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Emergence of invasive pneumococcal disease caused by nonvaccine serotypes in the era of 7-valent conjugate vaccine.
Clin Infect Dis. 2008 Jan 15; 46(2):174-82.CI

Abstract

BACKGROUND

Little is known about the epidemiology of invasive pneumococcal disease (IPD) after the introduction of 7-valent pneumococcal conjugate vaccine (PCV7) in Spain and other European countries.

METHODS

We performed a 10-year prospective study including all children with culture-proven IPD admitted to Sant Joan de Deu Hospital, a children's center in the southern area of Barcelona, Catalonia, Spain. PCV7 was introduced in June 2001, and the current estimate of PCV7 coverage is 45%-50%.

RESULTS

Comparing the prevaccine period (1997-2001) with the vaccine period (2002-2006), among children aged <2 years, the rate of IPD increased from 32.4 episodes per 100,000 population to 51.3 episodes per 100,000 population (an increase of 58%; 95% confidence interval, 2%-145%), and among children aged 2-4 years, the rate increased from 11.3 episodes per 100,000 population to 26.5 episodes per 100,000 population (an increase of 135%; 95% confidence interval, 31%-320%). At clinical presentation, the rate of pneumonia and/or empyema among children aged <5 years increased from 3.6 episodes per 100,000 population to 15.1 episodes per 100,000 population (an increase of 320%; 95% confidence interval, 98%-790%). These increased rates of IPD were caused by non-PCV7 serotypes, which represented 38% and 72% of infecting serotypes in the prevaccine and vaccine periods, respectively (P=.001). Penicillin resistance decreased from 48% in the prevaccine period to 27% in the vaccine period (P=.005). In the vaccine period, there was an emergence of previously established virulent clones of non-PCV7 serotypes 1 and 5. There was also an increase in the prevalence of serotypes 19A and 6A expressed with different clonal types, including Spain(23F)-1 and Spain(6B)-2.

CONCLUSIONS

Since the introduction of PCV7 for children, there has been an emergence of IPD caused by virulent clones of non-PCV7 serotypes that has been associated with significant clinical changes and a decrease in antibiotic resistance.

Authors+Show Affiliations

Department of Microbiology, Hospital Universitari Sant Joan de Deu, Esplugues, Spain.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18171247

Citation

Muñoz-Almagro, Carmen, et al. "Emergence of Invasive Pneumococcal Disease Caused By Nonvaccine Serotypes in the Era of 7-valent Conjugate Vaccine." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 46, no. 2, 2008, pp. 174-82.
Muñoz-Almagro C, Jordan I, Gene A, et al. Emergence of invasive pneumococcal disease caused by nonvaccine serotypes in the era of 7-valent conjugate vaccine. Clin Infect Dis. 2008;46(2):174-82.
Muñoz-Almagro, C., Jordan, I., Gene, A., Latorre, C., Garcia-Garcia, J. J., & Pallares, R. (2008). Emergence of invasive pneumococcal disease caused by nonvaccine serotypes in the era of 7-valent conjugate vaccine. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 46(2), 174-82. https://doi.org/10.1086/524660
Muñoz-Almagro C, et al. Emergence of Invasive Pneumococcal Disease Caused By Nonvaccine Serotypes in the Era of 7-valent Conjugate Vaccine. Clin Infect Dis. 2008 Jan 15;46(2):174-82. PubMed PMID: 18171247.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Emergence of invasive pneumococcal disease caused by nonvaccine serotypes in the era of 7-valent conjugate vaccine. AU - Muñoz-Almagro,Carmen, AU - Jordan,Iolanda, AU - Gene,Amadeo, AU - Latorre,Cristina, AU - Garcia-Garcia,Juan J, AU - Pallares,Roman, PY - 2008/1/4/pubmed PY - 2008/2/27/medline PY - 2008/1/4/entrez SP - 174 EP - 82 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin Infect Dis VL - 46 IS - 2 N2 - BACKGROUND: Little is known about the epidemiology of invasive pneumococcal disease (IPD) after the introduction of 7-valent pneumococcal conjugate vaccine (PCV7) in Spain and other European countries. METHODS: We performed a 10-year prospective study including all children with culture-proven IPD admitted to Sant Joan de Deu Hospital, a children's center in the southern area of Barcelona, Catalonia, Spain. PCV7 was introduced in June 2001, and the current estimate of PCV7 coverage is 45%-50%. RESULTS: Comparing the prevaccine period (1997-2001) with the vaccine period (2002-2006), among children aged <2 years, the rate of IPD increased from 32.4 episodes per 100,000 population to 51.3 episodes per 100,000 population (an increase of 58%; 95% confidence interval, 2%-145%), and among children aged 2-4 years, the rate increased from 11.3 episodes per 100,000 population to 26.5 episodes per 100,000 population (an increase of 135%; 95% confidence interval, 31%-320%). At clinical presentation, the rate of pneumonia and/or empyema among children aged <5 years increased from 3.6 episodes per 100,000 population to 15.1 episodes per 100,000 population (an increase of 320%; 95% confidence interval, 98%-790%). These increased rates of IPD were caused by non-PCV7 serotypes, which represented 38% and 72% of infecting serotypes in the prevaccine and vaccine periods, respectively (P=.001). Penicillin resistance decreased from 48% in the prevaccine period to 27% in the vaccine period (P=.005). In the vaccine period, there was an emergence of previously established virulent clones of non-PCV7 serotypes 1 and 5. There was also an increase in the prevalence of serotypes 19A and 6A expressed with different clonal types, including Spain(23F)-1 and Spain(6B)-2. CONCLUSIONS: Since the introduction of PCV7 for children, there has been an emergence of IPD caused by virulent clones of non-PCV7 serotypes that has been associated with significant clinical changes and a decrease in antibiotic resistance. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/18171247/Emergence_of_invasive_pneumococcal_disease_caused_by_nonvaccine_serotypes_in_the_era_of_7_valent_conjugate_vaccine_ DB - PRIME DP - Unbound Medicine ER -