Long-term Impact of Pneumococcal Conjugate Vaccine (PCV) on Antibiotic Resistant Invasive Pneumococcal Disease (IPD) in the United States (ID 892)
- Tamara Pilishvili, United States of America
- Tamara Pilishvili, United States of America
- Ryan Gierke, United States of America
- Monica Farley, United States of America
- William Schaffner, United States of America
- Ann Thomas, United States of America
- Arthur Reingold, United States of America
- Lee Harrison, United States of America
- Ruth Lynfield, United States of America
- Kari Burzlaff, United States of America
- Susan Petit, United States of America
- Rachel Herlihy, United States of America
- Salina Torres, United States of America
- Bernard Beall, United States of America
Abstract
Background
PCVs have been recommended for U.S. children since 2000 and for adults aged ≥65 years since 2014. We evaluated impact of PCVs on antibiotic non-susceptible (NS) IPD.
Methods
IPD cases were identified through CDC’s Active Bacterial Core surveillance during 1998-2018. Isolates were serotyped and classified as PCV13 or non-vaccine type (NVT). We applied 2019 Clinical and Laboratory Standards Institute breakpoints to minimum inhibitory concentrations (using broth microdilution or whole genome sequencing) to classify isolates as NS to >1 antibiotic (NS-IPD) or to >3 drug classes (multi-drug-NS). Incidence rates (per 100,000) were calculated using U.S. Census Bureau population denominators.
Results
From 1998-1999 to 2017-2018, penicillin-NS IPD incidence decreased from 12 to 0.4 among children <5 years-old and from 5 to 0.8 among adults ≥65 years-old. Incidence of PCV13-type NS-IPD decreased among all ages, while incidence of NVT NS-IPD increased for all ages (Figure). In 2018, serotypes 19A (37%), 23A (13%) and 23B (13%) and serotypes 35B (42%), 19A (19%), and 15A (12%) accounted for most penicillin NS and multi-drug-NS IPD, respectively.
Conclusions
NS-IPD incidence decreased following 18 years of PCV use among children, driven by reductions in PCV serotypes. Increases in NVTs have started to erode PCV benefits on NS-IPD, especially among adults.