Comparative incidence dynamics and serotypes of meningitis, bacteremic pneumonia and other-IPD in young children in the PCV era: Insights from Israeli surveillance studies. Issue 36 (28th August 2018)

• Record Type: Journal Article
• Authors: Ben-Shimol, Shalom; Givon-Lavi, Noga; Grisaru-Soen, Galia; Megged, Orli; Greenberg, David; Dagan, Ron
• Is Part Of: Vaccine. Volume 36:Issue 36(2018)
• Page Start: 5477
• Page End: 5484
• Publication Date: 2018-08-28
• Subjects: Pneumonia -- IPD – invasive pneumococcal disease -- PCV – pneumococcal conjugate vaccine -- Dynamics -- Children -- Surveillance; IPD invasive pneumococcal disease -- PCV7 7-valent pneumococcal conjugated vaccine -- PCV13 13-valent pneumococcal conjugated vaccine -- NIP national immunization program -- PCV pneumococcal conjugated vaccine -- CSF cerebrospinal fluid -- PCR polymerase chain reaction -- IRR incidence rate ratio -- CI confidence interval -- VT7 PCV7 serotype -- VT13 PCV13 serotype -- VT6 additional PCV13 serotypes; Vaccines -- Periodicals; 615.372
• DOI: 10.1016/j.vaccine.2017.05.059
• Languages: English
• ISSNs: 0264-410X

Abstract

Highlights: PCV7/13 impact on meningitis, bacteremic-pneumonia (BP) and other-IPD differed. In all 3 entities, disease caused by PCV13 serotypes (VT13) declined by ∼90%. Diseases caused by non-VT13 increased by 256%, 302% and 116%, respectively. Meningitis patients were younger; BP had higher proportion of non-PCV7 serotypes. This suggests different pathogenesis and host susceptibility between the 3 entities. Abstract: Introduction: Widespread introduction of pneumococcal conjugated vaccines (PCVs) impacted on invasive pneumococcal disease (IPD). However, IPD reduction may not be similar in all outcomes within IPD. We assessed PCV7/PCV13 impact on pneumococcal meningitis, bacteremic pneumonia (BP) and other (non-meningitis, non-pneumonia) IPD episodes in children <5 years in Israel. Methods: A prospective, population-based, active nationwide surveillance. All pneumococcal invasive episodes with positive blood/CSF cultures, July 2000 through June 2016, were included. Three sub-periods were defined: pre-PCV (2000–2008), PCV7 (2009–2011) and PCV13 (2014–2016). Incidence rate ratios (IRRs) were calculated. Results: Overall, 4321 episodes were recorded; 456 (10.6%) meningitis, 1478 (34.2%) pneumonia and 2387 (55.2%) other-IPD. In the pre-PCV period, proportion of serotypes in PCV13, but not in PCV7 (mainly serotypes 1, 5 and 19A) was higher in BP (43.3%) compared with other-IPD episodes (32.8%, p < 0.001) and similar to that of meningitis (37.6%, p = 0.1). The proportion of episodes in children <12 months was higher in meningitis (52.1%) compared with pneumonia (23.2%) and other-IPD episodes (39.5%; p < 0.001 for both). The declines of the 3 entities were not similar; Meningitis rate non-significantly declined by 24% (IRR = 0.76; 95% CI 0.57–1.01), while BP and other-IPD rates significantly declined by 57% and 70%, respectively. In contrast to other entities, BP did not decline significantly after PCV7 introduction but started to decline only after PCV13 introduction. Rates of meningitis, pneumonia and other-IPD caused by PCV13-serotypes (VT13) substantially declined by 88%, 95% and 97%, respectively, comparing PCV13 and the pre-PCV periods. However, diseases caused by non-VT13 increased by 256%, 302% in meningitis and pneumonia, respectively, but only 116% in other-IPD. Conclusions: Following PCV7/PCV13 introduction, rates of episodes caused by VT13 were substantially reduced in all 3 groups. However, differences in age distribution, serotype replacement and specific serotype decrease suggest different pathogenesis and host susceptibility between the 3 entities.