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Laboratory results of outbreak-associated cases of lower respiratory tract infection in a residential home, England, 2012
Source publication
SUMMARY In August 2012, an explosive outbreak of severe lower respiratory tract infection (LRTI) due to Streptococcus pneumoniae serotype-8 occurred in a highly vaccinated elderly institutionalized population in England. Fifteen of 23 residents developed LRTI over 4 days (attack rate 65%); 11 had confirmed S. pneumoniae serotype-8 disease, and two...
Citations
... Occupational risks in the current UK guidelines cover welders or metal workers [3]. However, other professional activities involving close contact with people with respiratory disease could be considered as relevant for vaccination (including individuals working in residential care homes, elderly care wards, oil rigs, prisons, those living in inner city high pollution settings and healthcare workers), as they are at higher risk of exposure to respiratory infections [109][110][111]. Indeed, several measures were implemented to control infections during outbreaks, including isolation, hand/respiratory hygiene practice, personal protective equipment, and use of antimicrobials [110]. ...
Introduction:
Pneumococcal disease (PD) significantly contributes to morbidity and mortality, carrying substantial economic and public health burden. This article is a targeted review of evidence for pneumococcal vaccination in the UK, the definitions of groups at particular risk of PD and vaccine effectiveness. In this context, the UK Joint Committee on Vaccination and Immunisation (JCVI) recently recommended the new 20-valent pneumococcal conjugate vaccine for adults in risk groups.
Areas covered:
Relevant evidence focusing on UK data from surveillance systems, randomized controlled trials, observational studies and publicly available government documents is collated and reviewed. Selected global data are included where appropriate.
Expert opinion:
National vaccination programs have reduced the incidence of vaccine-type PD, despite the rising prominence of non-vaccine serotypes in the UK. The introduction of higher-valency conjugate vaccines provides an opportunity to improve protection against PD for adults in risk groups. Several incentives are in place to encourage general practitioners to vaccinate risk groups, but uptake is low-suboptimal particularly among at-risk individuals. Wider awareness and understanding among the public and healthcare professionals may increase vaccination uptake and coverage. National strategies targeting organizational factors are urgently needed to achieve optimal access to vaccines. Finally, identifying new risk factors and approaches to risk assessment for PD are crucial to ensure those at risk of PD can benefit from pneumococcal vaccination.
... Although both immunization strategies were found to be immunogenic, safe, and cost-effective [22], a previous study in adults over 65 years old in the US, taking into account the pneumococcal vaccination recommendations at the time (PCV13-PPSV23 or PPSV23-PCV13, per ACIP recommendation [5]), showed that only 16.8% had received the complete vaccination, with 34.3% receiving only one dose (11.6% PPSV23, 22.7% PCV13) and 49% not receiving any pneumococcal vaccine, highlighting the challenges of sequential vaccination [15]. Moreover, during an outbreak of serotype 8 in an elderly population previously vaccinated with PPSV23, researchers found that the median number of years since PPSV was significantly higher for cases than non-cases, suggesting waning immunity [92]. Furthermore, in adults aged 65 years and above, PPSV23 showed a modest trend towards avoidance of CAP-related hospitalization and prevention of death or ICU admission in hospitalized CAP patients [93], whereas PCV13 ensured protection against disease by vaccinal serotypes [94]. ...
Pneumococcal disease is a major cause of morbidity/mortality worldwide, and vaccination is an important measure in its prevention. Despite European children being vaccinated with pneumococcal conjugate vaccines (PCVs), pneumococcal infections are still a major cause of morbidity/mortality in adults with risk conditions and their vaccination might be an important prevention strategy. New PCVs have been approved, but information is lacking on their potential impact in European adults. In our review, we searched PubMed, MEDLINE, and Embase for studies on the additional PCV20 serotypes (concerning incidence, prevalence, disease severity, lethality, and antimicrobial resistance) in European adults, between January 2010 and April 2022, having included 118 articles and data from 33 countries. We found that these serotypes have become more prevalent in both invasive and non-invasive pneumococcal disease (IPD and NIPD), representing a significant proportion of cases (serotypes 8, 12F, 22F) and more serious disease and/or lethality (10A, 11A, 15B, 22F), showing antimicrobial resistance (11A, 15B, 33F), and/or affecting more vulnerable individuals such as the elderly, immunocompromised patients, and those with comorbidities (8, 10A, 11A, 15B, 22F). The relevance of pneumococcal adult carriers (11A, 15B, 22F, and 8) was also identified. Altogether, our data showed an increase in the additional PCV20 serotypes’ prevalence, accounting for a proportion of approximately 60% of all pneumococcal isolates in IPD in European adults since 2018/2019. Data suggest that adults, as older and/or more vulnerable patients, would benefit from vaccination with higher-coverage PCVs, and that PCV20 may address an unmet medical need.
