Distribution of 13-Valent Pneumococcal Conjugate Vaccine Streptococcus pneumoniae Serotypes in US Adults Aged &gt;=50 Years With Community-Acquired Pneumonia

Sherwin, Robert; Gray, Sharon; Alexander, Ronika; McGovern, Paul C.; Graepel, Jay; Pride, Michael W.; Purdy, Jay; Paradiso, Peter R.; File, Thomas M.

doi:10.1093/infdis/jit506

Cited by 85 publications

(85 citation statements)

References 28 publications

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“…Reductions in the incidence of PCV7-type IPD were also seen in the unvaccinated adult population, due to herd protection effects. However, invasive pneumococcal disease accounts for only 7-14% of pneumococcal CAP in adults presenting to hospitals [3,8]. Changes in pneumococcal serotype distribution implicated in adult non-bacteraemic pneumococcal disease as a consequence of the introduction of PCV13 have not been reported to date.…”

Section: Introductionmentioning

confidence: 99%

Impact of infant 13-valent pneumococcal conjugate vaccine on serotypes in adult pneumonia

et al. 2015

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Infant 13-valent pneumococcal conjugate vaccination (PCV13) was introduced to the UK in 2010. Its impact on serotypes implicated in adult non-bacteraemic pneumococcal pneumonia is not known.Beginning in 2008, a 5-year prospective cohort study of adults admitted to hospital with communityacquired pneumonia (CAP) was conducted. Pneumococcal serotype was established using a validated multiplex immunoassay (Bio-Plex; Bio-Rad, Hercules, CA, USA).The overall incidence for hospitalised CAP and pneumococcal CAP was 79.9 (95% CI 76.6-83.3) and 23.4 (95% CI 21.6-25.3) per 100 000 population, respectively. A decline in CAP (incidence rate ratio (IRR) per year 0.96, 95% CI 0.94-0.99; p=0.016) and pneumococcal CAP (IRR per year 0.84, 95% CI 0.80-0.89; p<0.001) was observed over the 5-year period of the study. Between the pre-and post-PCV13 periods of the study, the incidence of CAP due to serotypes included in the PCV7 declined by 88% (IRR 0.12, 95% CI 0.08-0.20; p<0.001), and CAP due to the additional 6 serotypes in PCV13 declined by 30% (IRR 0.70, 95% CI 0.51-0.96; p=0.024).Incidence of adult pneumococcal pneumonia declined over the last 5 years, with serotypes included in PCV13 declining post-PCV13 introduction, indicating early herd protection effects from PCV13 infant vaccination on adult non-bacteraemic disease. These effects may accrue over the coming years with implications for national pneumococcal vaccination policies in adults. @ERSpublications This is the first study to indicate herd protection from infant PCV13 on adult non-bacteraemic pneumococcal pneumonia

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Section: Introductionmentioning

confidence: 99%

Impact of infant 13-valent pneumococcal conjugate vaccine on serotypes in adult pneumonia

et al. 2015

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“…Previously, diagnosis was dependent on assays that relied on isolation of the organism (culture) or that had insufficient sensitivity and specificity (such as BinaxNOW). 36 Most earlier randomized studies of vaccination with either free polysaccharide vaccines in older adults 37 or pneumococcal conjugate vaccines in HIV-infected adults 21 were underpowered to show efficacy against vaccinetype community-acquired pneumonia; results of these studies and other observational studies have been inconsistent. [11][12][13][14] Our study had several limitations.…”

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Polysaccharide Conjugate Vaccine against Pneumococcal Pneumonia in Adults

et al. 2015

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BACKGROUNDPneumococcal polysaccharide conjugate vaccines prevent pneumococcal disease in infants, but their efficacy against pneumococcal community-acquired pneumonia in adults 65 years of age or older is unknown. METHODSIn a randomized, double-blind, placebo-controlled trial involving 84,496 adults 65 years of age or older, we evaluated the efficacy of 13-valent polysaccharide conjugate vaccine (PCV13) in preventing first episodes of vaccine-type strains of pneumococcal community-acquired pneumonia, nonbacteremic and noninvasive pneumococcal community-acquired pneumonia, and invasive pneumococcal disease. Standard laboratory methods and a serotype-specific urinary antigen detection assay were used to identify community-acquired pneumonia and invasive pneumococcal disease. RESULTSIn the per-protocol analysis of first episodes of infections due to vaccine-type strains, community-acquired pneumonia occurred in 49 persons in the PCV13 group and 90 persons in the placebo group (vaccine efficacy, 45.6%; 95.2% confidence interval [CI], 21.8 to 62.5), nonbacteremic and noninvasive community-acquired pneumonia occurred in 33 persons in the PCV13 group and 60 persons in the placebo group (vaccine efficacy, 45.0%; 95.2% CI, 14.2 to 65.3), and invasive pneumococcal disease occurred in 7 persons in the PCV13 group and 28 persons in the placebo group (vaccine efficacy, 75.0%; 95% CI, 41.4 to 90.8). Efficacy persisted throughout the trial (mean follow-up, 3.97 years). In the modified intention-totreat analysis, similar efficacy was observed (vaccine efficacy, 37.7%, 41.1%, and 75.8%, respectively), and community-acquired pneumonia occurred in 747 persons in the PCV13 group and 787 persons in placebo group (vaccine efficacy, 5.1%; 95% CI, −5.1 to 14.2). Numbers of serious adverse events and deaths were similar in the two groups, but there were more local reactions in the PCV13 group. CONCLUSIONSAmong older adults, PCV13 was effective in preventing vaccine-type pneumococcal, bacteremic, and nonbacteremic community-acquired pneumonia and vaccinetype invasive pneumococcal disease but not in preventing community-acquired pneumonia from any cause. (Funded by Pfizer; CAPITA ClinicalTrials.gov number NCT00744263.)

