Stephen I. Pelton, United States of America
Boston University School of Medicine Pediatrics and EpidemiologyAuthor Of 5 Presentations
IMPACT OF PNEUMOCOCCAL CONJUGATED VACCINES ON CHILDHOOD PNEUMOCOCCAL MENINGITIS, 2002/2017 (ID 498)
Abstract
Background
7-valent-pneumococcal-conjugated-vaccine(PCV7) was implemented in Massachusetts in 2000 and was replaced by PCV13 in 2010. We assessed the impact of PCVs on the epidemiology of pneumococcal central nervous system disease(PCNS).
Methods
A population-based, enhanced surveillance for IPD among Massachusetts children is ongoing since 2001. Pneumococcal isolates from normally sterile body sites are sent to the Department of Public Health and serotyped using Quellung-reaction. Parents/guardians/providers are interviewed to obtain demographic and clinical information.
Results
Eighty-three PCNS cases were identified between 04/2002-03/2017. Incidence of PCNS declined 65% in all ages in 2016/2017 compared to prePCV13 baseline (0.27/100,000 vs 0.77/100,000, rate ratio 0.38, 95%CI 0.02-0.47)(Figure). Median age was 17-months in prePCV13-era and 41-months in postPCV13-era. Twenty-seven (32.5%) children had >1 comorbidity. Mortality rate was 8.4%. Serotypes 19A(17.0%), 22F(9.4%), 6C,7F (7.6% each), 3,33F(5.7% each) were the most frequent serotypes in the prePCV13-era; 15B,23B(16% each), 3, 33F, 10A, 20(10.5% each) were the most frequent serotypes in the postPCV13-era. Nonvaccine serotypes (NVST) were isolated in 30(56.6%) and 16(84.2%) PCNS cases in prePCV13 and postPCV13 eras, respectively. Five(14.4%) and one(5.3%) isolates were ceftriaxone non-susceptible in prePCV13 and postPCV13-era, respectively.
Conclusions
Incidence of PCNS has declined 65% since 2002. It now occurs in older children and is most often caused by NVST.
TWENTY YEAR IMPACT OF PNEUMOCOCCAL CONJUGATE VACCINE ON INVASIVE PNEUMOCOCCAL DISEASE SYNDROMES IN US CHILDREN LESS THAN 5 YEARS OF AGE (ID 243)
- Ruth Chapman, United Kingdom
- Kelly Sutton, United Kingdom
- Rotem Lapidot, United States of America
- Erica Chilson, United States of America
- Vincenza Snow, United States of America
- Shreeya Patel, United Kingdom
- Des Dillon-Murphy, United Kingdom
- Raymond A. Farkouh, United States of America
- Margaret Moffatt, United States of America
- Matt Wasserman, United States of America
- Stephen I. Pelton, United States of America
13-VALENT PNEUMOCOCCAL CONJUGATE VACCINE FAILURES IN MASSACHUSETTS CHILDREN, 2010/2017 (ID 492)
Abstract
Background
Despite high vaccine coverage rates in children and efficacy of pneumococcal conjugate vaccines, invasive pneumococcal disease (IPD) episodes due to serotypes included in the vaccine following completion of the recommended course of immunisation [i.e. vaccine failure (VF)] have been reported.
Methods
Cases of IPD in children <18 years of age were detected through an enhanced surveillance system. Parents/physicians/providers are interviewed for confirmation of demographic and clinical data. All Streptococcus pneumoniae from sterile body sites are submitted to Department of Public Health and serotyped by Quellung reaction.
Results
Out of 307 IPD cases identified during 2010/2017 following implementation of PCV13, 101 (32.9%) were due to PCV13 serotypes and 27 (8.8%) were among children who completed age-recommended immunization schedule (Table). Median age was 26 months, 21 (67.7%) were male and 6 (22.2%) of cases had >1 comorbidity. Serotype 19A (n=13, 48.2%) and 3 (n=11, 40.7%) were responsible for majority of VF cases. Mortality rate among VF cases was 11.1%.
