Efficacy of inactivated trivalent influenza vaccine in rural India: a 3-year cluster-randomised controlled trial

By Prof Wayne M Sullender, MD, Prof Karen B Fowler, Vivek Gupta, MD, Anand Krishnan, Debjani Ram Purakayastha, Raghuram Srungaram VLN, PhD, Kathryn E Lafond, MPH, Siddhartha Saha, MD, Francisco S Palomeque, MPH, Paul Gargiullo, PhD, Seema Jain, MD, Renu Lal, PhD, Marc-Alain Widdowson, VetMB, Prof Shobha Broor, MD

The Lancet Global Health. To be published July 2019

 

Paediatric vaccination against influenza can result in indirect protection, by reducing transmission to their unvaccinated contacts. We investigated whether influenza vaccination of children would protect them and their household members in a resource-limited setting.

We did a cluster-randomised, blinded, controlled study in three villages in India. Clusters were defined as households (ie, dwellings that shared a courtyard), and children aged 6 months to 10 years were eligible for vaccination as and when they became age-eligible throughout the study. Households were randomly assigned (1:1) by a computer-based system to intramuscular trivalent inactivated influenza vaccine (IIV3) or a control of inactivated poliovirus vaccine (IPV) in the beginning of the study; vaccination occurred once a year for 3 years. The primary efficacy outcome was laboratory-confirmed influenza in a vaccinated child with febrile acute respiratory illness, analysed in the modified intention-to-treat population (ie, children who received at least one dose of vaccine, were under surveillance, and had not an influenza infection within 15 days of last vaccine dose). The secondary outcome for indirect effectiveness (surveillance study) was febrile acute respiratory illness in an unvaccinated household member of a vaccine study participant. Data from each year (year 1: November, 2009, to October, 2010; year 2: October, 2010, to October, 2011; and year 3: October, 2011, to May, 2012) were analysed separately. Safety was analysed among all participants who were vaccinated with at least one dose of the vaccine. This trial is registered with ClinicalTrials.gov, number NCT00934245.

Continue reading
Tags:
22 Hits
0 Comments

Semiannual Versus Annual Influenza Vaccination in Older Adults in the Tropics: An Observer-blind, Active-comparator–controlled, Randomized Superiority Trial

By Barnaby Young, Sapna Sadarangani, Sen Yew Haur, Chee Fu Yung, Ian Barr, John Connolly, Mark Chen, Annelies Wilder-Smith

Clinical Infectious Diseases, To be Published July 1, 2019

 

Antibody titres and vaccine effectiveness decline within 6 months after influenza vaccination in older adults. Biannual vaccination may be necessary to provide year-round protection in the tropics, where influenza circulates throughout the year.

Tropical Influenza Control Strategies (TROPICS1) was a single-center, 1:1 randomized, observer-blinded, active-comparator–controlled, superiority study in 200 community-resident adults aged ≥65 years. Participants received a standard-dose trivalent inactivated influenza vaccination (IIV3) at enrollment, and either tetanus-diphtheria-pertussis vaccination or IIV3 6 months later. The primary outcome was the proportion of participants with haemagglutination-inhibition (HI) geometric mean titre (GMT) ≥1:40 1 month after the second vaccination (month 7). Secondary outcomes included GMTs to month 12, the incidence of influenza-like illness (ILI), and adverse reactions after vaccination.

Continue reading
Tags:
26 Hits
0 Comments

Differences in the Impact of Pneumococcal Serotype Replacement in Individuals With and Without Underlying Medical Conditions

By Daniel M Weinberger, Joshua L Warren, Tine Dalby, Eugene D Shapiro, Palle Valentiner-Branth, Hans-Christian Slotved, Zitta Barrella Harboe

Clinical Infectious Diseases, To be Published July 1, 2019

 

Pneumococcal conjugate vaccines (PCVs) have had a well-documented impact on the incidence of invasive pneumococcal disease (IPD). However, declines in IPD due to vaccine-targeted serotypes have been partially offset by increases in IPD due to nonvaccine serotypes (NVTs). The goal of this study was to quantify serotype-specific changes in the incidence of IPD that occurred in different age groups, with or without certain comorbidities, following the introduction of 7-valent pneumococcal conjugate vaccine (PCV7) and 13-valent pneumococcal conjugate vaccine (PCV13) in the childhood vaccination program in Denmark.

