Invasive Pneumococcal Disease in UK Children <1 Year of Age in the Post–13-Valent Pneumococcal Conjugate Vaccine Era: What Are the Risks Now?

Invasive Pneumococcal Disease in UK Children <1 Year of Age in the Post–13-Valent Pneumococcal Conjugate Vaccine Era: What Are the Risks Now?

Abstract Background Invasive pneumococcal disease (IPD) has declined significantly since the introduction of pneumococcal conjugate vaccines (PCVs). It is not known whether certain infant populations remain at higher risk of IPD in countries with established 13-valent PCV (PCV13) programs. We aimed...

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Veröffentlicht in:Clinical infectious diseases 2019-06, Vol.69 (1), p.84-90
Hauptverfasser: Kent, Alison, Makwana, Ashley, Sheppard, Carmen L., Collins, Sarah, Fry, Norman K., Heath, Paul T., Ramsay, Mary, Ladhani, Shamez N.
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container_end_page 90
container_issue 1
container_start_page 84
container_title Clinical infectious diseases
container_volume 69
creator Kent, Alison
Makwana, Ashley
Sheppard, Carmen L.
Collins, Sarah
Fry, Norman K.
Heath, Paul T.
Ramsay, Mary
Ladhani, Shamez N.
description Abstract Background Invasive pneumococcal disease (IPD) has declined significantly since the introduction of pneumococcal conjugate vaccines (PCVs). It is not known whether certain infant populations remain at higher risk of IPD in countries with established 13-valent PCV (PCV13) programs. We aimed to describe the epidemiology, clinical characteristics, serotype distribution, and outcomes of IPD in infants, and to estimate the relative risk of PCV13-type, non-PCV13-type, and overall IPD in premature infants compared to term infants during a 4-year period after the PCV13 program was established. Methods This was a prospective, enhanced national surveillance of laboratory-confirmed IPD in England in infants aged
doi_str_mv 10.1093/cid/ciy842
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It is not known whether certain infant populations remain at higher risk of IPD in countries with established 13-valent PCV (PCV13) programs. We aimed to describe the epidemiology, clinical characteristics, serotype distribution, and outcomes of IPD in infants, and to estimate the relative risk of PCV13-type, non-PCV13-type, and overall IPD in premature infants compared to term infants during a 4-year period after the PCV13 program was established. Methods This was a prospective, enhanced national surveillance of laboratory-confirmed IPD in England in infants aged &lt;1 year diagnosed during 2013–2016. Results There were 517 cases of IPD (incidence: 19/100000 infants). Incidence was significantly higher in premature infants compared with those born at term (49/100000 vs 17/100000; incidence rate ratio [IRR], 2.87; P &lt; .001), with infants born before 28 weeks’ gestation having the highest incidence (150/100000; IRR, 8.8; P &lt; .001). Of the 454 IPD cases with serotyped isolates, most were caused by non-PCV13 serotypes (369 cases, 71.4%), with 85 cases (16.4%) due to PCV13 serotypes. There were 31 deaths (case fatality rate [CFR], 6.2% [95% confidence interval, 4.3%–8.6%]). Premature infants did not have a higher CFR than term infants (P = .62). Conclusions IPD incidence in infants remains lower than rates reported prior to PCV7 introduction in England. The risk of IPD remains significantly higher in premature infants compared to infants born at term, for both PCV13 and non-PCV13 serotypes. Any changes to the infant PCV13 immunization schedule may disproportionally affect premature infants. While the incidence of invasive pneumococcal disease (IPD) in infants in England remains low, the risk of IPD is significantly higher in premature infants compared with term infants. Changes to the infant pneumococcal immunization schedule may disproportionally affect premature infants.</description><identifier>ISSN: 1058-4838</identifier><identifier>EISSN: 1537-6591</identifier><identifier>DOI: 10.1093/cid/ciy842</identifier><identifier>PMID: 30281069</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><subject>ARTICLES AND COMMENTARIES</subject><ispartof>Clinical infectious diseases, 2019-06, Vol.69 (1), p.84-90</ispartof><rights>The Author(s) 2018</rights><rights>The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com. 2018</rights><rights>The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-ab061c73be6d2418587e83acbe9aed2fcd6ed100a9b41c95f6716148911927043</citedby><cites>FETCH-LOGICAL-c375t-ab061c73be6d2418587e83acbe9aed2fcd6ed100a9b41c95f6716148911927043</cites><orcidid>0000-0002-3196-2355</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,1578,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30281069$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kent, Alison</creatorcontrib><creatorcontrib>Makwana, Ashley</creatorcontrib><creatorcontrib>Sheppard, Carmen L.