scholarly journals The epidemiology of pneumococcal infection in children in the developing world

1999 ◽  
Vol 354 (1384) ◽  
pp. 777-785 ◽  
Author(s):  
Brian Greenwood
Keyword(s):  
Young Children ◽  
Invasive Pneumococcal Disease ◽  
Pneumococcal Disease ◽  
Developing World ◽  
Pneumococcal Infection ◽  
Field Trials ◽  
Industrialized Countries ◽  
Pneumococcal Infections ◽  
Increased Risk ◽  
Meningitis In Children

Pneumonia causes about three million deaths a year in young children, nearly all of which are in developing countries. Streptococcus pneumoniae (the pneumococcus) is the most important bacterial cause of pneumonia in young children and so is likely to be responsible for a high proportion of these deaths. The pneumococcus is also responsible for a substantial proportion of the 100 000–500 000 deaths that occur from meningitis in children each year. The incidence of invasive pneumococcal disease in children in the developing world is several times higher than in industrialized countries. This discrepancy may, in part, be due to socio–economic differences but genetic factors may also play a role. Children with sickle cell disease have a substantially increased risk of invasive pneumococcal infection and a search is being made for other possible genetic risk factors. Infection with human immunodeficiency virus (HIV) also predisposes to invasive pneumococcal disease and so the incidence of this disease in young children is expected to rise as increasing numbers of African and Asian children are born with a perinatally acquired HIV infection. Until recently, pneumococcal infections could be treated effectively with penicillin, a cheap and safe antibiotic. However, pneumococci that are resistant to penicillin are becoming prevalent in many countries, necessitating a change to more costly antibiotics which may be beyond the reach of the health services of poor, developing counties. The spread of antibiotic resistance has provided an added stimulus to the development of vaccines that might be able to prevent pneumococcal disease in infants. Recently developed polysaccharide–protein conjugate vaccines show promise and are now undergoing field trials. How deployment of these vaccines will influence the balance between invasive pneumococcal infections and asymptomatic nasopharyngeal carriage of pneumococci is uncertain.

scholarly journals Celiac disease and complement activation in response to Streptococcus pneumoniae

2019 ◽  
Vol 179 (1) ◽  
pp. 133-140
Author(s):  
Anna Röckert Tjernberg ◽  
Hanna Woksepp ◽  
Kerstin Sandholm ◽  
Marcus Johansson ◽  
Charlotte Dahle ◽  
...  
Keyword(s):  
Celiac Disease ◽  
Streptococcus Pneumoniae ◽  
Invasive Pneumococcal Disease ◽  
Complement Activation ◽  
Pneumococcal Disease ◽  
Excess Risk ◽  
Enzyme Linked Immunosorbent Assay ◽  
Control Group ◽  
Pneumococcal Infections ◽  
Increased Risk

Abstract Individuals with celiac disease (CD) are at increased risk of invasive pneumococcal disease (IPD). The aim of this study was to explore whether the complement response to Streptococcus pneumoniae differed according to CD status, and could serve as an explanation for the excess risk of IPD in CD. Twenty-two children with CD and 18 controls, born 1999–2008, were included at Kalmar County Hospital, Sweden. The degree of complement activation was evaluated by comparing levels of activation products C3a and sC5b-9 in plasma incubated for 30 min with Streptococcus pneumoniae and in non-incubated plasma. Complement analyses were performed with enzyme-linked immunosorbent assay (ELISA). Pneumococcal stimulation caused a statistically significant increase in C3a as well as sC5b-9 in both children with CD and controls but there was no difference in response between the groups. After incubation, C3a increased on average 4.6 times and sC5b-9 22 times in both the CD and the control group (p = 0.497 and p = 0.724 respectively). Conclusion: Complement response to Streptococcus pneumoniae seems to be similar in children with and without CD and is thus unlikely to contribute to the increased susceptibility to invasive pneumococcal disease in CD.What is Known:• An excess risk of pneumococcal infections has been demonstrated in individuals with celiac disease.• Infectious complications can depend on hyposplenism but alternative mechanisms are sparsely examined.What is New:• Complement activation in response to Streptococcus pneumoniae was examined in children with and without celiac disease but no differences could be demonstrated.

