Neumonía bacteriana en niños en Ecuador: una mirada al impacto de las vacunas

Introducción: La neumonía adquirida en la comunidad es una de las enfermedades con mayor prevalencia en la comunidad pediátrica en nuestro país. De las diferentes etiologías que pueden causarlas, la neumonía ocasionada por Streptococcus pneumoniae puede ser prevenida con el uso de inmunización. Actualmente se disponen de tres tipos de vacunas antineumocócicas conjugadas autorizadas de uso pediátrico de forma sistemática. Objetivo: Identificar la prevalencia de neumonía bacteriana en niños bajo 5 años de edad, que requirieron hospitalización comparando la vacuna neumocócica recibida: 10 valente (PCV10) versus 13 valente (PCV13). Pacientes y Métodos: Estudio de descriptivo, retrospectivo. Se incluyeron pacientes hospitalizados bajo 5 años de edad, con diagnóstico de neumonía bacteriana mediante codificación CIE10 en un hospital de tercer nivel de la ciudad de Quito-Ecuador, durante el año 2019. Resultados: Se estudiaron 175 pacientes de los cuales 74 cumplieron con criterios clínicos de neumonía, de estos 46 recibieron PCV10 y 28 recibieron vacuna PCV13. Discusión y Conclusiones: La prevalencia de neumonía bacteriana fue mayor en los pacientes inmunizados con PCV10 lo que sugiere una relación de menor probabilidad de neumonía con el uso de la vacuna PCV13.

Background: Community-acquired pneumonia is one of the most prevalent diseases in the pediatric community in our country, of the different etiologies that can cause them, pneumonia caused by Streptococcus pneumoniae can be prevented with the use of immunization. Currently there are three types of authorized pneumococcal conjugate vaccines for pediatric use in a systematic way. Aim: To identify the prevalence of bacterial pneumonia in children under 5 years of age who required hospitalization by comparing the pneumococcal vaccine received: 10 valent (PCV10) versus 13 valent (PCV13). Methods: Descriptive, retrospective study. Hospitalized patients under 5 years of age with a diagnosis of bacterial pneumonia by ICD10 coding in a third level hospital in the city of Quito - Ecuador during 2019 were included. Results: 175 patients were studied, of which 74 patients met clinical criteria for pneumonia, of these 46 received PCV10 and 28 received PCV13 vaccine. Discussion and Conclusions: The prevalence of bacterial pneumonia was higher in patients immunized with PCV10, suggesting a relationship of lower probability of pneumonia with the use of the PCV13 vaccine.

Impact of PCV10 on pediatric pneumococcal disease burden in Brazil: time for new recommendations?

Abstract Objective: To describe the impact of the 10-valent pneumococcal conjugate vaccine on the pediatric burden of pneumococcal infections, carriage, serotype replacement, and antimicrobial resistance in Brazil since its introduction in 2010. Data source: A narrative review of English, Spanish, and Portuguese articles published in online databases and in Brazilian epidemiological surveillance databases was performed. The following keywords were used: Streptococcus pneumoniae, pneumococcal disease, conjugate vaccine, PCV10, antimicrobial resistance, and meningitis. Summary of the findings: Declines in hospitalization rates of all-cause pneumonia occurred in the target age groups and some age groups not targeted by vaccination early after the use of PCV10. Large descriptive studies of laboratory-confirmed pneumococcal meningitis and hospital-based historical series of hospitalized children with IPD have evidenced a significant impact on disease burden, in-hospital fatality rates, and admission to the intensive care unit before and after the inclusion of the vaccine. Impact data on otitis media is limited and inconsistent; the main benefit remains the prevention of complicated diseases. During the late post-vaccine years, a significant and progressive increase in high-level penicillin non-susceptibility pneumococci has been described. Since 2014 serotype 19A has been the leading serotype in all ages and was responsible for 28.2%-44.6% of all IPD in children under 5 yrs. Conclusions: PCV10 has performed a significant impact on IPD in Brazil since 2010, however, progress has been continuously hampered by replacement. Broader spectrum PCVs could provide expanded direct and indirect protection against ST19A and other additional serotypes of increasing importance if administered to children in the Brazilian National Immunization Program.

Effectiveness of influenza and pneumococcal vaccines in patients with diabetes / 中国生物制品学杂志

@#Authoritative guidelines and consensus domestic and overseas suggest that patients with diabetes get influenza vaccine and pneumococcal vaccine,which can significantly reduce the incidence and hospitalization rate of influenza and pneumococcal diseases in diabetic patients,and can also reduce the risk of cardiovascular events and mortality.The protective effect of simultaneous administration is more significant.At present,the vaccination rate of influenza and pneumococcal vaccines for diabetic patients is still low in China.Effective measures should be taken to promote the integration of medical treatment and prevention,strengthen knowledge popularization and guide publicity,and improve the vaccination rate,so as to effectively improve the survival status and prognosis of diabetic patients.This paper compre-hensively reviews the research progress on the effectiveness of influenza and pneumococcal vaccines in diabetic patients at home and abroad in recent years.