We used nationwide surveillance data for IPD and a hierarchical Bayesian regression framework to estimate changes in the incidence of IPD associated with the introduction of PCV7 (2007) and PCV13 (2010) while controlling for serotype-specific epidemic cycles and unrelated secular trends.

Continue reading
Tags:
23 Hits
0 Comments

Invasive Pneumococcal Disease in UK Children cal Conjugate Vaccine Era: What Are the Risks Now?

By Alison Kent, Ashley Makwana, Carmen L Sheppard, Sarah Collins, Norman K Fry, Paul T Heath, Mary Ramsay, Shamez N Ladhani

Clinical Infectious Diseases, To be Published July 1, 2019

 

Invasive pneumococcal disease (IPD) has declined significantly since the introduction of pneumococcal conjugate vaccines (PCVs). It is not known whether certain infant populations remain at higher risk of IPD in countries with established 13-valent PCV (PCV13) programs. We aimed to describe the epidemiology, clinical characteristics, serotype distribution, and outcomes of IPD in infants, and to estimate the relative risk of PCV13-type, non-PCV13-type, and overall IPD in premature infants compared to term infants during a 4-year period after the PCV13 program was established.

This was a prospective, enhanced national surveillance of laboratory-confirmed IPD in England in infants aged <1 year diagnosed during 2013–2016.

Continue reading
Tags:
23 Hits
0 Comments

Impact of the 13-Valent Pneumococcal Conjugate Vaccine Among Adults: A Systematic Review and Meta-analysis

By Nirma Khatri Vadlamudi, Anna Chen, Fawziah Marra

Clinical Infectious Diseases, To be Published July 1, 2019

 

A notable reduction of the pneumococcal disease burden among adults was observed after the introduction of a 7-valent pneumococcal conjugate vaccine (PCV7) in childhood immunization programs. In 2010, a 13-valent pneumococcal conjugate vaccine (PCV13) replaced PCV7 in many jurisdictions; a comparative assessment of PCV13’s impact was missing. Our objective was to summarize the available data and assess the change in the incidence of invasive pneumococcal disease (IPD) in adults after the introduction of PCV13 in childhood immunization programs.

We conducted a systematic literature search from January 1946 to May 2017 of randomized, controlled trials and observational studies OBS reporting the incidence of IPD, non-invasive pneumococcal disease, hospitalizations, and mortality in adults for the periods before and after the introduction of PCV13. Incidence rate ratios (IRRs) were pooled across studies using restricted, maximum-likelihood, random-effects models.

Continue reading
Tags:
24 Hits
0 Comments

Vaccine Reduces Pneumonia in Kenya

By M.J. Friedrich

JAMA. June 18, 2019

 

Introduction of the 10-valent pneumococcal conjugate vaccine (PCV10) resulted in sharply reduced pneumonia cases in Kenya, according to a report from an international team of researchers.

In 2011, Kenya was the first African country to add PCV10 to its national childhood immunization schedule. The vaccine protects against 10 common strains of Streptococcus pneumoniae. The schedule called for a 3-dose series administered to infants at 6, 10, and 14 weeks of age, with a catch-up campaign for children younger than 5 years.

Continue reading
14 Hits
0 Comments

Pneumococcal Colonization in Healthy Adult Research Participants in the Conjugate Vaccine Era, United Kingdom, 2010–2017

By Hugh Adler, Elissavet Nikolaou, Katherine Gould, Jason Hinds, Andrea M Collins, Victoria Connor, Caz Hales, Helen Hill, Angela D Hyder-Wright, Seher R Zaidi, Esther L German, Jenna F Gritzfeld, Elena Mitsi, Sherin Pojar, Stephen B Gordon, Adam P Roberts, Jamie Rylance, Daniela M Ferreira

The Journal of Infectious Diseases, June 15, 2019.

