Incidence of Pneumococcal Disease Due to Non-Pneumococcal Conjugate Vaccine (PCV7) Serotypes in the United States during the Era of Widespread PCV7 Vaccination, 1998–2004

Johns Hopkins University, Baltimore, Maryland, United States
The Journal of Infectious Diseases (Impact Factor: 6). 11/2007; 196(9):1346-54. DOI: 10.1086/521626
Source: PubMed


Widespread use of pneumococcal conjugate vaccine (PCV7) resulted in decreases in invasive disease among children and elderly persons. The benefits may be offset by increases in disease due to serotypes not included in the vaccine (hereafter, "nonvaccine serotypes"). We evaluated the effect of PCV7 on incidence of disease due to nonvaccine serotypes.
Cases of invasive disease were identified in 8 geographic areas through the Centers for Disease Control and Prevention's Active Bacterial Core surveillance. Serotyping and susceptibility testing of isolates were performed. We calculated the incidence of disease for children aged <5 years and adults aged > or =65 years. We compared rates of serotype-specific disease before and after PCV7 was licensed for use.
The annual incidence of disease due to nonvaccine serotypes increased from an average of 16.3 cases/100,000 population during prevaccine years (1998-1999) to 19.9 cases/100,000 population in 2004 for children aged <5 years (P=.01) and from 27.0 cases/100,000 population during prevaccine years to 29.8 cases/100,000 population in 2004 for adults aged > or =65 years (P=.05). Significant increases in the incidences of disease due to serotypes 3, 15, 19A, 22F, and 33F were observed among children during this period (P<.05 for each serotype); serotype 19A has become the predominant cause of invasive disease in children. The incidence of disease due to these serotypes also increased among elderly persons.
The incidence of pneumococcal disease caused by nonvaccine serotypes is increasing. Ongoing surveillance is needed to monitor the magnitude of disease caused by nonvaccine serotypes, to ensure that future vaccines target the appropriate serotypes.