Conclusions
PCVs are highly effective, but sustaining high vaccine coverage, ongoing surveillance and understanding the mechanisms involved in VF cases is essential
IMPACT OF 13-VALENT PNEUMOCOCCAL CONJUGATE VACCINE ON INVASIVE PNEUMOCOCCAL DISEASE IN MASSACHUSETTS CHILDREN, 2010/2017 (ID 495)
Abstract
Background
The 13-valent-pneumococcal conjugate vaccine (PCV13) replaced PCV7 in Massachusetts(MA) beginning in April,2010. We describe the current epidemiology of invasive pneumococcal disease (IPD) in MA children after 7 years of PCV13 use.
Methods
Cases of IPD in children <18 years of age were detected through an enhanced surveillance system. Parents/physicians/providers are interviewed for confirmation of demographic and clinical data. All Streptococcus pneumoniae from sterile body sites are submitted to Department of Public Health and serotyped by Quellung reaction.
Results
Incidence of IPD declined to 2.8/100,000 in 2017/18 (71% decline compared to prePCV13 baseline 9.8/100,000; incidence rate ratio 0.29,95%CI 0.24-0.32) mostly due to reduction in additional serotypes included in PCV13 (Figure). The most common clinical presentation was bacteremia(55%), followed by pneumonia(32%) and CNS disease(7%); 91(27%) children had >1 comorbidity [asthma(12%), hematologic malignancy(12%), prematurity(10%), sickle cell disease(10%)]. Mortality rate was 4.4%. Isolates from 302 (89%) were available for serotyping. Vaccine serotypes (VST) were identified in 98 (33%) IPD cases [19A(48%),7F(20%),3(18%), 19F(7%), 6A(3%), 14,18C,5(1% each). Serotypes 15BC(14%), 22F(12%) and 33F(12%) were the most common nonvaccine serotypes(NVST).
Conclusions
IPD declined >70% following 7-years of PCV13 use.NVSTs, specifically serotypes 15BC,33F and 22F are responsible for majority of the remaining disease which is disproportionately observed in children with comorbid conditions.
IMPACT OF 13-VALENT PNEUMOCOCCAL CONJUGATE VACCINE (PCV13) ON PEDIATRIC BACTEREMIC PNEUMOCOCCAL PNEUMONIA, 2010/2017 (ID 497)
Abstract
Background
Streptococcus pneumoniae (SPN) is a major cause of hospitalized community-acquired-pneumonia. We assessed the impact of PCV13 on the epidemiology of bacteremic pneumococcal pneumonia (BPP).
Methods
A population-based, enhanced surveillance for invasive pneumococcal disease among Massachusetts children is ongoing since 2001. SPN isolates from normally sterile body sites are sent to the Department of Public Health and serotyped using Quellung reaction. Parents/guardians/providers are interviewed to obtain demographic and clinical information.
Results
Three-hundred-ninety-one BPP cases were identified between 04/2002 and 03/2017. Incidence of BPP declined 79% in 2016/2017 compared to prePCV13 baseline (0.68/100,000 vs 3.35/100,000,rate ratio 0.19,95%CI 0.09-0.25)(Figure). One-hundred-six(26.0%) children had >1 comorbidity. Mortality rate was 2.6%. Serotypes 19A(37.5%), 7F(21.3%), 3(6.0%), 22F(3.7%) were the most frequent serotypes in the prePCV13-era; 19A(16.0%), 22F(11.7%),7F(11.7%),3(7.5%), and 33F(5.3%) were the most frequent serotypes in the postPCV13-era. Nonvaccine serotypes (NVST) were isolated in 42(19.4%) and 55(58.5%) of BPP cases in prePCV13 and postPCV13-eras, respectively. The incidence of NVST BPP increased from 0.36/100,000 to 0.56/100,000 annually in postPCV13 eras. Twenty-six(8.4%) isolates were penicillin-non-susceptible and 93(30.2%) were macrolide-non-susceptible.
Conclusions
In the post-PCV13 era, NVST are the most common cause of BPP, supporting a need for strategies to further reduce the burden of childhood pneumonia.