 

 

Pneumococcal colonization is rarely studied in adults, except as part of family surveys. We report the outcomes of colonization screening in healthy adults (all were nonsmokers without major comorbidities or contact with children aged <5 years) who had volunteered to take part in clinical research. Using nasal wash culture, we detected colonization in 6.5% of volunteers (52 of 795). Serotype 3 was the commonest serotype (10 of 52 isolates). The majority of the remaining serotypes (35 of 52 isolates) were nonvaccine serotypes, but we also identified persistent circulation of serotypes 19A and 19F. Resistance to at least 1 of 6 antibiotics tested was found in 8 of 52 isolates.

Continue reading
Tags:
27 Hits
0 Comments

Effectiveness of the 10-valent pneumococcal conjugate vaccine among girls, boys, preterm and low-birth-weight infants - Results from a randomized, double-blind vaccine trial.

By H.Nieminen, H.Rinta-Kokko, J.Jokinen, T.Puumalainen, M.Moreira, D.Borys, L.Schuerman, A.A.Palmu

Vaccine, To be published June 19, 2019

 

Several studies have shown differences in susceptibility to infections and immune response to vaccines by sex. Prematurely born infants are at higher risk for pneumococcal diseases, with lower effectiveness for some vaccines compared to term infants. We have reported the effectiveness of the 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV10) on several endpoints in the Finnish Invasive Pneumococcal disease (FinIP) vaccine trial. Now, we present the results of a post-hoc analysis evaluating PHiD-CV10 effectiveness in subgroups by sex, gestational age, and birth weight.

The FinIP trial was a phase III/IV cluster-randomized, double-blind trial. Infants enrolled < 7 months of age received PHiD-CV10 in two thirds of clusters (3 + 1 or 2 + 1 schedule) and hepatitis B vaccine as control in remaining third. Outcome data included invasive pneumococcal disease, pneumonia, tympanostomy tube placements, and antimicrobial purchases collected through national, routinely used health registers. Negative binomial model was used in the incidence and vaccine effectiveness estimation, and differences in incidences between subgroups were tested among control children.

Continue reading
Tags:
34 Hits
0 Comments

Evolution of serotypes in bacteremic pneumococcal adult pneumonia in the period 2001–2014, after introduction of the pneumococcal conjugate vaccine in bizkaia (spain)

By Pedro P. España, Ane Uranga, Luis Alberto, Ruiz Jose María Quintana, Amaia Bilbao, Amaia Aramburu, Leyre Serrano, Rafael Ayarza, Ana Patricia Martinez, Rafael Zalacain

Vaccine, To be Published June 27, 2019

 

The introduction of pneumococcal conjugate vaccines (PCV7 and PCV13) in children has led to a change in the pattern of pneumococcal serotypes causing pneumococcal disease in adults. The aim of this study is to analyze the distribution of pneumococcal serotypes in adults with bacteremic pneumococcal community-acquired pneumonia (BPP) after the introduction of PCVs in childhood, and the impact of age and comorbidity on this distribution. We conducted an observational study of all adults hospitalized with BPP between 2001 and 2014, in two tertiary hospitals. Overall, we identified 451 cases of BPP (2001–2005: 194, 2006–2010: 134, 2011–2014: 123). The rate of appearance of new cases decreased over the study period. In 70% of the cases, the serotypes found were among those included in PCV13. The most prevalent serotypes were 3 (23.1%), 7F (14.6%), 19A (8.4%) and 1 (7.5%). There was a significant trend to decrease in the percentage of BPP cases due to PCV7 from period 2001–2005 to 2011–2014 (p = 0.0166) and a significant trend to increase in the six serotypes added to form PCV 13 (p = 0.0003). Serotype 3 was the most frequent in patients who developed complications during hospitalization. We did not detect a significant increase in cases caused by non-PCV13 serotypes. The most frequent non-PCV13 serotype was 22F. In conclusion, a significant proportion of adults continue to develop BPP with vaccine serotypes despite infant pneumococcal vaccination. There is a need for further strategies to reduce the current burden of this disease on adults.

