Invasive Streptococcus pneumoniae Infections and Vaccine Failures in Children in Ireland From the Postvaccine Era From 2007 to 2018.
Adolescent
Child
Child, Preschool
Heptavalent Pneumococcal Conjugate Vaccine
/ administration & dosage
Humans
Immunization Schedule
Incidence
Infant
Ireland
/ epidemiology
Pneumococcal Infections
/ epidemiology
Pneumococcal Vaccines
/ administration & dosage
Serogroup
Streptococcus pneumoniae
/ classification
Treatment Failure
Journal
The Pediatric infectious disease journal
ISSN: 1532-0987
Titre abrégé: Pediatr Infect Dis J
Pays: United States
ID NLM: 8701858
Informations de publication
Date de publication:
04 2020
04 2020
Historique:
pubmed:
10
12
2019
medline:
10
2
2021
entrez:
10
12
2019
Statut:
ppublish
Résumé
Invasive pneumococcal disease (IPD) causes life-threatening illnesses including meningitis and bloodstream infection. Here, we report the impact of 7- and 13-valent pneumococcal conjugate vaccines (PCV7/PCV13) after introduction into the Irish pediatric immunization schedule in 2008 and 2010, respectively, and the clinical details surrounding suspected PCV vaccine failures. Serotyping and antimicrobial susceptibility testing of all culture-confirmed cases referred from children <16 years of age from July 2007 to June 2018 were assessed. Surveillance data were assessed to identify any potential vaccine failures. The number of IPD cases has decreased by >50% since the introduction of PCVs. The most significant decline PCV serotypes in children <2 years of age, with a 97% decline in PCV7 serotypes, incidence rate ratio (IRR) 0.03, 95% confidence interval (CI): 0.00-0.21; and a 78% decline PCV13-only (PCV13-7) serotypes, IRR 0.22, 95% CI: 0.05-1.04, respectively. However, there has been an increase in non-PCV13 serotypes in children <2 years during the same period (IRR: 2.82, 95% CI: 1.02-7.84; P = 0.0463), with similar serotype trends observed for those 2-4 and 5-15 years of age. There were no clear vaccine replacement serotypes, instead a number of different serotypes emerged. Sixteen vaccine failures were identified, 10 of which were postbooster vaccine failures. Most failures were serotype 19A and resistant to antimicrobials. Further reducing the incidence of IPD is more challenging as the number of non-PCV13 serotypes has expanded and is now less susceptible to antimicrobials. Consequently, higher valency or broader target vaccines are now required to further prevent IPD in children.
Sections du résumé
BACKGROUND
Invasive pneumococcal disease (IPD) causes life-threatening illnesses including meningitis and bloodstream infection. Here, we report the impact of 7- and 13-valent pneumococcal conjugate vaccines (PCV7/PCV13) after introduction into the Irish pediatric immunization schedule in 2008 and 2010, respectively, and the clinical details surrounding suspected PCV vaccine failures.
METHODS
Serotyping and antimicrobial susceptibility testing of all culture-confirmed cases referred from children <16 years of age from July 2007 to June 2018 were assessed. Surveillance data were assessed to identify any potential vaccine failures.
RESULTS
The number of IPD cases has decreased by >50% since the introduction of PCVs. The most significant decline PCV serotypes in children <2 years of age, with a 97% decline in PCV7 serotypes, incidence rate ratio (IRR) 0.03, 95% confidence interval (CI): 0.00-0.21; and a 78% decline PCV13-only (PCV13-7) serotypes, IRR 0.22, 95% CI: 0.05-1.04, respectively. However, there has been an increase in non-PCV13 serotypes in children <2 years during the same period (IRR: 2.82, 95% CI: 1.02-7.84; P = 0.0463), with similar serotype trends observed for those 2-4 and 5-15 years of age. There were no clear vaccine replacement serotypes, instead a number of different serotypes emerged. Sixteen vaccine failures were identified, 10 of which were postbooster vaccine failures. Most failures were serotype 19A and resistant to antimicrobials.
CONCLUSIONS
Further reducing the incidence of IPD is more challenging as the number of non-PCV13 serotypes has expanded and is now less susceptible to antimicrobials. Consequently, higher valency or broader target vaccines are now required to further prevent IPD in children.
Identifiants
pubmed: 31815827
doi: 10.1097/INF.0000000000002549
pii: 00006454-202004000-00017
doi:
Substances chimiques
13-valent pneumococcal vaccine
0
Heptavalent Pneumococcal Conjugate Vaccine
0
Pneumococcal Vaccines
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
339-344Références
Johnson HL, Deloria-Knoll M, Levine OS, et al. Systematic evaluation of serotypes causing invasive pneumococcal disease among children under five: the pneumococcal global serotype project. PLOS Med. 2010:7:e1000348.