scholarly journals Invasive pneumococcal infection in South and West England

1998 ◽  
Vol 120 (2) ◽  
pp. 117-123 ◽  
Author(s):  
M. D. SMITH ◽  
J. STUART ◽  
N. J. ANDREWS ◽  
W. A. TELFER BRUNTON ◽  
K. A. V. CARTWRIGHT
Keyword(s):  
Blood Culture ◽  
Invasive Pneumococcal Disease ◽  
Pneumococcal Disease ◽  
Statistical Significance ◽  
Pneumococcal Infection ◽  
Vaccine Uptake ◽  
Pneumococcal Infections ◽  
Sex Structure ◽  
Catchment Population ◽  
Admission Rates

Variation in the incidence of invasive pneumococcal disease across South and West England, in 1995, was measured through a survey of microbiology laboratories. A 100% response rate was achieved. The incidence by laboratory varied between 5·2 and 20·4 per 100000 catchment population (P<0·001). Adjusting for pneumococcal vaccine uptake rate in over 65 year olds, hospital admission rates, blood culture system used and for the age and sex structure of the population, did not account for this variation. When blood culture sampling rates were included in a logistic regression model, the variation between laboratories was much less and of lower statistical significance (P=0·019). Higher rates of blood culture sampling were associated with a higher incidence of invasive pneumococcal disease. Consistently high sampling should be encouraged because a higher diagnostic rate should result in more selective prescribing of antibiotics, and secondly because improved ascertainment of severe pneumococcal infections is a prerequisite for the evaluation of new pneumococcal conjugate vaccines.

scholarly journals Modern Approaches to Vaccinal Prevention of a Pneumococcal Infection in Adults Patients with Diabetes Mellitus (Literature Review)

2018 ◽  
Vol 17 (2) ◽  
pp. 83-90
Author(s):  
J. A. Paramonova ◽  
L. B. Postnikova ◽  
M. P. Kostinov ◽  
A. A. Tarasova ◽  
V. A. Pogrebetzkaya
Keyword(s):  
Diabetes Mellitus ◽  
Conjugate Vaccine ◽  
Pneumococcal Conjugate Vaccine ◽  
Pneumococcal Disease ◽  
Pneumococcal Infection ◽  
Cost Effective ◽  
Morbidity Rate ◽  
Pneumococcal Infections ◽  
Increased Risk ◽  
Patients With Diabetes

At present, pneumococcal infections remain a major cause of morbidity and mortality around the world, being one of the ten leading causes of death worldwide. Some medical conditions, like  diabetes mellitus (DM) are associated with an increased risk of  pneumococcal infections and vaccination was calculated to be highly  cost-effective among those adults with an increased risk. The article  analyzes world data on pneumococcal infection morbidity rate among diabetes mellitus patients and possible ways of reducing it through  immunization. In December 2011, the Food and Drug Administration  (FDA) licensed 13-valent pneumococcal conjugate vaccine (PCV13)  for prevention of pneumonia and invasive pneumococcal disease in  adults aged ≥ 50 years. However, the efficacy of PCV in individuals  with specific comorbidities is yet unknown. The article presents the  findings of research which investigated the efficacy of  antipneumococcal vaccination among diabetes mellitus patients. It  also gives data of first-hand experience of 13-valent pneumococcal conjugate vaccine use (Prevenar 13, Pfizer).

scholarly journals Coeliac disease and invasive pneumococcal disease: a population-based cohort study

2017 ◽  
Vol 145 (6) ◽  
pp. 1203-1209 ◽  
Author(s):  
A. RÖCKERT TJERNBERG ◽  
J. BONNEDAHL ◽  
M. INGHAMMAR ◽  
A. EGESTEN ◽  
G. KAHLMETER ◽  
...  
Keyword(s):  
Cohort Study ◽  
Coeliac Disease ◽  
Invasive Pneumococcal Disease ◽  
Pneumococcal Disease ◽  
Cox Regression ◽  
Statistical Significance ◽  
Pneumococcal Vaccination ◽  
Population Based ◽  
Increased Risk ◽  
Severe Infections