Development and verification of high performance liquid chromatography for determination of residual 4-dimethylaminopyridine content in pneumococcal polysaccharide-protein conjugate vaccine / 中国生物制品学杂志

@#Objective To develop and verify a high performance liquid chromatography(HPLC) for determination of residual 4-dimethylamino-pyridine(DMAP)content in pneumococcal polysaccharide-protein conjugate vaccine.Methods A HPLC method for determination of residual DMAP content in pneumococcal polysaccharide-CRM197 protein conjugate vaccine was developed by optimization of type of chromatographic column and composition of mobile phase,verified for specificity,accuracy,repeatability and reproducibility,and determined for limit of detection(LOD),limit of quantitation(LOQ)and linear range.The residual DMAP contents in pneumococcal polysaccharide-CRM197 protein conjugate vaccine of 13 serotypes and the intermediates of 1-cyano-4-dimethylamino pyridinium tetrafluoroborate(CDAP)-activated pneumococcal polysaccharide were determined by the developed method.Results The condition for HPLC was optimized as follows:Sepax HP-C18 chromatographic column(5 μm,4.6 mm × 250 mm)was adopted,using the mixture of 5 mmol/L sodium heptanesulfonate containing 20 mmol/L potassium dihydrogen phosphate(the pH value was adjusted to 3.0 with phosphoric acid)and acetonitrile at a ratio of 87∶13(v/v)as mobile phase at a detection wavelength of 280 nm,a flow rate of 1 mL/min,a sample load of 10 μL and a column temperature of 35 ℃.The mechanism of samples and solvent for pre-treatment showed no interference to the determination result,indicating good specificity of the developed method.The LOD and LOQ were 3.6 and 14.4 ng/mL respectively,while the linear range was 0.05 ～ 10 μg/mL with a R2value of0.999 9.The spike recovery rate was 83% ～ 105%,while the RSDs in repeatability and reproducibility tests were 0.28% ～0.72% and 7.38% respectively.The residual DMAP contents in pneumococcal polysaccharide-CRM197 protein conjugate vaccine of 13 serotypes were 0.135 ～ 1.635 μg/mL.DMAP was detected in the first step of activation of pneumococcal polysaccharide with CDAP,while no CDAP was detected.Conclusion The developed HPLC method is simple,specific,accurate,repeatable and reproducible,which is effective for quality control of pneumococcal polysac-charide-protein conjugate vaccine.

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.

Dose-response relationship between age and Streptococcus pneumoniae vaccination coverage in kindergarten children / 中国当代儿科杂志

OBJECTIVES@#To investigate the potential relationship between age and Streptococcus pneumoniae vaccination coverage in kindergarten children, and to provide a basis for guiding vaccination and developing new protein vaccines.@*METHODS@#The stratified cluster random sampling method was used to select 1 830 healthy children from six kindergartens in Shunde District, Foshan City, China, and nasopharyngeal swabs were collected for the isolation and identification of Streptococcus pneumoniae. The logistic regression model based on restricted cubic spline was used to analyze the dose-response relationship between age and Streptococcus pneumoniae vaccination coverage.@*RESULTS@#The rate of nasal Streptococcus pneumoniae carriage was 22.46% (411/1 830) among the kindergarten children, with the predominant serotypes of 6B, 19F, 15A, 23A, 34, and 23F. The coverage rates of 10-valent pneumococcal conjugate vaccine (PCV10) and 13-valent pneumococcal conjugate vaccine (PCV13) were 53.0% and 57.9%, respectively, and there was a significant non-linear dose-response relationship between age and the coverage rates of PCV10 and PCV13 (P<0.05), with a higher coverage rate of PCV10 (88.0%) and PCV13 (91.1%) in the children aged 2 years. There was a significant non-linear dose-response relationship between age and the coverage rates of pilus islet 1 (PI-1) and pilus islet 2 (PI-2) (P<0.05), with a lower vaccination coverage rate for PI-1 (37.7%) and PI-2 (16.1%). The coverage rates of PI-1 (13.0%-58.5%) and PI-2 (6.0%-29.4%) were lower in all age groups. The virulence genes lytA (99.5%) and ply (99.0%) associated with candidate protein vaccines showed higher vaccination coverage rates.@*CONCLUSIONS@#There is a significant non-linear dose-response relationship between the age of kindergarten children and the coverage rates of PCV10 and PCV13 serotypes, and kindergarten children aged 2 years have a relatively high coverage rate of PCV. The high prevalence of the virulence genes lytA and ply shows that they are expected to become candidate virulence factors for the development of a new generation of recombinant protein vaccines.

