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Decrease of invasive pneumococcal disease (IPD) in adults after introduction of pneumococcal 13-valent conjugate vaccine in Spain

View Article: PubMed Central - PubMed

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.

No MeSH data available.


Regional changes in IPD by serotype group.Dots expressed the percentage of change and lines the limits of 95% CI. The decrease of IPD due to PCV7 and PCV13 additional serotypes was more noticeable in Madrid (the only region that included universal children vaccination with PCV13) than in the Basque Country or Catalonia.
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pone.0175224.g001: Regional changes in IPD by serotype group.Dots expressed the percentage of change and lines the limits of 95% CI. The decrease of IPD due to PCV7 and PCV13 additional serotypes was more noticeable in Madrid (the only region that included universal children vaccination with PCV13) than in the Basque Country or Catalonia.

Mentions: The overall incidence of IPD decreased by -33.9% (95% CI, -40.3% to -26.8%) from 12.3 to 8.1 episodes per 100,000 population (Table 2). This decrease was statistically significant for all age groups. IPD due to PCV7 serotypes decreased 2.0 to 1.0 episodes per 100,000 (-52.7%; 95% CI, -64.2% to -37.5%) and IPD due to PCV13 additional serotypes declined from 5.7 to 2.6 episodes per 100,000 (-55.0%; 95% CI, -46.7% to -62.0%). The incidence of IPD due to non-PCV13 serotypes remained stable: 1.0% (95%CI, -12.9% to 17.2%), from 4.5 to 4.6 episodes per 100 000 population. Among patients aged 18–50 years, the incidence of IPD due to both PCV13 and non-PCV13 serotypes showed a statistically significant decrease. In those groups of patients aged >50 years, the IPD incidence due to PCV13 additional serotypes decreased (p<0.001) whereas the IPD incidence due to non-PCV13 serotypes increased, although this difference was not statistically significant. Since the hospitals are located in three different Spanish regions, we also analyzed IPD changes by regions. The decrease of IPD due to PCV7 and PCV13 additional serotypes was more noticeable in Madrid than in the Basque Country or Catalonia, although these differences were not statistically significant (Fig 1).


Decrease of invasive pneumococcal disease (IPD) in adults after introduction of pneumococcal 13-valent conjugate vaccine in Spain
Regional changes in IPD by serotype group.Dots expressed the percentage of change and lines the limits of 95% CI. The decrease of IPD due to PCV7 and PCV13 additional serotypes was more noticeable in Madrid (the only region that included universal children vaccination with PCV13) than in the Basque Country or Catalonia.
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Related In: Results  -  Collection

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Show All Figures
getmorefigures.php?uid=PMC5383258&req=5

pone.0175224.g001: Regional changes in IPD by serotype group.Dots expressed the percentage of change and lines the limits of 95% CI. The decrease of IPD due to PCV7 and PCV13 additional serotypes was more noticeable in Madrid (the only region that included universal children vaccination with PCV13) than in the Basque Country or Catalonia.
Mentions: The overall incidence of IPD decreased by -33.9% (95% CI, -40.3% to -26.8%) from 12.3 to 8.1 episodes per 100,000 population (Table 2). This decrease was statistically significant for all age groups. IPD due to PCV7 serotypes decreased 2.0 to 1.0 episodes per 100,000 (-52.7%; 95% CI, -64.2% to -37.5%) and IPD due to PCV13 additional serotypes declined from 5.7 to 2.6 episodes per 100,000 (-55.0%; 95% CI, -46.7% to -62.0%). The incidence of IPD due to non-PCV13 serotypes remained stable: 1.0% (95%CI, -12.9% to 17.2%), from 4.5 to 4.6 episodes per 100 000 population. Among patients aged 18–50 years, the incidence of IPD due to both PCV13 and non-PCV13 serotypes showed a statistically significant decrease. In those groups of patients aged >50 years, the IPD incidence due to PCV13 additional serotypes decreased (p<0.001) whereas the IPD incidence due to non-PCV13 serotypes increased, although this difference was not statistically significant. Since the hospitals are located in three different Spanish regions, we also analyzed IPD changes by regions. The decrease of IPD due to PCV7 and PCV13 additional serotypes was more noticeable in Madrid than in the Basque Country or Catalonia, although these differences were not statistically significant (Fig 1).

View Article: PubMed Central - PubMed

ABSTRACT

A prospective laboratory-based multicenter study that collected all adult invasive pneumococcal disease (IPD) episodes from 6 Spanish hospitals before (2008&ndash;2009) and after (2012&ndash;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&lt;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.

No MeSH data available.