SUMMARYSevere infections are recognized complications of coeliac disease (CD). In the present study we aimed to examine whether individuals with CD are at increased risk of invasive pneumococcal disease (IPD). To do so, we performed a population-based cohort study including 29 012 individuals with biopsy-proven CD identified through biopsy reports from all pathology departments in Sweden. Each individual with CD was matched with up to five controls (n = 144 257). IPD events were identified through regional and national microbiological databases, including the National Surveillance System for Infectious Diseases. We used Cox regression analyses to estimate hazard ratios (HRs) for diagnosed IPD. A total of 207 individuals had a record of IPD whereas 45/29 012 had CD (0·15%) and 162/144 257 were controls (0·11%). This corresponded to a 46% increased risk for IPD [HR 1·46, 95% confidence interval (CI) 1·05–2·03]. The risk estimate was similar after adjustment for socioeconomic status, educational level and comorbidities, but then failed to attain statistical significance (adjusted HR 1·40, 95% CI 0·99–1·97). Nonetheless, our study shows a trend towards an increased risk for IPD in CD patients. The findings support results seen in earlier research and taking that into consideration individuals with CD may be considered for pneumococcal vaccination.

Chronic graft versus host disease is associated with long-term risk for pneumococcal infections in recipients of bone marrow transplants

Blood ◽  
2000 ◽  
Vol 95 (12) ◽  
pp. 3683-3686 ◽  
Author(s):  
Samar Kulkarni ◽  
Ray Powles ◽  
Jennie Treleaven ◽  
Unell Riley ◽  
Seema Singhal ◽  
...  
Keyword(s):  
Graft Versus Host Disease ◽  
Chronic Gvhd ◽  
Pneumococcal Infection ◽  
Pneumococcal Infections ◽  
Hematopoietic Stem ◽  
Host Disease ◽  
Graft Versus Host ◽  
Increased Risk ◽  
Penicillin Prophylaxis

Abstract Incidences of and risk factors for Streptococcus pneumoniaesepsis (SPS) after hematopoietic stem cell transplantation were analyzed in 1329 patients treated at a single center between 1973 and 1997. SPS developed in 31 patients a median of 10 months after transplantation (range, 3 to 187 months). The infection was fatal in 7 patients. The probability of SPS developing at 5 and 10 years was 4% and 6%, respectively. Age, sex, diagnosis, and graft versus host disease (GVHD) prophylaxis did not influence the development of SPS. Allogeneic transplantation (10-year probability, 7% vs 3% for nonallogeneic transplants; P = .03) and chronic GVHD (10-year probability, 14% vs 4%; P = .002) were associated with significantly higher risk for SPS. All the episodes of SPS were seen in patients who had undergone allograft or total body irradiation (TBI) (31 of 1202 vs 0 of 127;P = .07). Eight patients were taking regular penicillin prophylaxis at the time of SPS, whereas 23 were not taking any prophylaxis. None of the 7 patients with fatal infections was taking prophylaxis for Pneumococcus. Pneumococcal bacteremia was associated with higher incidences of mortality (6 of 15 vs 1 of 16;P = .04). We conclude that there is a significant long-term risk for pneumococcal infection in patients who have undergone allograft transplantation, especially those with chronic GVHD. Patients who have undergone autograft transplantation after TBI-containing regimens also appear to be at increased risk. These patients should receive lifelong pneumococcus prophylaxis. Consistent with increasing resistance to penicillin, penicillin prophylaxis does not universally prevent SPS, though it may protect against fatal infections. Further studies are required to determine the optimum prophylactic strategy in patients at risk.

scholarly journals Increased Risk for and Mortality From Invasive Pneumococcal Disease in HIV-Exposed but Uninfected Infants Aged <1 Year in South Africa, 2009–2013

2015 ◽  
Vol 60 (9) ◽  
pp. 1346-1356 ◽  
Author(s):  
Claire von Mollendorf ◽  
Anne von Gottberg ◽  
Stefano Tempia ◽  
Susan Meiring ◽  
Linda de Gouveia ◽  
...  
Keyword(s):  
South Africa ◽  
Invasive Pneumococcal Disease ◽  
Pneumococcal Disease ◽  
Increased Risk ◽  
Hiv Exposed

