Age-Specific Incidence of Invasive Pneumococcal Disease in the United States by Disease Type, Based on Data from Active Bacterial Core Surveillance

<p>Meningitis incidence is plotted only up to 30 mo, after which it remains at or below 1/100,000 person-years. “Pneumonia” indicates bacteremic pneumonia, while “bacteremia” indicates nonfocal bacteremia. “Total” includes other invasive diagnoses.</p

Box-Whisker Plot of Anti-Type-14 Polysaccharide Antibodies in Israeli Toddlers, by 6-Mo Age Groups

<p>Central boxes indicate median and 25th and 75th percentiles; whiskers indicate upper and lower adjacent values.</p

Age-Specific Incidence of Invasive Pneumococcal Disease Caused by Serogroups 6 and 14 in Finland, Based on Active Laboratory-Based Surveillance

<p>Age-Specific Incidence of Invasive Pneumococcal Disease Caused by Serogroups 6 and 14 in Finland, Based on Active Laboratory-Based Surveillance</p

Age-Specific Incidence of Invasive Pneumococcal Disease in the United States by Serogroup, Based on Data from Active Bacterial Core Surveillance

<p>Serogroups 4 and 23 are shown only up to 48 mo, after which incidence is less than 1/100,000 person-years. All serogroups besides those in the heptavalent vaccine are shown combined as non-vaccine serogroups (NVG).</p

Figure 2

<p>A. Pneumococcal carriage prevalence by cohort and weeks since start of training. B. Odds ratio and 95% confidence interval for pneumococcal carriage prevalence during training compared to first visit, adjusted for season and frequency of sharing drinking glass.</p

Initial Effects of the National PCV7 Childhood Immunization Program on Adult Invasive Pneumococcal Disease in Israel

<div><p>Background</p><p>PCV7 was introduced as universal childhood vaccination in Israel in July 2009 and PCV13 in November 2010. Here we report data on adult invasive pneumococcal disease (IPD), two years post PCV7 implementation and before an expected effect of PCV13.</p><p>Methods</p><p>An ongoing nationwide active-surveillance (all 27 laboratories performing blood cultures in Israel), providing all blood & CSF <i>S. pneumoniae</i> isolates from persons >18 y was initiated in July 2009. Capture-recapture method assured reporting of >95% cases. All isolates were serotyped in one central laboratory. IPD outcome and medical history were recorded in 90%. Second year post PCV implementation is compared to the first year.</p><p>Results</p><p>During July 2009 to June 2011, 970 IPD cases were reported (annual incidence [/100,000] of 9.17 and 10.16 in the two consecutive years, respectively). Respective case fatality rates (CFRs) were 20% and 19.1%. Incidence of IPD and CFR increased with age and number of comorbidities. Incidence rate was significantly greater during the second winter, 7.79/100,000 vs. 6.14/100,000 in first winter, p = 0.004, with a non-significant decrease during summer months (3.02 to 2.48/100,000). The proportion of IPD cases due to PCV7-serotypes decreased from 27.5% to 13.1% (first to second year) (p<0.001). Yet, non-PCV13-strains increased from 32.7% to 40.2% (p = 0.017). The increase in non-PCV13-strains was highly significant in immunocompromised patients and to a lesser degree in non-immunocompromised at risk or in older patients (>64 y). Among younger/healthier patients serotype 5 was the major increasing serotype. Penicillin and ceftriaxone resistance decreased significantly in the second year.</p><p>Conclusions</p><p>While overall annual incidence of IPD did not change, the indirect effect of PCV7 vaccination was evident by the significant decrease in PCV7 serotypes across all age groups. Increase in non-VT13 strains was significant in immunocompromised patients. A longer follow-up is required to appreciate the full effect of infant vaccination on annual IPD.</p></div

Pneumococcal cumulative acquisition rate per 100 participants by cohort and weeks since start of training.

<p>Pneumococcal cumulative acquisition rate per 100 participants by cohort and weeks since start of training.</p

Observed and expected cluster units of pneumococcal clones in three cohorts of trainees, Israel, 2007.

a<p>A cluster unit was defined by the presence of >50% of identified clones in one of the 3 cohorts.</p>b<p>Expected number of cluster units in the current study for each cluster unit size was derived by multiplying the observed number of groups with the same clone and the same size by the <i>P</i>-value for being a true cluster unit.</p>c<p>For clonal group of 5, if minimal number needed for cluster unit is defined as ≥4 (as was the observed cluster unit) then <i>P</i> value is .037.</p

Timing of acquisition of pneumococci during training in confined setting in Israel, identified by multivariable repeated measures analysis^a.

a<p>Controlling for sharing drinking glass frequency, company and three seasons.</p>b<p>1003 observations included n unbalanced model, including contribution until loss to follow-up.</p>c<p>593 observations included in balanced model, i.e. including only those who were sampled in all 5 visits.</p

IPD cases by age and vaccine serotype coverage.

<p>Dark grey – serotypes included in PCV7 (VT7), light grey – serotypes included in PCV13 (but not 7) (+VT13), white – serotypes not included in either PCV7 or PCV13 (Non-VT13).</p