Access article here

Tags:
34 Hits
0 Comments

Effects of Sequential Influenza A(H1N1)pdm09 Vaccination on Antibody Waning

By Jon Zelner, Joshua G Petrie, Rob Trangucci, Emily T Martin, Arnold S Monto

The Journal of Infectious Diseases, To be published July 2019

 

Antibody waning following influenza vaccination has been repeatedly evaluated, but waning has rarely been studied in the context of longitudinal vaccination history.

We developed a Bayesian hierarchical model to assess the effects of sequential influenza A(H1N1)pdm09 vaccination on hemagglutination inhibition antibody boosting and waning in a longitudinal cohort of older children and adults from 2011 to 2016, a period during which the A(H1N1)pdm09 vaccine strain did not change.

Continue reading
Tags:
40 Hits
0 Comments

Pneumococcal lineages associated with serotype replacement and antibiotic resistance in childhood invasive pneumococcal disease in the post-PCV13 era: an international whole-genome sequencing study

By Stephanie W Lo, Rebecca A Gladstone, Andries J van Tonder, John A Lees, Mignon du Plessis, Rachel Benisty, Noga Givon-Lavi, Paulina A Hawkins, Jennifer E Cornick, Brenda Kwambana-Adams, Pierra Y Law, Pak Leung Ho, Martin Antonio, Dean B Everett, Prof Ron Dagan, Anne von Gottberg, Prof Keith P Klugman, Lesley McGee, Robert F Breiman, Stephen D Bentley, and The Global Pneumococcal Sequencing Consortium

The Lancet Infectious Diseases, June 10, 2019

 

Invasive pneumococcal disease remains an important health priority owing to increasing disease incidence caused by pneumococci expressing non-vaccine serotypes. We previously defined 621 Global Pneumococcal Sequence Clusters (GPSCs) by analysing 20 027 pneumococcal isolates collected worldwide and from previously published genomic data. In this study, we aimed to investigate the pneumococcal lineages behind the predominant serotypes, the mechanism of serotype replacement in disease, as well as the major pneumococcal lineages contributing to invasive pneumococcal disease in the post-vaccine era and their antibiotic resistant traits.

We whole-genome sequenced 3233 invasive pneumococcal disease isolates from laboratory-based surveillance programmes in Hong Kong (n=78), Israel (n=701), Malawi (n=226), South Africa (n=1351), The Gambia (n=203), and the USA (n=674). The genomes represented pneumococci from before and after pneumococcal conjugate vaccine (PCV) introductions and were from children younger than 3 years. We identified predominant serotypes by prevalence and their major contributing lineages in each country, and assessed any serotype replacement by comparing the incidence rate between the pre-PCV and PCV periods for Israel, South Africa, and the USA. We defined the status of a lineage as vaccine-type GPSC (≥50% 13-valent PCV [PCV13] serotypes) or non-vaccine-type GPSC (>50% non-PCV13 serotypes) on the basis of its initial serotype composition detected in the earliest vaccine period to measure their individual contribution toward serotype replacement in each country. Major pneumococcal lineages in the PCV period were identified by pooled incidence rate using a random effects model.

Continue reading
Tags:
34 Hits
0 Comments

Haemophilus influenzae type b vaccination and anthropometric, cognitive, and schooling outcomes among Indian children

By Arindam Nandi, Anil B. Deolalikar, David E. Bloom, Ramanan Laxminarayan

Annals of the New York Academy of Sciences, June 10, 2019

 

