Monica Farley, United States of America

Author Of 5 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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STREPTOCOCCUS PNEUMONIAE (SP) NASOPHARYNGEAL CARRIAGE (NPC) AMONG ADOLESCENTS AGE 11-17 YEARS, ATLANTA, GA, USA 2018 (ID 1000)

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

Abstract

Background

Pneumococcal nasopharyngeal carriage (SP-NPC) in children aged <5 years is well-described. Less is known about SP-NPC in adolescents. SP-NPC studies in Atlanta documented carriage rates of ~30% in children aged <5 years. We evaluated SP-NPC in adolescents.

Methods

NP swabs collected from children aged 11-17 years in an Atlanta emergency department from December 2017-December 2018 were broth-enriched, cultured for SP, and serotyped. Demographics and medical and immunization records were collected.

Results

Of 260 adolescents enrolled, 8 (3.1%) had SP-NPC. Mean age of enrollees was 13.5 years (12.9 years for carriers); 58% were female (63% for carriers). 72% had no documented underlying conditions (50% for carriers). 50% of carriers reported having asthma. Among enrollees with immunization records available, 132/219 (60%) overall and 5/6 (83%) carriers were fully immunized for SP with PCV7. 2 carried vaccine serotypes (VT): S3 (PCV13 VT), S19F (PCV7/13 VT) but were immunized with PCV7 only. 6 carried non-VT: S6C, S15C, S21, S23A, S23B, S37.

Conclusions

Adolescent SP-NPC was low compared to children aged <5 years in Atlanta, GA USA, illustrating adolescents’ limited role in SP-NPC. Adolescent SP-NPC of mostly non-VT, despite lack of PCV13 immunization, supports successes of routine pediatric vaccination and herd immunity.

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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).

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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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DETECTION OF STREPTOCOCCUS PNEUMONIAE (SP) NASOPHARYNGEAL CARRIAGE (NPC) BY PCR ON DNA ISOLATED FROM PEDIATRIC NP SWABS PREVIOUSLY DETERMINED TO BE SP-NPC NEGATIVE BY CULTURE (ID 916)

Session Name
Clinical Sciences - Diagnosis
Presenter
Authors

Abstract

Background

Monitoring Streptococcus pneumoniae nasopharyngeal carriage (SP-NPC) and SP serotype distribution is critical to evaluate the impact and efficacy of pneumococcal vaccine programs. The gold standard for pneumococcal colonization and serotype distribution is culture, followed by serotyping with antisera. Detection of very low density SP colonization or concurrent colonization by multiple serotypes may be missed by culture. Real-Time PCR (RT-PCR) targeting SP genes lytA (major autolysin) and SP2020 (putative transcriptional regulator) has been identified as a powerful and sensitive molecular strategy for identification of SP.

Methods

NP swabs collected from children <5 years in an emergency department in Atlanta, GA in 2017 were broth-enriched, cultured for SP, and serotyped. RT-PCR targeting lytA and SP2020 was performed on all NP swabs negative for SP by culture. Subsequent RT-PCR targeting capsule polysaccharide-specific cpsA, associated with encapsulated SP strains, was performed on all ltyA and SP2020-positive/culture-negative NP swabs.

Results

622 children were enrolled; 182 (29.3%) had SP-NPC by culture. Of the 440 culture-negative, 59/440 (13.4%) were positive for lytA/SP2020 with 45/59 (76.2%) cspA+.

Conclusions

Molecular detection of SP from NP swabs increased carriage from 29.3% to 38.7%. 76.2% of SP identified by RT-PCR appear to be encapsulated and molecular serotyping is currently underway.

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IMPACT OF 13-VALENT PNEUMOCOCCAL CONJUGATE VACCINE (PCV13) ON NON-BACTEREMIC PNEUMOCOCCAL PNEUMONIA (NBPP) IN THE UNITED STATES 2013-2017 (ID 222)

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

Abstract

Background

PCV13 was recommended for U.S. children in 2010 and for adults ≥65 years in 2014. Vaccine coverage among adults ≥65 years was 43% in 2017. We evaluated PCV13 impact on NBPP among adults.

Methods

NBPP cases (clinically or radiographically-confirmed pneumonia and a positive pneumococcal urine antigen test in a hospitalized adult aged ≥18 years) were identified at select hospitals in 10 sites within CDC’s Active Bacterial Core surveillance during 2013-2017. NBPP rates (cases per 100,000) were estimated using U.S. Census Bureau population denominators and adjusted for the proportion of pneumonia patients tested by UAT and the number of pneumonia admissions in the catchment area.

Results

Between 2013 and 2017, 4,430 NBPP cases were identified. From 2013 to 2014, rates of NBPP declined from 153 to 90 (41% reduction, 95%CI 30%, 51%) in ≥65 year-olds; 60 to 40 (34% reduction, 95%CI 22%, 45%) in 50-64 year-olds; and 15 to 10 (36% reduction, 95%CI 25%, 47%) in 18-49 year-olds. From 2014 to 2017, rates of NBPP increased in all ages but remained below 2013 rates (Figure).

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Conclusions

Reductions in NBPP among adults were primarily due to indirect effects of PCV13 use in children, with no additional declines following PCV13 introduction for adults aged ≥65 years.

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