Chronic medical conditions associated with invasive pneumococcal diseases in inpatients in teaching hospitals in São Paulo city: Estimating antimicrobial susceptibility and serotype-coverage of pneumococcal vaccines

ABSTRACT Background: Chronic conditions increase the risk of invasive pneumococcal diseases (IPD). Pneumococcal vaccination remarkably reduced IPD morbimortality in vulnerable populations. In Brazil, pneumococcal vaccines are included in the National Immunization Program (PNI): PCV10 for < 2 years-old, and PPV23 for high risk-patients aged ≥ 2 years and institutionalized ≥ 60 years. PCV13 is available in private clinics and recommended in the PNI for individuals with certain underlying conditions. Methods: A retrospective study was performed using clinical data from all inpatients from five hospitals with IPD from 2016 to 2018 and the corresponding data on serotype and antimicrobial-non-susceptibility of pneumococcus. Vaccine-serotype-coverage was estimated. Patients were classified according to presence of comorbidities: healthy, without comorbidities; at-risk, included immunocompetent persons with specific medical conditions; high-risk, with immunocompromising conditions and others Results: 406 IPD cases were evaluated. Among 324 cases with information on medical conditions, children < 5 years were mostly healthy (55.9%), while presence of comorbidity prevailed in adults ≥ 18 years old (> 82.0%). Presence of ≥1 risk condition was reported in ≥ 34.8% of adults. High-risk conditions were more frequent than at-risk in all age groups. Among high-risk comorbidity (n = 211), cancer (28%), HIV/AIDS (25.7%) and hematological diseases (24.5%) were the most frequent. Among at-risk conditions (n = 89), asthma (16.5%) and diabetes (8.1%) were the most frequent. Among 404 isolates, 42.9% belonged to five serotypes: 19A (14.1%), 3 (8.7%), 6C (7.7%), 4 and 8 (6.2% each); 19A and 6C expressed antimicrobial-non-susceptibility. The vaccine-serotype-coverage was: PCV10, 19.1%, PCV13, 43.8%; PCV15, 47.8%; PCV20, 62.9%; PCV21, 65.8%, and PPV23, 67.3%. Information on hospital outcome was available for 283 patients, of which 28.6% died. Mortality was 54.2% for those with meningitis. Conclusion: Vaccine with expanded valence of serotypes is necessary to offer broad prevention to IPD. The present data contribute to pneumococcal vaccination public health policies for vulnerable patients, mainly those with comorbidity and the elderly.

Parental knowledge of pneumococcal diseases and pneumococcal conjugate vaccines: A cross-sectional study in Immunization Clinic, Medical College, and Hospital, Kolkata

Background: Pneumococcal conjugate vaccine (PCV) had been introduced in National Immunization Schedule recently in West Bengal in view to prevent pneumococcal diseases mainly pneumonia and meningitis, which was a leading cause mortality and morbidity particularly in under 5 age group. Like all other health program, success of this initiative would be dependent on awareness level of beneficiaries. Aim and Objective: The present study aimed at estimating parenteral awareness level related to pneumococcal diseases and PCV. Materials and Methods: The observational and analytic study was conducted among parents of 404 children (who were eligible for PCV-1) attended in Immunization Clinic, Medical College, Kolkata. Sociodemographic parameters of families of study participants were elicited. Parenteral knowledge regarding pneumococcal diseases and PCV was assessed. Results: About 58.4% of parents neither had any awareness regarding pneumococcal diseases, nor had any idea related to PCV. Only 30.7% of parents had any knowledge regarding pneumococcal diseases and 31.7% had any awareness related to PCV. Maternal education, social class, and residence were found to significant predictor of parenteral knowledge both in unadjusted model as well as when adjusted with sociodemographic variables. Conclusion: As parenteral knowledge level in the present study was not satisfactory, more stress to be given in conducting awareness generation campaign for newly introduced PCV vaccine throughout the state in general, and in vulnerable urban areas particularly, where awareness among beneficiaries was significantly poorer.

