Stephen I Pelton's research while affiliated with Boston Medical Center and other places
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Publications (339)
Background
Influenza is associated with substantial morbidity and mortality in the United States. Increasing influenza vaccination rates among all persons extends the benefits of immunization programs on reducing illnesses, especially those accrued to the older adult population who has the highest risk of severe outcomes. This research assesses the...
Cell-based manufacturing of seasonal influenza vaccines eliminates the risk of egg-adaptation of candidate vaccine viruses, potentially increasing vaccine effectiveness (VE). We present an overview of published data reporting the VE and cost-effectiveness of a cell-based quadrivalent influenza vaccine (QIVc) in preventing influenza-related outcomes...
Influenza can exacerbate underlying medical conditions. In this study, we modelled the potential impact of an egg-based quadrivalent influenza vaccine (QIVe) or adjuvanted QIV (aQIV) on hospitalizations and mortality from influenza-related cardiovascular disease (CVD), respiratory, and other complications in adults ≥65 years of age in the US with u...
Vaccination offers the best way to prevent invasive meningococcal disease (IMD). As demonstrated in countries with national immunization programs (NIPs) against IMD, meningococcal conjugate vaccines have contributed to significant declines in incidence. Since some meningococcal vaccines are associated with modest immunogenicity in infants, possible...
Background
The effect of pneumococcal vaccination of mothers with HIV on infant responses to childhood vaccination has not been studied. We compared the immunogenicity of PCV-10 in HIV-exposed uninfected infants born to mothers who received PCV-10, PPV-23 or placebo during pregnancy.
Methods
Antibody levels against seven serotypes were measured at...
Pneumococcal conjugate vaccines reduce the burden of invasive pneumococcal disease, but the sustained effect of these vaccines can be diminished by an increase in disease caused by non-vaccine serotypes. To describe pneumococcal serotype epidemiology in Botswana following introduction of 13-valent pneumococcal conjugate vaccine (PCV-13) in July 201...
Background
Complement classical pathway (CCP) activation is the major mechanism leading to opsonophagocytic pneumococcal killing. Following immunization with 13-valent pneumococcal conjugate vaccine (PCV13), opsonophagocytic titers are lowest against serotype 3 among the 13 vaccine serotypes. Post licensure surveillance indicated early declines in...
Background
Changes in the influenza hemagglutinin protein during replication of influenza in eggs during vaccine production may contribute to low vaccine effectiveness (VE). This phenomenon, egg adaptation, can explain VE differences between egg-based (QIVe-SD) and cell-based (QIVc) quadrivalent influenza vaccines. This research evaluated the relat...
Background
Cell-derived influenza vaccines are not subject to egg adaptive mutations that have potential to decrease vaccine effectiveness. This retrospective analysis estimated the relative vaccine effectiveness (rVE) of cell-derived quadrivalent influenza vaccine (IIV4c) compared to standard egg-derived quadrivalent influenza vaccines (IIV4e) amo...
Background
Non-egg-based influenza vaccine manufacturing reduces egg adaptation and therefore has the potential to increase vaccine effectiveness. This study evaluated whether the cell-based quadrivalent influenza vaccine (QIVc) improved relative vaccine effectiveness (rVE) compared to standard-dose egg-based quadrivalent influenza vaccine (QIVe-SD...
Background
According to the Centers for Disease Control and Prevention (CDC), during the 2019-20 U.S. influenza season, influenza resulted in almost 180,000 hospitalizations and over 13,000 deaths in adults ≥ 65 years. The current study evaluated the relative vaccine effectiveness (rVE) of adjuvanted trivalent influenza vaccine (aTIV) compared to h...
Background
Pneumococcal vaccination is recommended in people with HIV prioritizing PCV. We compared the immunogenicity of PCV-10 and PPV-23 administered antepartum or postpartum.
Methods
This double-blind study randomized 346 pregnant women with HIV on antiretrovirals to PCV-10, PPV-23, or placebo at 14-34 weeks gestational age. Women who received...
