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Published on: September 11, 2020
Early Streptococcus pneumoniae serotype changes in Utah adults after the introduction of PCV13 in children
Brian A Kendall1, Kristin K Dascomb2, Rajesh R Mehta3
1Departments of Medicine and Pathology, University of Utah, Salt Lake City, UT, USA.
Insights
The introduction of pneumococcal conjugate vaccine 13 (PCV13) in children reduced PCV13-exclusive serotypes of invasive pneumococcal disease (IPD) in adults. Serotype changes in adults mirrored those in children, with potential sex-based differences observed.
Area of Science:
- Epidemiology
- Vaccinology
- Infectious Diseases
Background:
- Pneumococcal conjugate vaccines (PCV) confer indirect protection by reducing Streptococcus pneumoniae colonization in vaccine recipients.
- The introduction of PCV13 into childhood immunization programs may influence the epidemiology of invasive pneumococcal disease (IPD) in unvaccinated populations, including adults.
Purpose of the Study:
- To evaluate the impact of PCV13 introduction in children on the epidemiology and clinical characteristics of IPD among adults.
- To compare the serotype distribution of IPD in adults and children following PCV13 introduction.
Main Methods:
- A retrospective study design was employed, describing demographics, comorbidities, clinical presentations, and serotypes of IPD in Utah adults.
- Data were collected before (November 2009-February 2010) and after (March 2010-March 2012) the introduction of PCV13 in the pediatric population.
- Serotype data from adult IPD cases were compared with those from pediatric IPD cases.
Main Results:
- Following PCV13 introduction in children, a significant decrease in IPD caused by PCV13-exclusive serotypes was observed in adults (64% to 40%, p=0.009), notably serotype 7F.
- Non-significant increases in IPD due to Pneumococcal polysaccharide 23 (PPV23) unique serotypes and non-vaccine serotypes, such as 22F, were noted.
- Changes in serotype proportions were consistent between adult and child populations. Meningitis cases were more frequently associated with non-vaccine serotypes (47% vs. 18%, p=0.007). Decreases in PCV13 serotype IPD were significant only in men (76% to 33%, p=0.001).
Conclusions:
- The serotype epidemiology of adult IPD closely mirrors that of children during the PCV13 era, suggesting herd effects.
- Continued surveillance is crucial to monitor for potential increases in pneumococcal meningitis due to replacement serotypes.
- Further investigation is warranted to understand potential sex-based differences in the indirect protective effects of childhood PCV vaccination.
Introduction:
Pneumococcal conjugate vaccines (PCV) have indirect effects due to decreased Streptococcus pneumoniae colonization in vaccine recipients. We sought to determine whether the introduction of PCV13 in children led to changes in the epidemiology and clinical manifestations of invasive pneumococcal disease (IPD) in adults.
Methods:
We described demographics, comorbidities, clinical manifestations, and serotypes of IPD in Utah adults before (November 2009-February 2010) and after (March 2010-March 2012) the introduction of PCV13 in children. We also compare serotypes causing IPD in Utah adults and children.
Results:
After the introduction of PCV13 in the childhood vaccine program, the proportion of IPD due to PCV13 exclusive serotypes decreased significantly in Utah adults (64-40%, p=0.009), primarily due to a decline in serotype 7F (36-15%, p=0.008). There were non-significant increases in IPD due to Pneumococcal polysaccharide 23 (PPV23) unique serotypes and non-vaccine serotypes, most notably serotype 22F. Changes in the proportions of vaccine and non-vaccine serotypes were similar in adults and children. Meningitis was more commonly due to non-vaccine serotypes relative to non-meningitis cases (47% vs. 18%, p=0.007). When stratified by sex, decreases in PCV13 serotype IPD were only noted in men (76-33%, p=0.001).
Conclusions:
Serotype epidemiology of IPD in adults closely follows that of children in the PCV13 era. Continued surveillance is needed to confirm whether replacement serotypes will lead to increases in pneumococcal meningitis and whether there are sex differences in the indirect effects of PCV vaccination in children.
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