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“…Conjugate polysaccharide vaccines, which incorporate a protein carrier (diphtheria toxin cross-reactive material 197 [CRM 197 ]) to the purified capsular saccharides of S. pneumoniae, elicit a more robust immunological memory (9). The 13-valent pneumococcal conjugate vaccine (PCV13) includes serotypes 19A, 7F, 3, 5, and 6A, which are the most common causes of pneumococcal pneumonia in adults Ͼ50 years of age (11). The response to PCV13 in patients with ESRD and on dialysis has not been well studied, and data on long-term immunogenicity after vaccination in this subset of patients are lacking.…”

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confidence: 99%

Immunogenicity of 13-Valent Conjugate Pneumococcal Vaccine in Patients 50 Years and Older with End-Stage Renal Disease and on Dialysis

Mitra

Stein

Bhupalam

et al. 2016

Clin Vaccine Immunol

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Patients with end-stage renal disease (ESRD) and on dialysis are at increased risk of pneumococcal disease. We evaluated the immunogenicity of the 13-valent pneumococcal conjugate vaccine (PCV13) in this population. Eligible patients with ESRD and on dialysis were given a single dose of PCV13. The concentrations of serum antibodies against 13 pneumococcal capsular polysaccharides were measured at the baseline and at 2 and 12 months postvaccination. A response to the vaccine was defined as a >2-fold increase in antibody concentration from that at the baseline and an absolute postvaccination value of at least 1 g/ml. Seventeen patients completed the study. Increases in the concentrations of antibodies to the vaccine serotype were demonstrated 2 months after vaccination. The geometric mean antibody concentrations at 12 months postvaccination declined by 38% to 72% compared to those measured at 2 months postvaccination. A response to at least 1 serotype in the vaccine was seen in all patients at both 2 and 12 months postvaccination. The overall rate of the response to each individual vaccine serotype varied between 23.5% and 94.1% at 2 months postvaccination and 23.5% and 65% at 12 months postvaccination. Pain at the injection site was the most common local reaction. Vaccination with PCV13 induces antibody responses to vaccine serotypes in patients with ESRD and on dialysis at 2 months postvaccination. However, the decline in antibody concentrations at 12 months postvaccination with a conjugate pneumococcal vaccine requires further study. (This study has been registered at ClinicalTrials.gov under registration no. NCT01974817.) P atients with end-stage renal disease (ESRD) and on dialysis are predisposed to infections with Streptococcus pneumoniae (1). Mortality rates from pneumonia in dialysis patients are about 10 to 16 times higher than those in the general population (2, 3). Furthermore, the emergence of multiple-antibiotic-resistant pneumococcal strains has added to this therapeutic challenge. This has led to an increased focus on vaccination for the prevention of pneumococcal diseases in this subset of patients.End-stage renal disease is associated with disorders of the adaptive immune system, which result in decreases in antigenpresenting function, the T-cell-mediated immune response, and immunological memory (4, 5). These patients are thus at risk of vaccine hyporesponsiveness. There is evidence of a decreased immunologic response to the 23-valent pneumococcal polysaccharide vaccine (PPSV23) in patients undergoing dialysis compared to that in the general population (6, 7). Moreover, a rapid decline in anti-pneumococcal IgG levels is observed in patients with ESRD within 1 year after vaccination with PPSV23 (8).PPSV23 predominantly induces a T-cell-independent immune response, and hence, immunologic memory is not achieved (9, 10). Conjugate polysaccharide vaccines, which incorporate a protein carrier (diphtheria toxin cross-reactive material 197 [CRM 197 ]) to the purified capsular saccharides of S. pneumoni...

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Distribution of 13-Valent Pneumococcal Conjugate Vaccine Streptococcus pneumoniae Serotypes in US Adults Aged >=50 Years With Community-Acquired Pneumonia

Cited by 85 publications

References 28 publications

Impact of infant 13-valent pneumococcal conjugate vaccine on serotypes in adult pneumonia

Impact of infant 13-valent pneumococcal conjugate vaccine on serotypes in adult pneumonia

Polysaccharide Conjugate Vaccine against Pneumococcal Pneumonia in Adults

Immunogenicity of 13-Valent Conjugate Pneumococcal Vaccine in Patients 50 Years and Older with End-Stage Renal Disease and on Dialysis

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