Hanage WP, Bishop CJ, Lee GM, et al. Clonal replacement among 19A Streptococcus pneumoniae in Massachusetts, prior to 13 valent conjugate vaccination. Vaccine. 2011;29:8877–8881.
Weinberger DM, Malley R, Lipsitch M. Serotype replacement in disease after pneumococcal vaccination. Lancet. 2011;378:1962–1973.
Watkins ER, Penman BS, Lourenço J, et al. Vaccination drives changes in metabolic and virulence profiles of Streptococcus pneumoniae. PLoS Pathog. 2015;11:e1005034.
Gladstone RA, Devine V, Jones J, et al. Pre-vaccine serotype composition within a lineage signposts its serotype replacement - a carriage study over 7 years following pneumococcal conjugate vaccine use in the UK. Microb Genom. 2017;3:e000119.
Chapman KE, Wilson D, Gorton R. Serotype dynamics of invasive pneumococcal disease post-PCV7 and pre-PCV13 introduction in North East England. Epidemiol Infect. 2013;141:344–352.
Wahl B, O’Brien KL, Greenbaum A, et al. Burden of Streptococcus pneumoniae and Haemophilus influenzae type b disease in children in the era of conjugate vaccines: global, regional, and national estimates for 2000-15. Lancet Glob Health. 2018;6:e744–e757.
Savulescu C, Krizova P, Lepoutre A, et al.; SpIDnet group. Effect of high-valency pneumococcal conjugate vaccines on invasive pneumococcal disease in children in SpIDnet countries: an observational multicentre study. Lancet Respir Med. 2017;5:648–656.
Hanquet G, Krizova P, Valentiner-Branth P, et al.; SpIDnet/I-MOVE+ Pneumo Group. Effect of childhood pneumococcal conjugate vaccination on invasive disease in older adults of 10 European countries: implications for adult vaccination. Thorax. 2019;74:473–482.
Waight PA, Andrews NJ, Ladhani SN, et al. Effect of the 13-valent pneumococcal conjugate vaccine on invasive pneumococcal disease in England and Wales 4 years after its introduction: an observational cohort study. Lancet Infect Dis. 2015;15:535–543.
Lewnard JA, Hanage WP. Making sense of differences in pneumococcal serotype replacement. Lancet Infect Dis. 2019;19:e213–e220.
Ladhani SN, Collins S, Djennad A, et al. Rapid increase in non-vaccine serotypes causing invasive pneumococcal disease in England and Wales, 2000-17: a prospective national observational cohort study. Lancet Infect Dis. 2018;18:441–451.
Pilishvili T, Gierke R, Farley M, et al. Direct and indirect impact of 13-valent pneumococcal conjugate vaccine (PCV13) on invasive pneumococcal disease (IPD) among children and adults in the U.S. Open Forum Infect Dis. 2017;4:S66–S67.
Summary Immunisation Uptake Statistics – Data up to Q4 2018. 39. Available at https://www.hpsc.ie/a-z/vaccinepreventable/vaccination/immunisationuptakestatistics/immunisationuptakestatisticsat12and24monthsofage/Summary%20Immunisation%20Uptake%20Statistics-%20National,%20CHO%20&%20LHO%20V1.0.pdf. Accessed July 30, 2019.
European Union. Amending decision 2002/253/EC laying down case definitions for reporting communicable diseases to the community network under decision No 2119/98/EC of the European Parliament and of the Council. section L159/72. Official Journal of the European Union. 2008. Available at https://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ%3AL%3A2008%3A159%3A0046%3A0090%3AEN%3APDF. Accessed December 12, 2018.
Health Protection Surveillance Centre (HPSC) website. Protocol for the enhanced surveillance of invasive pneumococcal disease (IPD) in Ireland. IPD protocol version 2.2. 2016. Available at https://www.hpsc.ie/a-z/vaccinepreventable/pneumococcaldisease/informationforhealthprofessionals/File,15539,en.pdf. Accessed July 4, 2019.
Siegrist C-A, Plotkin SA, Orenstein WA, et al. Chapter 2 - vaccine immunology. In: Plotkin’s Vaccines. 2018:7th ed. Elsevier; 16–34.e7.
