Reduction in High Rates of Antibiotic-Nonsusceptible Invasive Pneumococcal Disease in Tennessee after Introduction of the Pneumococcal Conjugate Vaccine

Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
Clinical Infectious Diseases (Impact Factor: 8.89). 09/2004; 39(5):641-8. DOI: 10.1086/422653
Source: PubMed


Invasive pneumococcal disease (IPD) is a burgeoning problem, with rates of antibiotic-nonsusceptible IPD, in particular, increasing during the past decade. One measure to combat IPD is vaccination with the recently introduced 7-valent pneumococcal conjugate vaccine (PCV).
To evaluate the effects of the introduction of PCV in 2000 on the epidemiology of antibiotic-nonsusceptible IPD, a database of IPD cases from January 1995 through December 2002 identified through active surveillance in 5 Tennessee counties was examined. For each case, clinical data were collected, and antibiotic susceptibility testing and serotyping were performed on available isolates.
Among children younger than 2 years, IPD rates peaked at 235 cases per 100,000 in 1999 before decreasing, after PCV licensure, to 46 cases per 100,000 in 2002 (P<.001). The proportion of penicillin-nonsusceptible IPD isolates from this age group declined from 59.8% in 1999 to 30.4% in 2002 (P<.01). After 2001, similar decreases in IPD rates and in the proportion of antibiotic-nonsusceptible isolates recovered were seen among persons aged 2 years and older (P<.01). Rates of IPD due to PCV-associated serotypes declined after PCV introduction in all age groups (P<.001), whereas the rate of IPD due to nonvaccine serotypes increased among persons aged 2 years and older.
In the 2 years since licensure, widespread PCV vaccination of children has resulted in dramatic declines in the proportion of antibiotic-nonsusceptible isolates in Tennessee. PCV vaccination of children also appears to be a highly effective method for reducing the burden of IPD in adults.

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    • "In Northern California, U.S., a population-based study suggested that the high level of penicillin resistance decreased from 15% in 2000 to 5% in the first half of 2003 [39]. In Tennessee, U.S., the proportion of penicillin-nonsusceptible pneumococci decreased from 59.8% in 1999 to 30.4% in 2002 among children aged < 2 years [40]. "
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    ABSTRACT: The wide use of antimicrobial agents and 7-valent pneumococcal conjugate vaccine (PCV7) has led to major changes in the epidemiology of childhood pneumococcal diseases. In Korea, data on the population-based incidence of childhood invasive pneumococcal diseases (IPD) are not available; however, institution-based surveillance data suggest a substantial burden of childhood IPD. Following the introduction of the PCV7 in Korea in 2003, the proportion of IPD caused by vaccine-type pneumococci has decreased, while non-PCV7 serotypes, especially serotypes 19A and 6A, whose proportions had been increasing before the introduction of the vaccine, became predominant among childhood IPD isolates. This article reviews the overall impact of PCV7 utilization and summarizes the results obtained so far. Continuous monitoring and gathering of scientific evidence for the epidemiological transition of pneumococcal carriage and IPD will be important for the management of pneumococcal infections in Korea.
    Full-text · Article · Jun 2013
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    • "The 23-valent pneumococcal polysaccharide vaccine (PPV23) and the 7-valent pneumococcal conjugate vaccine (PCV7) have been successful in reducing the burden of IPDs in high-risk groups. The USA and several countries in Europe have adopted PCV7 into their national immunization programmes for all children, and a decline in IPDs has been reported (Stephens et al., 2005; Talbot et al., 2004; Whitney et al., 2003). The prevalence of serotypes causing IPDs varies over time and geographically (Hausdorff et al., 2005). "
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    ABSTRACT: We investigated changes in serotypes and antimicrobial susceptibilities among 386 isolates of invasive Streptococcus pneumoniae collected from numerous hospitals in Korea from 1996-2008. Serotype 19F (9.8%), 23F (8.3%), 19A (7.8%), 6A (7.5%), 3 (7.3%), 9V (6.5%), 6B (6.2%), 14 (4.9%), 1 (3.9%), 11A (3.9%) and 4 (3.1%) represented 69.2% of all isolates. While the overall proportion of PCV7 serotypes was stable over time, we observed modest decreases in children < 5-years-of-age and adults ≥ 65-years-of-age between 1996-1999 and 2007-2008. An increased prevalence of non-PCV7 serotypes in these age groups was primarily attributable to an increase in serotypes 3, 6A and 19A. Most invasive S. pneumoniae isolates showed high resistance rates to erythromycin (74.9%), tetracycline (71.1%) and clindamycin (61.7%). From 1996-2003 and 2004-2008, non-susceptibility rates to cefotaxime and multi-drugs (three or more classes) in PCV7 serotypes showed a declining trend, while in non-PCV7 serotypes there was an increasing trend. Non-PCV7 serotypes 6A and 19A, which mostly exhibited multidrug-resistant phenotypes (69.0% and 76.7% respectively), increased between 1996-2003 and 2004-2008. Although PCV7 was introduced in Korea in November 2003, pneumococcal vaccination has not been included in the national child vaccination program. Our results provide serotype coverage useful to consider the adoption of universal pneumococcal vaccination in Korea.
    Preview · Article · May 2013 · Journal of Medical Microbiology
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    • "Data from the U.S. suggests significant reductions in antibiotic prescribing for paediatric cases of otitis media have occurred following licensing of PCV7 [37]. Similarly, a reduction in the incidence of antibiotic-non-susceptible IPD has also been reported, and has been attributed to widespread PCV7 vaccination [41]. This potential benefit is of significant importance in Malaysia where S. pneumoniae isolates have exhibited increased antibiotic resistance. "
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    ABSTRACT: Pneumococcal disease is the leading cause of vaccine-preventable death in children younger than 5 years of age worldwide. The World Health Organization recommends pneumococcal conjugate vaccine as a priority for inclusion into national childhood immunization programmes. Pneumococcal vaccine has yet to be included as part of the national vaccination programme in Malaysia although it has been available in the country since 2005. This study sought to estimate the disease burden of pneumococcal disease in Malaysia and to assess the cost effectiveness of routine infant vaccination with PCV7. A decision model was adapted taking into consideration prevalence, disease burden, treatment costs and outcomes for pneumococcal disease severe enough to result in a hospital admission. Disease burden were estimated from the medical records of 6 hospitals. Where local data was unavailable, model inputs were obtained from international and regional studies and from focus group discussions. The model incorporated the effects of herd protection on the unvaccinated adult population. At current vaccine prices, PCV7 vaccination of 90% of a hypothetical 550,000 birth cohort would incur costs of RM 439.6 million (US$128 million). Over a 10 year time horizon, vaccination would reduce episodes of pneumococcal hospitalisation by 9,585 cases to 73,845 hospitalisations with cost savings of RM 37.5 million (US$10.9 million) to the health system with 11,422.5 life years saved at a cost effectiveness ratio of RM 35,196 (US$10,261) per life year gained. PCV7 vaccination of infants is expected to be cost-effective for Malaysia with an incremental cost per life year gained of RM 35,196 (US$10,261). This is well below the WHO's threshold for cost effectiveness of public health interventions in Malaysia of RM 71,761 (US$20,922).
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