</creatorcontrib><creatorcontrib>Collins, Sarah</creatorcontrib><creatorcontrib>Fry, Norman K.</creatorcontrib><creatorcontrib>Heath, Paul T.</creatorcontrib><creatorcontrib>Ramsay, Mary</creatorcontrib><creatorcontrib>Ladhani, Shamez N.</creatorcontrib><title>Invasive Pneumococcal Disease in UK Children &lt;1 Year of Age in the Post–13-Valent Pneumococcal Conjugate Vaccine Era: What Are the Risks Now?</title><title>Clinical infectious diseases</title><addtitle>Clin Infect Dis</addtitle><description>Abstract Background Invasive pneumococcal disease (IPD) has declined significantly since the introduction of pneumococcal conjugate vaccines (PCVs). It is not known whether certain infant populations remain at higher risk of IPD in countries with established 13-valent PCV (PCV13) programs. We aimed to describe the epidemiology, clinical characteristics, serotype distribution, and outcomes of IPD in infants, and to estimate the relative risk of PCV13-type, non-PCV13-type, and overall IPD in premature infants compared to term infants during a 4-year period after the PCV13 program was established. Methods This was a prospective, enhanced national surveillance of laboratory-confirmed IPD in England in infants aged &lt;1 year diagnosed during 2013–2016. Results There were 517 cases of IPD (incidence: 19/100000 infants). Incidence was significantly higher in premature infants compared with those born at term (49/100000 vs 17/100000; incidence rate ratio [IRR], 2.87; P &lt; .001), with infants born before 28 weeks’ gestation having the highest incidence (150/100000; IRR, 8.8; P &lt; .001). Of the 454 IPD cases with serotyped isolates, most were caused by non-PCV13 serotypes (369 cases, 71.4%), with 85 cases (16.4%) due to PCV13 serotypes. There were 31 deaths (case fatality rate [CFR], 6.2% [95% confidence interval, 4.3%–8.6%]). Premature infants did not have a higher CFR than term infants (P = .62). Conclusions IPD incidence in infants remains lower than rates reported prior to PCV7 introduction in England. The risk of IPD remains significantly higher in premature infants compared to infants born at term, for both PCV13 and non-PCV13 serotypes. Any changes to the infant PCV13 immunization schedule may disproportionally affect premature infants. While the incidence of invasive pneumococcal disease (IPD) in infants in England remains low, the risk of IPD is significantly higher in premature infants compared with term infants. 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It is not known whether certain infant populations remain at higher risk of IPD in countries with established 13-valent PCV (PCV13) programs. We aimed to describe the epidemiology, clinical characteristics, serotype distribution, and outcomes of IPD in infants, and to estimate the relative risk of PCV13-type, non-PCV13-type, and overall IPD in premature infants compared to term infants during a 4-year period after the PCV13 program was established. Methods This was a prospective, enhanced national surveillance of laboratory-confirmed IPD in England in infants aged &lt;1 year diagnosed during 2013–2016. Results There were 517 cases of IPD (incidence: 19/100000 infants). Incidence was significantly higher in premature infants compared with those born at term (49/100000 vs 17/100000; incidence rate ratio [IRR], 2.87; P &lt; .001), with infants born before 28 weeks’ gestation having the highest incidence (150/100000; IRR, 8.8; P &lt; .001). Of the 454 IPD cases with serotyped isolates, most were caused by non-PCV13 serotypes (369 cases, 71.4%), with 85 cases (16.4%) due to PCV13 serotypes. There were 31 deaths (case fatality rate [CFR], 6.2% [95% confidence interval, 4.3%–8.6%]). Premature infants did not have a higher CFR than term infants (P = .62). Conclusions IPD incidence in infants remains lower than rates reported prior to PCV7 introduction in England. The risk of IPD remains significantly higher in premature infants compared to infants born at term, for both PCV13 and non-PCV13 serotypes. Any changes to the infant PCV13 immunization schedule may disproportionally affect premature infants. While the incidence of invasive pneumococcal disease (IPD) in infants in England remains low, the risk of IPD is significantly higher in premature infants compared with term infants. Changes to the infant pneumococcal immunization schedule may disproportionally affect premature infants.</abstract><cop>US</cop><pub>Oxford University Press</pub><pmid>30281069</pmid><doi>10.1093/cid/ciy842</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-3196-2355</orcidid><oa>free_for_read</oa></addata></record>
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title Invasive Pneumococcal Disease in UK Children <1 Year of Age in the Post–13-Valent Pneumococcal Conjugate Vaccine Era: What Are the Risks Now?
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