... 41,47,48 Adult-toadult pneumococcal transmission has also been documented within nursing homes and other institutions, evidenced by cluster analysis of disease outbreaks within these settings. 12,15,49,50 Our meta-analysis identified nursing home residence as a risk factor, although total participant numbers were small in this subgroup. Findings suggest that this, in combination with reports of nursing home pneumococcal outbreaks, could support the designating of residents as higher-risk and therefore worthy of PCV and pneumococcal polysaccharide vaccine (PPV) vaccination to protect against severe pneumococcal disease. ...
Background
Colonisation with Streptococcus pneumoniae can lead to invasive pneumococcal disease and pneumonia. Pneumococcal acquisition and prevalence of colonisation are high in children. In older adults, a population susceptible to pneumococcal disease, colonisation prevalence is reported to be lower, but studies are heterogeneous.
Methods
This is a systematic review and meta-analysis of prevalence of, and risk factors for, pneumococcal colonisation in adults ≥ 60 years of age (PROSPERO #42016036891). We identified peer-reviewed studies reporting the prevalence of S. pneumoniae colonisation using MEDLINE and EMBASE (until April 2016), excluding studies of acute disease. Participant-level data on risk factors were sought from each study.
Findings
Of 2202 studies screened, 29 were analysable: 18 provided participant-level data (representing 6290 participants). Prevalence of detected pneumococcal colonisation was 0-39% by conventional culture methods and 3-23% by molecular methods. In a multivariate analysis, colonisation was higher in persons from nursing facilities compared with the community (odds ratio (OR) 2•30, 95% CI 1•26-4•21 and OR 7•72, 95% CI 1•15-51•85 respectively), in those who were currently smoking (OR 1•69, 95% CI 1•12-2•53) or those who had regular contact with children (OR 1•93, 95%CI 1•27-2•93). Persons living in urban areas had significantly lower carriage prevalence (OR 0•43, 95%CI 0•27-0•70).
Interpretation
Overall prevalence of pneumococcal colonisation in older adults was higher than expected but varied by risk factors. Future studies should further explore risk factors for colonisation, to highlight targets for focussed intervention such as pneumococcal vaccination of high-risk groups.
Funding
No funding was required.
... after their last PPSV23 dose, compared with 7.2 years (range: 6.8-12.8) in unaffected residents. 19 Moreover, both Kawakami et al. 14,20 and Ohshima et al. 15 reported persistent immunogenicity following PPSV23 vaccination, lasting approximately seven years, but revaccination can induce comparable immunogenicity to the initial dose. Suzuki et al. also reported that the efficacy of PPSV23 declines beyond 5 years after primary vaccination. ...
... It is important to create an awareness of pneumococcal revaccination, because pneumococcal pneumonia incidence and mortality among vaccinated person would be associated with time since the initial dose was administered. 19 ...
In July 2017, the Japanese Association for Infectious Diseases issued guidance for the administration of the PPSV23 revaccination. Despite increasing recognition of its protective benefits, levels of PPSV23 revaccination coverage rate in Japanese elderly population are unclear at present. Here, we report the results of a survey to know PPSV23 revaccination rates among elderly patients aged 65 and older. We asked an array of questions related to PPSV23 revaccination to Elderly adults and doctors across Japan via Web-based surveys in June 2018. The sampled population consisted of 5,085 men and women aged 65 and older. The PPSV23 revaccination coverage rate was estimated by survey questions regarded vaccination counts, intervals, and vaccine type. In addition, 400 internal medicine physicians were surveyed and asked about their reasons for recommending PPSV23 revaccination to elderly patients. In total, 1,648 elderly adults had received at least one PPSV23 dose; of these, 58 had received it at least twice (revaccination coverage rate: 3.5%). The most commonly cited justification for revaccination with PPSV23 among the surveyed physicians was that the benefits of revaccination exceed the risks of revaccination. In addition, multivariate analysis showed revaccinated status was most strongly associated with recommendations from peers (e.g. spouse, family, friends) among elderly subjects. This study reports PPSV23 revaccination coverage rate among Japanese adults aged 65 and older for the first time and concludes that the coverage rate is very low.
... Both outbreaks described the development of antibiotic resistance over the course of the outbreak [64,70]. LTCF reported infectionprevention and vaccination (2), infection-prevention and antibiotics (1), and all three (1) [66,88], one reported 7% [89], and one reported 57% [93]. At least one vaccine failure was reported for 6 studies [71,74,88,91,93,97]. ...
... LTCF reported infectionprevention and vaccination (2), infection-prevention and antibiotics (1), and all three (1) [66,88], one reported 7% [89], and one reported 57% [93]. At least one vaccine failure was reported for 6 studies [71,74,88,91,93,97]. Two reports described one case-patient vaccine failure of a vaccine received within five years of the outbreak [71,74]. ...