Enfermedad invasiva por Streptococcus pneumoniae, en pacientes adultos. Periodo 2016 al 2018

Introducción: En Paraguay y en otras partes del mundo el Streptococcus pneumoniae es el principal agente causante de neumonía bacteriana, otitis media, meningitis y septicemia. Objetivo: Describir las características clínico-epidemiológicas de pacientes con enfermedad invasiva por Streptococcus pneumoniae atendidos en el Instituto de Medicina Tropical (IMT) durante los años 2016 al 2019. Metodología: Estudio observacional, descriptivo, transversal. Se incluyeron a todos los pacientes con enfermedad invasiva por Streptococcus pneumoniae confirmada. Resultados: Fueron incluidos 34 pacientes, la edad promedio fue de 44años, 76% fueron varones, 61% diagnóstico de infección por VIH. El foco infeccioso predominante fue el pulmonar. De las muestras biológicas con cultivos positivos, el 73% fueron aislados en sangre, y los restantes distribuidos entre muestras de esputo, líquido ceflorraquideo y liquido pleural. El 24% de los pacientes presentaron complicaciones, entre falla orgánica (15%) y empiema (9%). El 59% de los pacientes recibió tratamiento con cefalosporinas. La mortalidad intrahospitalaria registrada fue del 18%.Conclusión: Los pacientes con enfermedad invasiva que acudieron al IMT durante los años 2016 al 2019 fueron en su mayoría adultos jóvenes, inmunosuprimidos, con neumonía.

Introduction: In Paraguay and in other parts of the world, Streptococcus pneumoniae is the main causative agent of bacterial pneumonia, otitis media, meningitis and septicemia. Objective: To describe the clinical-epidemiological characteristics of patients with invasive disease due to Streptococcus pneumoniae treated at the Institute of Tropical Medicine (IMT) during the years 2016 to 2019. Methodology: Observational, descriptive, cross-sectional study. All patients with confirmed invasive disease due to Streptococcus pneumoniae were included. Results: 34 patients were included, the average age was 44 years, 76% were male, 61% diagnosed with HIV infection. The predominant infectious focus was the lung. Of the biological samples with positive cultures, 73% were isolated from blood, and the rest distributed among samples of sputum, cerebrospinal fluid, and pleural fluid. 24% of the patients presented complications, between organic failure (15%) and empyema (9%). 59% of the patients received treatment with cephalosporins. The registered intrahospital mortality was 18%. Conclusion: The patients with invasive disease who attended the IMT during the years 2016 to 2019 were mostly young adults, immunosuppressed, with pneumonia.

Impacto de la vacuna antineumocócica en la incidencia y hospitalización de niños con neumonía adquirida en la comunidad

Introducción: A nivel mundial, el 99 % de las muertes por neumonía la sufren los niños menores de 5 años. La Organización Mundial de la Salud recomienda la inclusión de vacunas antineumocócicas en los programas de inmunización infantil con ampliación internacional para reducir muertes anuales en este grupo de edad. Objetivo: Evaluar el impacto de la vacuna antineumocócica en la incidencia y hospitalización de niños menores de 5 años con neumonía adquirida en la comunidad. Métodos: Revisión sistemática de diversas publicaciones científicas relacionadas con el tema. Las fuentes de búsqueda fueron PubMed, SciELO y Google Scholar. Las palabras clave fueron: "niños", "vacuna neumocócica" en combinación con "neumonía adquirida en la comunidad" o "child", "pneumococcalvaccines" y "pneumonia, bacterial". Se seleccionaron los artículos de corte analítico publicados desde 1 de enero de 2017 hasta 6 de octubre de 2021. Se excluyeron los artículos que no consignen autor o Digital Object Identifier System o se refieran a neumonías intrahospitalarias o nosocomiales. Análisis y síntesis de la información: De los 136 artículos encontrados se descartaron 125 por no cumplir con los criterios de inclusión y exclusión, quedaron 4 artículos para la base teórica y 7 artículos para esta revisión. Se observó que la vacuna antineumocócica PCV 13 disminuye la incidencia hasta 22 % y las tasas de hospitalización en 35 %. Conclusión: La vacunación es una estrategia de salud muy eficaz para reducir esta clase de enfermedades, prevenibles por medio de la inmunización.

Introduction: Globally, 99% of pneumonia deaths are children under 5 years old. The World Health Organization recommends the inclusion of pneumococcal vaccines in internationally expanded childhood immunization programs to reduce annual deaths in this age group. Objective: To evaluate the impact of pneumococcal vaccine on the incidence and hospitalization of children under 5 years of age with community-acquired pneumonia. Methods: Systematic review of various scientific publications related to the subject. The search sources were PubMed, SciELO and Google Scholar. The key words were: "children", "pneumococcal vaccine" in combination with "community-acquired pneumonia" or "child", "pneumococcal vaccines" and "pneumonia, bacterial". Analytical articles published from January 1, 2017 to October 6, 2021 were selected. Articles that do not include an author or Digital Object Identifier System or refer to hospital or nosocomial pneumonias were excluded. Analysis and synthesis of information: Of the 136 articles found, 125 were discarded for not meeting the inclusion and exclusion criteria, 4 articles remained for the theoretical basis and 7 articles for this review. Pneumococcal vaccine PCV 13 was found to decrease incidence by up to 22% and hospitalization rates by 35%. Conclusion: Vaccination is a very effective health strategy to reduce this kind of diseases, which are preventable through immunization.

