Risk factors associated with Streptococcus pneumonia carriage in children under five years old with acute respiratory infection in Niger

 By Dano, Ibrahim Dan et al

 

The Pan African Medical Journal , July 19, 2019

 

A questionnaire was addressed to parents for the collection of sociodemographic and medical information. Nasopharyngeal swabbing was processed using a molecular method. We used logistic regression models to examine independent associations between pneumococcal carriage and potential risk factors. All associations with a p-value of < 0.25 in the bivariate regression analyses were subsequently entered in the multivariate regression model.

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Increasing Rates of Pediatric Empyema and Disease Severity With Predominance of Serotype 3 S. pneumonia

By Haggie, Stuart, Fitzgerald, Dominic A, Pandit, Chetan, Selvadurai, Hiran, Robinson, Paul, Gunasekera, Hasantha,, Britton, Philip.

The Pediatric Infectious Disease Journal: December 2019.

 A retrospective study between 2011 and 2018 of empyema cases admitted to a large pediatric referral hospital, for management with either pleural drainage and fibrinolytics or surgical intervention.

There were 195 cases in 8 years. Empyema incidence and ICU admission rates significantly increased during the study with a peak incidence of 7.1/1000 medical admissions in 2016 (χ2 for trend of incidence 37.8, P < 0.001 and for ICU admissions 15.3, P < 0.001). S. pneumoniae was the most common pathogen (75/195, 39%) with serotype 3 the most detected (27/75: 27%). S. pyogenes compared with S. pneumoniae had significantly fewer days of fever before admission (3.9 vs. 6.4, mean difference 2.4, 95% CI: 0.84–4.08, P = 0.003) and higher proportion requiring direct ICU admission (6/75; 8% vs. 7/15; 47%, P < 0.001). Compared with S. pneumoniae, cases with no pathogen detected by culture or PCR had fewer days of fever post intervention (4.4 vs. 7.4 days, mean difference 2.7 days, P = 0.002). S. aureus occurred more commonly in infants (10/25; 40% vs. 1/75; 1%, P < 0.001) and children of indigenous background (5/25; 20% vs. 1/75; 1%, P < 0.001) compared with S. pneumoniae.

We report increasing rates of pediatric empyema with higher proportions requiring ICU treatment. The most common pathogens detected were S. pneumoniae, S. aureus and S. pyogenes. Despite high 13-valent pneumococcal conjugate vaccine coverage, serotype 3 was the most common S. pneumoniae serotype identified.

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Potential effect of age of BCG vaccination on global paediatric tuberculosis mortality: a modelling study

By Partho Roy, Johan Vekemans, Andrew Clark, Colin Sanderson, Rebecca C Harris, Richard G White.

 

The Lancet, Global Health, December 1, 2019

 

BCG has been recommended at birth in countries with a high tuberculosis burden for decades, yet delayed vaccination is widespread. To support a WHO guidance review, we estimated the potential global tuberculosis mortality benefit of administering BCG on time and consequences of later administration.

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Pneumococcal conjugate vaccines decrease community-acquired alveolar pneumonia with and without pleural effusion in children

By Triadou D, Givon-Lavi N, Greenberg D, Ben-Shimol S

Infectious Diseases, November 27, 2019.

Radiographically-proven community-acquired alveolar pneumonia with pleural effusion (PE-CAP) has a less favourable outcome than pneumonia without pleural effusion (NPE-CAP). We assessed PE-CAP and NPE-CAP rate dynamics in children <60 months in southern Israel before and after 7- and 13-valent pneumococcal conjugate vaccine (PCV7/PCV13) implementation (2002–2016).

An ongoing, prospective observational study. Our hospital serves a captive population of ∼75,000 children <60 months, enabling incidence calculation. PCV7/PCV13 were implemented in Israel in July 2009/November 2010, respectively. All chest radiographs (CXRs) were digitalized and analysed according to the WHO Standardization of Interpretation. Annual incidences of PE-CAP and NPE-CAP were calculated, 2002–2016. Incidence-rate ratios (IRRs) comparing PCV13 (2013–2016), PCV7 (2010–2011) and pre-PCV (2002–2008) periods were calculated.

Following PCV7/PCV13 introduction, PE-CAP and NPE-CAP rates substantially declined. However, the rate dynamics were different, with steeper declines observed in PE-CAP rates, possibly deriving from differences in disease aetiology.

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Cost-effectiveness of introducing the pneumococcal conjugate vaccine for children under 5 years in the Islamic Republic of Iran

By Ezoji K, Yaghoubi M, Nojomi M, Mahmoody S, Zahraie SM, Moradi-Lakeh M, Tabatabaei SR, Karimi A.

