Carlos Grijalva, United States of America

Presenter of 1 Presentation

 Conference Calendar

EVOLVING RISK PROFILE OF PATIENTS WITH INVASIVE PNEUMOCOCCAL DISEASE DURING THE PNEUMOCOCCAL CONJUGATE VACCINE ERA (ID 1144)

Session Name
Population Sciences - Epidemiology, Economics, and Mathematical Modelling
Presenter
Authors

Abstract

Background

The incidence of invasive pneumococcal disease (IPD) due to serotypes covered by pneumococcal conjugate vaccines (PCVs) has declined since PCVs introduction. Whether the risk profile of IPD cases have changed following PCVs introduction is unclear.

Methods

We examined the comorbidity profile of all laboratory-confirmed IPD cases identified in Tennessee through active population and laboratory-based surveillance (1998-2017). Comorbidities were identified through chart review, and classified as high-risk and at-risk, as previously described (Figure). We examined changes in the proportion of patients with relevant comorbidities over time, and stratified estimates according to serotype information.

Results

pngfigure.pngThe proportion of IPD cases with high-risk and at-risk comorbidities increased over time from 9% (1998-1999) to 26% (2016-2017) and from 22% to 59%, respectively. For IPD caused by vaccine-covered serotypes (PCV7 or those only covered by PCV13), increases in comorbidities prevalence were attenuated during recent years, but estimates’ precision was limited. For IPD caused by serotypes not in PCV13, the prevalence of comorbidities increased continuously (Figure).

Conclusions

After widespread use of PCVs, patients with residual IPD in Tennessee have a higher prevalence of relevant comorbidities than in previous years. These risk profile changes need to be considered in future prevention plans.

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Author Of 9 Presentations

 Conference Calendar

INCIDENCE OF PNEUMOCOCCAL AND ALL-CAUSE PNEUMONIA IN ADULTS IN TENNESSEE AND GEORGIA, USA, 2018-2019: RESULTS FROM THE PNEUMO STUDY (ID 350)

Session Name
Clinical Sciences - Disease Burden in Infants, Children/Youth, and Adults
Presenter
Authors

EVOLVING RISK PROFILE OF PATIENTS WITH INVASIVE PNEUMOCOCCAL DISEASE DURING THE PNEUMOCOCCAL CONJUGATE VACCINE ERA (ID 1144)

Session Name
Population Sciences - Epidemiology, Economics, and Mathematical Modelling
Presenter
Authors

Abstract

Background

The incidence of invasive pneumococcal disease (IPD) due to serotypes covered by pneumococcal conjugate vaccines (PCVs) has declined since PCVs introduction. Whether the risk profile of IPD cases have changed following PCVs introduction is unclear.

Methods

We examined the comorbidity profile of all laboratory-confirmed IPD cases identified in Tennessee through active population and laboratory-based surveillance (1998-2017). Comorbidities were identified through chart review, and classified as high-risk and at-risk, as previously described (Figure). We examined changes in the proportion of patients with relevant comorbidities over time, and stratified estimates according to serotype information.

Results

pngfigure.pngThe proportion of IPD cases with high-risk and at-risk comorbidities increased over time from 9% (1998-1999) to 26% (2016-2017) and from 22% to 59%, respectively. For IPD caused by vaccine-covered serotypes (PCV7 or those only covered by PCV13), increases in comorbidities prevalence were attenuated during recent years, but estimates’ precision was limited. For IPD caused by serotypes not in PCV13, the prevalence of comorbidities increased continuously (Figure).

Conclusions

After widespread use of PCVs, patients with residual IPD in Tennessee have a higher prevalence of relevant comorbidities than in previous years. These risk profile changes need to be considered in future prevention plans.

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INVASIVE PNEUMOCOCCAL DISEASE IN ADULTS IN TENNESSEE AND GEORGIA, USA: RESULTS FROM THE PNEUMO STUDY (ID 351)

Session Name
Clinical Sciences - Disease Burden in Infants, Children/Youth, and Adults
Presenter
Authors

Abstract

Background

Surveillance of invasive pneumococcal disease (IPD) is important to understand the effects of direct and indirect protection from pneumococcal vaccination programs and inform vaccine development and policy.

Methods

As part of the ongoing Pneumococcal Pneumonia Epidemiology, Urine Serotyping, and Mental Outcomes (PNEUMO) study, we enrolled adults hospitalized with IPD in Nashville and Atlanta from September-2018 to August-2019. IPD was defined by isolation of Streptococcus pneumoniae from a normally-sterile site.