Enfermedad neumocócica invasiva en pacientes de un hospital pediátrico de Perú, 2017-2020 / Invasive pneumococcal disease in patients from a pediatric hospital in Peru, 2017-2020

El propósito del presente estudio fue describir las características clínicas, serotipos y susceptibilidad antibiótica en pacientes con enfermedad neumocócica invasiva (ENI). Se revisaron las historias clínicas de los pacientes con ENI hospitalizados en el Instituto Nacional de Salud del Niño-Breña (Lima, Perú). Se evaluaron a 29 pacientes. La mediana de edad fue 1,9 años (rango intercuartílico 1 a 4 años). El 51,7% eran mujeres y la forma clínica de la ENI más frecuente fue la bacteriemia en 18 (62,1%) pacientes. El 65,5% tenía el esquema de vacunación completo, según el Ministerio de Salud de Perú. El 82,8% del aislamiento del germen fue de sangre. La resistencia antibiótica fue más frecuente a la eritromicina (55,2%), trimetoprim-sulfametoxazol (48,3%) y penicilina (24,1%). Los serotipos registrados fueron 6C, 19A, 23A y 24F. Un paciente falleció por meningitis. En conclusión, la ENI fue más frecuente en niños de uno a cinco años y en la forma clínica de bacteriemia. Se encontraron cinco serotipos reportados en estudios previos con resistencia a penicilina y eritromicina.

This study aimed to describe the clinical characteristics, serotypes, and antibiotic susceptibility in patients with invasive pneumococcal disease (IPD). The medical records of patients with IPD who were hospitalized at the Instituto Nacional de Salud del Niño-Breña (Lima, Peru) were reviewed. We evaluated 29 patients. The median age was 1.9 years (interquartile range: 1 to 4 years). Of the sample, 51.7% were women and the most frequent clinical form of IPD was bacteremia in 18 (62.1%) patients; 65.5% had a complete vaccination schedule, according to the Peruvian Ministry of Health. Germ isolation was performed from blood samples in 82.8% of patients. Antibiotic resistance to erythromycin (55.2%) was the most frequent, followed by resistance to trimethoprim-sulfamethoxazole (48.3%) and penicillin (24.1%). The isolated serotypes were 6C, 19A, 23A and 24F. One patient died of meningitis. In conclusion, IPD was more frequent in children aged one to five years and the most frequent clinical form was bacteremia. Five serotypes reported in previous studies were found to be resistant to penicillin and erythromycin.

The inverse correlation between serum levels of anti-pneumococcal and ferritin after pneumococcal vaccination in splenectomised beta thalassemia major

Splenectomy is necessary in beta thalassemia major patients when the spleen becomes hyperactive, leading to extreme destruction of erythrocytes. This study assessed the ferritin effect on serum pneumococcal antibody response following pneumococcal vaccination, in patients with beta thalassemia major after splenectomy. In this case series study, convenience sampling was used to recruit 347 splenectomised beta thalassemia patients under the auspices of Jahrom University of Medical Sciences. Demographic data such as age, sex, and time after splenectomy were recorded by a questionnaire. All participants had been splenectomised and received a dose of Pneumovax1 23 vaccine 14 days before surgery. The IgG antibody responses to pneumococcal vaccine and levels of serum specific ferritin were determine by commercial enzyme immunoassay kits. For the analysis, SPSS software version 16 was used. A p-value less than 0.05 was considered statistically significant. Most of the participants (63.4 percent) were hypo-responders to pneumococcal vaccine. Also, serum anti-pneumococcal IgG antibody was related to post splenectomy duration and serum ferritin (p 0.05). An important result was a relation of serum anti-pneumococcal IgG antibody to serum ferritin according to post splenectomy duration groups. Therefore, in three groups of post splenectomy duration, the serum ferritin was higher in hypo-responder than in good responder subjects. Our results indicate that serum anti-pneumococcal IgG antibody decreased with increment of serum ferritin and post splenectomy duration. Thus, there is a need to re-address the approach towards revaccination in this immune-compromised group of patients by administering a booster pneumococcal vaccination in an attempt to recover immunity and reduce morbidity(AU)

