Pediatric Pneumococcal Serotypes in 4 European Countries

TOC Summary: Non–heptavalent pneumococcal conjugate vaccine serotypes have increased in Spain, France, Belgium, and England and Wales

Effect of high-valency pneumococcal conjugate vaccines on invasive pneumococcal disease in children in SpIDnet countries: an observational multicentre study

Background The Streptococcus pneumoniae Invasive Disease network (SpIDnet) actively monitors populations in nine sites in seven European countries for invasive pneumococcal disease. Five sites use 13-valent pneumococcal conjugate vaccine (PCV13) alone and four use the ten-valent PCV (PCV10) and PCV13. Vaccination uptake is greater than 90% in six sites and 67–78% in three sites. We measured the effects of introducing high-valency PCVs on the incidence of invasive pneumococcal disease in children younger than 5 years. Methods We compared the incidence of invasive pneumococcal disease in each of the 4 years after the introduction of PCV13 alone or PCV10 and PCV13 with the average incidence during the preceding period of heptavalent PCV (PCV7) use, overall and by serotype category. We calculated incidence rate ratios (IRRs) and 95% CIs for each year and pooled the values for all sites in a random effects meta-analysis. Findings 4 years after the introduction of PCV13 alone or PCV10 and PCV13, the pooled IRR was 0·53 (95% CI 0·43–0·65) for invasive pneumococcal disease in children younger than 5 years caused by any serotype, 0·16 (0·07–0·40) for disease caused by PCV7 serotypes, 0·17 (0·07–0·42) for disease caused by 1, 5, and 7F serotypes, and 0·41 (0·25–0·69) for that caused by 3, 6A and 19A serotypes. We saw a similar pattern when we restricted the analysis to sites where only PCV13 was used. The pooled IRR for invasive pneumococcal disease caused by non-PCV13 serotypes was 1·62 (1·09–2·42). Interpretation The incidence of invasive pneumococcal disease caused by all serotypes decreased due to a decline in the incidence of vaccine serotypes. By contrast, that of invasive pneumococcal disease caused by non-PCV13 serotypes increased, which suggests serotype replacement. Long-term surveillance will be crucial to monitor the further effects of PCV10 and PCV13 vaccination programmes in young children

Effect of childhood pneumococcal conjugate vaccination on invasive disease in older adults of 10 European countries: implications for adult vaccination.

BackgroundPneumococcal conjugate vaccines (PCVs) have the potential to prevent pneumococcal disease through direct and indirect protection. This multicentre European study estimated the indirect effects of 5-year childhood PCV10 and/or PCV13 programmes on invasive pneumococcal disease (IPD) in older adults across 13 sites in 10 European countries, to support decision-making on pneumococcal vaccination policies.MethodsFor each site we calculated IPD incidence rate ratios (IRR) in people aged ≥65 years by serotype for each PCV10/13 year (2011-2015) compared with 2009 (pre-PCV10/13). We calculated pooled IRR and 95% CI using random-effects meta-analysis and PCV10/13 effect as (1 - IRR)*100.ResultsAfter five PCV10/13 years, the incidence of IPD caused by all types, PCV7 and additional PCV13 serotypes declined 9% (95% CI -4% to 19%), 77% (95% CI 67% to 84%) and 38% (95% CI 19% to 53%), respectively, while the incidence of non-PCV13 serotypes increased 63% (95% CI 39% to 91%). The incidence of serotypes included in PCV13 and not in PCV10 decreased 37% (95% CI 22% to 50%) in six PCV13 sites and increased by 50% (95% CI -8% to 146%) in the four sites using PCV10 (alone or with PCV13). In 2015, PCV13 serotypes represented 20-29% and 32-53% of IPD cases in PCV13 and PCV10 sites, respectively.ConclusionOverall IPD incidence in older adults decreased moderately after five childhood PCV10/13 years in 13 European sites. Large declines in PCV10/13 serotype IPD, due to the indirect effect of childhood vaccination, were countered by increases in non-PCV13 IPD, but these declines varied according to the childhood vaccine used. Decision-making on pneumococcal vaccination for older adults must consider the indirect effects of childhood PCV programmes. Sustained monitoring of IPD epidemiology is imperative