Results

We enrolled 25 IPD cases, including 18 (72%) pneumonia, 5 (20%) bacteremia without an identified focus, 1 meningitis, and 1 septic arthritis. Pneumococcal serotype was identified from blood culture in 20 cases, including serotypes: 35B–(3 cases), 3-(2 cases), 15A-(2 cases), 19F-(2 cases), 20-(2 cases), 23A-(2 cases), 22F, 8, 9N, 11A, 23B, 31, 35F. Median age was 62 years; 23 (92%) presented from a community residence; 12 (48%) were immunocompromised; and all had ≥1 major chronic medical condition. In-hospital outcomes: 0 deaths; 10 (40%) ICU admissions; 9 (36%) mechanical ventilation; 3 (12%) vasopressors; 3 (12%) pleural drainage procedure; 1 (4%) new renal-replacement-therapy.

Conclusions

IPD is a highly morbid disease in US adults, with most cases in this study caused by serotypes not in the current 13-valent pneumococcal conjugate vaccine.

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ADULT ALL-CAUSE AND PNEUMOCOCCAL PARAPNEUMONIC EMPYEMA HOSPITALIZATION RATES IN THE ERA OF DECLINING INVASIVE PNEUMOCOCCAL DISEASE AFTER PCVS INTRODUCTION IN THE US (ID 1176)

Session Name
Clinical Sciences - Disease Burden in Infants, Children/Youth, and Adults
Presenter
Authors

Abstract

Background

Parapneumonic empyema, a severe pneumonia complication, increased among US adults (especially older adults) after the introduction of 7-valent pneumococcal conjugate vaccine (PCV7), though the trend since PCV13 introduction remains unclear. We examined parapneumonic and pneumococcal empyema hospitalization rates among US adults during the PCVs era.

Methods

National Inpatient Sample and Census Data were used to calculate national annual all-cause and pneumococcal parapneumonic empyema hospitalization rates among adults. Rates were compared to national invasive pneumococcal disease (IPD) estimates from the CDC Active Bacterial Core surveillance system (1997-2017). We examined age-specific rates by vaccine era [pre-PCV7 (1997-1999); PCV7 (2001-2009); early-PCV13 era (2011-2015); and late-PCV13 (2016-2017) after transition from ICD9 to ICD10 codes].

Results

All-cause parapneumonic empyema hospitalization rates increased in every adult age group during the study period (Table). Pneumococcal parapneumonic empyema hospitalization rates followed similar trends as overall IPD and declined in every age group after PCV13 introduction (Figure). Modest increases were observed after PCV13 introduction for streptococcal parapneumonic empyema and parapneumonic empyema without an identified causative organism.

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Conclusions

While the rate of all-cause parapneumonic empyema hospitalizations among US adults has increased in the last 2 decades, modest changes have been observed in pneumococcal parapneumonic empyema with declines following PCV13 introduction.

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QUALITY OF LIFE FOLLOWING PNEUMOCOCCAL AND ALL-CAUSE PNEUMONIA: RESULTS FROM THE PNEUMO STUDY (ID 352)

Session Name
Clinical Sciences - Disease Burden in Infants, Children/Youth, and Adults
Presenter
Authors

PNEUMOCOCCAL COLONIZATION DENSITY PATTERNS OVER TIME IN YOUNG CHILDREN IN THE PERUVIAN ANDES (ID 246)

Session Name
Population Sciences - Global Pneumonia Control and Vulnerable Populations
Presenter
Authors

Abstract

Background

Factors associated with nasopharyngeal pneumococcal colonization density have not been comprehensively characterized. Age, immunization status, geographical location, population density, season, and/or acute respiratory illness (ARI) may play a role. We assessed longitudinal colonization density patterns in young rural Peruvian children.

Methods

Nasopharyngeal samples were collected monthly from children aged <3 years followed prospectively each week for ARI from May 2009-September 2011. PCV7 was introduced in the region in 2009. Longitudinally-collected samples from a convenience sample of children with >=1 pneumococcus-positive sample underwent density assessment by lytA qPCR. Density values were log10-transformed to reduce skewness. Assessments were stratified by enrollment age.

Results

Pneumococcus was detected in 471/625 (75%) samples from 30 children; 20/30 (67%) were enrolled before age 1. Variability was observed in colonization densities by calendar quarter and enrollment age, with substantial overlap in density levels and trajectories over time among age groups (Figure). Median densities during ARI episodes (n=62) were 5.60 (IQR 4.36-6.24) compared to non-ARI periods (5.00 [3.98-5.93], n=409, p=0.023). fig_1_01.13.20.jpg

Conclusions

Among these children, density varied by ARI status but did not clearly decrease with age. Future trajectory analyses will assess serotype-specific density colonization patterns and the association of serotype co-colonization, vaccination, and ARI status with pneumococcal density over time.

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COGNITIVE FUNCTION FOLLOWING PNEUMOCOCCAL AND ALL-CAUSE PNEUMONIA: RESULTS FROM THE PNEUMO STUDY (ID 353)

Session Name
Clinical Sciences - Disease Burden in Infants, Children/Youth, and Adults
Presenter
Authors

Abstract

Background

Systemic inflammation from pneumonia may lead to acute brain dysfunction and long-term cognitive impairment, especially in older patients with severe pneumonia.

