Effectiveness of 13-valent pneumococcal conjugate vaccine against hypoxic pneumonia and hospitalisation in Eastern Highlands Province, Papua New Guinea: An observational cohort study

Blyth, Christopher C; Britton, Kathryn J.; Nguyen, Cattram; Sapura, Joycelyn; Kave, John; Nivio, Birunu; Chan, Jocelyn; Satzke, Catherine; Ford, Rebecca; Kirarock, Wendy; Lehmann, Deborah; Pomat, William; Russell, Fiona M.

doi:10.1016/j.lanwpc.2022.100432

Cited by 7 publications

(9 citation statements)

References 19 publications

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“…Pneumococcal conjugate vaccines (PCV) have been highly effective in reducing invasive pneumococcal disease [ 9 ]. While the target of PCV was to protect against invasive disease caused by Streptococcus pneumoniae , introduction of PCV programs have also shown protection against all-cause pneumonia in high-risk populations [ 10 , 11 ]. In a large randomized controlled trial of young children in South Africa, PCV lowered the risk of pneumonia associated with laboratory-confirmed RSV infection by 22% [ 12 ].…”

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confidence: 99%

Pneumococcal Conjugate Vaccines Are Protective Against Respiratory Syncytial Virus Hospitalizations in Infants: A Population-Based Observational Study

Gidding

Blyth

et al. 2023

Open Forum Infectious Diseases

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Background Pneumococcal conjugate vaccines (PCV) reduced the risk of respiratory syncytial virus (RSV) in a randomised clinical trial. We aimed to assess the real-world effectiveness of PCV on RSV-hospitalisations among Western Australian infants. Methods We conducted a population-based cohort study of births 2000-2012, using probabilistically linked individual-level immunisation, hospitalisation, respiratory microbiology testing and perinatal data. We performed Cox proportional hazard models with time varying exposure (receipt of infant PCV doses) against the first RSV-confirmed hospitalisation 0-12 months adjusted for perinatal and socio-demographic factors. Results From 360,994 children, three-dose PCV coverage in Aboriginal infants ranged from 29-51% in 2001-04 when PCV was funded for Aboriginal children only. Following universal funding in 2005, coverage increased to 85% for Aboriginal and 73% for non-Aboriginal infants. RSV-hospitalisation rates were highest in young infants 0-5 months (22.5/1000) and more than two times higher in Aboriginal infants than in non-Aboriginal infants. Receipt of 3 or more PCV doses in the universal funded period was associated with a 30% reduction in RSV-hospitalisation in Aboriginal infants (adjusted hazard ratio, aHR 0.70 [95% confidence interval, CI 0.46-1.06]) and 21% reduction in non-Aboriginal infants (aHR 0.79 [95% CI 0.63-0.99]) compared with unvaccinated infants. Conclusions Prior to the introduction of RSV vaccines, our study suggests that universal childhood PCV vaccination may result in a reduction in severe RSV infections in children and maybe important for countries who are yet to consider PCV programs.

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confidence: 99%

Pneumococcal Conjugate Vaccines Are Protective Against Respiratory Syncytial Virus Hospitalizations in Infants: A Population-Based Observational Study

Gidding

Blyth

et al. 2023

Open Forum Infectious Diseases

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“…A total of 27 serotype 33G isolates have now been detected, including in Thailand (n=5) (18), South Africa (n=2) (16) and Mongolia (this study, n=20). We have tested over 18,000 swabs from across Asia and have not detected 33G in any of our previous pneumococcal carriage studies in healthy children or children with acute respiratory infection including Lao PDR (55), Fiji (56), Vietnam (57), Indonesia (58) or Papua New Guinea (59). It will be interesting to see whether 33G will be identified in other countries in the future, especially as sequence-based analysis becomes more accessible.…”

Section: Discussionmentioning

confidence: 99%

Streptococcus pneumoniaeserotype 33G: genetic, serological, and structural analysis of a new capsule type