Biorepositories provide a critical resource for gaining knowledge of emerging infectious diseases and offer a mechanism to rapidly respond to outbreaks; the emergence of the novel coronavirus, SARS-CoV-2, has proved their importance. During the COVID-19 pandemic, the absence of centralized, national biorepository efforts meant that the onus fell on...
The burden of influenza is disproportionally higher among older adults. We evaluated the relative vaccine effectiveness (rVE) of adjuvanted trivalent (aIIV3) compared to high-dose trivalent influenza vaccine (HD-IIV3e) against influenza and cardio-respiratory disease (CRD)-related hospitalizations/ER visits among adults ≥65 years during the 2019–20...
Background
Pneumonia in infancy has been linked to long-term consequences for the rapidly developing lung. We examined the impact of hospitalized community-acquired pneumonia (CAP) on subsequent respiratory health.
Methods
We conducted a retrospective matched-cohort study using the Optum® de-identified Electronic Health Record Dataset (2009-2018)....
Amid the current US opioid crisis, hepatitis C virus (HCV) infection rates continue to rise in young adults, including among pregnant women, yet few studies describe linkage to care and treatment in pregnant or postpartum women with HCV infection. We used electronic health record data to estimate HCV treatment rates for postpartum women before (Jan...
Pneumococcal conjugate vaccines (PCVs) have been used in the United States since 2000. To assess the cumulative 20-year effect of PCVs on invasive pneumococcal disease (IPD) incidence among children <5 years of age, we analyzed Active Bacterial Core Surveillance data, conducted a literature review, and modeled expected and observed disease. We foun...
COVID-19 disease has been a pandemic caused by a β-coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). A life-threatening multisystem inflammatory syndrome (MIS), secondary to SARS-CoV-2 virus infection, sharing common features with Kawasaki disease shock syndrome, staphylococcal/streptococcal shock syndrome, and macrophage ac...
Background
Increasing evidence suggests the impact of pneumonia persists beyond hospital discharge and the acute phase of respiratory symptoms. We characterized short-term and long-term risks of mortality and hospital readmission across the adult age span and spectrum of comorbidities.
Methods
Retrospective cohort design and Optum’s de-identified...
Background:
Pneumococcus remains an important cause of morbidity in pregnant women with HIV and their infants. We compared the safety and immunogenicity of PCV-10 and PPV-23 with placebo administered in pregnancy.
Methods:
This double-blind, multicentre, randomised controlled trial was done at eight outpatient clinics in Brazil. Eligible partici...
Purpose
To evaluate the relative vaccine effectiveness (rVE) against influenza-related hospitalizations/emergency room (ER) visits, influenza-related office visits, and cardio-respiratory disease (CRD)-related hospitalizations/ER visits and compare all-cause and influenza-related costs associated with two vaccines specifically indicated for older a...
Non-egg-based influenza vaccines eliminate the potential for egg-adapted mutations and potentially increase vaccine effectiveness. This retrospective study compared hospitalizations/emergency room (ER) visits and all-cause annualized healthcare costs among subjects aged 4–64 years who received cell-based quadrivalent (QIVc) or standard-dose egg-bas...
Background
Influenza vaccine effectiveness decreases with increasing age due to the senescence of immune function and a reduced immune response to antigens. There is also considerable vaccine effectiveness heterogeneity depending on the influenza activity time period, especially in seasons where two different circulating strains predominated, such...
Background
Community-acquired pneumonia (CAP) in infancy (i.e., among children aged < 2 years) may have long-term consequences for the rapidly developing lung. We examined the impact of pneumonia in infancy on subsequent respiratory health.
Methods
A retrospective matched-cohort design and data from Optum’s de-identified Integrated Claims-Clinical...
Background
Influenza generates a substantial economic burden ($3.2B in the U.S. annually) due to direct medical costs such as physician office visits or hospitalizations, especially among the elderly. Recent published literature for the 2018–19 influenza season has demonstrated similar clinical effectiveness between adjuvanted trivalent influenza v...