Haemophilus influenzae type b (Hib) affects 337,000 Indian children every year. A vaccine against Hib was introduced in 2011 as part of the pentavalent vaccine and scaled up nationwide. This study investigated the associations between Hib vaccination and child anthropometry, cognition, and schooling outcomes in India. We used longitudinal survey data and employed propensity score matching to control for observed systematic differences between children who reported receipt or nonreceipt of Hib vaccine before age 6 years (n = 1824). Z‐scores of height‐for‐age (HAZ) and BMI‐for‐age (BMIZ), percentage scores of English, mathematics, reading, and Peabody Picture Vocabulary tests, and attained schooling grade of children were examined. Hib‐vaccinated children had 0.25 higher HAZ, scored 4.09 percentage points (pp) higher on the English test and 4.78 pp higher on the mathematics test, and attained 0.16 more schooling grades than Hib‐unvaccinated children at age 11–12 years. At age 14–15 years, they had 0.18 higher HAZ, scored 3.63 pp higher on the reading test and 3.22 pp higher on the mathematics test, and attained 0.15 more schooling grades than Hib‐unvaccinated children. The findings indicate potential long‐term health, cognitive, and schooling benefits of the Hib vaccine, subject to the effect of unobserved confounding factors.

Access article here

Tags:
24 Hits
0 Comments

Predictors of uptake of newly introduced vaccines in Malawi – monovalent human rotavirus and pneumococcal conjugate vaccines: Evidence from the 2015–16 Malawi demographic and health survey

By Peter Austin Morton Ntenda, Edward Tisungane Mwenyenkulu, Nuntiput Putthanachote, Owen Nkoka, Thomas Gabriel Mhone, Mfundi President Sebenele Motsa, Tinashe Tizifa

Journal of Tropical Pediatrics, June 2019

 

The purpose of this study was to examine the uptake and predictors of monovalent human rotavirus and pneumococcal conjugate vaccines among children of age 12–35 months in Malawi.

This study used cross-sectional data obtained from the 2015–16 Malawi Demographic and Health Survey. Multivariate logistic regression was used to identify the factors related to uptake of pneumococcal and rotavirus vaccination.

Continue reading
Tags:
31 Hits
0 Comments

Neutralizing Antibody Responses to Homologous and Heterologous H1 and H3 Influenza A Strains After Vaccination With Inactivated Trivalent Influenza Vaccine Vary With Age and Prior-year Vaccination

By Wei Wang, Qiong Chen, Lauren A Ford-Siltz, Leah C Katzelnick, Gabriel I Parra, Hyo Sook Song, Russell Vassell, Carol D Weiss

Clinical Infectious Diseases, to be published June 15, 2019

 

Prior influenza immunity influences the homologous neutralizing antibody responses elicited by inactivated influenza vaccines (IIV), but neutralizing antibody responses to heterologous strains have not been extensively characterized.

We analyzed neutralizing antibody titers in individuals aged 1–88 who received the 2009–2010 season IIV before infection by or vaccination against the 2009 pandemic H1N1 virus. Neutralization titers to homologous and heterologous past, recent, and advanced H1 and H3 strains, as well as H2, H5, and H7 strains, were measured using influenza hemagglutinin pseudoviruses. We performed exploratory analyses based on age, prior-year IIV, and prevaccination titer, without controlling for Type I errors.

Continue reading
Tags:
35 Hits
0 Comments

Impact of the 13-Valent Pneumococcal Conjugate Vaccine on the Incidence of All-cause Pneumonia in Adults Aged ≥60 Years: A Population-based, Retrospective Cohort Study

By Martin Kolditz, Jochen Schmitt, Mathias W Pletz, Falko Tesch

Clinical Infectious Diseases, to be published June 15, 2019

 

In this population-based study evaluating the effectiveness of the 13-valent pneumococcal conjugate vaccine (2012–2016) to prevent all-cause pneumonia in adults ≥60 years of age, we found significant, 0.63% absolute risk and 11.9% relative risk reductions on the 3-year (2014–2016) cumulative incidences of all-cause pneumonia after vaccination.