Vickers I, Fitzgerald M, Murchan S, et al. Serotype distribution of Streptococcus pneumoniae causing invasive disease in the Republic of Ireland. Epidemiol Infect. 2011;139:783–790.
Moore MR, Link-Gelles R, Schaffner W, et al. Effect of use of 13-valent pneumococcal conjugate vaccine in children on invasive pneumococcal disease in children and adults in the USA: analysis of multisite, population-based surveillance. Lancet Infect Dis. 2015;15:301–309.
Corcoran M, Mereckiene J, Murchan S, et al. Is it time to review the vaccination strategy to protect adults against invasive pneumococcal disease? Ir Med J. 2019;112:894.
Corcoran M, Vickers I, Mereckiene J, et al. The epidemiology of invasive pneumococcal disease in older adults in the post-PCV era. Has there been a herd effect? Epidemiol Infect. 2017;145:2390–2399.
Balsells E, Guillot L, Nair H, et al. Serotype distribution of Streptococcus pneumoniae causing invasive disease in children in the post-PCV era: a systematic review and meta-analysis. PLoS One. 2017;12:e0177113.
Balsells E, Dagan R, Yildirim I, et al. The relative invasive disease potential of Streptococcus pneumoniae among children after PCV introduction: a systematic review and meta-analysis. J Infect. 2018;77:368–378.
Greenberg D, Hoover PA, Vesikari T, et al. Safety and immunogenicity of 15-valent pneumococcal conjugate vaccine (PCV15) in healthy infants. Vaccine. 2018;36:6883–6891.
Pfizer. Pfizer granted FDA breakthrough therapy designation for 20-valent pneumococcal conjugate vaccine for the prevention of invasive disease and pneumonia in adults aged 18 years and older: Pfizer. 2018 Available at: https://www.pfizer.com/news/press-release/press-release-detail/pfizer_granted_fda_breakthrough_therapy_designation_for_20_valent_pneumococcal_conjugate_vaccine_for_the_prevention_of_invasive_disease_and_pneumonia_in_adults_aged_18_years_and_older. Accessed July 4, 2019.
Domínguez Á, Ciruela P, Hernández S, et al. Effectiveness of the 13-valent pneumococcal conjugate vaccine in preventing invasive pneumococcal disease in children aged 7-59 months. A matched case-control study. PLoS One. 2017;12:e0183191.
Almeida AF, Sobrinho-Simões J, Ferraz C, et al. Pneumococcal pneumonia vaccine breakthroughs and failures after 13-valent pneumococcal conjugated vaccine. Eur J Public Health. 2016;26:887–889.
Moraga-Llop F, Garcia-Garcia JJ, Díaz-Conradi A, et al. Vaccine failures in patients properly vaccinated with 13-valent pneumococcal conjugate vaccine in catalonia, a region with low vaccination coverage. Pediatr Infect Dis J. 2016;35:460–463.
Snape MD, Klinger CL, Daniels ED, et al. Immunogenicity and reactogenicity of a 13-valent-pneumococcal conjugate vaccine administered at 2, 4, and 12 months of age: a double-blind randomized active-controlled trial. Pediatr Infect Dis J. 2010;29:e80–e90.
Oligbu G, Collins S, Andrews N, et al. Characteristics and serotype distribution of childhood cases of invasive pneumococcal disease following pneumococcal conjugate vaccination in England and Wales, 2006-2014. Clin Infect Dis. 2017;65:1191–1198.
van der Linden M, Falkenhorst G, Perniciaro S, et al. Effectiveness of pneumococcal conjugate vaccines (PCV7 and PCV13) against invasive pneumococcal disease among children under two years of age in Germany. PLoS One. 2016;11:e0161257.
Yildirim I, Shea KM, Little BA, et al.; Members of the Massachusetts Department of Public Health. Vaccination, underlying comorbidities, and risk of invasive pneumococcal disease. Pediatrics. 2015;135:495–503.
Kaplan SL, Barson WJ, Lin PL, et al. Early trends for invasive pneumococcal infections in children after the introduction of the 13-valent pneumococcal conjugate vaccine. Pediatr Infect Dis J. 2013;32:203–207.
Godot C, Levy C, Varon E, et al. Pneumococcal meningitis vaccine breakthroughs and failures after routine 7-Valent and 13-Valent pneumococcal conjugate vaccination in children in France. Pediatr Infect Dis J. 2015;34:e260–e263.
Levy C, Varon E, Ouldali N, et al. Changes in invasive pneumococcal disease spectrum after 13 valent pneumococcal conjugate vaccine implementation. Clin Infect Dis. 2019.[Epub ahead of print]