Manna,

Werren,

Ortika

et al. 2023

Preprint

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Streptococcus pneumoniae(the pneumococcus) is a human pathogen responsible for a spectrum of diseases such as pneumonia, sepsis, and meningitis. The capsule is the major pneumococcal virulence factor and is encoded by the capsular polysaccharide (cps) locus, a recombination hot spot that has resulted in over 100 distinct capsular polysaccharide types (serotypes) identified to date. Recently, 33X (also known as 10X) was proposed as a putative novel serotype, but the capsule structure had not been elucidated. Here, we provide an in-depth investigation of 33X, demonstrating it is a new pneumococcal capsular serotype. In this study, we screened 12,850 nasopharyngeal swabs from both healthy children and pneumonia patients (adults and children) in Mongolia collected between 2015-2022. We identified 20 pneumococcal 33X isolates. Using whole genome sequencing, we found that the 33Xcpslocus is a chimera of genes from pneumococcal serogroups 35, 10 and 33, as well as other Streptococcal species. Serotyping of 33X pneumococci by the Quellung reaction revealed a unique serological profile, typing as both 10B and 33B. Competitive ELISAs confirmed that antibodies that were generated in mice directed against 33X were inhibited by 33X pneumococci but not 10B or 33B. Lastly, elucidation of the 33X capsule structure revealed that the polysaccharide is distinct from other serotypes, consisting of an O-acetylated hexasaccharide repeat unit of →5)-β-Galf-(1→3)-β-Glcp-(1→5)-β-Galf2Ac-(1→3)-β-GalpNAc-(1→3)-α-Galp-(1→4)-Rib-ol-(5→P→. Therefore, 33X meets the requisite genetic, serological, and biochemical criteria to be designated as a new serotype, which we have named 33G.IMPORTANCEStreptococcus pneumoniae(the pneumococcus) is a bacterial pathogen with the greatest burden of disease in Asia and Africa. The pneumococcal capsular polysaccharide has biological relevance as a major virulence factor, as well as public health importance as it is the target for currently licensed vaccines. These vaccines have limited valency, covering up to 23 of the >100 known capsular types (serotypes) with higher valency vaccines in development. Here, we have characterized a new pneumococcal serotype, which we have named 33G. We detected serotype 33G in nasopharyngeal swabs (n=20) from children and adults hospitalized with pneumonia, as well as healthy children in Mongolia. We show that the genetic, serological, and biochemical properties of 33G differs from existing serotypes, satisfying the criteria to be designated as a new serotype. Future studies should focus on the geographical distribution of 33G and any changes in prevalence following vaccine introduction.

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“…Aetiology of moderate or severe pneumonia and meningitis in children aged <5 years enrolled through urban outpatient clinics or admitted to Eastern Highlands Provincial Hospital∗, Goroka, EHP‡ [25]…”

Section: Methodsmentioning

confidence: 99%

“…Specimen collection, blood and CSF culture, phenotypic pneumococcal serotyping and antimicrobial susceptibility have been described in detail elsewhere [1,2,15,19,25]. Serotyping and antimicrobial susceptibility for all studies were conducted at the PNGIMR laboratory in Goroka.…”

Section: Impact Statementmentioning

confidence: 99%

“…invasive disease surveillance † (blood culture), Goroka Hospital * , EHP ‡ Samples from children with meningitis/sepsis with no additional predefined puncture indicated in PNG child with febrile convulsion? (Modilon Hospital, Madang Province)[23,45] Hospitalised children with one or more fever associated seizure or severe pneumonia and meningitis in children aged <5 years enrolled through urban outpatient clinics or admitted to Eastern Highlands Provincial Hospital * , Goroka, EHP ‡[25] Samples from children with pneumonia and meningitis, no additional predefined Regional Hospital previously known as Goroka General Hospital, Goroka Base Hospital, and Goroka Hospital; Goroka located in the Asaro Valley. †Opportunistic sampling as requested by paediatrician.…”

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Distinct Streptococcus pneumoniae cause invasive disease in Papua New Guinea

Mellor

Yoannes

et al. 2022

Microbial Genomics

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Streptococcus pneumoniae is a key contributor to childhood morbidity and mortality in Papua New Guinea (PNG). For the first time, whole genome sequencing of 174 isolates has enabled detailed characterisation of diverse S. pneumoniae causing invasive disease in young children in PNG, 1989-2014. This study captures the baseline S. pneumoniae population prior to the introduction of 13-valent pneumococcal conjugate vaccine (PCV13) into the national childhood immunisation programme in 2014. Relationships amongst lineages, serotypes and antimicrobial resistance traits were characterised, and the population was viewed in the context of a global collection of isolates. The analyses highlighted adiverse S. pneumoniae population associated with invasive disease in PNG, with 45 unique Global Pneumococcal Sequence Clusters (GPSCs) observed amongst the 174 isolates reflecting multiple lineages observed in PNG that have not been identified in other geographic locations. The majority of isolates were from children with meningitis, of which 52% (n=72) expressed non-PCV13 serotypes. Over a third of isolates were predicted to be resistant to at least one antimicrobial. PCV13 serotype isolates had 10.1 times the odds of being multidrug-resistant (MDR) compared to non-vaccine serotype isolates, and no isolates with GPSCs unique to PNG were MDR. Serotype 2 was the most commonly identified serotype; we identified a highly clonal cluster of serotype 2 isolates unique to PNG, and a distinct second cluster indicative of long-distance transmission. Ongoing surveillance, including whole-genome sequencing, is needed to ascertain the impact of the national PCV13 programme upon the S. pneumoniae population, including serotype replacement and antimicrobial resistance traits.

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Effectiveness of 13-valent pneumococcal conjugate vaccine against hypoxic pneumonia and hospitalisation in Eastern Highlands Province, Papua New Guinea: An observational cohort study

Cited by 7 publications

References 19 publications

Pneumococcal Conjugate Vaccines Are Protective Against Respiratory Syncytial Virus Hospitalizations in Infants: A Population-Based Observational Study

Pneumococcal Conjugate Vaccines Are Protective Against Respiratory Syncytial Virus Hospitalizations in Infants: A Population-Based Observational Study

Streptococcus pneumoniaeserotype 33G: genetic, serological, and structural analysis of a new capsule type

Distinct Streptococcus pneumoniae cause invasive disease in Papua New Guinea

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