PNEUMOCOCCAL AND INFLUENZA VACCINATION STATUS AMONG CHILDREN WITH SICKLE-CELL DISEASE: STILL MISSING THE TARGET (ID 249)
PROPORTION OF PNEUMOCOCCAL PNEUMONIA AND SEROTYPE DISTRIBUTION IN COMMUNITY-ACQUIRED PNEUMONIA PATIENTS WITH UNDERLYING COMORBIDITIES IN JAKARTA, INDONESIA (ID 269)
EFFICACY OF PNEUMOCOCCAL VACCINATION IN PATIENTS WITH MULTIPLE MYELOMA RECEIVING NOVEL AGENTS: RESULTS OF A PROSPECTIVE CLINICAL STUDY (ID 409)
NEUMORISK: A MULTIPLATFORM APP TO ASSESS THE INDIVIDUAL RISK OF COMMUNITY-ACQUIRED PNEUMONIA (ID 759)
- Irene Rivero-Calle, Spain
- Miriam Cebey-López, Spain
- Jacobo Pardo-Seco, Spain
- Jose Yuste, Spain
- Enrique Mascarós, Spain
- Esther Redondo, Spain
- Manuel Linares-Rufo, Spain
- Isabel Jimeno, Spain
- Angel Gil de Miguel, Spain
- Jesús Molina, Spain
- Daniel Ocaña, Spain
- Federico Martinón-Torres, Spain
- Jose Luis L. Díaz-Maroto, Spain
Abstract
Background
Risk characterization of community-acquired pneumonia (CAP) in primary care and an adequate understanding of individual phenotypes could allow the implementation of specific preventive measures and individualized clinical interventions. Aim of the study was to develop an application that assesses the individual risk of suffering pneumonia.
Methods
This application is based on mathematical algorithms validated in a retrospective-observational-controlled study with >28,000 Spanish adult CAP (BMC InfectDis. 2016 Nov 7;16(1):645).
Results
25 lifestyle factors and comorbidities identified as risk factors related to CAP, stratified by age and sex, were analysed; allowing the development of a multiplatform application that identifies the individual risk of pneumonia. The user responds to 17 test questions, asked differently depending on the user profile (general population or health professional). The app provides as result a number expressing the odds ratio of suffering CAP compared to an age matched healthy subject. Additionally, the application provides you with a link to specific practical recommendations. More than 7300 people have use it.
Conclusions
A multiplatform application that assesses the individual risk of pneumonia was developed to raise the awareness of CAP and help clinicians identify patients at higher risk of pneumonia and to provide additional recommendations for prevention, including vaccination strategies against CAP.
PLASMABLAST RESPONSE AFTER REVACCINATION WITH 13 VALENT CONJUGATED PNEUMOCOCCAL VACCIN IN PATIENTS WITH CHRONIC LYMPHOCYTIC LEUKEMIA (ID 969)
Abstract
Background
Between 2013-2016, 126 treatment naïve chronic lymphocytic leukemia (CLL) patients (median age, 69 years; range, 46–87 years) were vaccinated in a randomized trial with PCV13 (n=63) or PPSV23 (n=63) at eight hematological clinics in Sweden. Antibody response, measured with ELISA and OPA was superior for PCV13. In the present study, we analyze the immune response, including plasmablasts, after revaccination with PCV13 and 3-6 years after primary vaccination.
Methods
In 2019-2020, 72 CLL patients were included for revaccination with PCV13. Immunophenotyping of peripheral plasmablasts (CD19+/CD38++/CD27++/CD138-/IgD-/IgM-) and plasma cells (CD19+/CD38++/ CD27++/ CD138+/ IgD-/IgM-) was performed before and seven days after revaccination using flow cytometry (n=13). Analyses of serotype specific antibodies (ELISA) and functionality (OPA) before and eight weeks, 16 weeks and 12 months after revaccination will be performed. Immunocompetent controls will be recruited.