La esplenectomía es necesaria en pacientes con beta talasemia mayor cuando el bazo se vuelve hiperactivo, lo que lleva a una destrucción extrema de los eritrocitos. Este estudio evaluó el efecto de la ferritina sobre la respuesta de anticuerpos antineumocócicos en suero después de la vacunación antineumocócica, en pacientes con talasemia beta mayor a los que se les realizó esplenectomía. En este estudio de serie de casos, se utilizó un muestreo de conveniencia para reclutar a 347 pacientes con beta talasemia esplenectomizados bajo los auspicios de la Universidad de Ciencias Médicas de Jahrom. Los datos demográficos como la edad, el sexo y el tiempo después de la esplenectomía se registraron mediante un cuestionario. Todos los participantes fueron esplenectomizados y recibieron una dosis de la vacuna Pneumovax® 23, 14 días antes de la cirugía. Las respuestas de anticuerpos IgG a la vacuna neumocócica y los niveles de ferritina sérica específica se determinaron mediante estuches comerciales de inmunoensayo enzimático. Para el análisis se utilizó el programa SPSS versión 16. Un valor de p inferior a 0,05 se consideró estadísticamente significativo. La mayoría de los participantes (63,4 por ciento) resultaron hiporrespondedores a la vacuna antineumocócica. Además, el anticuerpo sérico antineumocócico IgG se relacionó con la duración de la esplenectomía y la ferritina sérica (p0,05). Un resultado importante fue la relación del anticuerpo sérico IgG antineumocócico con la ferritina sérica según los grupos de duración postesplenectomía. Por lo tanto, en tres grupos de duración posterior a la esplenectomía, la ferritina sérica fue mayor en los sujetos con hiporrespuesta que en los sujetos con buena respuesta. Nuestros resultados indican que el anticuerpo sérico IgG antineumocócico disminuyó con el incremento de la ferritina sérica y la duración posterior a la esplenectomía. Por lo tanto, existe la necesidad de volver a abordar el enfoque hacia la revacunación en este grupo de pacientes inmunocomprometidos mediante la administración de una vacunación antineumocócica de refuerzo en un intento por recuperar la inmunidad y reducir la morbilidad(AU)

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.

Incremento de los costos del Programa Nacional de Inmunización por la introducción del candidato vacunal contra neumococo / Increase in the costs of the National Immunization Program due to the introduction of the pneumococcal vaccine candidate

Introducción: La industria nacional ha desarrollado un candidato vacunal contra neumococo. Ante su posible introducción en el sistema de salud debe valorarse el costo incremental que acarrearía. Objetivo: Estimar el incremento de los costos del Programa Nacional de Inmunización por la introducción del candidato vacunal contra neumococo. Métodos: Estudio de descripción de costos desde la perspectiva social para el año 2021. Se estudiaron ocho policlínicos de La Habana y se entrevistaron 38 familiares de lactantes. Se estimó el costo institucional, el gasto de bolsillo y el costo indirecto mediante microcosteo. Se estimó el costo incremental para un esquema de tres dosis (2p+1), concomitantes con otras vacunas. Resultados: El costo total para el Programa Nacional de Inmunización en estos policlínicos estuvo entre los 337 000,00 CUP y los 513 000,00 CUP, con un costo por dosis entre 33,11 CUP y 47,30 CUP. El 31,6 por ciento de las familias reportó gastos en transportación de entre 5,00 CUP y 40,00 CUP. La introducción de la vacuna representaría un incremento entre 8,43 por ciento y 18,99 por ciento del costo base del Programa Nacional de Inmunización en los policlínicos. El costo por dosis sería de entre 34,17 CUP y 47,82 CUP, para un incremento de entre 0,28 CUP y 1,33 CUP. Conclusiones: La mayor parte del costo del Programa Nacional de Inmunización lo asume el Estado. La aplicación de la vacuna cubana contra neumococo solo aumentaría muy levemente el costo por dosis(AU)

Introduction: The national industry has developed a vaccine candidate against pneumococcus. Given its possible introduction into the health system, the incremental cost that it would entail must be assessed. Objective: To estimate the increase in the costs of the National Immunization Program due to the introduction of the pneumococcal vaccine candidate. Methods: Study of cost description from the social perspective for the year 2021. Eight polyclinics in Havana were studied and 38 relatives of infants were interviewed. Institutional cost, out-of-pocket costs and indirect costs were estimated through microcost. The incremental cost was estimated for a three-dose schedule (2p+1), concomitant with other vaccines. Results: The total cost for the National Immunization Program in these polyclinics was between 337,000.00 CUP and 513,000.00 CUP, with a cost per dose between 33.11 CUP and 47.30 CUP. 31.6percent of families reported transportation expenses from 5.00 CUP to 40.00 CUP. The introduction of the vaccine would represent an increase between 8.43 percent and 18.99 percent of the base cost of the National Immunization Program in polyclinics. The cost per dose would be between 34.17 CUP and 47.82 CUP, for an increase of between 0.28 CUP and 1.33 CUP. Conclusions: Most of the cost of the National Immunization Program is borne by the State. The application of the Cuban pneumococcal vaccine would only slightly increase the cost per dose(AU)

Cross Sectional Study of Knowledge about Pneumococcal Conjugate Vaccine Among Medical and Nursing Students studying at Civil Hospital campus, Ahmedabad

