumonia IPD – invasive pneumococcal disease PCV – pneumococcal conjugate vaccine Dynamics Children Surveillance IPD"} {"#name":"keyword" "$":{"id":"k0040"} "$$":[{"#name":"text" "_":"invasive pneumococcal disease PCV7"} {"#name":"keyword" "$":{"id":"k0050"} "$$":[{"#name":"text" "_":"7-valent pneumococcal conjugated vaccine PCV13"} {"#name":"keyword" "$":{"id":"k0060"} "$$":[{"#name":"text" "_":"13-valent pneumococcal conjugated vaccine NIP"} {"#name":"keyword" "$":{"id":"k0070"} "$$":[{"#name":"text" "_":"national immunization program PCV"} {"#name":"keyword" "$":{"id":"k0080"} "$$":[{"#name":"text" "_":"pneumococcal conjugated vaccine CSF"} {"#name":"keyword" "$":{"id":"k0090"} "$$":[{"#name":"text" "_":"cerebrospinal fluid PCR"} {"#name":"keyword" "$":{"id":"k0100"} "$$":[{"#name":"text" "_":"polymerase chain reaction IRR"} {"#name":"keyword" "$":{"id":"k0110"} "$$":[{"#name":"text" "_":"incidence rate ratio CI"} {"#name":"keyword" "$":{"id":"k0120"} "$$":[{"#name":"text" "_":"confidence interval VT7"} {"#name":"keyword" "$":{"id":"k0130"} "$$":[{"#name":"text" "_":"PCV7 serotype VT13"} {"#name":"keyword" "$":{"id":"k0140"} "$$":[{"#name":"text" "_":"PCV13 serotype VT6"} {"#name":"keyword" "$":{"id":"k0150"} "$$":[{"#name":"text" "_":"additional PCV13 serotypes |
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