Decrease of invasive pneumococcal disease (IPD) in adults after introduction of pneumococcal 13-valent conjugate vaccine in Spain

Abstract

A prospective laboratory-based multicenter study that collected all adult invasive pneumococcal disease (IPD) episodes from 6 Spanish hospitals before (2008–2009) and after (2012–2013). The 13-valent pneumococcal conjugate vaccine (PCV13) licensure was conducted in order to analyze the impact of PCV13 introduction for children on adult IPD. A total of 1558 IPD episodes were detected. The incidence of IPD decreased significantly in the second period by -33.9% (95% CI, -40.3% to -26.8%). IPD due to PCV7 serotypes (-52.7%; 95% CI, -64.2% to -37.5%) and to PCV13 additional serotypes (-55.0% 95% CI, -62.0% to -46.7%) significantly decreased whereas IPD due to non-PCV13 serotypes remained stable (1.0% 95% CI, -12.9% to 17.2%). IPD due to all PCV13 additional serotypes significantly declined with the exception of serotype 3 (-11.3%; 95%CI -35.0% to 21.1%). IPD due to two non-PCV13 serotypes varied: serotype 6C that rose (301.6%; 95%CI, 92.7% to 733.3%, p<0.001), related to the expansion of ST3866C, and serotype 8 that decreased (-34.9%, 95%CI, -57.1 to -1.2, p = 0.049), related to a decline of the ST638. The recombinant clone ST652111A (variant of ST1569V) increased in frequency. The decrease of serotype 19A IPD was linked to a fall in those antibiotic susceptible clones. In the last period, rates of penicillin- and cefotaxime-resistance remained under 10% and 4%, respectively. Adult IPD decreased after the PCV13 introduction in Spain due to herd protection. The spread of multidrug resistant clones (ST3866C, ST652111A) related to non-PCV13 serotypes needs further surveillance.

Novel Immunoprotective Proteins of Streptococcus pneumoniae Identified by Opsonophagocytosis Killing Screen

“…The broadest PPV and PCV vaccines include 23 (e.g., Pneumovax) and 13 (e.g., Prevnar 13) serotypes, respectively. While the CPS-based vaccines have substantially reduced invasive pneumococcal disease (IPD) in the countries where the vaccines are used (9), their impact is in part hampered by limited coverage of pathogen serotypes. A recent carriage study in children revealed that, after introduction of PCVs, many new isolates with non-PCV13 capsular types have emerged (e.g., types 22F, 12F, 33F, 24F, 15C, 15B, 23B, 10A, and 38) (10).…”

Two multi-fragment recombination events resulted in the β-lactam-resistant serotype 11A-ST6521 related to Spain9V-ST156 pneumococcal clone spreading in south-western Europe, 2008 to 2016

“…Current prevention of pneumococcal infections is based on vaccination and vaccines are serotype-dependent, offering protection against a subset of known serotypes. Only 13 serotypes are included in the conjugate vaccine with the highest available valency, PCV13; its widespread use changed the worldwide serotype distribution [1]. During a multicentre study, a clonal replacement was observed among invasive pneumococci of serotype 11A (not included in PCV13), associated with the emergence of β-lactam resistance.…”

“…Pneumococci can invade sterile sites causing different invasive pneumococcal diseases (IPD) such as bacteraemic pneumonia, meningitis or primary bacteraemia. Furthermore, pneumococci cause other non-invasive diseases such as acute otitis media in children or acute exacerbations of COPD in adults [1,2]. The polysaccharide capsule, which presents one of more than 97 serotypes, is the main virulence factor and its diversity has been associated with differences in invasiveness and mortality.…”

“…The emergence of new recombinant clones along with serotype replacement has changed the serotype distribution after the introduction of paediatric vaccination [4,5]. Among them, an increase in serotype 11A, not included in PCV13, has been reported worldwide [1,4,6,7]. Many studies suggest that serotype 11A has a low invasive potential [5] being present mainly in child carriers [8] and patients with chronic obstructive pulmonary disease (COPD) [9].…”

Invasive Pneumococcal Disease in Children below 14 Years before and after the Introduction of Pneumococcal Conjugated Vaccine

“…Serotype prevalence varies significantly in different countries and in different seasons [9]. It also has a cycling pattern every 3-5 years.…”