Introduction: India is committed to to prevent pneumonia related deaths in children which is leading cause of vaccine preventable deaths among children under five globally and in India. Objective : To know awareness about pneumococcal (PC) vaccine among medical and nursing students of civil hospital, Ahmedabad. Method: This cross sectional study was conducted on medical and nursing students of civil hospital, Ahmedabad, Gujarat. Baseline knowledge of PC Vaccine, side effects of PC vaccine, was assessed by a self-administered structured questionnaire. Statistical analysis - Data analysis was done in Microsoft excel and chi square test was applied. Results: There were 444 respondents and among them 240 (54%) were medical students and 204 (46%) were nursing students, with male female ratio was 95:127. Awareness regarding PC vaccine integration to national immunization schedule found significantly more in nursing students as compare to medical students, (Chi-square = 63.4 at p < 0.05). Medical students had more knowledge about PC vaccine as compared to nursing students. Conclusion: There is still gap in awareness of PC vaccine integration to national immunization schedule among medical students. Field visits among nursing students have positive effects on awareness of nursing students. Medical students should visit to this type of field activities to improve their knowledge about ongoing activities like this

Comparison of the clinical features of invasive pneumococcal disease with those of pneumococcal pneumonia in adults / Journal of Rural Medicine

Background: Invasive pneumococcal disease (IPD) is an infectious disease where Streptococcus pneumoniae can be detected in the cerebrospinal fluid or blood.Methods: Eight patients presented to our hospital with adult IPD. We compared with 69 cases of pneumococcal pneumonia treated in our department between 2012 and 2014. None of the patients had a history of pneumococcal vaccine administration.Results: Hematological examination showed the platelet count was significantly lower and the serum C-reactive protein level was significantly higher in the IPD group. There was a significant difference in the use of a respirator and mortality in the IPD group. About antibiotics, Carbapenem and quinolone were used for the treatment of many patients in the IPD group. In the fatal three cases of IPD, the age of all members were 65 years or younger. Two of three had no underlying disease.Conclusion: IPD develops without elderly people and in those without underlying disease. Also, the patients who took a sudden course may result in death. In line with previous studies that have reported the effectiveness of the pneumococcal vaccine, our study findings emphasize the need of administering vaccination for prevention of IPD in person who was younger than 65 years old.

Organ transplantation and vaccination / 器官移植

Organ transplant recipients are at a high risk of infection with high hospitalization rate, critical rate and fatality, due to low immune function caused by taking immunosuppressants for a period of long time after organ transplantation. Currently, vaccination is recognized as an effective approach to prevent infection. Organ transplant recipients may be vaccinated according to individual conditions. However, the sensitivity to vaccines may decline in organ transplant recipients. The types, methods and timing of vaccination have constantly been the hot spots of clinical trials. In this article, the general principles, specific vaccines and SARS-CoV-2 vaccines of vaccination in organ transplant recipients were briefly reviewed, aiming to provide reference for the vaccination of organ transplant recipients. Moreover, current status of SARS-CoV-2 vaccination for organ transplant recipients was illustrated under the global outbreak of novel coronavirus pneumonia pandemic.

Post-marketing immunogenicity and safety of domestic 23-valent pneumococcal polysaccharide vaccine: a multicenter study / 中华微生物学和免疫学杂志

Objective:To evaluate the post-marketing safety and immunogenicity of a 23-valent pneumococcal polysaccharide vaccine (PPV23).Methods:From September 2020 to June 2021, a clinical trial of single-dose PPV23 was conducted in people ≥3 years old in Centers for Disease Control and Prevention of Guizhou, Hunan and Fujian provinces. Blood samples were collects from the subjects before and 30 d after vaccination. ELISA was used to quantitatively detect IgG antibodies against capsular polysaccharides of 23 Streptococcus pneumoniae serotypes in serum samples. The adverse events (AEs) were monitored within 7 d after vaccination. Results:A total of 409 subjects were enrolled and included in safety analysis. Except for one with antibody level inversion, the other 408 participants were included in immunogenicity analysis. The levels of antibodies against the 23 Streptococcus pneumoniae serotypes were all increased after vaccination by an average of 4.24 folds. The two-fold growth rates of the antibodies ranged from 51.72% to 96.81% with a total two-fold growth rate of 78.59%. The overall rate of AEs was 27.14% (111/409). Local AEs were mainly pain, induration, redness and swollen. No serious adverse events related to vaccination occurred. Conclusions:This study preliminarily demonstrated the good immunogenicity and safety of PPV23 vaccine.

Clinical characteristics and risk factors of children with streptococcus pneumoniae infection in children / 中国小儿急救医学