Eastern Mediterranean Health Journal, November 27, 2019

Pneumococcal disease is estimated to affect 18 713 211 children under 5 years (519 412 pneumonia, 18 148 116 acute otitis media, 6884 meningitis, and 38 799 non-pneumonia, non-meningitis) in 10 years (2014-2023) without use of the vaccine. Introduction of PCV-13 would prevent 4 900 084 cases of pneumococcal disease (190 849 pneumonia, 4 692 450 acute otitis media, 2529 meningitis, and 14 256 non-pneumonia, non-meningitis). Pneumococcal infection would cause 287 950 hospital admissions and 29 399 deaths; vaccination could avert 105 802 hospital admissions and 9997 deaths. The incremental cost-effectiveness was estimated to be US$ 1890 and US$ 1538 per averted DALY for the government and society respectively.

 

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Indirect Effects of 10-Valent Pneumococcal Conjugate Vaccine Against Adult Pneumococcal Pneumonia in Rural Western Kenya.

By Godfrey M. Bigogo, Allan Audi, Joshua Auko,George O. A1 Benjamin J. Ochieng, Herine Odiembo,Arthur Odoyo,Marc-Alain Widdowson, Clayton Onyango,Martien W. Borgdorff, Daniel R. Feikin,Maria da G Carvalho, Cynthia G. Whitney, and Jennifer R. Verani

Clinical Infectious Diseases, November 27, 2019

Data on pneumococcal conjugate vaccine (PCV) indirect effects in low-income countries with high HIV burden are limited. We examined adult pneumococcal pneumonia incidence before and after 10-valent PCV introduction in Kenya in 2011

 

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Improving Influenza Vaccine Effectiveness: Ways to Begin Solving the Problem

By Arnold S Monto, Joshua G Petrie

 

Clinical Infectious Diseases, November 15, 2019

 

For decades, the World Health Organization influenza collaborating centers have met late each winter to recommend the viruses to be included in the vaccine for the next influenza season. That meeting now takes place twice each year: once, usually in February, to select strains for the Northern hemisphere vaccine, and again, typically in September, for the Southern hemisphere [1]. The necessity for a second meeting each year reflects the potential for the rapid evolution of circulating viruses even over that 6-month period.

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Influenza Vaccine Effectiveness: Defining the H3N2 Problem

By Edward A Belongia, Huong Q McLean

 

Clinical Infectious Diseases, November 15, 2019

 

Observational studies have consistently shown that influenza vaccine effectiveness (VE) is lower for H3N2 relative to H1N1pdm09 and type B, and this is not entirely explained by antigenic match. The triad of virus, vaccine, and host immunity provides a framework to examine contributing factors. Antigenic evolution facilitates H3N2 immune escape, and increasing glycosylation of the hemagglutinin shields antigenic sites from antibody binding. Egg passage adaptation of vaccine viruses generates mutations that alter glycosylation, impair the neutralizing antibody response, and reduce VE. Complex host immune factors may also influence H3N2 VE, including early childhood imprinting and repeated vaccination, but their role is uncertain. Of the triad of contributing factors, only changes to the vaccine are readily achievable. However, it is unclear whether current licensed non–egg-based vaccines generate superior protection against H3N2. The optimal strategy remains to be defined, but newer vaccine technology platforms offer great potential.

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Effectiveness of Seasonal Influenza Vaccination in Children in Senegal During a Year of Vaccine Mismatch: A Cluster-randomized Trial

By Aldiouma Diallo, Ousmane M Diop, Doudou Diop, Mbayame Nd Niang, Jonathan D Sugimoto, Justin R Ortiz, El hadji Abdourahmane Faye, Bou Diarra, Deborah Goudiaby, Kristen D C Lewis, et al.

 

Clinical Infectious Diseases, November 15, 2019

 

In this double-blind, cluster-randomized trial, villages were randomly allocated (1:1) for the high-coverage vaccination of children aged 6 months through 10 years with either the 2008–09 northern hemisphere IIV3 or an inactivated polio vaccine (IPV). Vaccinees were monitored for serious adverse events. All village residents, vaccinated and unvaccinated, were monitored for signs and symptoms of influenza illness using weekly home visits and surveillance in designated clinics. The primary outcome was all laboratory-confirmed symptomatic influenza.

