Invasive Pneumococcal Disease in England and Wales: Vaccination Implications

Sleeman, Karen; Knox, Kyle; George, Robert C.; Miller, Elizabeth; Waight, Pauline; Griffiths, David; Efstratiou, Androulla; Broughton, Karen; Mayon-White, Richard; Moxon, E. Richard; Crook, Derrick W.

doi:10.1086/317924

Cited by 118 publications

(64 citation statements)

References 53 publications

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“…On the basis of the results of the present surveillance study, 74% of the patients Ͻ5 years of age with pneumococcal meningitis were infected with isolates with serotypes represented in the seven-valent conjugate vaccine; this proportion is similar to that found for pediatric patient groups in the United States and other countries (23). Furthermore, conjugate vaccines may have an important additional benefit in reducing the transmission of antibiotic-resistant strains.…”

supporting

confidence: 71%

Population-Based Survey of Antimicrobial Susceptibility and Serotype Distribution of Streptococcus pneumoniae from Meningitis Patients in Salvador, Brazil

et al. 2002

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Penicillin-nonsusceptible strains were isolated from 15% of 303 individuals with pneumococcal meningitis identified during a 4-year surveillance study in Salvador, Brazil. The estimated rate of coverage of the seven-valent conjugate vaccine was 74% among patients <5 years of age and 94% among those infected with nonsusceptible isolates, indicating that the use of conjugate vaccines may be an approach to the control of emerging penicillin resistance in Brazil.Pneumococcal disease is responsible for over 1 million deaths each year in children under 5 years of age (22). Its public health impact has been further compounded by the global emergence of penicillin-resistant Streptococcus pneumoniae (1). Resistant strains have been isolated in all continents (1) and in several countries; over 50% of the clinical isolates demonstrate high-level resistance to penicillin (7,19).With the emergence of penicillin resistance, it is ever more urgent that surveillance be implemented in developing countries, where conditions of poverty contribute to an already large burden of pneumococcal disease (25,26). In Latin America, surveys of reference collections of isolates (13, 24) and laboratory-based surveillance (2, 3, 5, 15) have documented penicillin resistance in up to 20% of clinical isolates. However, significant variabilities in antimicrobial susceptibility and serotype patterns have been observed between and within countries (2, 3, 15). These findings may be due, in part, to regional differences in case ascertainment and isolation procedures (12) and emphasize the importance of population-based information in guiding antibiotic control strategies and national vaccine policies.Active surveillance for pneumococcal meningitis was established at the state infectious disease hospital in the city of Salvador, Brazil. The state health secretary requires that suspected cases of meningitis from the metropolitan region be referred to that hospital, and more than 95% of the reports of meningitis from the region are reported from that site (secretary of health for the state of Bahia, unpublished case notification records). Therefore, patients referred to that hospital represent patients with population-based cases of meningitis occurring in this city. Between December 1995 and November 1999, 317 patients were consecutively identified with cerebrospinal fluid cultures positive for S. pneumoniae, as determined by morphology on Gram staining of smears, susceptibility to optochin (Difco Laboratories, Detroit, Mich.), and bile solubility (BBL Microbiology Systems, Cockeysville, Md.). After enrollment of patients by protocols approved by the institutional review boards of the Brazilian Ministry of Health and Weill Medical College of Cornell University, information on the demographic characteristics and the clinical presentations of the patients was obtained for 305 patients (97% of 317 patients) during interviews or medical chart review. On the basis of the fact that 140 patients who resided within the municipal borders of Salvador (population ...

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supporting

confidence: 71%

Population-Based Survey of Antimicrobial Susceptibility and Serotype Distribution of Streptococcus pneumoniae from Meningitis Patients in Salvador, Brazil

et al. 2002

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“…Notably, the panel of serotypes covered includes all those incorporated in both seven-valent and nine-valent conjugate vaccine preparations, thus offering a minimally invasive method for monitoring serotype replacement following introduction of these vaccines. The panel also covers the major causes of invasive pneumococcal infections both in the United Kingdom and internationally (20,22). Less common causes of invasive pneumococcal infection, including serotypes 8, 9N, 12F, and 22F, could readily be added to the assay panel if suitable monoclonal antibodies become available.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of Invasive Pneumococcal Infection by Serotype-Specific Urinary Antigen Detection