Objective:To analyze the clinical characteristics, changes of bacterial resistance and death risk factors of children with streptococcus pneumoniae infection, so as to provide reference for clinical diagnosis and treatment.Methods:From January 2012 to December 2019, hospitalized pediatric patients at Shengjing Hospital of China Medical University were selected.Patients with streptococcus pneumoniae positive in bacterial culture in body fluids of various parts (including alveolar lavage fluid, blood, cerebrospinal fluid, external auditory canal secretions, and local abscess drainage fluid) within one week after admission were selected as subjects.The clinical characteristics and changes of bacterial resistance of 146 children with streptococcus pneumoniae infection were retrospectively analyzed, and 141 children were divided into improved group (124 cases) and death group (17 cases) according to the follow-up results, and the risk factors related to death of streptococcus pneumoniae infection were analyzed.Results:(1)A total of 146 children were included, mainly at age of 1 to 3 years (74 cases, 50.68%), and 14 cases had underlying diseases, including congenital malformation, spinal muscular atrophy, epilepsy and so on.(2) There were 76 (52.05%) cases of invasive streptococcus pneumoniae.There were 106 (72.60%) cases of pulmonary infection, 59 (40.41%) cases of sepsis, 42 (28.77%) cases of purulent meningitis, and five cases of local and pelvic abscess.Five cases were discharge from hospital, 17 cases died, and the rest were all improved.Among the dead children, five cases died because of multiple organ failure, ten cases died because of brain failure and two cases died because of severe sepsis.Six deaths were complicated with septic shock.(3) There were 169 streptococcus pneumoniae positive samples, among them 51 (30.18%) blood samples, 39 (23.08%) cerebrospinal fluid samples, 67 (39.64%) alveolar lavage fluid samples, seven (4.14%) pleural fluid samples, and other body fluid culture samples were five strains.(4) The sensitivity rates of vancomycin, linezolid, moxifloxacin and telithromycin to streptococcus pneumoniae were 100.00%, and that for levofloxacin was 98.82%.The resistant rate of erythromycin to streptococcus pneumoniae was 97.01%, and multidrug resistant rate was 85.61%.(5) Previous convulsions, cerebrospinal fluid or positive blood culture, sepsis, meningitis were risk factors for death(all P<0.05). Children in the death group had shorter out-of-hospital course of disease, lower levels of 24-hour hemoglobin, platelets, serum albumin, and higher levels of C-reactive protein and D-dimer (all P<0.05). Logistics multi-factor analysis showed that, low hemoglobin ( OR=0.31, P=0.025), high D-dimer( OR=1.16, P=0.038), septic shock ( OR=27.81, P=0.008), and positive cerebrospinal fluid culture ( OR=6.34, P=0.034) were independent risk factors for death from streptococcus pneumoniae infection. Conclusion:The average age of streptococcus pneumoniae infection is small, the onset of severe infection is rapid, and the fatality rate as well as and the incidence of invasive pneumococcal disease are high.During clinical treatment, the utilization rate of amoxicillin should be appropriately increased, and the application of cephalosporin antibiotics should be reduced.

Evaluation of the direct and indirect impact on pneumonia hospitalization after almost a decade of the 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine in Brazil

Introduction: Pneumococcal pneumonia is a leading cause of severe disease, leading to approximately 2.2 million hospital admissions in 2019 in Brazil. Since 2010, the 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine was introduced in Brazil, as part of the National Immunization Program (NIP) with universal access, approximated coverage of 91.4% in 2019. Although studies from many countries are available, there is still a need to understand the effect of the vaccine introduction on the incidence of pneumonia hospitalizations in Brazil.Methods: Data on hospitalization associated with the diagnosis of pneumonia in the population assisted by the Brazilian Public Health System were accessed to fit a time series analysis, which tested the main hypothesis of the influence of vaccination on the trends for the incidence of pneumonia hospitalizations.Results: The post-vaccination period showed a negative trend, reducing 1.75, 0.16, and 0.11 cases per 100,000 inhabitants per month for the groups < 1, 1­4, and 5­9 years old, respectively. In individuals older than 20 years, the post-vaccination period has a positive trend, but not as great as compared trends before the vaccination period. These results indicate a protective herd effect in the older population, nine years after introducing the pneumococcal vaccine in the NIP.Conclusion: Vaccination with pneumococcal conjugated vaccine reduces hospitalizations associated with pneumonia diagnosis in vaccinated and non-vaccinated populations in a sustained and progressive manner.

Facilitating access to pneumococcal vaccine for people living with HIV: an experience report / Como facilitar el acceso a la vacuna neumocócica a las personas que viven con el VIH: informe de una experiencia / Facilitando o acesso à vacina pneumocócica para pessoas vivendo com HIV: relato de experiência

ABSTRACT The article describes a strategy to facilitate access to pneumococcal conjugate vaccine 13 (PCV-13) for people living with HIV/AIDS (PLHIV) during the COVID-19 pandemic. Method: report on the experience regarding the organization of a care service for PLHIV in the city of São Paulo to facilitate access to PCV-13 in the framework of the 2020 influenza vaccination campaign during the COVID-19 pandemic. Results: through the integration between a PLHIV care service and an Immunization Center (CRIE in Portuguese), it was possible to offer PCV-13 to PLHIV at the point of care, reducing physical barriers to access to immunization. Thus, of the 1,906 PLHIV who passed through the service during the period March 23-July 31, 2020, 84.4% (1,609) received the influenza vaccine, PCV-13 or both. Of the 1609 vaccinated, 50.6% (814) were eligible and received PCV-13. Conclusion: offering the vaccine at the point of care and orienting PLHIV on the importance of vaccination as a disease prevention strategy, identifying those eligible to receive it, was an important action carried out by the institution together with the nursing team, as a strategy to facilitate access to vaccination.

