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A 32-Year Study of the Effect of Pneumococcal Vaccines on Invasive Streptococcus pneumoniae Disease
Ronald J Stanek1, Nancy B Norton2, Maurice A Mufson3
1Department of Medicine, Marshall University Joan C. Edward School of Medicine, Huntington, West Virginia; Veterans Administration Medical Center, Huntington, West Virginia.
Background:
Worldwide, Streptococcus pneumoniae commonly causes community-acquired pneumonia, meningitis, septicemia and otitis media. Invasive pneumococcal infection (IPD) represents the most serious presentation, occurs in approximately 1 in 4 cases and engenders case fatality rates (CFR) in pneumonia of 20-25% and meningitis of 35-40%. We investigated IPD for 32 years in an American city to assess the effect of differing pneumococcal vaccines on serotype occurrence and CFR among children and adults.
Methods:
In this retrospective study of IPD conducted from 1983-2014, consecutive pneumococcal strains were obtained from inpatients at 3 affiliated hospitals. Each hospital laboratory submitted to our research laboratory S pneumoniae strains recovered from blood and otherwise sterile sites for serotyping by Quellung and penicillin susceptibility tests by ETEST. Clinical data were abstracted from hospital medical records.
Results:
IPD occurred among 193 children and 1,003 adults. The overall CFR among adults was 19.2%. Only 2 children died. From 1983-2004, PCV7 serotypes dominated, but after routine PCV7 immunization began in 2000, PCV7 serotypes decreased and nearly disappeared, including penicillin-resistant PCV7 serotypes, few IPD occurred among children and incidence rates declined markedly, which continued after PCV13 replaced PCV7 in 2010. The 11 additional serotypes in PPSV23 became dominant during the past 5 years. Nonvaccine serotypes emerged also. Only serotypes 6B, 15 and 35F showed a significant relative risk of death.
Conclusions:
Community-wide usage of PCV7, then PCV13, changed the predominant serotypes. PCV7 serotypes and IPD among children almost disappeared and PPSV23 and nonvaccine serotypes became more dominant.
Insights
Pneumococcal vaccines PCV7 and PCV13 significantly reduced invasive pneumococcal disease (IPD) in children. Adult IPD cases shifted to non-vaccine serotypes, with PPSV23 becoming dominant.
Area of Science:
- Infectious Diseases
- Vaccinology
- Epidemiology
Background:
- Streptococcus pneumoniae is a leading cause of community-acquired pneumonia and invasive pneumococcal infection (IPD).
- IPD has high case fatality rates, particularly in adults.
- Understanding serotype distribution and vaccine impact is crucial for public health.
Purpose of the Study:
- To assess the long-term impact of pneumococcal conjugate vaccines (PCV7, PCV13) and polysaccharide vaccine (PPSV23) on serotype prevalence.
- To evaluate changes in invasive pneumococcal infection (IPD) incidence and case fatality rates (CFR) in children and adults over 32 years.
Main Methods:
- Retrospective study of invasive pneumococcal infection (IPD) cases from 1983-2014.
- Serotyping of Streptococcus pneumoniae strains and penicillin susceptibility testing.
- Abstraction of clinical data from hospital records.
Main Results:
- Invasive pneumococcal infection (IPD) occurred in 193 children and 1,003 adults; adult CFR was 19.2%.
- PCV7 introduction led to a decrease in PCV7 serotypes and IPD among children.
- Following PCV13 introduction and continued PCV7 use, non-vaccine serotypes and PPSV23 serotypes became dominant.
Conclusions:
- Widespread use of PCV7 and PCV13 has dramatically altered pneumococcal serotype epidemiology.
- IPD in children has significantly declined, while serotype distribution has shifted in adults.
- Emergence of non-vaccine serotypes necessitates ongoing surveillance and vaccine strategy evaluation.
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