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    • "Our survey showed improvement of the drug susceptibility profile of S. pneumoniae after introduction of PCV7 in Japan. There have already been reports that PCV7 decreases the rate of invasive pneumococcal disease, such as meningitis, sepsis, and pneumonia [20]. In the Northern California Kaiser Permanente (NCKP) Trial, total AOM episodes decreased by 7% in the vaccinated group, while the decrease was 6% in the Finnish Otitis Media (FinOM) Vaccine Trial [23] [24]. "
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    ABSTRACT: Introduction Streptococcus pneumoniae is one of the most common bacteria causing otorhinolaryngological infections, such as acute otitis media and upper respiratory tract infection. Our group surveyed the drug susceptibility profile of S. pneumoniae isolates from otorhinolaryngology patients. Materials and methods A total of 41,069 S. pneumoniae isolates were detected at Miyagi Medical Association Health Center between May 2001 and December 2012. Specimens were obtained from patients at 40 otorhinolaryngology outpatient clinics in Miyagi Prefecture, Japan. The minimum inhibitory concentrations (MICs) of 8 antimicrobial agents were measured using the broth microdilution method according to Clinical and Laboratory Standards Institute guidelines. Results In children aged 0–2 years old, the MIC50 values of penicillins decreased after 2010 (PCG: 1 μg/ml (2010) to 0.06 μg/ml (2012); ABPC: 1 μg/ml (2010) to 0.25 μg/ml (2012)). The prevalence of penicillin-resistant S. pneumoniae (PRSP) decreased from 35.2% (2010) to 14.6% (2012) in rhinorrhea specimens and from 43.4% (2010) to 14.3% (2012) in otorrhea specimens. Susceptibility to cephems (ceftriaxone and cefditoren) and carbapenems (panipenem) also showed improvement after 2010. For macrolides (clarithromycin) and lincosamides (clindamycin), MIC50 values increased in all age groups during the study period, and a high level of resistance was seen until 2012. There were no marked changes of susceptibility to fluoroquinolones (LVFX) during the study period. Conclusion Improvement of susceptibility of S. pneumoniae to β-lactams occurred after 2010 in Miyagi Prefecture, Japan.
    Journal of Infection and Chemotherapy 11/2014; 20(11). DOI:10.1016/j.jiac.2014.07.014 · 1.49 Impact Factor
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    • "The selection of serotypes included in the 7-, 10-, and 13- valent pneumococcal conjugate vaccines (PCVs) is based upon the frequency with which these serotypes caused invasive pneumococcal disease (IPD) prior to conjugate vaccine introduction, with the aim to maximally reduce the frequency of pneumococcal disease. Although the introduction of the pneumococcal conjugate vaccines in national vaccination schemes has reduced the incidence of pneumococcal disease caused by the vaccine serotypes [3], non-vaccine serotypes are increasingly being isolated from both pediatric and adult patients with IPD [4] [5] [6]. Also in The Netherlands serotype replacement has been observed following the introduction of PCV7 in the National Pediatric Vaccination Program in 2006 [7]. "
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    ABSTRACT: The introduction of a 7-valent conjugate pneumococcal vaccine (PCV7) in children largely affected the prevalence of adult pneumococcal pneumonia. In this study we investigated whether the clinical severity of adult bacteremic pneumococcal pneumonia has also altered following the introduction of pediatric PCV7 vaccination. Adults hospitalized with bacteremic pneumococcal pneumonia between 2001 and June 2011 at two Dutch hospitals were included retrospectively. Clinical data on patient characteristics, comorbidities and severity of disease were obtained and pneumococcal serotypes were determined. Among 343 patients investigated, those infected with PCV7 serotypes had a higher PSI score (p=0.0072) and mortality rate (p=0.0083) compared with the remainder of the cohort. Since the introduction of PCV7 the proportion of pneumococcal pneumonias caused by serotypes 1 and 7F (p-values 0.037 and 0.025) increased, as well as the rate of pleural effusion and empyema (p-values 0.011 and 0.049). Whilst de proportion of adults infected with PCV7 serotypes decreased after the introduction of PCV7 (p=0.015), PSI scores in these patients remained higher (p=0.030), although mortality rates between PCV7 and non PCV7 types equalized. After the introduction of PCV7 a marked shortening in hospital stay was observed only among patients infected with non PCV7 serotypes (p=0.019). After pediatric PCV7 vaccination, adult bacteremic pneumococcal pneumonia was more frequently caused by serotype 1 or 7F and pleural effusion occurred more often. Although PSI scores remained higher among adults infected with PCV7 serotypes, mortality rates equalized between PCV7 and non PCV7 types alongside shortening of hospital stay in patients infected with PCV7 serotypes.
    Vaccine 05/2014; 32(31). DOI:10.1016/j.vaccine.2014.04.089 · 3.62 Impact Factor
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    • "The serotype coverage for the PCV7, PCV10, and PCV13 was 77%, 81%, and 90%, respectively (Fig. 3). The proportion of IPD caused by vaccine types was higher compared to previous similar studies [17, 18, 19, 20]. The serotype distribution in the present investigation was similar to that found in previous studies [17, 21], except that serotype 14 was less prevalent than that found in an earlier study [20]. "
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    ABSTRACT: Streptococcus pneumoniae causes life-threatening infections such as meningitis, pneumonia, and febrile bacteremia, particularly in young children. The increasing number of drug-resistant isolates has highlighted the necessity for intervening and controlling disease. To achieve this, information is needed on serotype distribution and patterns of antibiotic resistance in children. All cases of invasive pneumococcal disease (IPD) in children aged less than 15 yr recorded at King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia, were reviewed for serotyping and antibiotic susceptibility. Isolates were collected from 78 consecutive patients with IPD between 2009 and 2012. All collected isolates were subjected to serotyping by co-agglutination, sequential multiplex PCR, and single PCR sequetyping as previously described. The most frequently isolated IPD serotypes were 23F, 6B, 19F, 18C, 4, 14, and 19A, which are listed in decreasing order and cover 77% of total isolates. The serotype coverage for the pneumococcal conjugate vaccine (PCV)7, PCV10, and PCV13 was 77%, 81%, and 90%, respectively. Results from sequential multiplex PCR agreed with co-agglutination results. All serotypes could not be correctly identified using single PCR sequetyping. Minimum inhibitory concentration showed that 50 (64%) isolates were susceptible to penicillin, whereas 70 (90%) isolates were susceptible to cefotaxime. The most common pneumococcal serotypes occur with frequencies similar to those found in countries where the PCV has been introduced. The most common serotypes in this study are included in the PCVs. Addition of 23A and 15 to the vaccine would improve the PCV performance in IPD prevention.
    Annals of Laboratory Medicine 05/2014; 34(3):210-215. DOI:10.3343/alm.2014.34.3.210 · 1.48 Impact Factor
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