Christian Theilacker, Germany

Pfizerc Inc Medical Development AND Scientific Affairs Vaccines

Poster Author Of 4 e-Posters

Presenter Of 1 Presentation

PNEUMOCOCCAL SEROTYPE DISTRIBUTION IN ADULTS HOSPITALIZED WITH RADIOLOGICALLY-CONFIRMED COMMUNITY-ACQUIRED PNEUMONIA IN MALMÖ, SWEDEN (ID 904)

Abstract

Background

In Sweden, pneumococcal serotype distribution in adults with community-acquired pneumonia (CAP) and potential coverage of licensed and developmental pneumococcal conjugate vaccines (PCVs) are unknown.

Methods

2016-2018, consecutive patients aged ≥18 years hospitalized with chest x-ray positive (CXR+) CAP were enrolled at Skåne University Hospital. Streptococcus pneumoniae (Spn) blood culture isolates were serotyped by multiprime PCR and Quellung reaction. Urine was tested by the pan-pneumococcal urinary antigen test (BinaxNOW®) and Pfizer’s proprietary serotype-specific urine antigen detection assays (UAD1/UAD2). UAD1 detects serotypes in PCV13, UAD2 detects additional serotypes in PCV15 and PCV20 plus serotypes 2,9N,17F and 20.

Results

Of 567 enrollees, 518 had CXR+CAP and urine sample collected and were included in analysis. Spn serotypes were identified by UAD or blood culture isolates.

Table CXR+CAP by age group and vaccine serotype categories.

Spn detected:

18-64 years
n=169 (32.6%)

≥65 years
n=349 (67.4%)

≥18 years
n=518 (100%)

PCV13-types*

12.4%

10.0%

10.8%

PCV15-types*

13.6%

12.0%

12.5%

PCV20-types*

20.7%

15.2%

17.0%

Any Spn

27.2%

22.9%

24.3%

*PCV13:1,3,4,5,6A/6C,6B,7F,9V,14,18C,19A,19F,23F

PCV15:PCV13+22F,33F

PCV20:PCV15+8,10A,11A,12F,15B/C

Conclusions

In the context of robust pediatric PCV immunization, PCV13 serotypes were relatively common in adult CXR+CAP, emphasizing the limits of relying on indirect protection. PCV20 will further increase the ability of direct vaccination to reduce adult pneumonia morbidity.

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Author Of 4 Presentations

COVERAGE OF NEXT GENERATION PNEUMOCOCCAL CONJUGATE VACCINES FOR INVASIVE PNEUMOCOCCAL DISEASE IN CHILDREN OF HIGH-INCOME COUNTRIES (ID 608)

Abstract

Background

The serotype distribution of invasive pneumococcal disease (IPD) informs the coverage of next generation pneumococcal conjugate vaccines (PCVs). This analysis describes IPD coverage by the current PCVs (PCV10/PCV13) and next generation, PCV15 and PCV20.

Methods

Serotype counts for children <5 years were obtained from national or regionally-representative IPD surveillance systems from high-income countries. Up to the three most recent years of data were included. Excluded countries reported <20 cases overall or only reported data prior to pediatric PCV introduction into the National Immunization Program (NIP). Coverage was calculated for PCV10 (1,4,5,6B,7F,9V,14,18C,19F,23F), PCV13 (PCV10-types, 3,6A,19A, plus 6C, which is highly-related to 6A), PCV15 (PCV13-types, 22F,33F), and PCV20 (PCV15-types, 8,10A,11A,12F,15B, plus 15C, which is highly-related to 15B) as the number of cases in PCVs divided by the total number of cases (excluding missing and non-typeable cases) reported for each country.

Results

Twenty-seven of 80 (34%) high-income countries met inclusion criteria, reporting >5,000 cases that were included in the analysis. Coverage by current and next generation PCVs varied by country and World Health Organization (WHO) region (Table).

global ipd st dist_isppd2020 lt5 table_2020.1010.jpg

Conclusions

PCV20 offers substantial coverage above current PCVs and next generation PCV15 and could address the considerable remaining IPD burden among children in high-income countries globally.

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COVERAGE OF NEXT GENERATION PNEUMOCOCCAL CONJUGATE VACCINES FOR INVASIVE PNEUMOCOCCAL DISEASE IN OLDER ADULTS OF HIGH-INCOME COUNTRIES (ID 612)

Abstract

Background

Despite the indirect effects of routine pediatric pneumococcal conjugate vaccine (PCV) use, invasive pneumococcal disease (IPD) persists in older adults. This analysis describes IPD coverage of current PCVs (PCV10/PCV13) and next generation, PCV15 and PCV20.