RESUMEN El artículo describe una estrategia para facilitar el acceso a la vacuna neumocócica conjugada 13 (PCV-13) a las personas que viven con VIH/SIDA (PVVS) durante la pandemia de COVID-19. Método: relato de experiencia sobre la organización de un servicio de atención a las PVVS en la ciudad de São Paulo, para facilitar el acceso a la PCV-13 en el marco de la campaña de vacunación contra la gripe de 2020, durante la pandemia de COVID-19. Resultados: a través de la integración entre un servicio de atención a las PVVS y un Centro de Inmunización (CRIE), fue posible ofrecer la PCV-13 a las PVVS en su punto de atención, reduciendo las barreras físicas para el acceso a la inmunización. Así, de las 1.906 PVVS que pasaron por el servicio durante el periodo comprendido entre el 23 de marzo y el 31 de julio de 2020, el 84,4% (1.609) recibieron la vacuna de la gripe, la PCV-13 o ambas. De los 1609 vacunados, el 50,6% (814) eran elegibles y recibieron la PCV-13. Conclusión: ofrecer la vacuna en el lugar de atención y orientar a las PVVS sobre la importancia de la vacunación como estrategia de prevención de enfermedades, identificando a las personas elegibles para recibirlas, fue una acción importante realizada por la institución junto con el equipo de enfermería, como estrategia para facilitar el acceso a la vacunación.

RESUMO Descrever uma estratégia para facilitar o acesso à vacina conjugada pneumocócica 13-valente (PCV-13) para pessoas vivendo com HIV (PVHIV), durante a pandemia de COVID-19. Método: relato de experiência sobre a organização de um serviço de atendimento para PVHIV na cidade de São Paulo, para facilitar o acesso à PCV-13 no decorrer da campanha de vacinação de influenza de 2020, durante a pandemia de COVID-19. Resultados: por meio da integração entre um serviço de atendimento para PVHIV e um Centro de Imunizações (CRIE) foi possível oferecer a PCV-13 para as PVHIV em seu local de atendimento, diminuindo barreiras físicas de acesso à imunização. Dessa forma, das 1906 PVHIV que passaram pelo serviço durante o período de 23 de março a 31 de julho de 2020, 84,4% (1609) receberam a vacina influenza, PCV-13 ou ambas. Dos 1609 vacinados, 50,6% (814) foram elegíveis e receberam a PCV-13. Conclusão: oferecer a vacina em seu local de tratamento e orientar as PVHIV sobre a importância da vacinação como estratégia de prevenção de doenças, identificando os elegíveis a recebê-las, foi uma importante ação realizada pela instituição em conjunto com a equipe de enfermagem, como estratégia de facilitar o acesso à vacinação.

Caracterización de la meningoencefalitis bacteriana en la provincia Camagüey en el período de 2016-2020

Introducción: Las infecciones del sistema nervioso central constituyen un importante problema de salud en todas las regiones del planeta; representan un reto para el médico de asistencia, el microbiólogo y el epidemiólogo, en función de un precoz y correcto diagnóstico, elementos básicos para un pronóstico satisfactorio. Objetivo: Determinar el comportamiento de la meningoencefalitis bacteriana en la provincia Camagüey. Métodos: Se realizó un estudio observacional descriptivo, transversal y retrospectivo, sobre el comportamiento de la meningoencefalitis bacteriana en la provincia Camagüey en el periodo comprendido desde el 2016 hasta el 2020. El universo de estudio estuvo constituido por todos los casos (128) diagnosticados con meningoencefalitis bacteriana, atendidos en los hospitales de más de 100 camas durante el período del primero de enero de 2016 al 31 de diciembre de 2020. Resultados: El año 2017 resultó ser el mayor número de casos, el agente causal predominante fue el Streptococcus pneumoniae; las edades pediátricas fueron las de mayor incidencia en especial el menor de un año y sexo masculino. El síntoma cardinal en el estudio fue la fiebre y el neumococo fue el más letal agente causal. Conclusiones: El diagnóstico precoz de las meningoencefalitis bacterianas conlleva a una menor letalidad y por ende menos secuelas.

Introduction: Central nervous system infections are an important health problem in all regions of the planet; they represent a challenge for the attending physician, the microbiologist and the epidemiologist, based on an early and correct diagnosis, basic elements for a satisfactory prognosis. Objective: To determine the behavior of bacterial meningoencephalitis in the Province of Camagüey. Methods: A descriptive, cross-sectional and retrospective observational study was carried out on the behavior of bacterial meningoencephalitis in Camagüey province during the period 2016-2020. The study universe consisted of all cases (128) diagnosed with bacterial meningoencephalitis, attended in Hospitals with more than 100 beds during the period from January 1st, 2016 to December 31st, 2020. Results: The year 2017 turned out to be the one with the largest number of cases, the predominant causal agent was Streptococcus pneumoniae; pediatric ages were those with the highest incidence, especially those under 1 year of age and males. The cardinal symptom in the study was fever, and pneumococcus was the most lethal causative agent. Conclusions: The early diagnosis of bacterial meningoencephalitis leads to less lethality and therefore fewer sequelae.