The COVID-19 pandemic as an opportunity for unravelling the causative association between respiratory viruses and pneumococcus-associated disease in young children: a prospective study

Dagan, Ron; Beek, Bart Adriaan van der; Ben‐Shimol, Shalom; Greenberg, David; Shemer‐Avni, Yonat; Weinberger, Daniel M; Danino, Dana

doi:10.1016/j.ebiom.2023.104493

Cited by 57 publications

(19 citation statements)

References 42 publications

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“…Our findings support this notion that vaccinating against S pneumoniae reduces severe RSV disease as the outcome measured in our analysis was RSV-confirmed hospitalization. Indeed, recent data from the coronavirus disease 2019 pandemic era has shown further relationships between pneumococcal disease and RSV, with the concomitant decline in pneumococcal disease following the abrupt disappearance of RSV [ 26 , 27 ]. The role of vaccination with PCV in reducing RSV infection or milder disease might now warrant further investigation to understand the immunological mechanisms of off-target vaccine effects.…”

Section: Discussionmentioning

confidence: 99%

Pneumococcal Conjugate Vaccines Are Protective Against Respiratory Syncytial Virus Hospitalizations in Infants: A Population-Based Observational Study

Gidding

Blyth

et al. 2023

Open Forum Infectious Diseases

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Background Pneumococcal conjugate vaccines (PCV) reduced the risk of respiratory syncytial virus (RSV) in a randomised clinical trial. We aimed to assess the real-world effectiveness of PCV on RSV-hospitalisations among Western Australian infants. Methods We conducted a population-based cohort study of births 2000-2012, using probabilistically linked individual-level immunisation, hospitalisation, respiratory microbiology testing and perinatal data. We performed Cox proportional hazard models with time varying exposure (receipt of infant PCV doses) against the first RSV-confirmed hospitalisation 0-12 months adjusted for perinatal and socio-demographic factors. Results From 360,994 children, three-dose PCV coverage in Aboriginal infants ranged from 29-51% in 2001-04 when PCV was funded for Aboriginal children only. Following universal funding in 2005, coverage increased to 85% for Aboriginal and 73% for non-Aboriginal infants. RSV-hospitalisation rates were highest in young infants 0-5 months (22.5/1000) and more than two times higher in Aboriginal infants than in non-Aboriginal infants. Receipt of 3 or more PCV doses in the universal funded period was associated with a 30% reduction in RSV-hospitalisation in Aboriginal infants (adjusted hazard ratio, aHR 0.70 [95% confidence interval, CI 0.46-1.06]) and 21% reduction in non-Aboriginal infants (aHR 0.79 [95% CI 0.63-0.99]) compared with unvaccinated infants. Conclusions Prior to the introduction of RSV vaccines, our study suggests that universal childhood PCV vaccination may result in a reduction in severe RSV infections in children and maybe important for countries who are yet to consider PCV programs.

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Section: Discussionmentioning

confidence: 99%

Pneumococcal Conjugate Vaccines Are Protective Against Respiratory Syncytial Virus Hospitalizations in Infants: A Population-Based Observational Study

Gidding

Blyth

et al. 2023

Open Forum Infectious Diseases

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“…Recent studies highlight the critical role of respiratory viruses (e.g. RSV, human metapneumovirus, influenza) in contributing to pneumococcal disease [15]. Large, out of season viral outbreaks which occurred following easing of COVID-19 restrictions [36] are therefore likely to have contributed to increasing pneumococcal disease reported here, which will need careful surveillance in future years.…”

Section: Resultsmentioning

confidence: 94%

“…Many countries, including the UK, implemented measures such as social distancing and school closures, intended to decrease SARS-CoV-2 transmission and alleviate pressure on healthcare services [13]. These measures reduced the transmission of other respiratory pathogens [12], but it is unclear to what extent they have disrupted pneumococcal transmission [14,15]. These measures may also have caused changes in serotype distribution of pneumococcal infection, and disease.…”

Section: Introductionmentioning

confidence: 99%

Trends in serotype distribution and disease severity in adults hospitalised withStreptococcus pneumoniaeinfection in Bristol and Bath: a retrospective cohort study, 2006-2022

