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Experimental Human Pneumococcal Carriage
Published on: February 15, 2013
Decrease of invasive pneumococcal disease (IPD) in adults after introduction of pneumococcal 13-valent conjugate
Jordi Càmara1, José María Marimón2,3, Emilia Cercenado3,4
1Hosp. Univ. de Bellvitge-Universitat de Barcelona-IDIBELL, L'Hospitalet de Llobregat, Spain.
Insights
The introduction of the 13-valent pneumococcal conjugate vaccine (PCV13) in children led to a significant 33.9% decrease in adult invasive pneumococcal disease (IPD) in Spain due to herd protection. Surveillance is needed for emerging drug-resistant non-PCV13 serotypes.
Area of Science:
- Infectious Diseases
- Epidemiology
- Vaccinology
Background:
- Invasive pneumococcal disease (IPD) remains a significant public health concern.
- The 13-valent pneumococcal conjugate vaccine (PCV13) was introduced for children in Spain.
- Understanding the impact of pediatric vaccination on adult IPD incidence is crucial for public health strategies.
Purpose of the Study:
- To analyze the impact of PCV13 introduction in children on adult IPD incidence in Spain.
- To evaluate changes in IPD serotype distribution and antimicrobial resistance patterns before and after PCV13 licensure.
- To identify emerging trends in non-vaccine serotypes and specific clones.
Main Methods:
- Prospective, laboratory-based, multicenter study.
- Collected adult IPD episodes from 6 Spanish hospitals.
- Compared IPD data from two periods: 2008-2009 (before PCV13) and 2012-2013 (after PCV13 introduction.
Main Results:
- Overall adult IPD incidence decreased by 33.9% after PCV13 introduction.
- Significant reductions observed in IPD caused by PCV7 serotypes (-52.7%) and PCV13 additional serotypes (-55.0%).
- IPD due to non-PCV13 serotypes remained stable, with notable increases in serotype 6C (linked to ST3866C) and decreases in serotype 8 (linked to ST638). Serotype 3 showed no significant change.
- Emergence of the recombinant clone ST652111A (variant of ST1569V) was observed.
- Penicillin and cefotaxime resistance rates remained below 10% and 4%, respectively, in the later period.
Conclusions:
- Pediatric PCV13 vaccination confers herd protection, significantly reducing adult IPD in Spain.
- While vaccine-type IPD decreased, the stability and emergence of non-PCV13 serotypes, particularly multidrug-resistant clones like ST3866C and ST652111A, warrant ongoing surveillance.
- Continued monitoring is essential to manage evolving pneumococcal epidemiology and antimicrobial resistance patterns.
Abstract:
A prospective laboratory-based multicenter study that collected all adult invasive pneumococcal disease (IPD) episodes from 6 Spanish hospitals before (2008-2009) and after (2012-2013). The 13-valent pneumococcal conjugate vaccine (PCV13) licensure was conducted in order to analyze the impact of PCV13 introduction for children on adult IPD. A total of 1558 IPD episodes were detected. The incidence of IPD decreased significantly in the second period by -33.9% (95% CI, -40.3% to -26.8%). IPD due to PCV7 serotypes (-52.7%; 95% CI, -64.2% to -37.5%) and to PCV13 additional serotypes (-55.0% 95% CI, -62.0% to -46.7%) significantly decreased whereas IPD due to non-PCV13 serotypes remained stable (1.0% 95% CI, -12.9% to 17.2%). IPD due to all PCV13 additional serotypes significantly declined with the exception of serotype 3 (-11.3%; 95%CI -35.0% to 21.1%). IPD due to two non-PCV13 serotypes varied: serotype 6C that rose (301.6%; 95%CI, 92.7% to 733.3%, p<0.001), related to the expansion of ST3866C, and serotype 8 that decreased (-34.9%, 95%CI, -57.1 to -1.2, p = 0.049), related to a decline of the ST638. The recombinant clone ST652111A (variant of ST1569V) increased in frequency. The decrease of serotype 19A IPD was linked to a fall in those antibiotic susceptible clones. In the last period, rates of penicillin- and cefotaxime-resistance remained under 10% and 4%, respectively. Adult IPD decreased after the PCV13 introduction in Spain due to herd protection. The spread of multidrug resistant clones (ST3866C, ST652111A) related to non-PCV13 serotypes needs further surveillance.
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