Results
Preliminary results show increased plasmablasts in 4/13 patients seven days after revaccination compared to baseline, previously vaccinated with PCV13 (n=3) and PPSV23 (n=1). Patients with detectable plasmablasts were still treatment naïve but those with previous/ongoing treatment (including two with Ibrutinib) had undetectable plasmablasts.
Conclusions
Preliminary results indicate a superior response after PCV13 revaccination in CLL patients if previously vaccinated with PCV13 than PPSV23. Further analyses will be conducted during 2020.
LIKELIHOOD OF PNEUMONIA IN ADULTS WITH OSA and CPAP USE (ID 315)
Abstract
Background
Chronic lung diseases (e.g., COPD, asthma) are recognized risk factors for pneumococcal disease, particularly pneumonia. Obstructive sleep apnea (OSA) is a prevalent chronic pulmonary disease in the US. This study evaluated whether OSA with continuous positive airway pressure (CPAP) or Bilevel positive airway pressure use may be an additional risk factor for pneumonia.
Methods
This study used records from the Optum-Humedica de-identified Electronic Health Record dataset from 01/2012-06/2018. Patients aged≥18 diagnosed with OSA with and without a procedure code indicating post-index CPAP were included. Logistic regression models adjusting for age, gender, region, calendar year, BMI and comorbidities were used to assess the association of CPAP with pneumonia within 1-year of OSA diagnosis by healthcare setting.
Results
Of 1,068,964 OSA patients, 36.3% used CPAP. Among the propensity score-matched groups, CPAP use was associated with increased risk of pneumonia [odds ratio(OR)=1.61, 95%CI=1.58-1.64]. Risk was highest in the inpatient setting (OR=1.95, 95%CI=1.90-1.99), and similar in the emergency department and outpatient settings (OR=1.55, 95%CI=1.49-1.61 and OR=1.51, 95%CI=1.47-1.55, respectively).
Conclusions
Preliminary results indicated CPAP use was associated with higher likelihood of pneumonia diagnosis. Identifying groups that may be at higher risk for pneumonia and potentially pneumococcal pneumonia is important given the growing incidence of OSA in the US.
THE RISK OF INVASIVE PNEUMOCOCCAL DISEASE (IPD) IN MEDICAL RISK-GROUPS – A NORWEGIAN POPULATION BASED COHORT STUDY (ID 576)
MAJOR ADVERSE CARDIOVASCULAR EVENTS DURING INVASIVE PNEUMOCOCCAL DISEASE ARE SEROTYPE DEPENDENT (ID 700)
Abstract
Background
Worldwide up to 30% of patients admitted to hospitals due to community-acquired pneumonia (CAP) develop major-adverse-cardiovascular events (MACE). Importantly, patients who develop MACE have a higher risk of dying during acute hospitalization and up to 10 years thereafter. Streptococcus pneumoniae (Spn) is the only etiological agent linked independently to MACE. However, there is no data regarding which Spn serotype is more associated with MACE in humans.
Methods
This is an observational, multicentric, retrospective cohort study conducted through the Health Secretary of Bogotá (HSB), Colombia. All patients with the diagnosis of invasive pneumococcal disease (IPD), reported in Bogota to the HIB between 2012 and 2019 were included. Serotyping was carryout at the HIB. MACE were defined as new/worsening heart failure, new/worsening arrhythmias, and/or myocardial infarctions. A multivariate analysis was performed.
Results
A total of 314 patients with IPD were included. 22.6% (71/314) developed MACE. As previously described, patients were older and with more comorbid conditions. However, patients with Spn serotype 3 were independently associated with MACE after adjusting for disease severity and comorbid conditions (OR 2.20; 95%CI 1.02, 4.76).
Conclusions
In patients admitted due to IPD, Spn serotype 3 is independently associated with MACE. Further molecular characterization and experiments are needed to prove causality.