Interpretation of expert consensus for diagnosis, treatment and prevention of pneumococcal diseases in children / 中华实用儿科临床杂志

The Streptococcus pneumoniae infection is still a leading cause of death and disability of children under 5 years old.To enhance the level of diagnosis and treatment in children′s pneumococcal diseases and contribute to the health of children in China, in April 2020, the Respiratory Group of Chinese Pediatric Society, Chinese Medical Association has developed an expert consensus for diagnosis, treatment and prevention of pneumococcal diseases in children.Now the consensus is interpreted as follows, including the burden of pneumococcal diseases, clinical characteristics, serotypes, drug resistance and vaccine precaution.

Carga económica de la enfermedad neumocócica en niños de edad preescolar en el Policlínico Docente Playa / Economic burden of pneumococcal disease in pre-school age children from Playa Teaching Policlinic

Introducción: El cálculo de la carga económica de las enfermedades neumocócicas en niños de edad preescolar en el nivel primario de salud en Cuba contribuye a visualizar la necesidad de buscar vías para prevenir su padecimiento. Objetivo: Estimar la carga económica de la enfermedad neumocócica en niños de edad preescolar en el Policlínico Docente de Playa en el 2016. Métodos: Se realizó un estudio descriptivo transversal. Para estimar la carga económica se aplicó el enfoque del costo de la enfermedad sobre la base de la incidencia, desde la perspectiva institucional. Para calcular el costo de atención por paciente se empleó el método de costeo paciente tipo. Resultados: La otitis media aguda fue la enfermedad de mayor incidencia, con el 49 por ciento de los casos seguida por la neumonía con el 47 por ciento. El costo esperado de la enfermedad fue entre 47,97 CUP y 103,38 CUP para la otitis media aguda, de entre 83,99 CUP y 194,94 CUP para la neumonía y entre 105,69 CUP y 189,97 CUP para la meningitis y la sepsis. Dentro de los procesos, las visitas al hogar presentaron el mayor gasto y dentro de las partidas, el salario. La enfermedad neumocócica representó una carga económica de 8849,15 CUP para el área de salud estudiada. Conclusiones: La enfermedad neumocócica en niños no presenta alto nivel de incidencia en el área del Policlínico Docente de Playa, pero representa una carga económica para los servicios de salud en el primer nivel de atención. Estos costos son susceptibles a disminuir con la introducción de la vacuna antineumocócica conjugada(AU)

Introduction: Calculation of the economic burden caused by pneumococcal diseases in pre-school age children in the primary health care of Cuba contributes to visualize the need for finding ways to prevent them. Objective: To estimate the economic burden caused by the pneumococcal disease in pre-school age children from Playa Teaching Policlinic during 2016. Methods: It was conducted a descriptive cross-sectional study. For estimating the economic burden, it was used the approach of cost of the disease based on the incidence and from the institutional perspective. For calculating the cost of the care per patient, it was used the method of cost-patient-type. Results: Acute otitis media was the disease with higher incidence with 49 percent of the cases, followed by pneumonia with 47 percent . The expected cost by diseases was among 47,97 CUP (Cuban peso) and 103,38 CUP for acute otitis media; among 83,99 CUP and 194,94 CUP for pneumonia; and among 105,69 CUP and 189,97 CUP for meningitis and sepsis. Within the processes, home visits showed the higher expense, and among the entries, it was the salary. Pneumococcal disease represented an economic burden of 8849,15 CUP for the studied health area. Conclusions: Pneumococcal disease in children does not represent a high level of incidence in the area of Playa Teaching Policlinic, but it represents an economic burden for health services in the primary care level. These costs are likely to decrease with the introduction of the pneumococcal conjugate vaccine(AU)

Distribution of PCV13 and PPSV23 Streptococcus pneumoniae serotypes in Argentinean adults with invasive disease, 2013-2017 / Distribución de los serotipos PCV13 y PPSV23 de Streptococcus pneumoniae en adultos argentinos con enfermedad invasiva, 2013-2017

