Incidence of pneumococcal disease from 2003 to 2019 in children ≤17 years in England

Abstract

Background Pneumococcal disease is a leading cause of communicable disease morbidity and mortality globally. We aimed to estimate invasive pneumococcal disease (IPD), pneumococcal pneumonia (PP) and all-cause pneumonia (ACP) incidence rates (IRs) in children aged 0–17 years in England from 2003 to 2019. Methods A retrospective study in children ≤17 years old from 2003 to 2019 using the Clinical Practice Research Datalink (CPRD) Gold and Hospital Episodes Statistics Admitted Patient Care (HES APC) databases. IPD episodes were identified in hospital records (HES APC). PP (caused by Streptococcus pneumoniae only) and ACP episodes (caused by any pathogen) were identified in primary care (CPRD) and in hospital records (HES APC). Annual IRs by age-group were calculated as the number of episodes/person-years (PY) at risk, with 95% confidence intervals (95% CI). Interrupted time series analyses were conducted to assess changes in IRs across the post-PCV7 (2007–2009), early post-PCV13 (2011–2014) and late post-PCV13 (2015–2019) periods compared to the pre-PCV7 period (2003–2005) using generalized linear models. Results 170 IPD episodes, 769 PP episodes and 12,142 ACP episodes were identified in 1,500,686 children in 2003–2019. The overall IPD, PP and ACP IRs (per 100,000 PY) were 2.29 (95% CI 1.96–2.66), 10.34 (95% CI 9.62–11.10) and 163.37 (95% CI 160.47–166.30), respectively. The highest IPD, PP and ACP IRs were observed in children aged < 2 years compared to older children (2–4 and 5–17 years). IPD IRs decreased between the pre-PCV7 period and the late post-PCV13 period from 3.28 (95% CI 2.42–4.33) to 1.41 (95% CI 0.80–2.29), IRR 0.28 (95% CI 0.09–0.90), p-value 0.033. PP IRs declined between the pre-PCV7 period and the late post-PCV13 period from 14.65 (95% CI 12.77–16.72) to 3.87 (95% CI 2.81–5.20), IRR 0.19 (95% CI 0.09–0.38), p-value < 0.001. ACP IRs declined between the pre-PCV7 period and the late post-PCV13 period from 167.28 (95% CI 160.78–173.96) to 124.96 (95% CI 118.54–131.63), IRR 0.77 (95% CI 0.66–0.88), p-value < 0.001. Conclusions The clinical burden of IPD, PP and ACP declined in children in England aged 0–17 years between 2003 and 2019, especially in the late post-PCV13 period. This study highlights the importance of PCV vaccination in reducing the burden of PD and ACP in children in England.

Estimating the Cost-Effectiveness of Switching to Higher-Valency Pediatric Pneumococcal Conjugate Vaccines in the United Kingdom

“…Historical IPD incidence was obtained from published data [8]. After the total number of cases of IPD is estimated, the model distributes these cases into meningitis and bacteremia using proportions from van Hoek et al [12] and Mohanty et al [21]. [21] (for ages 0-17 years); and HES (for ages ≥18 years) [24].…”

“…After the total number of cases of IPD is estimated, the model distributes these cases into meningitis and bacteremia using proportions from van Hoek et al [12] and Mohanty et al [21]. [21] (for ages 0-17 years); and HES (for ages ≥18 years) [24]. e Mohanty et al [25] (for ages 0-17 years); and The Health Improvement Network (THIN) database (for ages ≥18 years) [26].…”

The Relation of Nasopharyngeal Colonization by Streptococcus pneumoniae in Comorbid Adults with Pneumonia and Unfavorable Outcomes in a Low-Middle Income Country

“…This colonization is possible due to several mechanisms, including the evasion of mucus entrapment by capsular polysaccharide, bio lm formation, expression of adhesion proteins, inhibition of complement proteins, and release of bacteriocins to mediate competition with local microbiota [8]. The systemic repercussions of NPC have been explored in the pediatric population [9], and a relationship with the development of acute respiratory infections has been established, especially when a high pneumococcal carriage density was present [10]. In adults, several risk factors for colonization have been described, such as smoking, living with children, and residence in a nursing home [11]; however, the relationship with LRTI is still unclear in adults.…”

Establishment of novel immortalized middle ear cell lines as models for otitis media

“…Otitis media (OM) is among the most frequently diagnosed pediatric diseases in the United States and accounts for up to 18% of all pediatric office visits 1–3 . OM is characterized by inflammation of the middle ear and can be further subdivided into acute otitis media (AOM) when presenting with acute inflammatory symptoms such as otalgia or fever, or otitis media with effusion (OME) when acute symptoms are absent but chronic middle ear fluid persists 4,5 .…”

“…Otitis media (OM) is among the most frequently diagnosed pediatric diseases in the United States and accounts for up to 18% of all pediatric office visits. [1][2][3] OM is characterized by inflammation of the middle ear and can be further subdivided into acute otitis media (AOM) when presenting with acute inflammatory symptoms such as otalgia or fever, or otitis media with effusion (OME) when acute symptoms are absent but chronic middle ear fluid persists. 4,5 Acute episodes of OM are frequently preceded by viral respiratory tract infection and most commonly include the bacterial pathogens Streptococcus pneumoniae, non-typeable Haemophilus influenzae (NTHi), and Moraxella catarrhalis.…”