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Increase in Streptococcus pneumoniae serotype 3 associated parapneumonic pleural effusion/empyema after the introduction of PCV13 in Germany

 By Goettler D, Streng A, Kemmling D, Schoen C, von Kries R, Rose MA, van der Linden M Liese JG.   

Vaccine. 2019 Nov 14.

 

In a nationwide pediatric hospital surveillance study in Germany we identified 584 children <18 years of age with bacteriologically confirmed PPE/PE from October 2010 to June 2018. Streptococcus pneumoniae was identified by culture and/or PCR of blood samples and/or pleural fluid and serotyped.

Following the introduction of PCV13 in general childhood vaccination we observed a strong emergence of serotype 3 associated PPE/PE in the German pediatric population, including a considerable number of younger children with serotype 3 vaccine breakthrough cases and failures. Future PCVs should not only cover newly emerging serotypes, but also include a more effective component against serotype 3.

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Immunising Kids Against Pneumonia

 

By Dr Jocelyn Chan and Professor Fiona Russell, University of Melbourne

Pursuit, November 12, 2019

Today is World Pneumonia Day, and although pneumonia is the leading infectious cause of death in children worldwide, it still often lags behind other diseases in terms of recognition.

Pneumonia is estimated to account for 15 per cent of all deaths among children aged under five years old, killing more than 800,000 children globally in 2017.

Across the Asia-Pacific, too many children are still dying from pneumonia, but a new study in Laos is proving that vaccinating the most vulnerable can protect entire communities.

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Serotype distribution and antimicrobial resistance of Streptococcus pneumoniae causing invasive diseases in China: a meta-analysis

By Jinjian Fu, Rongsong Yi, Yongjiang Jiang, Shaolin Xu,Peixu Qin, Zhuoxin Liang, and Jichang Chen

 

BMC Pediatrics, November 11, 2019

 

Sixteen eligible studies were included in this systematic review and the random effect model was used to estimate the pool prevalence of IPD.

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Association of Seasonal Severity and Vaccine Effectiveness With Influenza Vaccination Rates in Children

 By Claire Abraham, Qixuan Chen, Weijia Fan, et al.

 

Jama Pediatrics, November 11, 2019

 

Influenza vaccination rates among children remain lower than other pediatric and adolescent vaccines.1,2 Many variables may affect whether a child is vaccinated against influenza.3 However, to what extent, if any, the severity of an influenza season and either current or prior year’s vaccine effectiveness (VE) may affect vaccination rates has yet to be studied, to our knowledge. This information may be important in understanding how to message severity and VE data to parents. Therefore, using publicly available data, we examined the associations of seasonal influenza severity as well as current and prior year’s VE with yearly vaccination rates within age groups.

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Change in Bacterial Causes of Community-Acquired Parapneumonic Effusion and Pleural Empyema in Children 6 Years After 13-Valent Pneumococcal Conjugate Vaccine Implementation.

By Madhi F, et al..

Journal of the Pediatric Infectious Diseases Society, November 8, 2019

We describe here changes in the bacterial causes of pleural empyema before and after implementation of the 13-valent pneumococcal conjugate vaccine (PCV13) program in France (2009–2017). For 220 (39.3%) of 560 children, a bacterial cause was found. The frequency of pneumococcal infection decreased during the study from 79.1% in 2009 to 36.4% in 2017 (P < .001). Group A streptococcus is now the leading cause of documented empyema (45.5%).

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Measles virus infection diminishes preexisting antibodies that offer protection from other pathogens

By Michael J. Mina, Tomasz Kula, Yumei Leng, et al

 

Science , November 1, 2019

 

Measles virus is directly responsible for more than 100,000 deaths yearly. Epidemiological studies have associated measles with increased morbidity and mortality for years after infection, but the reasons why are poorly understood. Measles virus infects immune cells, causing acute immune suppression. To identify and quantify long-term effects of measles on the immune system, we used VirScan, an assay that tracks antibodies to thousands of pathogen epitopes in blood. We studied 77 unvaccinated children before and 2 months after natural measles virus infection. Measles caused elimination of 11 to 73% of the antibody repertoire across individuals. Recovery of antibodies was detected after natural reexposure to pathogens. Notably, these immune system effects were not observed in infants vaccinated against MMR (measles, mumps, and rubella), but were confirmed in measles-infected macaques. The reduction in humoral immune memory after measles infection generates potential vulnerability to future infections, underscoring the need for widespread vaccination.