Abstract Streptococcus pneumoniae is a major cause of severe invasive disease associated with high mortality and morbidity worldwide. To identify the serotypes most commonly associated with infection in adults in Argentina, 791 pneumococcal isolates from 56 hospitals belonging to 16 provinces and Buenos Aires city were serotyped. The isolates were submitted as part of a National Surveillance Program for invasive pneumococcal disease in adults, which started in 2013. Serotypes 3, 8, 12F, 7F and 1 were the most prevalent among adult patients. During the study period there was no significant difference in serotype distribution between the age groups studied (18-64 and >65 years old), except for serotype 1, 3 and 23A. Most prevalent serotypes in pneumonia were serotype 7F, 1, 12F, 8, and 3. When the clinical diagnosis was meningitis, serotype 3 and 12F were the most prevalent, whereas when the diagnosis was sep-sis/bacteremia the most prevalent was serotype 8. In this work, for the 18-64-year-old group, PPSV23 and PCV13 serotypes accounted for 74.56% and 44.54% respectively of the cases in the studied period. On the other hand, for the >65-year-old group, these serotypes represented 72.30% and 41.42% respectively. The aim of this work was to establish the knowledge bases of the serotypes that cause invasive pneumococcal diseases in the adult population in Argentina and to be able to detect changes in their distribution over time in order to explore the potential serotype coverage of the vaccines in current use.

Resumen Streptococcus pneumoniae es una causa importante de enfermedad invasiva grave asociada con una alta mortalidad y morbilidad en todo el mundo. Para identificar los serotipos principales asociados con la infección en adultos en Argentina, 791 aislamientos de neumococo de 56 hospitales pertenecientes a 16 provincias y la ciudad de Buenos Aires fueron serotipificados. Los aislamientos fueron remitidos como parte del Programa Nacional de Vigilancia para la enfermedad neumocócica invasiva en adultos, que comenzó en 2013. Los serotipos 3, 8, 12F, 7F y 1 fueron los más prevalentes. Durante el período de estudio no hubo diferencias significativas en la distribución de serotipos entre los dos grupos de adultos estudiados (18-64 y >65 años), excepto para los serotipos 1, 3 y 23A. Los serotipos más prevalentes en casos de neumonía fueron 7F, 1, 12F, 8 y 3. Cuando el diagnóstico clínico fue meningitis, los serotipos 3 y 12F fueron los más prevalentes. Y el serotipo 8 fue el más prevalente en la sepsis/bacteriemia. En el grupo de 18-64 años, los serotipos PPSV23 y PCV13 representaron, respectivamente, el 74,56 y el 44,54% de los casos de enfermedad invasiva en el período estudiado. En el grupo de >65 años, estos serotipos representaron el 72,30 y 41,42%, respectivamente. Es importante conocer los serotipos causantes de infecciones neumocócicas invasivas en la población adulta en Argentina y detectar eventuales cambios en su distribución a lo largo del tiempo, para explorar la potencial cobertura de las vacunas utilizadas.

The difference of anti-pneumococcal capsular polysaccharide IgG levels in plasma of asthmatic and non-asthmatic children / 临床儿科杂志

Objectives To explore the humoral immunologic mechanisms of the susceptibility to invasive pneumococcal diseases (IPD) in asthmatic children. Methods Plasma samples were collected from 43 asthmatic and 20 non-asthmatic chil-dren. Anit-pneumococcal capsular polysaccharide (PPS)-IgG concentrations were measured by enzyme-linked immunosorbent assays. Results The mean concentrations of anti-PPS 14, 19A and 23F-IgG were signiifcantly higher in asthmatic children than in non-asthmatic children (P<0.05). The ratios of the asthmatic children who had anti-PPS 14, 19A and 23F-IgG concentrations higher than the protective antibody level (≥0.2 μg/ml ) were 100%for all the serotypes. Conclusions The immune responses of producing anti-PPS IgG to defense IPD were normal in asthmatic children. Asthmatic children may be more susceptive to pneumococcal infection or colonization than non-asthmatic children.