Methods

Serotype counts for adults ≥60/≥65 years were obtained from national or regionally-representative IPD surveillance systems in high-income countries. Up to the three most recent years of data were included. Excluded countries reported <20 cases overall or only reported data prior to pediatric PCV introduction into the National Immunization Program (NIP). Coverage was calculated for PCV10 (1,4,5,6B,7F,9V,14,18C,19F,23F), PCV13 (PCV10-types,3,6A,19A, plus 6C, which is highly-related to 6A), PCV15 (PCV13-types, 22F,33F), and PCV20 (PCV13-types, 8,10A,11A,12F,15B, plus 15C, which is highly-related to 15B) as the number of cases in PCVs divided by total number of cases (excluding missing and non-typeable) reported for each country.

Results

Twenty-eight of 80 (35%) high-income countries met inclusion criteria, reporting >25,000 cases that were included in the analysis. Coverage by current and next generation PCVs varied by country and World Health Organization (WHO) region (Table).

global ipd st dist_isppd2020 65+ table_2020.1010.jpg

Conclusions

PCV20 offers substantial coverage above current PCVs and next generation PCV15 and could address the considerable remaining IPD burden among older adults in high-income countries globally.

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VACCINE-PREVENTABLE CLINICAL VERSUS RADIOLOGICALLY- OR ETIOLOGICALLY-CONFIRMED DISEASE IN PNEUMOCOCCAL CONJUGATE VACCINE EFFICACY TRIALS: A SYSTEMATIC LITERATURE REVIEW AND RE-ANALYSIS (ID 762)

Abstract

Background

While regulatory endpoints for pneumococcal conjugate vaccines (PCVs) routinely include radiologically- or vaccine serotype (VST) confirmed disease, public health decision-making benefits from consideration of all disease prevented regardless of diagnostic or etiological confirmation.

Methods

We followed PRISMA guidelines to perform a systematic literature review for Phase III/IV efficacy trials of PCVs from 1997 through 2019. We estimated study-specific vaccine-preventable disease incidence (VPDI) (control group minus intervention group incidences) for all-cause disease versus radiologically- and/or etiologically-confirmed outcomes. VPDI ratios between the broadest clinical and most narrowly defined outcomes were calculated [PROSPERO registration, CRD42019145268].

Results

Ten studies met the criteria. In children < 5 years, VPDI ratios ranged from 0.6 to 3.7 for otitis media (clinical versus VST etiologically-confirmed); from 1.3 to 1.8 for pneumonia (clinical versus radiologically-confirmed); 3.1 and 19.0 for pneumonia (clinical versus bacterial or VST); and 3.8 in one study of invasive pneumococcal disease (non-laboratory to laboratory-confirmed). In adults, VPDI ratios ranged from 2.2 to 2.9 for pneumonia (clinical to pneumococcal or VST).

table_fig2.gif

Conclusions

Relying on only radiologically-confirmed or etiologically-confirmed outcomes substantially underestimated PCVs’ public health benefits. Broader clinical outcomes should be considered by vaccine technical committees when making decisions for pediatric and adult PCV use.

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PNEUMOCOCCAL SEROTYPE DISTRIBUTION IN ADULTS HOSPITALIZED WITH RADIOLOGICALLY-CONFIRMED COMMUNITY-ACQUIRED PNEUMONIA IN MALMÖ, SWEDEN (ID 904)

Abstract

Background

In Sweden, pneumococcal serotype distribution in adults with community-acquired pneumonia (CAP) and potential coverage of licensed and developmental pneumococcal conjugate vaccines (PCVs) are unknown.

Methods

2016-2018, consecutive patients aged ≥18 years hospitalized with chest x-ray positive (CXR+) CAP were enrolled at Skåne University Hospital. Streptococcus pneumoniae (Spn) blood culture isolates were serotyped by multiprime PCR and Quellung reaction. Urine was tested by the pan-pneumococcal urinary antigen test (BinaxNOW®) and Pfizer’s proprietary serotype-specific urine antigen detection assays (UAD1/UAD2). UAD1 detects serotypes in PCV13, UAD2 detects additional serotypes in PCV15 and PCV20 plus serotypes 2,9N,17F and 20.

Results

Of 567 enrollees, 518 had CXR+CAP and urine sample collected and were included in analysis. Spn serotypes were identified by UAD or blood culture isolates.

Table CXR+CAP by age group and vaccine serotype categories.

Spn detected:

18-64 years
n=169 (32.6%)

≥65 years
n=349 (67.4%)

≥18 years
n=518 (100%)

PCV13-types*

12.4%

10.0%

10.8%

PCV15-types*

13.6%

12.0%

12.5%

PCV20-types*

20.7%

15.2%

17.0%

Any Spn

27.2%

22.9%

24.3%

*PCV13:1,3,4,5,6A/6C,6B,7F,9V,14,18C,19A,19F,23F

PCV15:PCV13+22F,33F

PCV20:PCV15+8,10A,11A,12F,15B/C

Conclusions

In the context of robust pediatric PCV immunization, PCV13 serotypes were relatively common in adult CXR+CAP, emphasizing the limits of relying on indirect protection. PCV20 will further increase the ability of direct vaccination to reduce adult pneumonia morbidity.

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