Background
In the 2018–19 influenza season, influenza resulted in almost 280,000 hospitalizations and over 25,000 deaths in U.S. adults > 65 years. This study aimed to evaluate the relative vaccine effectiveness (rVE) of adjuvant trivalent influenza vaccine (aTIV) compared to high-dose trivalent influenza vaccine (TIV-HD), against influenza-related...
Background
Increasing evidence suggests that the impact of community-acquired pneumonia (CAP) extends beyond discharge from the hospital and the acute phase of illness. We sought to characterize mortality and hospital readmission across the adult age span and spectrum of comorbidities.
Methods
A retrospective cohort design and data from Optum’s de...
Background
Clinical trials of PCV7 demonstrate significant reductions in vaccine-type (VT) invasive pneumococcal disease (IPD), clinically diagnosed pneumonia in children less than 5 years of age and VT acute otitis media in children < 2 years of age. Observational, population-based studies demonstrate a reduction in overall IPD in US children foll...
The influenza-related disease burden is highest among the elderly. We evaluated the relative vaccine effectiveness (rVE) of adjuvanted trivalent influenza vaccine (aTIV) compared to other egg-based influenza vaccines (high-dose trivalent (TIV-HD), quadrivalent (QIVe-SD), and standard-dose trivalent (TIVe-SD)) against influenza-related and cardio-re...
Background
Cell-based influenza vaccine manufacturing reduces egg adaptations that can decrease vaccine effectiveness. We evaluated the relative vaccine effectiveness (rVE) of cell-based quadrivalent influenza vaccine (QIVc) compared to standard-dose egg-based quadrivalent influenza vaccines (QIVe-SD) against influenza-related and serious respirato...
Aim
To describe trends in antibiotic (AB) prescriptions in children in primary care over 11 years, using a large data warehouse.
Methods
A retrospective cohort study assessed outpatient AB prescriptions 2007‐2017, using the Massachusetts Health Disparities Repository. The evolution of pediatric outpatient AB prescriptions was assessed using time s...
Pneumolysin is a highly conserved, cholesterol-dependent cytolysin that is an important Streptococcus pneumoniae virulence factor and an attractive target for vaccine development. To attenuate pneumolysin toxicity, a genetic toxoid was constructed with two amino acid changes, G293S and L460D, termed PLY-D, that reduced cytolytic activity > 125,000-...
Background:
Although a substantial decline in vaccine-serotype invasive pneumococcal disease (IPD) incidence was observed following the introduction of pneumococcal conjugate vaccines (PCV), the estimated range of thirteen-valent conjugate vaccine (PCV13) effectiveness for serotype 3 disease is wide and includes zero. We assessed the impact of PCV...
Background:
In 2010, the 13-valent pneumococcal conjugate vaccine (PCV13) replaced 7-valent PCV (PCV7) for protection against invasive pneumococcal disease (IPD). This study used laboratory surveillance data to examine the effect of PCV13 on IPD before and after PCV13 introduction among children aged 6 weeks to <6 years and those aged ≥6 weeks.
M...
Introduction: Most of the current evidence regarding pneumococcal upper respiratory colonization in adults suggests that despite high disease burden, carriage prevalence is low. Contemporary studies on adult pneumococcal colonization have largely followed the pediatric approach by which samples are obtained mostly from the nasopharynx and bacterial...
Background:
Despite high vaccine coverage rates in children and efficacy of pneumococcal conjugate vaccines, invasive pneumococcal disease (IPD) episodes due to serotypes included in the vaccine following completion of the recommended course of immunisation (i.e. vaccine failure) have been reported.
Methods:
We used data gathered from a populati...
Objective:
To review and highlight significant advances made towards vaccine development and understanding of the immunology of otitis media (OM) since the 19th International Symposium on Recent Advances in Otitis Media (ISOM) in 2015, as well as identify future research directions and knowledge gaps.
