Welcome to the WSPID 2022 Virtual Congress Calendar

Background

New Zealand has changed pneumococcal conjugate vaccine (PCV) several times since 2008, more recently changing PCV13 to PCV10. Globally, some regions which have made this switch have had a rise in serotype 19A IPD rates. The World Health Organisation concluded in 2019 that there is no evidence PCV10 produces indirect protection against serotype 19A (WHO Position Paper 2019).

Aims

To determine the changes in pneumococcal serogroups causing IPD in New Zealand children

Methods

IPD notification data from the Institute of Environmental Science and Research (ESR), Census data and information from the National Immunisation Register were merged to examine serotype trends over time. Antimicrobial resistance analyses were conducted at the ESR.

Results

The overall rates of IDP have reduced between 2011 and 2020. Following the change to PCV10 in 2017 incidence of serotype 19A in children <2 years increased from 0.0 to 7.3 cases per 100,000, whilst PCV10 preventable serotypes continued to decrease. In children < 5 years the proportion of vaccine-preventable cases that are serotype 19A increased from 50% (2011), to 57% (2017), to 100% (2020). Penicillin resistance of serotype 19A isolates has increased from 20% in 2010 to 65% in 2019.

Conclusions

Since the reintroduction of PCV10 serotype 19A has become the dominant vaccine-preventable serotype causing IPD in children < 5 years. This data supports the WHO position that PCV10 does not provide clinically significant cross-cover for serotype 19A. These epidemiological changes and increasing antimicrobial resistance of serotype 19A cases highlight the need to review NZ’s pneumococcal vaccine choice.

Background

India has been significantly progressed in full immunization care over the last few decades. Existing literature has not been unaddressed the potential spatial variations in relationships between full immunization coverage and its influence on socio-economic factors.

Aims

This study aims to explore place-specific spatially varying relationships between district-level complete immunization coverage and socio-economic and healthcare factors in India using the 4th wave of the National Family Health Survey, 2015–16.

Methods

Univariate Moran’s I and LISA maps were used to confirm the spatial autocorrelation and geographical hotspots of the district-level full immunization coverage. Multivariate Ordinary Least Squares and Geographically Weighted Regression models were employed to examine spatial relationships and to decrypt location-based district-level analysis.

Results

The prevalence of full immunization care was 62% as per the national figure. The GWR results revealed that the relationships between outcome and set of cofactors were significantly place-specific and spatially clustering in terms of their respective magnitude, direction, and differences in due to local characteristics across India. In terms of model performance and prediction accuracy, the GWR model was performing better over OLS estimates through comparisons of R2 and Akaike Information Criterion (AICC) in both models.

Conclusions

Thus, the findings suggest that the local GWR model has the potential to explain complexities in place-specific variations that could be ignored by OLS on the local causes of immunization coverage. Highlighting the socio-economic importance of spatial dependence and heterogeneity, appropriate intervention should be devised to safeguard the child from vaccine-preventable diseases reduce the geographical heterogeneity of full immunization coverage across India.

Background

Otitis media (OM) is a common childhood infection and a reason for antibiotic prescriptions. Pneumococcal conjugate vaccines (PCVs) prevent initial OM episodes, thereby reducing both short- and long-term clinical, economic, humanistic, and societal consequences (Figure 1). These broader societal impacts associated with OM prevention are rarely quantified or included in cost-effectiveness analyses (CEAs) of PCVs.

Aims

Estimate the broader impact of preventing OM in children less than 5 years old following PCV use in the United States (US).

Methods

A literature review was conducted on the long-term broader implications of OM. Data were then used from US studies to retrospectively estimate the societal burden of OM avoided due to pediatric PCV use.

Results

PCV use has been estimated to avert more than 97 million cases of OM over 20 years in the US. Extrapolating from this estimation, 5,235 deaths and 542,086 cases of hearing loss have been avoided. Twenty-year nationwide societal returns were realized, with over 131.8 million parental workdays gained and over 59.6 million absent daycare days avoided. Health system benefits include over 1.3 and 1.4 million days saved in clinic wait and physician consultation time, respectively, as well as over 83.6 million avoided antibiotic prescriptions (Figure 2).

Conclusions

PCVs’ role in preventing OM has led to substantial broader value beyond averted cases in the US population. PCVs in development may further reduce OM cases and increase broader benefits. Future CEAs of PCVs should include broader benefits of OM prevention for communicating the full value to diverse US stakeholders and improving implementation.

Background

MenB-FHbp vaccine (Trumenba^®; bivalent rLP2086; Pfizer Inc, Philadelphia, PA) is licensed to prevent meningococcal serogroup B disease in Europe (≥10 years) and the United States (10-25 years). A MenABCWY vaccine containing MenB-FHbp is being developed.

Aims

Assess immunogenicity against serogroup B and safety of MenB-FHbp (2-dose schedule) and MenABCWY.