Hyams

Challen

Hettle

et al. 2023

Preprint

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BackgroundPaediatric pneumococcal conjugate vaccination (PCV) has reduced adult PCV-serotype disease: PCV7 has greater indirect effects than PCV13. Ongoing surveillance is required to evaluate current vaccine usage and inform future vaccine deployment, particularly with respiratory infection epidemiology changing following SARS-CoV-2 emergence.Methods and FindingsA retrospective cohort study, all adults >16 years admitted to three UK hospitals, 2006-2022, with pneumococcal disease. Medical records were reviewed for each clinical episode and serotype data were obtained from the UK Health Security Agency national reference laboratory. We identified 1,501 (40.3%) cases of invasive pneumococcal disease (IPD) with known serotype, 134 (3.6%) IPD cases without serotype data, and 2,084 (56.0%) non-IPD cases, which are typically missed in national surveillance. Disease incidence increased progressively from 2006-2020, followed by a sudden decline after COVID-19 emergence and then a gradual increase to pre-pandemic levels. Paediatric PCV7 introduction reduced adult PCV7 serotype IPD from 29.4% [24.1-35.4] of IPD in 2006-09 to 7.0% [3.7-12.7] in 2021-22. PCV13 introduction also decreased adult vaccine serotype IPD, but considerable residual adult disease remains, causing 34.3% [28.6-40.4] of IPD in 2006-09 and 21.7% [15.5-29.6] 9 in 2021-22, respectively. Serotype replacement diminished the benefits of PCV introduction: PCV20-13 and non-PCV serotypes represented 27.0% [21.9-32.9] and 9.3% [6.3-13.5] of disease in 2006-2009, and 39.5% [31.5-48.2] and 31.8% [24.4-40.2] in 2021-2022, respectively. Serotype shifts have resulted in increasing disease caused by serotype 3 and 8, and the re-emergence of serotype 19F and 19A. These serotype shifts occurred as clinical disease severity changed, and whilst the COVID-19 pandemic disrupted disease severity trends, these have now largely reverted to previous trajectories. Patient age trended upwards and although CURB65 severity decreased there were increased ICU admission rates. Overall, inpatient mortality decreased and hospitalisation duration remained stable.ConclusionsAfter 17 years of PCV use, residual pneumococcal disease due to the vaccine serotypes among hospitalised adults remains. The sharp decline in pneumococcal disease during the COVID-19 pandemic has now reversed, with increasing cases due to vaccine serotypes, especially serotype 3. Around 68.2% of cases in 2022 were potentially covered by the recently licensed 20-valent PCV.

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“…This may have exposed the population to an important circulation of GAS after NPI relaxing, as it has been reported for other respiratory pathogens [ 15 ]. However, it has been shown that carriage of other bacterial pathogens like Streptococcus pneumoniae persisted despite NPIs [ 16 , 17 ]. Carriage of GAS has been less studied during the NPI period.…”

Section: Discussionmentioning

confidence: 99%

Unexpected Increase in Invasive Group A Streptococcal Infections in Children After Respiratory Viruses Outbreak in France: A 15-Year Time-Series Analysis

Lassoued

Assad

Ouldali

et al. 2023

Open Forum Infectious Diseases

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The COVID-19 pandemic as an opportunity for unravelling the causative association between respiratory viruses and pneumococcus-associated disease in young children: a prospective study

Cited by 57 publications

References 42 publications

Pneumococcal Conjugate Vaccines Are Protective Against Respiratory Syncytial Virus Hospitalizations in Infants: A Population-Based Observational Study

Pneumococcal Conjugate Vaccines Are Protective Against Respiratory Syncytial Virus Hospitalizations in Infants: A Population-Based Observational Study

Trends in serotype distribution and disease severity in adults hospitalised withStreptococcus pneumoniaeinfection in Bristol and Bath: a retrospective cohort study, 2006-2022

Unexpected Increase in Invasive Group A Streptococcal Infections in Children After Respiratory Viruses Outbreak in France: A 15-Year Time-Series Analysis

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