Advertisement
Mayo Clinic Proceedings Home

Changing Trends of Invasive Pneumococcal Disease in the Era of Conjugate Pneumococcal Vaccination in Olmsted County: A Population-Based Study

Published:November 05, 2022DOI:https://doi.org/10.1016/j.mayocp.2022.06.037

      Abstract

      Objective

      To estimate the incidence of invasive pneumococcal disease (IPD) in the pre–13-valent pneumococcal conjugate vaccine (pre-PCV13; 7-valent pneumococcal conjugate vaccine era, 2002-2010) and post-PCV13 (2011-2018) time periods.

      Patients and Methods

      Using the Rochester Epidemiology Project, we conducted a population-based cohort study of all IPD cases in Olmsted County, Minnesota, from January 1, 2002, to December 31, 2018.

      Results

      Overall, 187 cases of IPD were identified. The incidence of IPD decreased significantly from 11.1 (95% CI, 9.1 to 13.2) to 5.6 (95% CI, 4.3 to 6.9) per 100,000 person-years when the pre- and post-PCV13 periods (2002-2010 vs 2011-2018) were compared (P<.001). Of the 187 patients with IPD, 112 (59.9%) had previously received at least 1 dose of pneumococcal vaccine. Among the IPD cases in the post-PCV13 period, there was an increase in non-PCV13 serotypes, mainly 11A (from 1.0% [1 of 105] to 6.2% [4 of 64]) and 33F (from 2.9% [3 of 105] to 15.6% [10 of 64]), while PCV13/non–7-valent pneumococcal conjugate vaccine serotypes declined from 38.1% (40 of 105) to 15.6% (10 of 64). At 30 days after an IPD diagnosis, the survival rate was 88.8% (95% CI, 84.4% to 93.4%).

      Conclusion

      A marked decline in IPD incidence occurred during the post-PCV13 era. Because of the observed increase in non-PCV13 serotypes, coupled with multiple factors that impact the epidemiology of IPD, ongoing surveillance of patients with IPD, particularly due to non-PCV13 serotypes, is warranted.

      Abbreviations and Acronyms:

