Increased Invasive Pneumococcal Disease, North East England, UK

Houseman, Catherine; Hughes, G.; Chapman, K. E.; Wilson, Deborah; Gorton, Russell

doi:10.3201/eid2301.160897

Cited by 25 publications

(23 citation statements)

References 10 publications

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“…Our findings showed a marked and concordant increasing trend for IPD notifications among individuals aged above 64 years, as compared to all other age groups. Similar increases in population aged above 64 years were reported in other European countries [30][31][32]. Our findings, alongside recent economic considerations [33] further support the introduction of a pneumococcal vaccination strategy targeting individuals aged above 64 years in Italy included in the latest NPVP released in 2017 [6].…”

Section: Epidemiology and Infectionsupporting

confidence: 88%

Impact of vaccination on invasive pneumococcal disease in Italy 2007–2017: surveillance challenges and epidemiological changes

et al. 2020

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Surveillance of new cases of invasive pneumococcal disease (IPD) in Italy was started in 2007 by the Ministry of Health (MoH). In 2012, pneumococcal childhood vaccination was introduced at the national level and, in 2017, for citizens aged 65 years and over. We describe here IPD epidemiology in Italy over the past 10 years investigating the impact of the vaccine programme on disease burden. Reports of IPD cases, data on serotype and vaccination coverage (VC) data were obtained from MoH annual reports, for the period 2007–2017. IPD notification rate and proportion by year, region, age and serotype were calculated. In 2007, 525 cases were reported (rate 0.88/100 000), rising to 1703 cases (rate 2.82/100 000) in 2017. The distribution of IPD cases by age group over time registered the largest share among individuals aged 65 years and over. A decreasing trend in notification rate was observed among those aged 0–4 years. During the same period, the 24-month VC increased, ranging from 80.9% to 96.7% in 2017. Molecular data indicated re-emergence of PPSV23-specific serotypes and non-vaccine serotypes. We observed an increase in IPD notifications during 2007–2017, likely due to an improved surveillance system, at least in some regions, with the relative quota of IPD notifications decreasing among vaccinated children cohorts. Further strengthening of IPD surveillance system, including molecular and vaccine coverage data, would be needed to assess and inform pneumococcal vaccination strategies in Italy.

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Section: Epidemiology and Infectionsupporting

confidence: 88%

Impact of vaccination on invasive pneumococcal disease in Italy 2007–2017: surveillance challenges and epidemiological changes

et al. 2020

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“…18,19 The only exception to this is a recent increase in total IPD incidence among persons 5-64 and ≥65 years of age in North East England that was observed seven years following introduction of PCV13 in the routine vaccination program in the United Kingdom. 37 Although our surveillance for non-VT IPD did not detect a significant increase in any age group, the direction of change was positive in all age-groups ≥2 months (IRRs 1·31-1·47). Given the low baseline incidence of non-VT IPD, comprising only one quarter of the pre-vaccine burden of IPD among children <5 years, the power of the study was only sufficient (i.e., >80%) to detect a ≥2·3-fold change (Supplemental Table 7).…”

Section: Discussionmentioning

confidence: 58%

Impact of 10-valent pneumococcal conjugate vaccine on invasive pneumococcal disease and nasopharyngeal carriage in Kenya

Hammitt

Etyang

Morpeth

et al. 2018

Preprint

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Background: 10-valent pneumococcal conjugate vaccine (PCV10), delivered at 6, 10 and 14 weeks of age, was introduced in Kenya in January 2011, accompanied by a catch-up campaign in Kilifi County for children <5 years. Coverage with ≥2 PCV10 doses in children 2-11 months was 80% in 2011 and 84% in 2016; coverage with ≥1 dose in children 12-59 months was 66% and 87%, respectively. Methods: Clinical and microbiological surveillance for invasive pneumococcal disease (IPD) among admissions of all ages at Kilifi County Hospital was linked to the Kilifi Health and Demographic Surveillance System from 1999-2016. We calculated the incidence rate ratio (IRR) comparing the pre-vaccine and postvaccine eras, adjusted for confounding, and reported percent reduction in IPD as 1-IRR. Annual crosssectional surveys of nasopharyngeal carriage were conducted from 2009-2016.Findings: Surveillance identified 667 IPD cases in 3,211,403 person-years of observation. IPD incidence in children <5 years fell sharply in 2011 following PCV10 introduction, and remained low (PCV10-type IPD: 60·8 vs 3·2/100,000 [92% reduction; 95%CI: 78, 97]; overall IPD: 81·6 vs 15·3/100,000 [68% reduction; 95%CI: 40, 83]; 1999-2010 vs 2012-2016. PCV10-type IPD also declined significantly in unvaccinated age groups (<2 months, 5-14 years, ≥15 years), with estimated reductions of 100%, 74%, and 81%, respectively. There was no significant change in the incidence of non-PCV10 type IPD. In children aged <5 years, PCV10-type carriage declined by 74% and non-PCV10-type carriage increased by 71%.

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“…Similar mechanisms are also suggested to be behind the extended response beyond the vaccinated populations to the subsequently introduced 13-valent S. pneumoniae vaccine [ 33 ]. Recently, IPD incidence has begun to increase in populations in the United Kingdom, particularly among persons 5–64 and greater than 65 years of age, and despite the ever-increasing proportion of the population obtaining direct protection through vaccination [ 37 ]. Serotype replacement, in conjunction with changes to the invasiveness of the non-vaccine strains, is a possible explanation [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

Implications of asymptomatic carriers for infectious disease transmission and control

Chisholm

Campbell

et al. 2018

R. Soc. open sci.

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For infectious pathogens such as Staphylococcus aureus and Streptococcus pneumoniae , some hosts may carry the pathogen and transmit it to others, yet display no symptoms themselves. These asymptomatic carriers contribute to the spread of disease but go largely undetected and can therefore undermine efforts to control transmission. Understanding the natural history of carriage and its relationship to disease is important for the design of effective interventions to control transmission. Mathematical models of infectious diseases are frequently used to inform decisions about control and should therefore accurately capture the role played by asymptomatic carriers. In practice, incorporating asymptomatic carriers into models is challenging due to the sparsity of direct evidence. This absence of data leads to uncertainty in estimates of model parameters and, more fundamentally, in the selection of an appropriate model structure. To assess the implications of this uncertainty, we systematically reviewed published models of carriage and propose a new model of disease transmission with asymptomatic carriage. Analysis of our model shows how different assumptions about the role of asymptomatic carriers can lead to different conclusions about the transmission and control of disease. Critically, selecting an inappropriate model structure, even when parameters are correctly estimated, may lead to over- or under-estimates of intervention effectiveness. Our results provide a more complete understanding of the role of asymptomatic carriers in transmission and highlight the importance of accurately incorporating carriers into models used to make decisions about disease control.

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Increased Invasive Pneumococcal Disease, North East England, UK

Cited by 25 publications

References 10 publications

Impact of vaccination on invasive pneumococcal disease in Italy 2007–2017: surveillance challenges and epidemiological changes

Impact of vaccination on invasive pneumococcal disease in Italy 2007–2017: surveillance challenges and epidemiological changes

Impact of 10-valent pneumococcal conjugate vaccine on invasive pneumococcal disease and nasopharyngeal carriage in Kenya

Implications of asymptomatic carriers for infectious disease transmission and control

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