Les Observatoires Régionaux du Pneumocoque, réseau de surveillance du pneumocoque

National audienc

Decrease in antibiotic resistance of Streptococcus pneumoniae between 2003 and 2009 in France and changes in serotype distribution: Ongoing survey of the French Pneumococcus Surveillance Network

French pneumococcal surveillance network = Observatoires Régionaux du PneumocoqueInternational audienceBackground:The French regional pneumococcal observatories (ORP) network was created in 1995, it participates to the close monitoring of the trends in antimicrobial resistance and serotype distribution with the National Reference Centre for Pneumococci (NRCP) and the Institut de Veille Sanitaire (InVS). The aim of this survey was to assess the antibiotic resistance and the distribution of vaccine and non-vaccine serotypes in invasive pneumococcal disease (IPD) in adults and children as well in otitis in children in France in 2009.Methods:Antimicrobial susceptibility testing was performed on 5,194 isolates of S. pneumoniae recovered from cerebrospinal fluid (CSF), blood, middle ear fluid (MEF) and pleural fluid during the year 2009 by the 23 ORP. MICs of penicillin (P), amoxicillin (AMX) and cefotaxime (CTX) were determined by the agar dilution method and interpreted according to the Antibiotics Comity of the French Society of Microbiology breakpoints. Serotyping was performed at the NRCP with serotype-specific antisera, by latex agglutination test.Results:Results of susceptibility between 2003 and 2009 to P are presented in Table 1. The pneumococci with decreased susceptibility to penicillin G (PDSP) decreased significantly in all types of samples except for MEF’s isolates in children between 2007 and 2009. In the global population, the percentage of I+R (2003 vs 2009) decreased significantly for AMX (30.3% versus 9.6%) and for CTX (18.2% versus 10.5%). Strains highly resistant (MIC &gt; 2 mg/L) remained rare: 0.4%, 1.1% and 0.2% for P, AMX and CTX respectively. The most frequent capsular types in CSF were 3, 7F, 19A, 6C, 23B for adults and 7F, 19A, 3, 33F and 15B for children. Serotypes included in the PCV-7 and PCV-13 vaccine accounted in children for 4% and 51% respectively and in adults for 12% and 48% respectively. By contrast, the serotype 19A remained highly predominant (80%) among MEF isolates.Conclusions:We observed a significant decrease of PDSP between 2003 and 2009 (50.2 to 33.0%). The decrease coincided with the introduction of PCV7 and with a general reduction in levels of antibiotic consumption in France. This continuous survey is necessary to underline modification in serotype distribution in France after PVC13 introduction (June 2010).</p

Épidémiologie des infections invasives à pneumocoque de l’adulte, phase pilote du réseau SIIP

National audienc

Invasive Pneumococcal Disease (IPD) in Adults : a french cohort survey

International audienc

Epidemiology and antimicrobial resistance of Streptococcus pneumoniae in France in 2007: data from the pneumococcus surveillance network.

International audienceAntimicrobial resistance of Streptococcus pneumoniae in France is closely monitored by the pneumococcus surveillance network, founded in 1995, which collects data from regional observatories (Observatoire Régionaux du Pneumocoque [ORP]). In 2007, 23 ORPs analyzed the antibiotic susceptibility of 5,302 isolates of S. pneumoniae recovered in France from cerebrospinal fluid, blood, middle ear fluid, and pleural fluid, as well as from adult respiratory samples. The study showed that 38.2% of the strains were nonsusceptible to penicillin, 19.3% nonsusceptible to amoxicillin, and 10.5% nonsusceptible to cefotaxime. The percentage of pneumococcus nonsusceptible to penicillin varied according to both the sample and the age of the patient (child/adult): blood (27.8%/32.5%), cerebrospinal fluid (33.7%/34.6%), middle ear fluid (60.2%/27.5%), and pleural fluid (50.0%/31.0%). Between 2003 and 2007, the frequency of penicillin resistance in invasive pneumococcal disease gradually decreased from 46.4% to 29.0% in children and from 43.8% to 32.7% in adults. This decrease coincided with the introduction of a seven-valent pneumococcal conjugate vaccine into immunization programs and with a general reduction in levels of antibiotic consumption in France