Control of pneumococcal disease in the United Kingdom – the start of a new era

2006 ◽  
Vol 55 (8) ◽  
pp. 975-980 ◽  
Author(s):  
Stuart C. Clarke
Keyword(s):  
Young Children ◽  
Disease Surveillance ◽  
Pneumococcal Disease ◽  
Pneumococcal Infection ◽  
Immunization Schedule ◽  
Childhood Immunization ◽  
Immunization Policy ◽  
New Era ◽  
The Usa ◽  
The Uk

In 2000, a multi-valent pneumococcal conjugate vaccine, known as Prevnar, was licensed for use in infants and young children in the USA. The subsequent introduction of the vaccine into the childhood immunization schedule in that country led to a significant decrease in pneumococcal disease. The vaccine is effective against invasive and non-invasive pneumococcal infection, can be used in young children as well as adults and, like all conjugate vaccines, provides long-lasting immunity. Moreover, it reduces the incidence of antibiotic resistance because a number of resistant serotypes are targeted by the vaccine. Prevnar, also known as Prevenar, has since been licensed in numerous countries, including the UK. On 8 February 2006, the Departments of Health in England, Scotland and Wales announced the inclusion of Prevenar in the childhood immunization schedule. This announcement has important implications for pneumococcal infection, disease surveillance and immunization policy in the UK.

scholarly journals Decreasing case fatality rate following invasive pneumococcal disease, North East England, 2006–2016

2019 ◽  
Vol 147 ◽  
Author(s):  
C. Houseman ◽  
K. E. Chapman ◽  
P. Manley ◽  
R. Gorton ◽  
D. Wilson ◽  
...  
Keyword(s):  
Invasive Pneumococcal Disease ◽  
Case Fatality Rate ◽  
Pneumococcal Disease ◽  
Demographic Data ◽  
Case Fatality ◽  
Risk Groups ◽  
Significant Decline ◽  
Fatality Rate ◽  
North East ◽  
Increased Risk

AbstractDeclining mortality following invasive pneumococcal disease (IPD) has been observed concurrent with a reduced incidence due to effective pneumococcal conjugate vaccines. However, with IPD now increasing due to serotype replacement, we undertook a statistical analysis to estimate the trend in all-cause 30-day case fatality rate (CFR) in the North East of England (NEE) following IPD. Clinical, microbiological and demographic data were obtained for all laboratory-confirmed IPD cases (April 2006–March 2016) and the adjusted association between CFR and epidemiological year estimated using logistic regression. Of the 2510 episodes of IPD included in the analysis, 486 died within 30 days of IPD (CFR 19%). Increasing age, male sex, a diagnosis of septicaemia, being in ⩾1 clinical risk groups, alcohol abuse and individual serotypes were independently associated with increased CFR. A significant decline in CFR over time was observed following adjustment for these significant predictors (adjusted odds ratio 0.93, 95% confidence interval 0.89–0.98; P = 0.003). A small but significant decline in 30-day all-cause CFR following IPD has been observed in the NEE. Nonetheless, certain population groups remain at increased risk of dying following IPD. Despite the introduction of effective vaccines, further strategies to reduce the ongoing burden of mortality from IPD are needed.

Incidence of invasive pneumococcal disease in Scotland, 1988–99

2002 ◽  
Vol 128 (2) ◽  
pp. 139-147 ◽  
Author(s):  
M. H. KYAW ◽  
S. CLARKE ◽  
I. G. JONES ◽  
H. CAMPBELL
Keyword(s):  
Invasive Pneumococcal Disease ◽  
Pneumococcal Disease ◽  
Age Groups ◽  
The Elderly ◽  
Invasive Disease ◽  
Increased Risk ◽  
Influenza Activity ◽  
The Mean ◽  
Pneumococcal Bacteraemia ◽  
Using Data