INVASIVE PNEUMOCOCCAL DISEASE IN PAEDIATRIC PATIENTS WITH SICKLE CELL DISEASE: A 10-YEAR RETROSPECTIVE STUDY (ID 909)
INVASIVE PNEUMOCOCCAL DISEASE IN PAEDIATRIC TRANSPLANT PATIENTS: A 10-YEAR RETROSPECTIVE STUDY (ID 922)
INVASIVE PNEUMOCOCCAL DISEASE IN PAEDIATRIC CANCER PATIENTS UNDERGOING ACTIVE TREATMENT: A 10-YEAR RETROSPECTIVE STUDY (ID 923)
INVASIVE PNEUMOCOCCAL DISEASE IN HIGH RISK PAEDIATRIC PATIENTS: A 10-YEAR RETROSPECTIVE STUDY (ID 924)
DEATH OF INVASIVE PNEUMOCOCCAL DISEASE IN RISK-GROUPS - A NATION-WIDE NORWEGIAN COHORT STUDY (ID 986)
IMMUNOGENICITY AND REACTOGENICITY OF THE 13-VALENT PNEUMOCOCCAL CONJUGATE VACCINE IN JAPANESE SUBJECTS AT INCREASED OR HIGH RISK OF PNEUMOCOCCAL DISEASE (ID 592)
- Masanori Ikeda, Japan
- Yoshitaka Yamazaki, Japan
- Takayuki Imada, Japan
- Kenji Furuno, Japan
- Yutaka Okano, Japan
- Tomoyuki Mizukami, Japan
- Richard De Solom, Australia
- Yasuko Shoji, Japan
- Motoki Oe, Japan
- Masakazu Aizawa, Japan
- Peter C. Giardina, United States of America
- Beate Schmoele-Thoma, Germany
- Dan A. Scott, United States of America
Abstract
Background
Pneumococcal disease (PD) is associated with significant disease burden among those with certain chronic medical conditions. An open-label phase 3 study evaluated the safety and immunogenicity of the 13-valent pneumococcal conjugate vaccine (PCV13) in Japanese individuals aged 6‒64 years with increased PD risk.
Methods
Subgroup analyses of immunogenicity and reactogenicity were conducted in subjects categorized as at-risk (ie, immunocompetent but having chronic medical conditions associated with increased PD risk) or high-risk (ie, immunocompromised due to diseases/conditions and/or medications). Immune responses were measured before and 1 month after one PCV13 dose.
Results
Among subjects aged 6‒<18 years, 66.0% were categorized as at-risk and 34.0% were high-risk; percentages for those aged 18‒<65 years were 52.3% and 47.7%, respectively (Table). Opsonophagocytic activity (OPA) geometric mean fold rises from prevaccination ranged from 3.9–635.1 across subgroups, with lower limits of the 2‑sided 95% CIs >1 for all 13 serotypes (Figure 1); Immunoglobulin G results were consistent with OPA analysis. Reactogenicity events were generally mild or moderate across subgroups (Figure 2).
Conclusions
PCV13 is immunogenic and well tolerated in individuals aged 6‒64 years at risk or high risk of PD. Results were similar to past PCV13 studies in other populations. Funded by Pfizer.
PATIENTS WITH MENINGITIS DUE TO STREPTOCOCCUS PNEUMONIAE ALSO MIGHT DEVELOP MAJOR ADVERSE CARDIOVASCULAR EVENTS (MACE) (ID 716)
Abstract
Background
Streptococcus pneumoniae (Spn) is the leading cause of community-acquired pneumonia (CAP) and bacterial meningitis in adults. Recent studies have shown that up to 30% of patients admitted due to pneumococcal CAP develop major adverse cardiovascular events (MACE, i.e., new/worsening arrhythmia, new/worsening heart failure, and myocardial infarction). However, it is unknown whether MACE could also be identified in patients with pneumococcal meningitis.
Methods
In this observational, multicentric retrospective study. We analyzed medical records from adult patients with invasive pneumococcal disease (IPD) reported in a surveillance program across all hospitals in Bogotá, Colombia, between 2012 and 2019. Pneumococcal meningitis was confirmed by the identification of Spn in blood cultures and/or cerebrospinal fluid cultures and clinical presentation. Adverse cardiac outcomes were blinded evaluated in each case.
