Ongoing Exposure of U.K. Infants to Vaccine Serotype Pneumococci

by Mary Slack, FRCPATH; Andrew Vyse, PhD; Harish Madhava, MD; Ralf-Rene Reinert, MD; Gillian Ellsbury, MD; Carole Czudek, PhD; Bradford Gessner, MD

Published in The Pediatric Infectious Disease Journal, April 2019. doi: 10.1097/INF.0000000000002184  "To the editors: 

We read with interest the article by Makwana et al. The authors note that most childhood invasive pneumococcal disease (IPD) cases are now due to non-13 valent pneumococcal conjugate vaccine (PCV13) serotypes though PCV13 serotypes remain in circulation with serotypes 3 and 19A listed among the top 10 that caused IPD in children in 2015/16. Of the 25 cases with PCV13-type IPD in 2015/16, 11 (44%) were due to serotype 19A.

 

Key insight is given into the IPD burden in infants 3–11 months of age, which over the 6-year study period accounted for a substantial proportion (508/1255, 40%) of the total in children <5 years of age. Additionally, meningitis was most prevalent in infants (209/456 cases, 45.8%) and was associated with the highest case fatality (9.6%). The most recent data from 2015/16 showed 103/271 (38%) of IPD cases occurred in infants 3–11 months of age, with 5 (4.8%) attributed to PCV13 serotypes. This reflects an increase in infant IPD compared with 2014/15 and slightly exceeds the number of cases in this age group in 2010/11 when PCV13 was first introduced illustrating a continuing and substantial burden of infant IPD. ..."

 

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Integrated Safety Profile of a New Approved, Fully Liquid DTaP5-HB-IPV-Hib Vaccine

by Jin Xu, PhD; Jon E. Stek, MS; Eddy Ziani, MD; G. Frank Liu, PhD; Andrew W. Lee, MD

Published in The Pediatric Infectious Disease Journal, April 2019. doi: 10.1097/INF.0000000000002257

 

 

DTaP5-HB-IPV-Hib is a fully liquid, hexavalent vaccine containing a 5-antigen pertussis component, approved since 2016 in Europe [Vaxelis; DTaP5-HB-IPV-Hib vaccine: Diphtheria, tetanus, pertussis (5 acellular components: pertussis toxoid [PT], filamentous haemagglutinin [FHA], pertactin (PRN), and fimbriae Types 2 and 3 [FIM]), hepatitis B (recombinant DNA: rDNA), poliomyelitis (inactivated) and Haemophilus influenzae type b conjugate vaccine (adsorbed); MCM Vaccine B.V., The Netherlands] for primary and booster vaccination in infants and toddlers against diphtheria, tetanus, pertussis, hepatitis B, poliomyelitis and invasive diseases caused by Haemophilus influenzae type b. The comparator vaccine (control) was INFANRIX hexa (GlaxoSmithKline Biologics S.A., Rixensart, Belgium) (DTaP3-IPV-HepB/Hib) in European studies and PENTACEL (DTaP5-IPV/Hib) (Sanofi Pasteur, Swiftwater, PA) in US studies.

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Invasive Pneumococcal Disease in Neonates Prior to Pneumococcal Conjugate Vaccine Use in South Africa 2003–2008

by Krishnee Moodley, MBChB, FCPath, MMed; Yacoob Mahomed Coovadia, MBChB, FCPathSA; Cheryl Cohen, MBChB, PhD; Susan Meiring, MBChB, DTM&H; Sarona Lengana, MBChB, DipHIVManSA; Linda De Gouveia, NDMed Tech; Claire von Mollendorf, MBChB, MSc, PhD; Penny Crowther-Gibson, MSc, MSc; Vanessa Quan, MBChB, MPH; Brian Eley, MBChB; Gary Reubenson, MBBCh, FCPaed; Trusha Nana, MBChB, FCPath, MMed; Anne von Gottberg, MBChB, PhD

Published in The Pediatric Infectious Disease Journal, April 2019. doi: 10.1097/INF.0000000000002096

 

 

Neonatal invasive pneumococcal disease (IPD) in developing countries is poorly described. Researchers provide a baseline description of neonatal IPD in South Africa, before implementation of the 7-valent pneumococcal conjugate vaccine (PCV7) in 2009.

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Influenza Epidemiology, Vaccine Coverage and Vaccine Effectiveness in Children Admitted to Sentinel Australian Hospitals in 2017: Results from the PAEDS-FluCAN Collaboration

by Christopher C Blyth, Kristine K Macartney, Jocelynne McRae, Julia E Clark, Helen S Marshall, Jim Buttery, Joshua R Francis, Tom Kotsimbos, Paul M Kelly, and Allen C Cheng

Published in Clinical Infectious Diseases, 05 March 2019. https://doi.org/10.1093/cid/ciy597

 

 

In 2017, Australia experienced record influenza notifications. Two surveillance programs combined to summarize the epidemiology of hospitalized influenza in children and report on vaccine effectiveness (VE) in the context of a limited nationally funded vaccination program.