      ABCS (Active Bacterial Core Surveillance), CSF (cerebrospinal fluid), IPD (invasive pneumococcal disease), PCV (pneumococcal conjugate vaccine), PCV7 (7-valent pneumococcal conjugate vaccine), PCV13 (13-valent pneumococcal conjugate vaccine), PPSV23 (23-valent pneumococcal polysaccharide vaccine), REP (Rochester Epidemiology Project)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Mayo Clinic Proceedings
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Fitzgerald D.
        • Waterer G.W.
        Invasive pneumococcal and meningococcal disease.
        Infect Dis Clin North Am. 2019; 33: 1125-1141
        • Drijkoningen J.J.C.
        • Rohde G.G.U.
        Pneumococcal infection in adults: burden of disease.
        Clin Microbiol Infect. 2014; 20: 45-51
        • Zhang D.
        • Petigara T.
        • Yang X.
        Clinical and economic burden of pneumococcal disease in US adults aged 19–64 years with chronic or immunocompromising diseases: an observational database study.
        BMC Infect Dis. 2018; 18: 436
        • Usuf E.
        • Bottomley C.
        • Bojang E.
        • et al.
        Persistence of nasopharyngeal pneumococcal vaccine serotypes and increase of nonvaccine serotypes among vaccinated infants and their mothers 5 years after introduction of pneumococcal conjugate vaccine 13 in The Gambia.
        Clin Infect Dis. 2019; 68: 1512-1521
        • Austrian R.
        A brief history of pneumococcal vaccines.
        Drugs Aging. 1999; 15: 1-10
        • Rodgers G.L.
        • Whitney C.G.
        • Klugman K.P.
        Triumph of pneumococcal conjugate vaccines: overcoming a common foe.
        J Infect Dis. 2021; 224: S352-S359
        • Yildirim I.
        • Shea K.M.
        • Pelton S.I.
        Pneumococcal disease in the era of pneumococcal conjugate vaccine.
        Infect Dis Clinic North Am. 2015; 29: 679-697
        • Kuehn B.
        Pneumococcal vaccine recommendation.
        JAMA. 2020; 323: 112
        • Advisory Committee on Immunization Practices
        Preventing pneumococcal disease among infants and young children: recommendations of the Advisory Committee on Immunization Practices (ACIP).
        MMWR Recomm Rep. 2000; 49: 1-35
        • Tsigrelis C.
        • Tleyjeh I.M.
        • Lahr B.D.
        • Nyre L.M.
        • Virk A.
        • Baddour L.M.
        Trends in invasive pneumococcal disease among older adults in Olmsted County, Minnesota.
        J Infect. 2009; 59: 188-193
        • Tomczyk S.
        • Bennett N.M.
        • Stoecker C.
        • et al.
        • Centers for Disease Control and Prevention (CDC)
        Use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine among adults aged ≥65 years: recommendations of the Advisory Committee on Immunization Practices (ACIP).
        MMWR Morb Mortal Wkly Rep. 2014; 63: 822-825
        • Centers for Disease Control and Prevention (CDC)
        Licensure of 13-valent pneumococcal conjugate vaccine for adults aged 50 years and older.
        MMWR Morb Mortal Wkly Rep. 2012; 61: 394-395
        • Centers for Disease Control and Prevention
        Active Bacterial Core Surveillance Report.
        Emerging Infections Program Network, 2019 (Streptococcus pneumoniae, 2019. Accessed November 1, 2022)
        • Moore M.R.
        • Link-Gelles R.
        • Schaffner W.
        • et al.
        Effect of use of 13-valent pneumococcal conjugate vaccine in children on invasive pneumococcal disease in children and adults in the USA: analysis of multisite, population-based surveillance.
        Lancet Infect Dis. 2015; 15: 301-309
        • Rocca W.A.
        • Yawn B.P.
        • St Sauver J.L.
        • Grossardt B.R.
        • Melton III, L.J.
        History of the Rochester Epidemiology Project: half a century of medical records linkage in a US population.
        Mayo Clin Proc. 2012; 87: 1202-1213
        • Rocca W.A.
        • Grossardt B.R.
        • Brue S.M.
        • et al.
        Data Resource Profile: Expansion of the Rochester Epidemiology Project medical records-linkage system (E-REP).
        Int J Epidemiol. 2018; 47 (368-368j)
        • Weinstein M.P.
        • Klugman K.P.
        • Jones R.N.
        Rationale for revised penicillin susceptibility breakpoints versus Streptococcus pneumoniae: coping with antimicrobial susceptibility in an era of resistance.
        Clin Infect Dis. 2009; 48: 1596-1600
        • van Werkhoven C.H.
        • Huijts S.M.
        Vaccines to prevent pneumococcal community-acquired pneumonia.
        Clin Chest Med. 2018; 39: 733-752
        • St Sauver J.L.
        • Grossardt B.R.
        • Yawn B.P.
        • Melton III, L.J.
        • Rocca W.A.
        Use of a medical records linkage system to enumerate a dynamic population over time: the Rochester Epidemiology Project.
        Am J Epidemiol. 2011; 173: 1059-1068
        • Therneau T.
        • Offord J.
        Expected Survival Based on Hazard Rates (Update): Report No. 63.