Results
From a total of 314 patients with microbiological Spn isolation, 19.7% (62/314) were diagnosed with pneumococcal meningitis. Out of the 62 patients evaluated, 10 (16%) developed MACE, 8.1% (5) new/worsening heart failure, 6.5% (4) new/worsening arrhythmia, and 3.2% (2) myocardial infarction.
Conclusions
To our knowledge, this is the first clinical study showing that patients with pneumococcal meningitis could be at risk of MACE as reported in pneumococcal CAP. Further studies are needed to characterize patients at risk better.
AN OVERVIEW ON CLINICAL FORMS AND COMPLICATIONS OF PNEUMOCOCCAL MENINGITIS IN ALBANIAN ADULTS. (ID 284)
Abstract
Background
Pneumococcal meningitis is one of the most common bacterial meningitis in Albanian adults.
Methods
It is a retrospective–descriptive study.We selected 26 cases of pneumococcal meningitis from 94 meningitis hospitalized in ICU of ID service of UHC,during 2015–2019,and analyzed epidemiological data(gender, age group),ranked risk factors by subject,clinical forms based on the severity of symptoms manifested at the time of hospitalization according to the classic triad fever-headache-neck stiffness,with particular focus on short-term complications during hospitalization and long-term within the 1st year of follow-up.
Results
According to the epidemiological aspect males were 14 cases;based on age group:14-20 y -5 cases,21 - 40 yo 3,41-60 yo 5, 61 - 80 yo 10, over 81yo 3cases.Clinical aspect:fulminant 8 cases,acute 12,subacute 6. Identified risk factors: 2 cases of otitis media,3 frontal and maxillary sinusitis,2 splenectomies,3 diabetes mellitus,4 post cranial fractures,2 HIV/AIDS,2 rheumatoid arthritis,3 acute leukemia 1 myeloma under chemotherapy,2 alcoholic cirrhosis,2 COPD. We observed complications in 7 cases:short term complications 1case- septic shock with MODS,1 kidney failure.Long term complications-1 case hearing impairment,1seizures,2 relapses of meningitis,1 memory related problems.Llethality in 3 cases.Etiological diagnosis was established through culture of cerebrospinal fluid and hemocultures.
Conclusions
Pneumococcal vaccine application is valuable in reducing relapse and attenuating disease severity especially those with compromised immunity
MODERATE CUMULATIVE EFFECT OF CONCURRENT COMORBIDITIES ON SEVERE NONMENINGITIS INVASIVE PNEUMOCOCCAL DISEASE IN ADULTS, FRANCE 2014-2018 (ID 453)
- Kostas Danis, France
- Jacques Gaillat, France
- Guy Mootien, France
- Farid Sifaoui, France
- Jennifer Tetu, France
- Louis Bernard Bernard, France
- Cécile Lebrun, France
- Simona Pavel, France
- Cristophe Strady, France
- Olivier Barraud, France
- Thomas Lafon, France
- Daniel Levy-Bruhl, France
- Marie-Cecile Ploy, France
Abstract
Background
In France, pneumococcal vaccination in adults is recommended for risk groups (chronic conditions/immunosuppression). During 2014-2018, we conducted a study in adults to identify factors associated with severe invasive pneumococcal disease (IPD).
Methods
We included nonmeningitis IPD cases from 25 acute care hospitals in 6/13 French regions. We defined severe cases as those with shock or severe sepsis or ICU admission/mechanical ventilation or those who died within 30 days of hospitalization. Infectious disease specialists collected clinical/microbiological data on cases. We calculated adjusted risk ratios (aRR) using binomial regression.