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Effect of 10-valent pneumococcal conjugate vaccine on the incidence of radiologically-confirmed pneumonia and clinically-defined pneumonia in Kenyan children: an interrupted time-series analysis

by Micah Silaba, MMed; Michael Ooko, MSc; Christian Bottomley, PhD; Joyce Sande, MMed; Rachel Benamore, FRCR; Kate Park, FRCR; James Ignas, MD; Kathryn Maitland, FMedSci; Neema Mturi, MMed; Anne Makumi, MSc; Mark Otiende, MSc; Stanley Kagwanja, Dip MIS; Sylvester Safari, Dip MIS; Victor Ochola, BSc; Tahreni Bwanaali, MBA; Evasius Bauni, PhD; Fergus Gleeson, FRCR; Maria Deloria Knoll, PhD; Ifedayo Adetifa, PhD; Kevin Marsh, FMedSci; Thomas N Williams, FMedSci; Tatu Kamau, MPH; Shahnaaz Sharif, MD; Orin S Levine, PhD; Laura L Hammitt, MD; and J Anthony G Scott, FMedSci

To be published in The Lancet Global Health, March 2019. DOI:https://doi.org/10.1016/S2214-109X(18)30491-1

 

 

Pneumococcal conjugate vaccines (PCV) are highly protective against invasive pneumococcal disease caused by vaccine serotypes, but the burden of pneumococcal disease in low-income and middle-income countries is dominated by pneumonia, most of which is non-bacteraemic. Researchers examined the effect of 10-valent PCV on the incidence of pneumonia in Kenya. Researchers linked prospective hospital surveillance for clinically-defined WHO severe or very severe pneumonia at Kilifi County Hospital, Kenya, from 2002 to 2015, to population surveillance at Kilifi Health and Demographic Surveillance System, comprising 45,000 children younger than 5 years. Chest radiographs were read according to a WHO standard. A 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PCV10) was introduced in Kenya in January, 2011. In Kilifi, there was a three-dose catch-up campaign for infants (aged <1 year) and a two-dose catch-up campaign for children aged 1–4 years, between January and March, 2011. Researchers estimated the effect of PCV10 on the incidence of clinically-defined and radiologically-confirmed pneumonia through interrupted time-series analysis, accounting for seasonal and temporal trends. Between May 1, 2002 and March 31, 2015, 44,771 children aged 2–143 months were admitted to Kilifi County Hospital. We excluded 810 admissions between January and March, 2011, and 182 admissions during nurses' strikes. In 2002–03, the incidence of admission with clinically-defined pneumonia was 2170 per 100,000 in children aged 2–59 months. By the end of the catch-up campaign in 2011, 4997 (61·1%) of 8181 children aged 2–11 months had received at least two doses of PCV10 and 23 298 (62·3%) of 37,416 children aged 12–59 months had received at least one dose. Across the 13 years of surveillance, the incidence of clinically-defined pneumonia declined by 0·5% per month, independent of vaccine introduction. There was no secular trend in the incidence of radiologically-confirmed pneumonia over 8 years of study. After adjustment for secular trend and season, incidence rate ratios for admission with radiologically-confirmed pneumonia, clinically-defined pneumonia, and diarrhoea (control condition), associated temporally with PCV10 introduction and the catch-up campaign, were 0·52, 0·73, and 0·63, respectively. Immediately before PCV10 was introduced, the annual incidence of clinically-defined pneumonia was 1220 per 100,000; this value was reduced by 329 per 100 000 at the point of PCV10 introduction. Over 13 years, admissions to Kilifi County Hospital for clinically-defined pneumonia decreased sharply (by 27%) in association with the introduction of PCV10, as did the incidence of radiologically-confirmed pneumonia (by 48%). The burden of hospital admissions for childhood pneumonia in Kilifi, Kenya, has been reduced substantially by the introduction of PCV10. This study is funded by the Gavi, The Vaccine Alliance and Wellcome Trust.  Access the full article here.    Also be sure to read the accompanying editorial by Corinne Levy and Robert Cohen, Tackling childhood pneumonia in Africa: a dream that becomes reality: 

"The close relationship between pneumococcus and pneumonia is a very old story. In 1882, Friedlander reported pneumococci in tissue from humans with pneumonia and, in 1884, recovered pneumococci from the blood of patients with pneumonia for the first time. However, regardless of the microbiological method used (culture, antigen detection, or molecular tools), only a small proportion of pneumonia cases can be attributed to pneumococcus, and pneumococcal bacteraemic pneumonia represents only a small portion of pneumonia cases. There is a disparity between the low proportion of pneumonia cases attributed to pneumococcus (7·2%), even if more accurate diagnostic methods are used, and the large worldwide reported effect of pneumococcal conjugate vaccines (PCVs) on pneumonia. This contrast highlights the need to specifically assess the effect of PCV implementation on pneumonia, particularly in low-income countries.

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