A review of the epidemiology of invasive pneumococcal disease in Scotland was carried out using data from laboratory-based systems during the period 1988–99. This comprised 5456 (90·8%) isolates of Streptococcus pneumoniae from blood, 467 (7·8%) from cerebrospinal fluid (CSF) and 84 (1·4%) from other sterile sites. The mean annual incidence of invasive disease was 9·8/105 population (9·0/105 for bacteraemia and 0·8/105 for meningitis). Invasive disease was highest in children <2 years of age and in the elderly [ges ]65 years (44·9/105 and 28·4/105 population in these age groups respectively). The highest incidence of pneumococcal meningitis, 11·8/105 persons occurred in children <2 years of age. Males had a higher incidence of pneumococcal bacteraemia and meningitis than females (male[ratio ]female = 1·2[ratio ]1 for bacteraemia (RR = 1·17, 95% CI 1·11, 1·24) and 1·5[ratio ]1 for meningitis (RR = 1·41, 95% CI 1·18, 1·70)). Pneumococcal disease was highest in winter periods and coincided with influenza activity. The proportion of penicillin and erythromycin non-susceptible isolates increased from 4·2% in 1992 to 12·6% in 1999 and from 5·6% in 1994 to 16·3% in 1999 respectively. Our data confirm the substantial and increasing disease burden from pneumococcal disease and rise in prevalence of antibiotic non-susceptibility among pneumococci in Scotland. Continued surveillance of groups at increased risk for pneumococcal disease and the antibiotic susceptibility and serotype distribution of isolates are important to develop appropriate policies for the prevention of pneumococcal disease in Scotland.

Antibody Response to Pneumococcal Polysaccharide Vaccination Predicts Pneumococcal Disease in Splenectomized Patients with Hematological Diseases.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1335-1335
Author(s):  
Honar Cherif ◽  
Magnus Bjorkholm ◽  
Mats Kalin ◽  
Helle B. Konradsen ◽  
Ola Landgren
Keyword(s):  
Antibody Response ◽  
Pneumococcal Disease ◽  
Pneumococcal Vaccination ◽  
Immunological Response ◽  
Poor Responders ◽  
Pneumococcal Infections ◽  
Hematological Diseases ◽  
Prophylactic Measures ◽  
Increased Risk ◽  
Antibody Titers

Abstract Patients with hematological diseases undergoing diagnostic or therapeutic splenectomy are at increased risk of acquiring fulminant pneumococcal infections. Vaccination is a straightforward option in reducing these infections. Certain patient subgroups showing inadequate immunological response to pneumococcal vaccination may be candidates for alternative prophylactic measures. We prospectively studied the antibody response to vaccination with 23-valent pneumococcal capsular polysaccharide vaccine (Pneumovax N) in splenectomized patients with hematological disorders in relation to clinical characteristics and pneumococcal disease. A total of 76 splenectomized patients (Hodgkin s lymphoma 26, indolent lymphoma 10, aggressive lymphoma 8, immune hemolytic anemia 6, immune thrombocytopenic purpura 22, and others 4) with a median age of 52 years (range 18–82) were included. Antibody titers were determined using an enzyme-linked immunosorbent assay before and 12 months after vaccination. A weak immunological response was observed in 27 (35%) patients (poor responders) and an adequate response in 49 (65%) (good responders). During the follow-up period of 5–9 years after vaccination and despite repeated revaccination in many cases, a total of 5 episodes of microbiologically verified pneumococcal infections were reported in poor responders, while only one episode was noted among good responders (p=.01). Underlying malignant hematological diseases were more frequent among poor responders than among good responders (p=.002). The distribution of patients according to age, gender, immunoglobulin levels, time between splenectomy and vaccination (&lt;1 year&gt;), time between preceding chemotherapy/radiotherapy and vaccination (&lt;6 months&gt;) and/or previous radiotherapy did not differ between poor and good responders. In conclusion, a significant number of splenectomized patients with hematological diseases respond poorly to pneumococcal vaccination and have a significantly increased risk of post-splenectomy pneumococcal infections despite vaccination. In the absence of clinical parameters that can reliably predict a poor antibody response, measurement of antibody titers 12 months after vaccination seems to be the most adequate method for identification of patients in this subgroup. Poor responders may be offered other prophylactic measures such as antibiotic prophylaxis and/or immunization with pneumococcal conjugate vaccines. Studies to further elucidate the last alternative are ongoing.

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