Access article here

Continue reading
Tags:
30 Hits
0 Comments

Effectiveness of 13-Valent Pneumococcal Conjugate Vaccine Against Invasive Disease Caused by Serotype 3 in Children: A Systematic Review and Meta-analysis of Observational Studies

By Heather L Sings, Philippe De Wals, Bradford D Gessner, Raul Isturiz, Craig Laferriere, John M McLaughlin, Stephen Pelton, Heinz-Josef Schmitt, Jose A Suaya, Luis Jodar

Clinical Infectious Diseases, to be published June 15, 2019

 

The 13-valent pneumococcal conjugate vaccine (PCV13) is the only licensed PCV with serotype 3 polysaccharide in its formulation. Postlicensure PCV13 effectiveness studies against serotype 3 invasive pneumococcal disease (IPD) in children have shown inconsistent results.  We performed a systematic review and meta-analysis of observational studies to assess PCV13 vaccine effectiveness (VE) for serotype 3 IPD in children. We systematically searched PubMed, Embase, and the Cochrane library for studies published before 14 August 2017. We identified 4 published studies and 2 conference posters that provided PCV13 VE estimates stratified by serotype. The pooled PCV13 VE against serotype 3 IPD from the random-effects meta-analysis was 63.5% (95% confidence interval [CI], 37.3%–89.7%). A sensitivity analysis including conference posters gave a pooled VE estimate of 72.4% (95% CI, 56.7%–88.0%). The pooled data from case-control studies with similar methodologies and high quality support direct PCV13 protection against serotype 3 IPD in children.

Access article here

Continue reading
Tags:
32 Hits
0 Comments

Determinants of Influenza and Pertussis Vaccination Uptake in Pregnancy

By Christopher R. Wilcox, Anna Calvert, Jane Metz, Eliz Kilich, Rachael MacLeod, Kristen Beadon, Paul T. Heath, Asma Khalil, Adam Finn, Matthew D. Snape, Tushna Vandrevala, Tom Nadarzynski, Matthew A. Coleman, Christine E. Jones

The Pediatric Infectious Disease Journal, June 2019

 

Uptake rates of antenatal vaccination remain suboptimal. Our aims were to determine (1) the acceptability of routine vaccination among pregnant women, (2) the confidence of maternity healthcare professionals (HCPs) discussing vaccination and (3) HCP opinion regarding the optimum healthcare site for vaccine administration.

Separate questionnaires for pregnant women and HCPs were distributed within 4 national health service (NHS) trusts in South England (July 2017 to January 2018).

Continue reading
Tags:
34 Hits
0 Comments

Low-cost pneumonia vaccine breaks into global market

By Ann Danaiya Usher

The Lancet, May 18, 2019  

Keith Klugman, the director of the Bill and Melinda Gates Foundation's Pneumonia programme, also welcomed the new, cheaper product. “We are excited by this because there are other vaccines that Gavi is interested in and has approved. Hopefully, this will free up Gavi funds for vaccines that, so far, have not rolled out in developing countries, like typhoid and cholera vaccine.” Another vaccine in the late stages of development that Gavi might be able to fund is against respiratory syncytial virus, a leading viral cause of pneumonia deaths among children in developing countries during the first 6 months of life, he says

Access article here

Tags:
49 Hits
0 Comments

Intraseason Waning of Influenza Vaccine Effectiveness

By G Thomas Ray, Ned Lewis, Nicola P Klein, Matthew F Daley, Shirley V Wang, Martin Kulldorff, Bruce Fireman

Clinical Infectious Diseases, May 15, 2019

In the United States, it is recommended that healthcare providers offer influenza vaccination by October, if possible. However, if the vaccine’s effectiveness soon begins to wane, the optimal time for vaccination may be somewhat later. We examined whether the effectiveness of influenza vaccine wanes during the influenza season with increasing time since vaccination.

Access article here

 

Continue reading
Tags:
50 Hits
0 Comments

Influenza Vaccine Effectiveness and Statin Use Among Adults in the United States, 2011–2017

By Fiona P Havers, Jessie R Chung, Edward A Belongia, Huong Q McLean, Manjusha Gaglani, Kempapura Murthy, Richard K Zimmerman, Mary Patricia Nowalk, Michael L Jackson, Lisa A Jackson

Clinical Infectious Diseases, May 15, 2019

 

Statin medications have immunomodulatory effects. Several recent studies suggest that statins may reduce influenza vaccine response and reduce influenza vaccine effectiveness (VE)

 

Continue reading
Tags:
49 Hits
0 Comments