Treatment Costs of Pneumonia, Meningitis, Sepsis, and Other Diseases among Hospitalized Children in Viet Nam.

The aim of this study was to estimate the costs of treatment of children who present with the signs and symptoms of invasive bacterial diseases in Khanh Hoa province, Viet Nam. The study was an incidencebased cost-of-illness analysis from the health system perspective. The hospital costs included labour, materials and capital costs, both direct and indirect. Costs were determined for 980 children, with an average age of 12.67 months (standard deviation±11.38), who were enrolled in a prospective surveillance at the Khanh Hoa General Hospital during 2005-2006. Of them, 57% were male. By disease-category, 80% were suspected of having pneumonia, 8% meningitis, 3% very severe disease consistent with pneumococcal sepsis, and 9% other diseases. Treatment costs for suspected pneumonia, meningitis, very severe disease, and other diseases were US$ 31, US$ 57, US$ 73, and US$ 24 respectively. Costs ranged from US$ 24 to US$ 164 across different case-categories. Both type of disease and age of patient had statistically significant effects on treatment costs. The results showed that treatment costs for bacterial diseases in children were considerable and might differ by as much as seven times among invasive pneumococcal diseases. Changes in costs were sensitive to both age of patient and case-category. These cost-of-illness data will be an important component in the overall evidence base to guide the development of vaccine policy in Viet Nam.

Community acquired Streptococcus pneumoniae infection in Thailand

Streptococcus pneumoniae (S. pneumoniae) is the major pathogen that causes health problems worldwide. Invasive disease includes meningitis, bacteremia with or without focus and pneumonia. It causes morbidity and mortality, especially in children. In Thailand, no relevant study was done to estimate the exact incidence of invasive pneumococcal diseases. Serotypes, in children with invasive diseases, differ slightly by age; less than five years old: serotype 23F, 6B, 14, 9V, and 19F, more than five years old: serotype 4, 23F, 19F, and 9V, while the most frequent serotypes in nasopharyngeal specimens are serotype 6B, 19F, 23F, and 14. The prevalence and the level of drug resistance of S. pneumoniae (DRSP) have been increasing. A significant risk factor for S. pneumonia infections is previous antibiotic use within three months. Seven-valent pneumococcal conjugate vaccine can prevent 73.9% of the most common pneumococcal serotypes in children younger than five years of age. There is a need for cost-effectiveness studies for inclusion of this vaccine in the national children immunization programme.

Ineffectiveness for infants of immunization of mothers with pneumococcal capsular polysaccharide vaccine during pregnancy

Pneumococcal (Pnc) carriage is associated with pneumococcal diseases. Breast feeding and maternal vaccination may be a useful approach to prevent pneumococcal infection in young infants. We examined the risk of Pnc carriage by infants at six months of age after pneumococcal polysaccharide vaccination of pregnant women. We selected 139 pregnant woman. The woman were randomly allocated to receive 23-valent polysaccharide vaccines during pregnancy (Group 1) after pregnancy (Group 2) or not receive any vaccine (Group 3). Nasopharyngeal swabs were collected from the infants at three and six months of age. The infants were evaluated monthly during the first six months. We included 47 mothers in Group 1, 45 mothers in Group 2 and 47 mothers in Group 3. Forty-seven percent of the babies were exclusively breast fed until six months, 26 percent received both breast feeding and artificial feeding and 13 percent received only artificial feeding. Among those patients, 26 percent were colonized by Pnc at six months (12 from Group 1, 13 from Group 2, and 12 from Group 3). There was no significant difference in colonization between the three groups. Thirty percent of the children were colonized by a non-susceptible strain. We concluded that young infants (three months old) are already susceptible to pneumococcal carriage. Vaccination during pregnancy with a polysaccharide vaccine did not decrease Pnc colonization.