Naim Ouldali1, Corinne Levy2, Emmanuelle Varon3, Stéphane Bonacorsi4, Stéphane Béchet5, Robert Cohen6, François Angoulvant7. 1. Association Clinique et Thérapeutique Infantile du Val-de-Marne, Saint Maur-des-Fossés, France; Groupe de Pathologie Infectieuse Pédiatrique, Paris, France; Unité d'épidémiologie clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, ECEVE UMR 1123, Paris, France; Urgences pédiatriques, Hôpital Necker Enfants Malades, Université Paris Descartes, Paris, France. 2. Groupe de Pathologie Infectieuse Pédiatrique, Paris, France; Association Française de Pédiatrie Ambulatoire, Saint-Germain-en-Laye, Paris, France; Université Paris Est, IMRB-GRC GEMINI, Créteil, France; Clinical Research Center, Centre Hospitalier Intercommunal de Créteil, Créteil, France. Electronic address: corinne.levy@activ-france.fr. 3. National Reference Center for Pneumococci, Laboratoire de Microbiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France. 4. Université Paris Diderot, Sorbonne Paris Cité, France; Service de Microbiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Robert-Debré, Paris, France. 5. Association Clinique et Thérapeutique Infantile du Val-de-Marne, Saint Maur-des-Fossés, France; Groupe de Pathologie Infectieuse Pédiatrique, Paris, France. 6. Association Clinique et Thérapeutique Infantile du Val-de-Marne, Saint Maur-des-Fossés, France; Groupe de Pathologie Infectieuse Pédiatrique, Paris, France; Association Française de Pédiatrie Ambulatoire, Saint-Germain-en-Laye, Paris, France; Université Paris Est, IMRB-GRC GEMINI, Créteil, France; Clinical Research Center, Centre Hospitalier Intercommunal de Créteil, Créteil, France; Unité Court Séjour, Petits Nourrissons, Service de Néonatalogie, Centre Hospitalier Intercommunal de Créteil, France. 7. Groupe de Pathologie Infectieuse Pédiatrique, Paris, France; Unité d'épidémiologie clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, ECEVE UMR 1123, Paris, France; Urgences pédiatriques, Hôpital Necker Enfants Malades, Université Paris Descartes, Paris, France.
Abstract
BACKGROUND: Successive implementation of seven-valent then 13-valent pneumococcal conjugate vaccines (PCVs) led to a marked decrease in pneumococcal disease burden, including pneumococcal meningitis. We assessed the long-term effect of implementation of PCVs on incidence of pneumococcal meningitis in children in France over a 16-year period. METHODS: We did a quasi-experimental, population-based interrupted time-series analysis with a nationwide prospective survey over 16 years in France, recruiting children aged younger than 15 years from 227 paediatric wards from January, 2001, to December, 2016. The main outcome by the time-series model was the estimated incidence of pneumococcal meningitis per 100 000 children (of a population of 12·6 million children in 2017) before and after PCV7 and PCV13 implementation. The time-series model was based on segmented regression with autoregressive error. FINDINGS: We enrolled 1778 children with pneumococcal meningitis. PCV13 implementation led to a significant reduction in monthly incidence of pneumococcal meningitis from 0·12 per 100 000 children before PCV13 to a nadir of 0·07 in December, 2014 (-38%, 95% CI -56·1 to -20·4; p<0·0001). A sharp increase occurred during 2015 and 2016, (+2·3% per month, incidence of 0·13 per 100 000 children at the end of the study period, p=0·0002), mainly related to an increase of serotype 24F, which was frequently penicillin resistant. INTERPRETATION: The early effect of PCV13 implementation greatly reduced the incidence of pneumococcal meningitis in children less than 15 years old. However, a sharp rebound in incidence linked to the emergence of serotype 24F compromised the long-term PCV efficacy. If confirmed in future studies and in other countries, pneumococcal meningitis incidence rebound and 24F emergence should be considered when developing next-generation PCVs. FUNDING: The French Pediatric Infectious Diseases Group, Association Clinique et Thérapeutique Infantile du Val de Marne, Pfizer, and for the National Reference Centre for Pneumococci, the French National Health Agency.
BACKGROUND: Successive implementation of seven-valent then 13-valent pneumococcal conjugate vaccines (PCVs) led to a marked decrease in pneumococcal disease burden, including pneumococcal meningitis. We assessed the long-term effect of implementation of PCVs on incidence of pneumococcal meningitis in children in France over a 16-year period. METHODS: We did a quasi-experimental, population-based interrupted time-series analysis with a nationwide prospective survey over 16 years in France, recruiting children aged younger than 15 years from 227 paediatric wards from January, 2001, to December, 2016. The main outcome by the time-series model was the estimated incidence of pneumococcal meningitis per 100 000 children (of a population of 12·6 million children in 2017) before and after PCV7 and PCV13 implementation. The time-series model was based on segmented regression with autoregressive error. FINDINGS: We enrolled 1778 children with pneumococcal meningitis. PCV13 implementation led to a significant reduction in monthly incidence of pneumococcal meningitis from 0·12 per 100 000 children before PCV13 to a nadir of 0·07 in December, 2014 (-38%, 95% CI -56·1 to -20·4; p<0·0001). A sharp increase occurred during 2015 and 2016, (+2·3% per month, incidence of 0·13 per 100 000 children at the end of the study period, p=0·0002), mainly related to an increase of serotype 24F, which was frequently penicillin resistant. INTERPRETATION: The early effect of PCV13 implementation greatly reduced the incidence of pneumococcal meningitis in children less than 15 years old. However, a sharp rebound in incidence linked to the emergence of serotype 24F compromised the long-term PCV efficacy. If confirmed in future studies and in other countries, pneumococcal meningitis incidence rebound and 24F emergence should be considered when developing next-generation PCVs. FUNDING: The French Pediatric Infectious Diseases Group, Association Clinique et Thérapeutique Infantile du Val de Marne, Pfizer, and for the National Reference Centre for Pneumococci, the French National Health Agency.
Authors: Morgan Congdon; Hwanhee Hong; Rebecca R Young; Coleen K Cunningham; Leslie A Enane; Tonya Arscott-Mills; Francis M Banda; Mamiki Chise; Keneilwe Motlhatlhedi; Kristen Feemster; Sweta M Patel; Sefelani Boiditswe; Tiroyaone Leburu; Samir S Shah; Andrew P Steenhoff; Matthew S Kelly Journal: Clin Infect Dis Date: 2021-07-15 Impact factor: 9.079
Authors: Matthew S Kelly; Catherine Plunkett; Yahe Yu; Jhoanna N Aquino; Sweta M Patel; Jillian H Hurst; Rebecca R Young; Marek Smieja; Andrew P Steenhoff; Tonya Arscott-Mills; Kristen A Feemster; Sefelani Boiditswe; Tirayaone Leburu; Tiny Mazhani; Mohamed Z Patel; John F Rawls; Jayanth Jawahar; Samir S Shah; Christopher R Polage; Coleen K Cunningham; Patrick C Seed Journal: ISME J Date: 2021-09-11 Impact factor: 10.302