Data sources:
PubMed database, National Libr...
Background
Human challenge studies demonstrate enhanced sensitivity of molecular technology for identification of vaccine serotype pneumococcal (SP) carriage in PCV13 immunized adults. We hypothesized that PCV13 immunized children would similarly harbor vaccine serotypes in their nasopharynx (NP) that could only be identified by molecular technolog...
It has been almost 20 years since the first conjugated pneumococcal vaccine (PCV) was introduced into childhood immunization schedules in the United States. Dramatic reductions in invasive pneumococcal disease (IPD) burden have been reported not only among children targeted for vaccination but also among unvaccinated children and adults in all sett...
This review of pediatric antibiotic stewardship programs (ASPs) summarized the antibiotic prescribing interventions and their impact on antibiotic use and antimicrobial resistance. We reviewed studies of pediatric ASP, including the search terms “antimicrobial stewardship,” “antibiotic stewardship,” “children,” and “pediatric.” The articles’ select...
Background: Recent studies of community-acquired pneumonia (CAP) have recognized acute cardiac complications—such as myocardial infarction, arrhythmia, or congestive heart failure (CHF)—as frequent complications during the acute process. As well, a prolonged vulnerability to exacerbations of underlying comorbidities—such as CHF and COPD—has been ob...
The 13-valent pneumococcal conjugate vaccine (PCV-13) was introduced in the United States in 2010. Using a large paediatric carriage sample collected from shortly after the introduction of PCV-7 to several years after the introduction of PCV-13, we investigate alterations in the composition of the pneumococcal population following the introduction...
Background
Thirteen-valent-pneumococcal conjugate vaccine (PCV13) replaced PCV7 in the childhood immunization schedule in Massachusetts beginning in April 2010. We evaluated the predictors of vaccine-type (VT) invasive pneumococcal infection (IPD) occurrence despite vaccination.
Methods
Cases of IPD in children <18 years of age were detected throu...
Background
The 13-valent pneumococcal conjugate vaccine (PCV13) replaced PCV7 in the childhood immunization schedule in Massachusetts (MA) beginning in April, 2010. We describe the current epidemiology of invasive pneumococcal disease (IPD) in Massachusetts (MA) children after introduction of PCV13.
Methods
Cases of invasive pneumococcal disease (...
The 13-valent pneumococcal conjugate vaccine (PCV13) is the only licensed PCV with serotype 3 polysaccharide in its formulation. Post-licensure PCV13 effectiveness studies against serotype 3 invasive pneumococcal disease (IPD) in children have shown inconsistent results. We performed a systematic review and meta-analysis of observational studies to...
Otits media (OM) is the most frequent indication for antimicrobial prescription to US children. Streptococcus pneumoniae (S. pneumoniae) remains one of the most common pathogens causing OM. Successful eradication of S. pneumoniae in the middle ear can be achieved by adhering to a 7-10 day regimen of oral antibiotics. However, oral drug administrati...
Introduction:
Following introduction of PCV7 in the US, epidemiology of pneumococcal disease shifted such that disease incidence in the elderly exceeded that in children. We evaluated the impact of replacing PCV7 with PCV13 on disease burden in adults, and identified age/risk-specific subgroups with highest remaining disease burden.
Methods:
A r...
Introduction: Pneumococcal diseases (including septicemia, meningitis, pneumonia, and upper respiratory infections) constitute a major public health problem. The World Health Organization recommends pneumococcal conjugate vaccine immunization of young children worldwide.
Areas covered: We reviewed evidence on the effects of the 10-valent pneumococc...
Objectives:
Burden of pneumococcal disease depends on the prevalence and invasive disease potential of serotypes. We aimed to estimate the invasive disease potential of serotypes in children under 5 years of age by combining data from different settings with routine immunisation with pneumococcal conjugate vaccines (PCV).
Methods:
We conducted a...
