Salina Torres, United States of America

New Mexico Department of Health Epidemiology & Response Division

Author Of 2 Presentations

 Conference Calendar

Long-term Impact of Pneumococcal Conjugate Vaccine (PCV) on Antibiotic Resistant Invasive Pneumococcal Disease (IPD) in the United States (ID 892)

Session Name
Vaccines - Impact of Vaccine programs and Serotype Replacement
Presenter
Authors

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.

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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.

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EPIDEMIOLOGY OF INVASIVE PNEUMOCOCCAL DISEASE (IPD) FOLLOWING 18 YEARS OF PNEUMOCOCCAL CONJUGATE VACCINE (PCV) USE IN THE UNITED STATES (ID 849)

Session Name
Vaccines - Impact of Vaccine programs and Serotype Replacement
Presenter
Authors

Abstract

Background

PCVs have been recommended for U.S. children since 2000 and for adults aged ≥65 years since August 2014. We evaluated PCV impact on IPD.

Methods

IPD cases (isolation of pneumococcus from sterile sites) were identified through CDC’s Active Bacterial Core surveillance during 1998-2018. Isolates were serotyped by Quellung or whole genome sequencing and classified as PCV13-type and non-vaccine-type (NVT). Incidence rates (cases/100,000) were calculated using U.S. Census Bureau population denominators.

Results

During 1998-2018, overall and PCV13-type IPD rates declined significantly among children and adults aged ≥65 years (Figures); serotypes 3, 19A, and 19F caused most of the remaining PCV13-type IPD. NVT IPD rates did not change. The most common NVTs in 2018 were 22F (10% of all IPD), 9N (7%) and 15A (5%). Among children, the proportion of cases with meningitis increased from 5% to 14%(p<0.01), and the proportion with pneumonia/empyema increased from 17% to 31%(p<0.01). Among adults, the proportion of cases with meningitis did not change (3%), while the proportion with pneumonia/empyema increased from 72% to 76%(p=0.01).

impact figures.png

Conclusions

Overall IPD incidence among children and adults decreased following PCV introduction for children, driven primarily by reductions in PCV-type IPD. Increases in NVT IPD were minimal compared with PCV benefits.

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