Streptococcus pneumoniae serotype 19A in Latin America and the Caribbean 2010–2015: A systematic review and a time series analysis

Introduction : With the use of pneumococcal conjugate vaccines(PCV), the behavior of invasive pneumococcal disease(IPD) has changed relative to serotype distribution. The introduction of these vaccines in national immunization programs has reduced the incidence of IPD, with a marked decrease in the circulation of the serotypes included in the vaccine used in each country. However, the subsequent emergence of other serotypes not included in the vaccine, such 19A in case of PCV7 and PCV10, has been documented. Materials and methods : This was case series study (2008–2017) in pediatric patients admitted to 10 hospitals in Bogota who were diagnosed with IPD. It was conducted during the transitional period of implementing the PCV10 vaccine in Colombia in 2012. Cases of bacteremic pneumococcal pneumonia, meningitis, primary bacteremia and osteoarticular infection were included. A descriptive analysis of the demographic, clinical and laboratory variables of patients with IPD by Spn19A, its trend over time, profiles of antimicrobial susceptibility and clinical outcomes was performed. Results : There were 463 cases of IPD, 315(68%) with known serotypes. The prevalence of IPD by Spn19A was 17.7%(56 cases), tending to increase over time. During 2008–2011, the prevalence was 4.4%, and during 2014–2017, it was 32.4%, The most frequent diagnosis was pneumonia(80.4%). In nonmeningeal isolates, 39.6% were not susceptible to penicillin. An increase in the resistance was observed over time. Conclusion : Spn19A is a prevalent cause of IPD in the pediatric population of the analyzed cohort, with an increasing trend of this serotype during the surveillance period after the introduction of PCV10, being the most common serotype identified in recent years.

Section: Resultssupporting

confidence: 56%

“…There are regional publications on the behavior of the serotype after vaccination with PCV10, including 19A. [15][16][17][18][19][20] However, there are no recent publications on the behavior of serotype 19A in Bogota after the massive use of PCV10.…”

Section: Introductionmentioning

confidence: 99%

Emergence of Streptococcus pneumoniae serotype 19A (Spn19A) in the pediatric population in Bogotá, Colombia as the main cause of invasive pneumococcal disease after the introduction of PCV10

Moreno

Imbachi

Leal

et al. 2020

“…The impact of PHiD-CV in the general population of Brazil are consistent with the findings from other countries including those in the Latin America and Caribbean region. [47][48][49][50] Findings from this review support the results of the original review that the PHiD-CV program in Brazil has a substantial direct and indirect positive impact on the IPD and noninvasive disease burden caused by vaccine-types, and furthermore evaluates the impact during the post-vaccination period after the change in vaccination scheme. 3 Among the vaccine target population, particularly < 5 year olds, vaccine-type IPD declined substantially post PHiD-CV introduction.…”

Section: Discussionsupporting

confidence: 73%

“…However, the prevalence of specific serotypes, such as 19A, has a relatively increasing trend, which is observed and sustains in most countries regardless of the vaccine used. 50 The increase in non-vaccine-type IPD after PHiD-CV introduction might be related to several factors such as antibiotic over-usage, pneumococcal carriage, the prevalence of IPD underlying illness or comorbidities, heterogeneity in vaccine coverage levels across a nation and the use of a passive laboratory-based surveillance system. 51 Non-vaccine types are now becoming an important cause of IPD regardless of differences in PCV programs (such as previous use of the 7-valent PCV, choice of higher valent PCV or immunization schedules), despite epidemiological differences (such as pre-PCV incidence or serotype distribution) and vaccination program (with catch-up scheme).…”

Section: Discussionmentioning

confidence: 99%

Impact after 10-year use of pneumococcal conjugate vaccine in the Brazilian national immunization program: an updated systematic literature review from 2015 to 2020

Guzmán-Holst¹,

Barros

Rubio

et al. 2021

Self Cite

In 2010, a 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) was introduced in the Brazilian national immunization program; the 3 + 1 dose schedule was replaced by a 2 + 1 dose schedule in 2016. This systematic review presents the latest published evidence (2015-2020) on the impact after 10-year use of PHiD-CV in Brazil from a total of 29 publications. Overall, the PHiD-CV program had a positive impact on the morbidity and mortality associated with invasive pneumococcal disease (IPD), pneumonia and acute otitis media (AOM) in children <5 years-old. A reduction in the vaccine-type invasive disease was observed in all-ages; suggesting indirect protection unvaccinated older children and adults. The occurrence of non-vaccine type disease was evidenced in some studies. Higher vaccination coverage is required at national and state level for sustained population impact. Given the change in the vaccination schedule and the dynamics of pneumococcal disease epidemiology, continuous surveillance is warranted.

“…shown increases in 19A disease, which now represents a significant proportion of pneumococcal disease in both countries 60,61 and there have been several recent studies pointing to limited cross-protection from PCV10 against 19A. 62,63 Furthermore, recent real-world evidence has emerged from Belgium where 18 months following a change from PCV13 to PCV10 there was a 10 fold increase in cases of 19A in children 0-<2 years olds 47 .…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of a national immunization program with the 13-valent pneumococcal conjugate vaccine compared with the 10-valent pneumococcal conjugate vaccine in South Korea

Kim

Park

Kang

et al. 2020

Introduction: Globally, pneumococcal disease represents a significant burden. South Korea implemented the 7-valent pneumococcal conjugate vaccine (PCV7) in 2003, replaced with the 10-valent (PCV10) and 13valent (PCV13) vaccine in 2010. In 2014, both vaccines were introduced in the national immunization program (NIP) for infants with 3 primary doses and one booster dose We performed a cost-effectiveness evaluation to elucidate which vaccine may be expected to provide greater impact if included in a NIP. Methodology: Using an established model, we estimated the impact of introducing either PCV13 or PCV10 into the South Korean NIP in 2015. Vaccine impact was based on historic observed impact of PCV13 from 2010 to 2015 in Korea given high uptake of PCV13, and PCV10 impact was estimated based on experiences in countries using PCV10. Incidence and costs for all ages and including invasive pneumococcal disease, pneumonia, and acute otitis media were derived from the literature and Health Insurance Review and Assessment database. Results: In the base-case, over 5-years PCV13 was estimated to avert 550,000 more cases of pneumococcal disease compared to PCV10, driven by broader serotype coverage and less replacement due to serotypes 3 and 19A. This translated to a cost-savings of $47.4 million USD despite PCV13's higher cost. Sensitivity analysis found incremental cost-effectiveness ratios (ICERs) ranged from cost-saving to $7,300 USD per quality-adjusted life year (QALY). Conclusion: A NIP using PCV13 was estimated to have a more substantial public health impact and be cost-saving compared to a program with PCV10 due to broader serotype coverage.