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Longitudinal Colonization With Streptococcus pneumoniae During the First Year of Life in a Healthy Newborn Cohort

By Sharon B Meropol, Michael R Jacobs, Kurt C Stange, Saralee Bajaksouzian, Robert A Bonomo

 

Journal of the Pediatric Infectious Diseases Society, October 31, 2019

 

During April 2013–February 2014, 326 infants were enrolled from an urban academic hospital well-baby nursery. At ages 4, 8, and 12 months, we collected antibiotic data, other exposure data, and nasopharyngeal cultures for pneumococcal isolation.

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Estimating the economic impact of pneumococcal conjugate, Haemophilus influenzae type b and rotavirus vaccines in India: National and state-level analyses

By D.Constenlaa,T.Liub

 

Vaccine, October 22, 2019

 

To support vaccine decision-making we estimated from the societal perspective the potential health impact and costs averted through immunization with three vaccines – Haemophilus influenzae type b (Hib), pneumococcal conjugate vaccine (PCV) and rotavirus vaccine (RVV).

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Monitoring of community-acquired pneumonia hospitalisations before the introduction of pneumococcal conjugate vaccine into Polish National Immunisation Programme (2009–2016): A nationwide retrospective database analysis

By MałgorzataGajewskaa1PawełGoryńskib1IwonaParadowska-Stankiewiczc, Katarzyna Lewtaka, Maria Piotrowicza, Ewa Urbana, Dorota Cianciaraad, Mirosław J.Wysockia, Alicja Książeke, Patricia Izurietaf

 

Vaccine, October 22, 2019

 

Using national public statistic data available from the National Institute of Public Health – National Institute of Hygiene, annual hospitalisation rates for pneumonia were analysed, categorised by aetiology and age (<2, 2–3, 4–5, 6–19, 20–59, 60+ years). Trends over time were assessed, as well as in-hospital mortality.

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Effect of Age on Relative Effectiveness of High-Dose Versus Standard-Dose Influenza Vaccines Among US Medicare Beneficiaries Aged ≥65 Years

By Yun Lu, Yoganand Chillarige, Hector S Izurieta, Yuqin Wei, Wenjie Xu, Michael Lu, Heng-Ming Sung, Arnstein Lindaas, Michael Wernecke, Thomas Macurdy, Jeffrey Kelman, Richard A Forshee. Published in The Journal of Infectoius Diseases. To be published November 1, 2019.   

 

Studies have found that the high-dose influenza vaccine has a higher relative vaccine effectiveness (rve) versus standard-dose vaccines in some seasons. We evaluated the effect of age on the rve of high-dose versus standard-dose influenza vaccines among medicare beneficiaries. A 6-season retrospective cohort study from 2012 to 2018 among medicare beneficiaries aged ≥65 years was performed. Poisson regression was used to evaluate the effect of age on the rve of high-dose versus standard-dose influenza vaccines in preventing influenza-related hospitalizations.The study included >19 million vaccinated beneficiaries in a community pharmacy setting. The poisson models indicated a slightly increasing trend in rve with age in all seasons. The high-dose vaccine was more effective than standard-dose vaccines in preventing influenza-related hospital encounters (ie, influenza-related inpatient stays and emergency department visits) in the 2012–2013 (rve, 23.1%; 95% confidence interval [ci], 17.6%–28.3%), 2013–2014 (rve, 15.3%; 95% ci, 7.8%–22.3%), 2014–2015 (rve, 8.9%; 95% ci, 5.6%–12.1%), and 2016–2017 (rve, 12.6%; 95% ci, 6.3%–18.4%) seasons and was at least as effective in all other seasons. We also found that the high-dose vaccine was consistently more effective than standard-dose vaccines across all seasons for people aged ≥85 years. Similar trends were observed for influenza-related inpatient stays. The rve of high-dose versus standard-dose influenza vaccines increases with age.

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Burden of Invasive Pneumococcal Disease

By Mary Slack, Andrew Vyse, Harish Madhava, Gillian Ellsbury, Carole Czudek, Ralf-Rene Reinert, Bradford Gessner. Published in Clinical Infectious Diseases. October 15, 2019.  

 

TO THE EDITOR—We read with interest the article by Kent et al [1]. The authors note that the burden of invasive pneumococcal disease (IPD) in UK infants aged <1 year is substantial and that the incidence of IPD in this age group increased over the study period (2013–2016). Although the majority of IPD cases (369/454, 71.4%) were due to non–13-valent pneumococcal conjugate vaccine (PCV13) serotypes, disease also was caused by PCV13 (vaccine type [VT]) serotypes (85/454, 16.4%), with a limited reduction in VT IPD from 36 cases in 2013 to 28 cases in 2016. Serotype 3 was the most common VT serotype identified…

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