et al. 2005

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Widespread use of conjugate pneumococcal polysaccharide-protein vaccines may alter the spectrum of pneumococci producing invasive disease. Novel sensitive diagnostic methods would be valuable for monitoring the epidemiology of pneumococcal disease within populations and vaccine recipients. Ideally, these methods should allow determination of the serotype of the infecting clone. Serotype-specific enzyme-linked immunosorbent assays (ELISA) for 13 capsular polysaccharides (types 1, 3, 4, 5, 6A, 6B, 7A, 9V, 14, 18C, 19A, 19F, and 23F) were developed. Experiments with pure capsular polysaccharide demonstrated that the assays were sensitive (0.01 to 1.0 ng/ml) and specific. These assays were used to detect capsular polysaccharide in urine from 263 adult patients with proven (blood culture-positive) invasive pneumococcal disease and pneumonia of unknown etiology and from patients with positive blood cultures yielding bacteria other than pneumococci (control group). Among 76 patients with invasive pneumococcal disease from whom blood culture isolates had been serotyped, 62 (82%) had infections with pneumococci of serotypes represented in the ELISA panel. Capsular antigen matching the serotype of the blood culture isolate was detected in the urine of 52 of these patients, giving a sensitivity of 83.9% for the target serotypes. The tests were significantly more sensitive for urine from patients with pneumococcal pneumonia (89.8%) than for urine from patients with nonpneumonic invasive infection (61.5%; P < 0.05). Data from the control group indicated a specificity of 98.8%. These assays should prove valuable in epidemiological investigation of invasive pneumococcal infection in adults, particularly if combined with a sensitive C-polysaccharide detection assay to screen for positive samples.

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“…Assessment and selection of these specific Pn serotypes were based on clinical observations linking these common serotypes to invasive disease in Post-print, not final published version. Cite this article as: Gallagher, S., Phillips, A.C., Drayson, M., & Carroll., D. (2009, invited article (Denham and Clarke, 2005;Sleeman et al, 2001). Further details of this assay are described elsewhere (Ferraro et al, 2008;Gallagher et al, 2008a;Lal et al, 2005).…”

Section: Blood Sampling and Antibody Analysismentioning

confidence: 99%

Parental caregivers of children with developmental disabilities mount a poor antibody response to pneumococcal vaccination

Gallagher¹,

Phillips²,

Drayson³

et al. 2009

Brain, Behavior, and Immunity

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In older populations, caregiving for a spouse with dementia has been associated with a poor antibody response to vaccination. The present study examined whether younger caregivers, specifically the parents of children with developmental disabilities, would also show a diminished antibody response to vaccination. At baseline assessment, 30 parents of children with developmental disabilities and 29 parents of typically developing children completed standard measures of depression, perceived stress, social support, caregiver burden, and child problem behaviours. They also provided a blood sample and were then vaccinated with a pneumococcal polysaccharide vaccine. Further blood samples were taken at 1- and 6-month follow-ups. Caregivers mounted a poorer antibody response to vaccination than control parents at both follow-ups. This effect withstood adjustment for a number of possible confounders and appeared to be, at least in part, mediated by child problem behaviours. The negative impact of caregiving on antibody response to vaccination is not restricted to older spousal caregivers, but is also evident in younger parents caring for children with developmental disabilities. The behavioural characteristics of the care recipients may be a key consideration in whether or not immunity is compromised in this context

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Invasive Pneumococcal Disease in England and Wales: Vaccination Implications

Cited by 118 publications

References 53 publications

Population-Based Survey of Antimicrobial Susceptibility and Serotype Distribution of Streptococcus pneumoniae from Meningitis Patients in Salvador, Brazil

Population-Based Survey of Antimicrobial Susceptibility and Serotype Distribution of Streptococcus pneumoniae from Meningitis Patients in Salvador, Brazil

Diagnosis of Invasive Pneumococcal Infection by Serotype-Specific Urinary Antigen Detection

Parental caregivers of children with developmental disabilities mount a poor antibody response to pneumococcal vaccination

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