Results
1,156 cases were diagnosed; 53% were severe; 85% had comorbidities; 20% died within 30 days of hospitalization; 8% were vaccinated against pneumococcus. Compared with previously healthy cases, the risk of severe IPD increased 16% (aRR=1.16; 95%CI=1.01-1.35), 20% (aRR=1.20; 95%CI=1.01-1.43) and 35% (aRR=1.35; 95%CI=1.11-1.65) in cases with 1 or 2 or >2 chronic diseases (excluding immunosuppression), respectively. The risk was 24% (aRR=0.76; 95%CI=0.58-0.99) lower in cases vaccinated with pneumococcal vaccines, but 30% (aRR=1.30; 95%CI=1.04-1.63) higher in those infected with serotype 3, compared with serotype 8.
Conclusions
The risk of severe IPD increased moderately with increasing number of comorbidities, adding evidence for future recommendations for adult pneumococcal immunization and disease prevention.
NASOPHARYNGEAL CARRIAGE OF S. PNEUMONIAE IN CHILDREN SEVERE ACUTE MALNUTRITION (SAM) AND/OR PNEUMONIA: PRELIMINARY FINDINGS FROM A SURVEILLANCE PROJECT AT THE DILI NATIONAL HOSPITAL, TIMOR-LESTE (ID 1172)
Abstract
Background
Children with SAM have impaired immune function (including mucosal defences) and an increased risk of pneumococcal pneumonia. We evaluated if SAM was associated with increased nasopharyngeal carriage of S. pneumoniae (Spn).
Methods
Pulmaun Saudavel is an ongoing surveillance study of children aged 1-59 months hospitalised with SAM and/or pneumonia in Dili, Timor-Leste, where no pneumococcal conjugate vaccine (PCV) is in use. SAM is defined according to World Health Organization (WHO) criteria. Pneumonia is defined as cough or difficulty breathing and any one of: respiratory rate >50bpm, oxygen saturation <90%, lower chest wall indrawing, or WHO-defined radiological pneumonia. NP swabs are collected after admission and processed according to WHO guidelines.
Results
Of 160 cases enrolled to date, 103 (64%) had pneumonia, 27 (17%) SAM, and 30 (19%) both pneumonia and SAM. Overall NP carriage of Spn was 27% (43/160). There was no difference in carriage between SAM cases (15/57, 26%) and pneumonia-only cases (27/97, 28%). Among children with SAM, those with pneumonia had higher carriage (11/30, 37%) compared to those without pneumonia (4/27, 15%; p=0.08).
Conclusions
Pneumonia is a common complication of SAM and may be associated with increased Spn carriage. PCV use in Timor-Leste is likely to benefit children with SAM.
HIGH INCIDENCE OF PRIMARY IMMUNODEFICIENCIES IN PATIENTS HOSPITALIZED FOR INVASIVE PNEUMOCOCCAL DISEASES (ID 865)
Abstract
Background
Introduction. Some primary immunodeficiencies (PIDs) confer predisposition to invasive pneumococcal disease (IPD).
Methods
Methods. Identification of pediatric patients with IPD (January 2000-February 2017). Clinical and epidemiologic data and immunological explorations.
Results
Results.We identified 209 children who suffered from IPD, of whom 78 patients (mean age 34 months; range, 0 days-13 years) required hospitalization. Sixteen of the 78 children (20.5%) had classical risk factors. Immunological evaluation could be performed to 44 patients. Eight patients suffered from a PID: IRAK-4 deficiency (1 patient), X- linked agammaglobulinemia (1), congenital asplenia (2), Ataxia-telangiectasia (1), DiGeorge Syndrome (1), Charge Syndrome (1), and partial Chromosome 16 trisomy with low numbers of switched-memory B cells and hypogammaglobulinemia (1). Only two patients had recurrent IPD, and 6/8 patients did not have a clinical history suggestive of PID. In 6 of the 8 patients with PID no serious infections were recorded after diagnosis.
Conclusions
Conclusions. Around 18% of pediatric cases hospitalized with IPD may be due to a PID. Prompt diagnosis and treatment after one episode of hospitalization for IPD, even in the absence of previous severe and/or recurrent infections, protect against posterior serious infections in patients with PID.