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Published on: February 23, 2014
Substantial reduction of antibiotic-non-susceptible pneumococcal otitis media following PCV7/PCV13 sequential
Shalom Ben-Shimol1,2, Noga Givon-Lavi1,2, David Greenberg1,2
1The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel.
Insights
Pneumococcal conjugated vaccines (PCVs) significantly reduced antibiotic-non-susceptible otitis media (ANSP-OM) in children. Sequential PCV7/PCV13 introduction led to a >90% decline in vaccine-type ANSP-OM and overall ANSP-OM.
Area of Science:
- Pediatric Infectious Diseases
- Vaccinology
- Microbiology
Background:
- Before pneumococcal conjugated vaccines (PCVs), specific serotypes in PCV7/PCV13 caused most pneumococcal otitis media (OM) and antibiotic-non-susceptible OM (ANSP-OM).
- Sequential introduction of PCV7 and PCV13 in southern Israel led to a significant reduction in vaccine-serotype OM.
Purpose of the Study:
- To evaluate the impact of sequential PCV7/PCV13 introduction on the dynamics of antibiotic-non-susceptible pneumococcal otitis media (ANSP-OM) requiring middle ear fluid culture in young children.
Main Methods:
- A prospective, population-based active surveillance study was conducted from 2004-2016, including children under 3 years old.
- Two periods were analyzed: pre-PCV (2004-2008) and PCV13 (2014-2016).
- Antibiotic non-susceptibility (ANSP) and multidrug resistance (MDR) were defined based on specific antibiotic minimum inhibitory concentrations (MICs) and resistance to ≥3 classes.
Main Results:
- Overall pneumococcal OM incidence decreased by 86% in the PCV13 period compared to pre-PCV.
- Incidence of ANSP-OM for penicillin, macrolide, tetracycline, clindamycin, ceftriaxone, and MDR decreased by over 90% post-PCV13 introduction.
- Proportions of ANSP for penicillin, ceftriaxone, and erythromycin decreased by approximately 70%.
Conclusions:
- Sequential introduction of PCV7/PCV13 vaccines rapidly and substantially reduced ANSP-OM.
- This reduction occurred alongside the near elimination of PCV13-serotype OM without an increase in replacement diseases.
Background:
In the pre-pneumococcal conjugated vaccines (PCVs) era, serotypes included in the 7/13-valent PCVs (PCV7/PCV13) caused most pneumococcal otitis media (OM) and antibiotic-non-susceptible pneumococcal OM (ANSP-OM) episodes. In southern Israel, sequential PCV7/PCV13 introduction resulted in >90% reduction of vaccine-serotype OM.
Objectives:
We assessed the dynamics of ANSP-OM necessitating middle ear fluid culture following PCV7/PCV13 sequential introduction in young children.
Methods:
This was a prospective, population-based, active surveillance. All episodes in children <3 years old, during 2004-16, were included. Two subperiods were defined: (i) pre-PCV: 2004-08; and (ii) PCV13: 2014-16. ANSP was defined for the following antibiotics: penicillin (MIC ≥0.1 mg/L and ≥1.0 mg/L), macrolide, tetracycline, clindamycin, ceftriaxone, trimethoprim/sulfamethoxazole and chloramphenicol. MDR was defined as ANSP for ≥3 classes.
Results:
Overall, 2270 pneumococcal OM episodes were identified. Annual overall pneumococcal, PCV13 and non-PCV13 serotype OM incidence declined by 86%, 97% and 33%, respectively, comparing pre-PCV with the PCV13 period. During 2004-08, 95% of ANSP was observed in vaccine serotypes. Incidence of penicillin (MIC ≥0.1 mg/L and ≥1.0 mg/L), macrolide, tetracycline, clindamycin, ceftriaxone and multidrug ANSP-OM declined by >90% in the PCV13 period. Rates of trimethoprim/sulfamethoxazole and chloramphenicol ANSP-OM declined by 85% and 79%, respectively. The proportions of ANSP of all pneumococcal isolates declined by ∼70% for penicillin, ceftriaxone and erythromycin; 53% for tetracycline; and 55% for MDR, versus no significant reductions observed for chloramphenicol, trimethoprim/sulfamethoxazole and clindamycin.
Conclusions:
PCV7/PCV13 sequential introduction resulted in rapid and substantial ANSP-OM reduction, in parallel with the near disappearance of PCV13-serotype OM and no increase in replacement disease.
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