Methods

As part of the ongoing Pneumococcal Pneumonia Epidemiology, Urine Serotyping, and Mental Outcomes (PNEUMO) study, we prospectively enrolled adults hospitalized with community-acquired pneumonia. We tested for Streptococcus pneumoniae with cultures and BinaxNOW urinary antigen tests. We assessed global cognition in patients ≥50 years old with the Montreal Cognitive Assessment-Blind Adaptation (MoCA-Blind). MoCA-Blind scores range from 0 to 22 with higher scores indicating better cognition. Adults with a MoCA-Blind score <18 are considered to have cognitive impairment. We administered the MoCA-Blind instrument at enrollment when the patient was acutely ill and 6-months later by phone.

Results

At the time of this interim analysis, 150 patients had cognitive assessments completed at enrollment and 6-months, including 12 (8.0%) with pneumococcal pneumonia. Median (IQR) age was 64 (58-71) years. Cognitive impairment was common at both enrollment and 6-months later (Figure). At 6-month follow-up, 58% of pneumococcal and 52% of non-pneumococcal pneumonia patients had a MoCA-Blind score <18.

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Conclusions

Hospitalization for pneumonia, including pneumococcal pneumonia, is associated with high risk of acute and persistent cognitive impairment among US adults ≥50 years old.

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NASOPHARYNGEAL ANTIBIOTIC RESISTANCE GENE DETECTION IN YOUNG CHILDREN BEFORE AND AFTER ARI-ASSOCIATED ANTIBIOTIC EXPOSURE IN AN URBAN AMBULATORY SETTING IN TENNESSEE, UNITED STATES (ID 314)

Session Name
Clinical Sciences - Disease Burden in Infants, Children/Youth, and Adults
Presenter
Authors

Abstract

Background

Antibiotic use for acute respiratory illnesses (ARI) is very common in children, but its impact on antibiotic-resistance gene detection among nasopharyngeal (NP) bacteria is incompletely characterized.

Methods

NP samples from children <5 years of age prescribed antibiotics for ARI in ambulatory settings in Nashville, Tennessee were collected at baseline (before antibiotics) and 7 days after the encounter (follow-up). Samples were cultured for Streptococcus pneumoniae and tested for several common pneumococcal antibiotic-resistance genes by real-time PCR.

Results

To date, 7/8 (88%) children who provided paired samples received amoxicillin; 2/8 (25%) received clindamycin. Pneumococcus was detected in 5/8 (63%) baseline and 1/8 (13%) follow-up samples. Pbp2b, mef and ermB genes were detected in 4/8 (50%), 8/8 (100%) and 7/8 (88%) children at baseline, respectively. Pbp2b became undetectable at follow-up in all 4 children with baseline detection. Detection of mef and ermB remained stable or increased in 5/8 (63%) and 5/7 (71%) subjects, respectively (Figure).

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Conclusions

In this ongoing study, targeted pneumococcal antibiotic-resistance genes were commonly detected in children before antibiotic treatment and were more prevalent than pneumococcal detection, suggesting that other species may harbor these resistance mechanisms. Antibiotic use may facilitate expansion of certain resistance genes, while minimizing others.

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SUSTAINED IMPACT OF 13-VALENT PNEUMOCOCCAL CONJUGATE VACCINE INTRODUCTION ON HOSPITALIZATIONS WITH ALL-CAUSE AND PNEUMOCOCCAL PARAPNEUMONIC EMPYEMA AMONG US CHILDREN (ID 421)

Session Name
Clinical Sciences - Disease Burden in Infants, Children/Youth, and Adults
Presenter
Authors

Abstract

Background

Parapneumonic empyema, a severe pneumonia complication, decreased shortly after 13-valent pneumococcal conjugate vaccine (PCV13) introduction among young US children but not among older children. We assessed the long-term impact of PCV13 introduction among US children encompassing the transition to the ICD10 coding system.

Methods

We used the National Inpatient Sample and Census Data to calculate national annual all-cause and pneumococcal parapneumonic empyema hospitalization rates among children <18 years (1997-2017). We examined rates during the late PCV13 era (2016-2017) after transition to ICD10 codes compared to pre-PCV7 (1997-1999), PCV7 (2001-2009) and early-PCV13 era (2011-2015) rates. We also examined changes in thoracentesis-related procedures.

Results

All-cause and pneumococcal parapneumonic empyema, as well as thoracentesis-related procedure rates reached historical lows in the late PCV13 era (Table). After initial declines following PCV13 introduction, rates have remained relatively stable (Figure). Modest, mostly downward, fluctuations were noted post-ICD10 transition.

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Conclusions

Parapneumonic empyema rates in US children increased following PCV7 introduction but decreased and reached historic lows following PCV13 introduction. The change in coding from ICD9 to ICD10 did not appear to influence trends, though further assessment is warranted. Our findings support the ongoing surveillance of all-cause and pneumococcal empyema in the ICD10 coding era.

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