... Two reports described one case-patient vaccine failure of a vaccine received within five years of the outbreak [71,74]. Two studies reported PPSV VE among older adults; 1.00 (95% CI: 0.30, 1.00) [63] and − 0.41 (95% CI: -2.33, 0.40) [93]. The poor VE and the outbreak occurring despite 57% vaccination coverage was partially attributed to "waning immunity" by the authors, since all case-patients received the vaccine more than 7 years prior to the outbreak [93]. ...
Abstract Background Streptococcus pneumoniae is capable of causing multiple infectious syndromes and occasionally causes outbreaks. The objective of this review is to update prior outbreak reviews, identify control measures, and comment on transmission. Methods We conducted a review of published S. pneumoniae outbreaks, defined as at least two linked cases of S. pneumoniae. Results A total of 98 articles (86 respiratory; 8 conjunctivitis; 2 otitis media; 1 surgical site; 1 multiple), detailing 94 unique outbreaks occurring between 1916 to 2017 were identified. Reported serotypes included 1, 2, 3, 4, 5, 7F, 8, 12F, 14, 20, and 23F, and serogroups 6, 9, 15, 19, 22. The median attack rate for pneumococcal outbreaks was 7.0% (Interquartile range: 2.4%, 13%). The median case-fatality ratio was 12.9% (interquartile range: 0%, 29.2%). Age groups most affected by outbreaks were older adults (60.3%) and young adults (34.2%). Outbreaks occurred in crowded settings, such as universities/schools/daycares, military barracks, hospital wards, and long-term care facilities. Of outbreaks that assessed vaccination coverage, low initial vaccination or revaccination coverage was common. Most (73.1%) of reported outbreaks reported non-susceptibility to at least one antibiotic, with non-susceptibility to penicillin (56.0%) and erythromycin (52.6%) being common. Evidence suggests transmission in outbreaks can occur through multiple modes, including carriers, infected individuals, or medical devices. Several cases developed disease shortly after exposure (
... Interestingly, vaccination of children has been shown to decrease the incidence of infection by the vaccine serotypes in the elderly (Menzies et al. 2014;Whitney et al. 2003), supporting this idea. Another evidence suggests that the effect of the pneumococcus is dependent on their serotype, as shown by outbreaks of pneumonia in residential care homes, caused by serotype 8 (Thomas et al. 2014), therefore, effects of ageing may be serotype specific, depending on which aspects of immunity are important for those strains. ...
Streptococcus pneumoniae is a complex Gram-positive bacterium comprising over 90 different serotypes and is a major cause of pneumonia. Susceptibility to S. pneumoniae is remarkably age-related being greatest in children under 5 years old and adults over 65. Whilst the immaturity of the immune system is largely responsible for poor immunity in the former, the underlying causes of susceptibility in older adults is complex. Immunity to S. pneumoniae is mediated predominantly through the inflammatory response in the nasopharyngeal mucosa recruiting phagocytes (neutrophils and monocyte/macrophages) which recognise the pathogen via TLR2 and ingest and kill the bacteria, with the induction of Th17 cells being required to maintain neutrophil recruitment and ensure clearance of the infection. In this review we discuss the impact of ageing upon these aspects of immunity to S. pneumoniae, as well as age-related changes to the serotypes present in the adult nasopharyngeal tract which could further influence susceptibility to infection.
... The serotype-specific Bio-Plex assay developed in our laboratory has demonstrated its utility previously in pneumococcal outbreak or cluster situations. It has played a major role in several such investigations in the past few years including school (Gupta et al., 2008) and nursing home (Thomas et al., 2015) clusters, but our study illustrates the first application in a rare, nosocomial dual-infection outbreak setting. In its current form, the assay is limited in its serotype repertoire but could be expanded by sourcing further mAbs to serotypes not currently included. ...
Introduction:
An outbreak of Streptococcus pneumoniae (pneumococcal) infection complicated by concomitant influenza A on an elderly care ward was detected.
Case presentation:
Thirteen patients with hospital-acquired respiratory infections were investigated during the course of the outbreak investigation. Six had a positive BinaxNOW S. pneumoniae urinary antigen test and two patients had culture-confirmed pneumococcal bacteraemia and a positive urine antigen test. Five patients gave positive influenza A PCR results of which two were also positive for S. pneumoniae antigen.
Conclusion:
The concurrence of influenza and pneumococcal infections made tracking the course of the infection difficult. This case study shows how the use of a sensitive, S. pneumoniae serotype-specific urine antigen assay, in the absence of cultured isolates, helped determine whether patients were infected with the same pneumococcal serotype. This was particularly useful when additional respiratory symptoms were seen following the administration of chemoprophylaxis.
