Gili Regev-Yochay1, Michal Katzir2, Jacob Strahilevitz3, Galia Rahav4, Talya Finn5, Dan Miron6, Yasmin Maor7, Bibiana Chazan8, Yehudith Schindler9, Ron Dagan10. 1. Sheba Med Ctr, Ramat-Gan, Israel; Tel-Aviv University, Tel-Aviv, Israel. Electronic address: gili.regev.y@gmail.com. 2. Tel-Aviv University, Tel-Aviv, Israel; Meir Med Ctr, Kfar Saba, Israel. 3. Haddassah Med Ctr, Jerusalem, Israel. 4. Sheba Med Ctr, Ramat-Gan, Israel; Tel-Aviv University, Tel-Aviv, Israel. 5. Tel-Aviv University, Tel-Aviv, Israel; Tel-Aviv Med Ctr, Tel-Aviv, Israel. 6. Rivka Ziv Med Ctr, Sefed, Israel. 7. Tel-Aviv University, Tel-Aviv, Israel; Wolfson Med Ctr, Holon, Israel. 8. Emek Med Ctr, Afula, Israel. 9. Maayanei Hayeshua Hosp, Bnei-Brak, Israel. 10. Ben-Gurion University, Beer-Sheva, Israel.
Abstract
BACKGROUND: Introduction of pneumococcal conjugate vaccine (PCV) has nearly eliminated vaccine-type (VT) invasive pneumococcal disease (IPD) in children, yet the reported resulting reduction of adult IPD is variable. We present the indirect impact of sequential PCV7/PCV13 implementation in Israel on adult IPD. METHODS: An ongoing nationwide active surveillance was initiated on July 2009 when PCV7 was implemented (with Catch-up). PCV7 was gradually replaced by PCV13 since November 2010. Comorbidity and outcome data were collected from medical files. Incidence rates were calculated for overall and vaccine-type IPD. RESULTS: A total of 2579 IPD cases were diagnosed among a population of 5.0-5.5 million adults >18y (2009-2015). Incidence rates were 9.15/100,000 and 10.16/100,000 in the first and second study years, respectively. However, after PCV13 implementation, the rates decreased to 7.19 within four years, and remained stable in the two following years. Within 6years, PCV7-VT-IPD incidence decreased from 2.52 to 0.52 (79%) and PCV13-VT-IPD from 6.15 to 1.81 (71%). Concurrently, non-VT13 incidence increased from 2.99 to 5.25. Approximately 50% of all patients were adults ≥65y, in whom the decrease in PCV13-VT-IPD incidence was smaller and slower (65% vs. >80% decrease in adults <50y). CONCLUSIONS: Despite continued reduction in PCV13-VT-IPD, overall IPD was stable during the last two years due to serotype replacement. Yet, the significant decrease in adult IPD, six years post-PCV7/13 implementation emphasizes the importance of indirect protection in achieving overall population impact and should be considered when discussing the potential additional benefits of direct adult PCV vaccination.
BACKGROUND: Introduction of pneumococcal conjugate vaccine (PCV) has nearly eliminated vaccine-type (VT) invasive pneumococcal disease (IPD) in children, yet the reported resulting reduction of adult IPD is variable. We present the indirect impact of sequential PCV7/PCV13 implementation in Israel on adult IPD. METHODS: An ongoing nationwide active surveillance was initiated on July 2009 when PCV7 was implemented (with Catch-up). PCV7 was gradually replaced by PCV13 since November 2010. Comorbidity and outcome data were collected from medical files. Incidence rates were calculated for overall and vaccine-type IPD. RESULTS: A total of 2579 IPD cases were diagnosed among a population of 5.0-5.5 million adults >18y (2009-2015). Incidence rates were 9.15/100,000 and 10.16/100,000 in the first and second study years, respectively. However, after PCV13 implementation, the rates decreased to 7.19 within four years, and remained stable in the two following years. Within 6years, PCV7-VT-IPD incidence decreased from 2.52 to 0.52 (79%) and PCV13-VT-IPD from 6.15 to 1.81 (71%). Concurrently, non-VT13 incidence increased from 2.99 to 5.25. Approximately 50% of all patients were adults ≥65y, in whom the decrease in PCV13-VT-IPD incidence was smaller and slower (65% vs. >80% decrease in adults <50y). CONCLUSIONS: Despite continued reduction in PCV13-VT-IPD, overall IPD was stable during the last two years due to serotype replacement. Yet, the significant decrease in adult IPD, six years post-PCV7/13 implementation emphasizes the importance of indirect protection in achieving overall population impact and should be considered when discussing the potential additional benefits of direct adult PCV vaccination.
Authors: Carlos M Luna; Laura Pulido; Michael S Niederman; Alberto Casey; Diego Burgos; Sebastián D Leiva Agüero; Alejandra Grosso; Evangelina Membriani; Andrea C Entrocassi; Marcelo Rodríquez Fermepin; Carlos A Vay; Susana Garcia; Angela Famiglietti Journal: Pneumonia (Nathan) Date: 2018-09-25
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