Inci Yildirim, United States of America

Emory University Infectious Diseases

Presenter of 4 Presentations

IMPACT OF PNEUMOCOCCAL CONJUGATED VACCINES ON CHILDHOOD PNEUMOCOCCAL MENINGITIS, 2002/2017 (ID 498)

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

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.

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Conclusions

Incidence of PCNS has declined 65% since 2002. It now occurs in older children and is most often caused by NVST.

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13-VALENT PNEUMOCOCCAL CONJUGATE VACCINE FAILURES IN MASSACHUSETTS CHILDREN, 2010/2017 (ID 492)

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

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%.

table isppd2020.jpg

Conclusions

PCVs are highly effective, but sustaining high vaccine coverage, ongoing surveillance and understanding the mechanisms involved in VF cases is essential

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IMPACT OF 13-VALENT PNEUMOCOCCAL CONJUGATE VACCINE ON INVASIVE PNEUMOCOCCAL DISEASE IN MASSACHUSETTS CHILDREN, 2010/2017 (ID 495)

Session Name
Vaccines - Impact of Vaccine programs and Serotype Replacement

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).

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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.

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IMPACT OF 13-VALENT PNEUMOCOCCAL CONJUGATE VACCINE (PCV13) ON PEDIATRIC BACTEREMIC PNEUMOCOCCAL PNEUMONIA, 2010/2017 (ID 497)

Session Name
Vaccines - Impact of Vaccine programs and Serotype Replacement

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.

figure 1.jpg

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.

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Author Of 8 Presentations

13-VALENT PNEUMOCOCCAL CONJUGATE VACCINE FAILURES IN MASSACHUSETTS CHILDREN, 2010/2017 (ID 492)

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

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%.

table isppd2020.jpg

Conclusions

PCVs are highly effective, but sustaining high vaccine coverage, ongoing surveillance and understanding the mechanisms involved in VF cases is essential

Hide

IMPACT OF 13-VALENT PNEUMOCOCCAL CONJUGATE VACCINE ON INVASIVE PNEUMOCOCCAL DISEASE IN MASSACHUSETTS CHILDREN, 2010/2017 (ID 495)

Session Name
Vaccines - Impact of Vaccine programs and Serotype Replacement

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).

figure 1.jpg

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.

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

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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IMPACT OF 13-VALENT PNEUMOCOCCAL CONJUGATE VACCINE (PCV13) ON PEDIATRIC BACTEREMIC PNEUMOCOCCAL PNEUMONIA, 2010/2017 (ID 497)

Session Name
Vaccines - Impact of Vaccine programs and Serotype Replacement

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.

figure 1.jpg

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.

Hide

IMPACT OF PNEUMOCOCCAL CONJUGATED VACCINES ON CHILDHOOD PNEUMOCOCCAL MENINGITIS, 2002/2017 (ID 498)

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

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.

figure 1.jpg

Conclusions

Incidence of PCNS has declined 65% since 2002. It now occurs in older children and is most often caused by NVST.

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

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.

pneumo_boxplot_fig_11-30-2019.jpg

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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