Introduction
In recent years, Streptococcus pneumoniae serotype 8 has become the most prevalent cause of invasive pneumococcal disease (IPD) in Madrid, Spain. The objective of this study was to characterize the invasive clones of S. pneumoniae serotype 8 in Madrid over the 2012–2015 period.
Methods
From January 2012 to December 2015, a total of 1543 invasive isolates were studied. Serotyping was carried out by Pneumotest-Latex agglutination and Quellung reaction. Susceptibilities to penicillin, erythromycin and levofloxacin were determined by the Etest®. All serotype 8 strains were typed by multilocus sequence typing (MLST) and by pulsed-field gel electrophoresis (PFGE).
Results
Two hundred and forty-eight (248) serotype 8 strains were detected (16.1%) and 243 of them were available for molecular typing. Nine sequence types (STs) by MLST (8-ST53, 8-ST63, 8-ST404, 8-ST1107, 8-ST989, 8-ST1110, 8-ST2231, 8-ST3544 and 8-ST4301), and nine PFGE profiles were identified (one corresponding to each ST). The 8-ST53 clone was the most widespread, and increased from 53.8% among all serotype 8 isolates in 2012, to 90.1% in 2015. In contrast, the 8-ST63 clone, resistant to levofloxacin and erythromycin, decreased from 30.8%, among all serotype 8 strains in 2012, to 5.0% in 2015.
Conclusions
The increase in our region of S. pneumoniae serotype 8, not included in conjugated vaccines, occurred at the expense of the 8-ST53 clone. On the contrary, the 8-ST63 clone decreased. Since clone 8-ST63 has the theoretical advantage of its levofloxacin-erythromycin resistance in comparison to 8-ST53, the predominance of 8-ST53 over 8-ST63 is striking.
Introduction:
Pneumococcal outbreaks are rare but they still occur, particularly in closed settings usually involving vulnerable groups. We undertook a systematic review to identify strategies for controlling pneumococcal outbreaks since the licensure of higher-valent pneumococcal conjugate vaccines (PCVs) METHODS: A systematic literature search was performed for pneumococcal outbreaks published since 2010. A cluster was defined as two or more cases of severe pneumococcal disease in a closed setting within 14 days.
Results:
Eleven reports were identified, including seven caused by serotypes in both the 13-valent PCV (PCV13) and the 23-valent polysaccharide vaccine (PPV23); two were due to a PCV13-only serotype (6A) and one each by a PCV13-related serotype (6C) and a non-vaccine serotype (15A). Eight reported infection control measures, including reinforcing hand washing, respiratory hygiene and patient cohorting. PPV23 was used in five outbreaks, while PCV13 and both vaccines were used in one outbreak each. Different antibiotics were used for chemoprophylaxis in eight outbreaks.
Conclusions:
Most pneumococcal outbreaks are currently caused by vaccine-preventable serotypes, and PPV23 is the preferred vaccine in more than half the outbreaks. Early implementation of infection control measures is important, and antibiotic chemoprophylaxis should be considered for high-risk individuals.
Introduction:
In recent years, Streptococcus pneumoniae serotype 8 has become the most prevalent cause of invasive pneumococcal disease (IPD) in Madrid, Spain. The objective of this study was to characterize the invasive clones of S. pneumoniae serotype 8 in Madrid over the 2012-2015 period.
Methods:
From January 2012 to December 2015, a total of 1543 invasive isolates were studied. Serotyping was carried out by Pneumotest-Latex agglutination and Quellung reaction. Susceptibilities to penicillin, erythromycin and levofloxacin were determined by the Etest®. All serotype 8 strains were typed by multilocus sequence typing (MLST) and by pulsed-field gel electrophoresis (PFGE).
Results:
Two hundred and forty-eight (248) serotype 8 strains were detected (16.1%) and 243 of them were available for molecular typing. Nine sequence types (STs) by MLST (8-ST53, 8-ST63, 8-ST404, 8-ST1107, 8-ST989, 8-ST1110, 8-ST2231, 8-ST3544 and 8-ST4301), and nine PFGE profiles were identified (one corresponding to each ST). The 8-ST53 clone was the most widespread, and increased from 53.8% among all serotype 8 isolates in 2012, to 90.1% in 2015. In contrast, the 8-ST63 clone, resistant to levofloxacin and erythromycin, decreased from 30.8%, among all serotype 8 strains in 2012, to 5.0% in 2015.
Conclusions:
The increase in our region of S. pneumoniae serotype 8, not included in conjugated vaccines, occurred at the expense of the 8-ST53 clone. On the contrary, the 8-ST63 clone decreased. Since clone 8-ST63 has the theoretical advantage of its levofloxacin-erythromycin resistance in comparison to 8-ST53, the predominance of 8-ST53 over 8-ST63 is striking.