        Mayo Clinic Section of Biostatistics, 1999
        • Jenkins S.G.
        • Brown S.D.
        • Farrell D.J.
        Trends in antibacterial resistance among Streptococcus pneumoniae isolated in the USA: update from PROTEKT US Years 1-4.
        Ann Clin Microbiol Antimicrob. 2008; 7: 1
        • Demirdal T.
        • Sen P.
        • Emir B.
        Predictors of mortality in invasive pneumococcal disease: a meta-analysis.
        Expert Rev Anti Infect Ther. 2021; 19: 927-944
        • Morton J.B.
        • Morrill H.J.
        • LaPlante K.L.
        • Caffrey A.R.
        Predictors of mortality among U.S. veterans with Streptococcus pneumoniae infections.
        Am J Prev Med. 2017; 52: 769-777
        • Yu V.L.
        • Chiou C.C.C.
        • Feldman C.
        • et al.
        • International Pneumococcal Study Group
        An international prospective study of pneumococcal bacteremia: correlation with in vitro resistance, antibiotics administered, and clinical outcome.
        Clin Infect Dis. 2003; 37: 230-237
        • Hausdorff W.P.
        • Siber G.
        • Paradiso P.R.
        Geographical differences in invasive pneumococcal disease rates and serotype frequency in young children.
        Lancet. 2001; 357: 950-952
        • Rosen J.B.
        • Thomas A.R.
        • Lexau C.A.
        • et al.
        • CDC Emerging Infections Program Network
        Geographic variation in invasive pneumococcal disease following pneumococcal conjugate vaccine introduction in the United States.
        Clin Infect Dis. 2011; 53: 137-143
        • Harboe Z.B.
        • Dalby T.
        • Weinberger D.M.
        • et al.
        Impact of 13-valent pneumococcal conjugate vaccination in invasive pneumococcal disease incidence and mortality [published correction appears in Clin Infect Dis. 2014;59(12):1812].
        Clin Infect Dis. 2014; 59: 1066-1073
        • Jayasinghe S.
        • Menzies R.
        • Chiu C.
        • et al.
        Long-term impact of a "3 + 0" schedule for 7- and 13-valent pneumococcal conjugate vaccines on invasive pneumococcal disease in Australia, 2002-2014.
        Clin Infect Dis. 2017; 64: 175-183
        • De Wals P.
        • Lefebvre B.
        • Deceuninck G.
        • Longtin J.
        Incidence of invasive pneumococcal disease before and during an era of use of three different pneumococcal conjugate vaccines in Quebec.
        Vaccine. 2018; 36: 421-426
        • Berezin E.N.
        • Jarovsky D.
        • Cardoso M.R.A.
        • Mantese O.C.
        Invasive pneumococcal disease among hospitalized children in Brazil before and after the introduction of a pneumococcal conjugate vaccine.
        Vaccine. 2020; 38: 1740-1745
        • Ouldali N.
        • Varon E.
        • Levy C.
        • et al.
        Invasive pneumococcal disease incidence in children and adults in France during the pneumococcal conjugate vaccine era: an interrupted time-series analysis of data from a 17-year national prospective surveillance study.
        Lancet Infect Dis. 2021; 21: 137-147
        • Weinberger D.M.
        • Malley R.
        • Lipsitch M.
        Serotype replacement in disease after pneumococcal vaccination.
        Lancet. 2011; 378: 1962-1973
        • Ho P.-L.
        • Chiu S.S.
        • Law P.Y.
        • Chan E.L.
        • Lai E.L.
        • Chow K.-H.
        Increase in the nasopharyngeal carriage of non-vaccine serogroup 15 Streptococcus pneumoniae after introduction of children pneumococcal conjugate vaccination in Hong Kong.
        Diagn Microbiol Infect Dis. 2015; 81: 145-148
        • Weinberger R.
        • von Kries R.
        • van der Linden M.
        • Rieck T.
        • Siedler A.
        • Falkenhorst G.
        Invasive pneumococcal disease in children under 16 years of age: incomplete rebound in incidence after the maximum effect of PCV13 in 2012/13 in Germany.
        Vaccine. 2018; 36: 572-577
        • Ladhani S.N.
        • Collins S.
        • Djennad A.
        • et al.
        Rapid increase in non-vaccine serotypes causing invasive pneumococcal disease in England and Wales, 2000-17: a prospective national observational cohort study [published correction appears in Lancet Infect Dis. 2018;18(4):376.
        Lancet Infect Dis. 2018; 18: 441-451
        • Tin Tin Htar M.
        • Christopoulou D.
        • Schmitt H.-J.
        Pneumococcal serotype evolution in Western Europe.
        BMC Infect Dis. 2015; 15: 419
        • Lewnard J.A.
        • Hanage W.P.
        Making sense of differences in pneumococcal serotype replacement.
        Lancet Infect Dis. 2019; 19: e213-e220
        • Lo S.W.
        • Gladstone R.A.
        • van Tonder A.J.
        • et al.
        • Global Pneumococcal Sequencing Consortium
        Pneumococcal lineages associated with serotype replacement and antibiotic resistance in childhood invasive pneumococcal disease in the post-PCV13 era: an international whole-genome sequencing study.
        Lancet Infect Dis. 2019; 19: 759-769