Despite advances in treatment and prevention, the pneumococcus continues as a dominant cause of severe pneumonia and sepsis, of otitis media, sinusitis and nonbacteremic pneumonia. Lewnard and colleagues use a unique data set of nasopharyngeal and middle ear fluid samples to provide further insight into the progression of nasopharyngeal pneumococca...
Serotype 3 is a more frequent cause of invasive pneumococcal disease (IPD) among adults than in children. To understand the impact of PCV13 vaccination against serotype 3 in children and adults, we conducted a non-systematic review of the literature to identify relevant studies using PCV13.
Table A. Selection of source populations, Table B. Selection of study populations.
(DOC)
Fig A. Cumulative percentage of ambulatory CAP patients and matched comparison patients who experienced an HF/COPD-related exacerbation, Fig B. Cumulative percentage of ambulatory CAP patients and matched comparison patients who experienced an HF/COPD-related exacerbation, by age, Fig C. Cumulative percentage of ambulatory CAP patients and matched...
Table A. Economic costs attributable to exacerbation encounters.
(DOC)
Fig A. Cumulative percentage of hospitalized CAP patients and matched comparison patients who experienced an HF/COPD-related alternative exacerbation, Fig B. Cumulative percentage of ambulatory CAP patients and matched comparison patients who experienced an HF/COPD-related alternative exacerbation, Fig C. Cumulative percentage of hospitalized CAP p...
Table A. Diagnosis, procedure, and drug codes for algorithms identifying source population, Table B. Diagnosis, procedure, and drug codes for algorithms identifying baseline chronic conditions, Table C. Diagnosis, procedure, and drug codes for algorithms identifying baseline immunocompromising conditions, Table D. Diagnosis, procedure, and drug cod...
Background
Recent evidence demonstrates increased short-term risk of cardiac complications and respiratory failure among patients with heart failure (HF) and chronic obstructive pulmonary disease (COPD), respectively, concurrent with an episode of community-acquired pneumonia (CAP). We evaluated patients with pre-existing HF or COPD, beginning 30 d...
Table A. Characteristics of CAP patients and matched comparison patients in heart failure population, Table B. Characteristics of CAP patients and matched comparison patients in chronic obstructive pulmonary disease population.
(DOC)
Background:
Rates of invasive pneumococcal disease have declined since widespread introduction of pneumococcal conjugate vaccines (PCVs) in the United States. We evaluated the impact of immunization status and recent antibiotic use on an individual child's risk of colonization.
Methods:
This study extends previously reported data from children <...
Background
Although a substantial decline in overall vaccine serotype invasive pneumococcal disease (IPD) incidence has been observed following immunization with PCV7 and subsequently PCV13, the reported effectiveness for individual vaccine serotypes has varied. Reported effectiveness of PCV13 for serotype 3 (ST3) disease has differed by study desi...
Background
Detecting Streptococcus pneumoniae (SP) carriage in children via conventional microbiological methods lacks sensitivity as high density is required for routine culture and identification of dual serotype colonization is a technical challenge. To increase understanding of post vaccine nasopharyngeal (NP) carriage, specifically persistence...
Background
A second generation 13-valent-pneumococcal conjugate vaccine (PCV13) replaced PCV7 in the childhood immunization schedule in Massachusetts (MA) beginning in April,2010
Methods
Cases of invasive pneumococcal disease (IPD) in children <18 years of age were detected through an enhanced surveillance system in MA since 2001. All cases in chi...
Background
Adults with comorbid illness are known to be at excess risk of IPD. We evaluated the burden of IPD in adults, with and without comorbidity, during the period before and after introduction of PCV13 in children and selected adults.
Methods
We employed a retrospective cohort design and data from a large US healthcare claims repository. The...
We compared antibiotic prescribing for children with and those without an underlying chronic condition associated with increased risk for invasive pneumococcal disease. Children with a chronic condition had significantly greater cumulative exposure to antibiotics and higher rates of prescriptions per person-year than those without a chronic conditi...