Methods

Participants (10-25 years) received MenB-FHbp (months 0,6) and MenACWY-CRM (month 0) or MenABCWY (months 0,6). Endpoints included percentages of participants achieving ≥4-fold increase from baseline in serum bactericidal assay using human complement (hSBA) titers for 4 primary serogroup B test strains and titers ≥lower limit of quantitation (LLOQ; 1:8 or 1:16) for primary strains combined (composite response) after dose 2 of MenB-FHbp or MenABCWY; a titer ≥1:4 is the accepted correlate of protection. Safety was assessed.

Results

Percentage of participants (n=814-850) achieving ≥4-fold increases in hSBA titers against primary strains after MenB-FHbp dose 2 ranged from 67.4%-95.0%; composite response was 74.3% (Figure 1). After MenABCWY dose 2, percentage of participants (n=418-432) achieving ≥4-fold increases in hSBA titers ranged from 75.8%-94.7%; composite response was 79.9% (Figure 2). For MenB-FHbp, most reactogenicity events were mild-to-moderate in severity. Adverse events (AEs), serious AEs, medically attended AEs, and newly diagnosed chronic medical conditions were reported by 40.7%, 0.8%, 26.7%, and 0.8% of participants, respectively. Safety and tolerability of MenABCWY was similar to MenB-FHbp.

Conclusions

MenB-FHbp at 0,6 months was well-tolerated and induced protective bactericidal antibody responses, supporting the 2-dose MenB-FHbp schedule. Results also support continued evaluation of MenABCWY .

Trial Registration: ClinicalTrials.gov: NCT03135834.

Background

Pneumococcal conjugate vaccines (PCVs) have reduced the proportion of vaccine-types isolates and resistance to antibiotics. In 2011, Colombia introduced PCV10 in routine childhood immunization program.

Aims

To determine pneumococcal lineages and antimicrobial resistance (AMR) genes in post-vaccine childhood using WGS.

Methods

Hundred and ten Streptococcus pneumoniae isolates recovered from children under 5 years old by passive laboratory surveillance during 2015-2018 were analyzed. Isolates were serotyped by Quellung and antimicrobial susceptibility was determined by broth micro-dilution. All isolates had resistance to one or more antibiotics. WGS was performed by Illumina in Sanger Institute. Global Pneumococcal Sequencing Cluster (GPSC) and penicillin-binding protein (PBPs) variants were assigned using Pathogenwatch. AMR genes were determined using GHRU-AMR pipelines protocols. Data was visualized on Microreact.

Results

Isolates were collected from patients with pneumonia (36.4%), sepsis (18.2%) and meningitis (10.9%). Eighteen lineages were identified. GPSC1 was the most abundant (n=66; 60%), composed by multidrug-resistant serotype 19A-ST320 (n=57), 19A-ST1451 (n=5) and 19A-ST13455 (n=3), which predominantly contained PBP1a, PBP2b, and PBP2x profile 13-11-16 with penicillin MIC >4ug/ml and AMR genes ermB-mefA-msr, tetM, and folP were found. GPSC10 included 19A-ST276 (n=10) and 24-ST230 (n=2), 75% with PBP profile 17-39-18 and penicillin MIC of 2-4ug/ml and carried ermB and tetM genes. GPSC5 and GPSC48 contained non-PVC10 isolates exhibited different PBP profiles and two had mefA-msrD and tetM genes.

Conclusions

WGS is a tool useful for surveillance and understanding the genetic composition of GPSCs associated with resistance that could be used to predict the impact of the vaccine and to design strategies for pneumococcal disease control.

Background

Maternal immunisation is a recommended strategy for protecting young infants from pertussis-related morbidity and mortality. Between 2014-2015, Australian jurisdictions introduced and funded diphtheria-tetanus-acellular pertussis (dTpa) vaccination programs for women from 28 weeks of pregnancy.

Aims

We aimed to estimate the effectiveness of maternal pertussis immunisation overall and by gestational age at dTpa vaccination.

Methods

We established a population-based cohort of mother-infant pairs between 2014 and 2017 using probabilistic linkage of three Australian jurisdictional data collections: Western Australia, Northern Territory and Queensland. Jurisdictional immunisation records were used to define maternal vaccination status; notification records were used to identify pertussis infections in infants from 0-6 months of age. Risk ratios (RR) were estimated using log-binomial regression weighted by inverse probability of vaccination. We estimated vaccine effectiveness (VE) as 1-RR overall and by gestational age at vaccination.

Results

Among 294,342 mother-infant pairs, 51.5% received dTpa vaccination during pregnancy, predominantly between 28­–31 weeks of pregnancy. VE was 74% (95% CI 54%, 86%) among <2 month olds, 64% (95% CI 31%, 81%) in 3–4 month olds, and 60% (95% CI 28%, 77%) in 5–6 month olds. We observed similar estimates of VE for pregnancies immunized prior to 28 weeks (VE: 72% 95% CI 37%, 88%) and pregnancies immunized at 32 weeks or later (VE 68%; 95% CI 40%, 83%).

Conclusions

Results support current policies recommending dTpa vaccination during pregnancy and indicate vaccination is effective when administered prior to 28 weeks of gestation. Pertussis immunisation during pregnancy could prevent a majority of pertussis cases in infants <6 months of age.