Muhannad Daana1, Galia Rahav2, Ayob Hamdan3, Amin Thalji4, Fuad Jaar5, Ziad Abdeen6, Hanaa Jaber2, Aviva Goral7, Amit Huppert8, Meir Raz9, Gili Regev-Yochay10. 1. Maccabi Healthcare Services, Jerusalem-Hashfela District, Israel; Hadassah University Medical Center, Jerusalem, Israel. 2. Infectious Disease Unit, Sheba Medical Center, Ramat-Gan, Israel. 3. Private Clinic, Nablus, Palestine. 4. Private Clinic, Ramallah, Palestine. 5. Private Clinic, Bethlehem, Palestine. 6. Al-Quds Nutrition and Health Research Institute, Al-Quds University, Abu-Dis, Palestine. 7. Infectious Disease Unit, Sheba Medical Center, Ramat-Gan, Israel; Section of Infectious Disease Epidemiology, Gertner Institute for Epidemiology Research, Ramat-Gan, Israel. 8. Section of Infectious Disease Epidemiology, Gertner Institute for Epidemiology Research, Ramat-Gan, Israel. 9. Maccabi Healthcare Services, Jerusalem-Hashfela District, Israel. 10. Infectious Disease Unit, Sheba Medical Center, Ramat-Gan, Israel; Section of Infectious Disease Epidemiology, Gertner Institute for Epidemiology Research, Ramat-Gan, Israel. Electronic address: gregev@hsph.harvard.edu.
Abstract
BACKGROUND: The Palestinian-Israeli Collaborative Research (PICR) cross-conflict setting provided a unique opportunity to study overall and indirect effects of pneumococcal conjugate vaccine (PCV7), in two closely related Palestinian populations governed by two distinct health authorities with distinct vaccination policies. Here, PCV7 effects on pneumococcal carriage, serotype distribution and antibiotic resistance are reported. METHODS: Annual cross-sectional surveys of pneumococcal carriage were performed during 2009-2011 among Palestinian children (≤5 years) (a) under Palestinian-Authority (PA) health policy (Ramallah, Nablus and Bethlehem), where PCV7 was unlicensed (b) under Israeli health policy (East-Jerusalem (EJ)) where PCV7 was rapidly implemented from July 2009. Clinical data were collected, pneumococci identified and characterized for antibiotic susceptibilities and serotype. Analyses included multivariate logistic models with an interaction term for PCV7-effect. RESULTS: Altogether, 2755 children from PA (n=1772) and EJ (n=983) were enrolled, of which ~30% were pneumococcal carriers. While overall carriage was not affected by vaccination policy, carriage of vaccine-type (VT7) strains decreased from 52% to 22% (p<0.001) in EJ, where PCV was implemented, but not in PA. This was accompanied by an increase in non-VT13 strains from 34% to 65% (p<0.001) in EJ, but not in PA. Furthermore, within two years post-PCV7 introduction, proportion of multi-drug resistant strains, which was initially 23% in both populations, decreased significantly in EJ, to 10%, while simultaneously it increased in PA to 33% (p<0.001). Similar trends were observed for resistance to most antibiotic groups. The proportion of resistant isolates among non-VT13 strains did not change during the study period. CONCLUSIONS: The unique study design distinguishes secular and seasonal effects from true vaccine effects. While PCV7 did not affect overall pneumococcal carriage rate, VT7 strains, many of which were antibiotic resistant decreased and were replaced by non-VT13 strains, which were mostly not antibiotic resistant, resulting in a net decrease in antibiotic resistance.
BACKGROUND: The Palestinian-Israeli Collaborative Research (PICR) cross-conflict setting provided a unique opportunity to study overall and indirect effects of pneumococcal conjugate vaccine (PCV7), in two closely related Palestinian populations governed by two distinct health authorities with distinct vaccination policies. Here, PCV7 effects on pneumococcal carriage, serotype distribution and antibiotic resistance are reported. METHODS: Annual cross-sectional surveys of pneumococcal carriage were performed during 2009-2011 among Palestinian children (≤5 years) (a) under Palestinian-Authority (PA) health policy (Ramallah, Nablus and Bethlehem), where PCV7 was unlicensed (b) under Israeli health policy (East-Jerusalem (EJ)) where PCV7 was rapidly implemented from July 2009. Clinical data were collected, pneumococci identified and characterized for antibiotic susceptibilities and serotype. Analyses included multivariate logistic models with an interaction term for PCV7-effect. RESULTS: Altogether, 2755 children from PA (n=1772) and EJ (n=983) were enrolled, of which ~30% were pneumococcal carriers. While overall carriage was not affected by vaccination policy, carriage of vaccine-type (VT7) strains decreased from 52% to 22% (p<0.001) in EJ, where PCV was implemented, but not in PA. This was accompanied by an increase in non-VT13 strains from 34% to 65% (p<0.001) in EJ, but not in PA. Furthermore, within two years post-PCV7 introduction, proportion of multi-drug resistant strains, which was initially 23% in both populations, decreased significantly in EJ, to 10%, while simultaneously it increased in PA to 33% (p<0.001). Similar trends were observed for resistance to most antibiotic groups. The proportion of resistant isolates among non-VT13 strains did not change during the study period. CONCLUSIONS: The unique study design distinguishes secular and seasonal effects from true vaccine effects. While PCV7 did not affect overall pneumococcal carriage rate, VT7 strains, many of which were antibiotic resistant decreased and were replaced by non-VT13 strains, which were mostly not antibiotic resistant, resulting in a net decrease in antibiotic resistance.
Authors: Nicholas T K D Dayie; Georgina Tetteh-Ocloo; Appiah-Korang Labi; Edeghonghon Olayemi; Hans-Christian Slotved; Margaret Lartey; Eric S Donkor Journal: PLoS One Date: 2018-11-08 Impact factor: 3.240
Authors: Daniel M Weinberger; Virginia E Pitzer; Gili Regev-Yochay; Noga Givon-Lavi; Ron Dagan Journal: Am J Epidemiol Date: 2019-01-01 Impact factor: 4.897
Authors: Jo Southern; Hector Roizin; Muhannad Daana; Carmit Rubin; Samantha Hasleton; Adi Cohen; Aviva Goral; Galia Rahav; Meir Raz; Gili Regev-Yochay Journal: Int J Equity Health Date: 2015-08-07