European data sources for computing burden of (potential) vaccine-preventable diseases in ageing adults.

BACKGROUND: To guide decision-making on immunisation programmes for ageing adults in Europe, one of the aims of the Vaccines and InfecTious diseases in the Ageing popuLation (IMI2-VITAL) project is to assess the burden of disease (BoD) of (potentially) vaccine-preventable diseases ((P)VPD). We aimed to identify the available data sources to calculate the BoD of (P)VPD in participating VITAL countries and to pinpoint data gaps. Based on epidemiological criteria and vaccine availability, we prioritized (P) VPD caused by Extra-intestinal pathogenic Escherichia coli (ExPEC), norovirus, respiratory syncytial virus, Staphylococcus aureus, and pneumococcal pneumonia. METHODS: We conducted a survey on available data (e.g. incidence, mortality, disability-adjusted life years (DALY), quality-adjusted life years (QALY), sequelae, antimicrobial resistance (AMR), etc.) among national experts from European countries, and carried out five pathogen-specific literature reviews by searching MEDLINE for peer-reviewed publications published between 2009 and 2019. RESULTS: Morbidity and mortality data were generally available for all five diseases, while summary BoD estimates were mostly lacking. Available data were not always stratified by age and risk group, which is especially important when calculating BoD for ageing adults. AMR data were available in several countries for S. aureus and ExPEC. CONCLUSION: This study provides an exhaustive overview of the available data sources and data gaps for the estimation of BoD of five (P) VPD in ageing adults in the EU/EAA, which is useful to guide pathogen-specific BoD studies and contribute to calculation of (P)VPDs BoD.

Programa de vacunación de grupos de riesgo: Fondo Nacional de Recursos: Uruguay 2004 / Program of vaccination of groups of risk: National Fund of Resources: Uruguay, 2004

El Fondo Nacional de Recursos, persona pública no estatal, financió más de 15.500 actos de medicina altamente especializada en el año 2004. Ese año agregó a las acciones complementarias (programas de prevención secundaria), la prevención de infecciones por influenza y neumococo por la vacunación, justificado por las recomendaciones internacionales al ser pacientes con factores de riesgo y debido a que la estrategia es costo-beneficio y costo-efectiva. Lograr el mayor porcentaje de vacunación en los pacientes asistidos en determinados actos y en determinados centros, que por patología o por edad cumplen con la recomendación de la vacunación. La estrategia fue clínica y de acciones individuales. Se realizó bajo protocolo durante todo el año para la vacunación contra el neumococo y dos meses para la vacunación antigripal. Esta última se complementó con una encuesta no aleatoria, representativa en el número de personas según estimación de proporciones. El Fondo Nacional de Recursos, financió 15.581 actos en 2004. Los actos del programa fueron hemodinamia, marcapasos, artroplastia y diálisis crónica. El universo fue 9.100 pacientes, la muestra de los centros seleccionados (total 42) fue de 6.945, se consultó 5.576 pacientes (80,3 por ciento) y 2.644 se vacunaron contra neumococo (38,1 por ciento). Los pacientes en diálisis crónica fueron los que mejor adhirieron al programa (51,9 por ciento). Existen dificultades en la vacunación de los adultos para desarrollar una estrategia de prevención secundaria en población de riesgo, como es la falta de aceptación previa del equipo de salud como estimulador de la misma.

[C-reactive protein, leukocyte count and ESR in the assessment of severity of community-acquired pneumonia]. / Toplum kökenli pnömonilerin agirliginin degerlendirilmesinde C-reaktif protein, lökosit sayisi ve eritrosit sedimentasyon hizinin yeri.

This study aimed to evaluate the relations between the levels of CRP, leukocyte count and ESR on admission and the severity of pneumonia according to the criteria of Turkish Thoracic Society (TTS) and British Thoracic Society (BTS) CAP guidelines. This study included the adult patients with CAP admitted to our clinic between the years 2003-2005. The history, physical findings, hemogram, ESR, the levels of CRP and the results of other laboratory investigations were obtained from the medical records. The patients were grouped according to BTS and TTS guidelines. The mean age was 47.2 years; 70 patients (75.3%) were male and 23 patients (24.7%) were female. The severity of pneumonia according to BTS criteria was correlated with the levels of CRP and leukocyte count (p= 0.037, p= 0.01, respectively). The severity of pneumonia according to TTS criteria was correlated with the levels of CRP, leukocyte count and ESR (p= 0.000, p= 0.014, p= 0.015, respectively). Among TTS pneumonia groups, there were statistically significant differences between groups 1 and 3; groups 1 and 4; groups 2 and 3 (p= 0.006, p= 0.041, p= 0.05, respectively) for mean CRP levels. The mean levels of CRP (103.2 +/- 76.4 mg/L), leukocyte count (19.8 +/- 9.5 x 10(3)/microL) and ESR (57.2 +/- 26.8 mm/hour) were statistically significantly higher in inpatients than the mean levels of CRP (53.2 +/- 52.8 mg/dL), leukocyte count (14.6 +/- 5.4 x 10(3)/microL) and ESR (43.1 +/- 25.9 mm/hour) in outpatients (p= 0.000, p= 0.001, p= 0.012, respectively) according to TTS. It is considered that CRP, a powerful marker of inflammation, is related with severity of pneumonia and a high level of CRP may be useful to make a decision about hospitalisation.

Pulmonary damage and bacterial load in assessment of the efficacy of simulated human treatment-like amoxicillin (2,000 milligrams) therapy of experimental pneumococcal pneumonia caused by strains for which amoxicillin MICs differ.

An experimental rat pneumonia model using two amoxicillin-susceptible (MICs, < or =0.015 and 2 microg/ml) and two non-amoxicillin-susceptible (MIC, 4 microg/ml) Streptococcus pneumoniae strains was developed for testing the efficacy of amoxicillin administered to simulate human serum kinetics after treatment with amoxicillin-clavulanate (2,000 and 125 mg, respectively, twice a day, for 2.5 days). The end points for efficacy were reductions in bacterial loads in the lungs and reductions in levels of pulmonary damage. For the amoxicillin-susceptible strains (serotypes 23F and 14), a decrease greater than 4.5 log(10) CFU/pair of lungs was obtained, and the time for which the serum antibiotic concentration (SAC) was higher than the MIC (T(S)(A)(C)(>)(MIC)) was greater than 60% of the dosing interval. For non-amoxicillin-susceptible strains, the decrease in bacterial load was 1.34 to 1.75 log(10) CFU/pair of lungs, with a T(S)(A)(C)(>)(MIC) of 46.7% of the dosing interval. An in vitro study showed that serotype 9V non-amoxicillin-susceptible strains behaved as tolerant-like to concentrations similar to those in the in vivo model. The high and maintained SACs (T(S)(A)(C)(>)(MIC), >46% for all strains) significantly diminished lung injury (affected area of the lung and lung weight), compared to that in controls, by all strains, regardless of the MIC, bactericidal behavior in in vitro killing curves, or the serotype of the infecting strain. These results show the importance of host therapeutic end points in the evaluation of antibiotic efficacy. The antibiotic was more efficacious, for one nonsusceptible strain tested, when the treatment was started early (1 h postinoculation [p.i.]) than when treatment was delayed (24 h p.i.).

Appropriate use of antimicrobials for drug-resistant pneumonia: focus on the significance of beta-lactam-resistant Streptococcus pneumoniae.

The beta-lactam antibiotics (penicillins and cephalosporins) are commonly prescribed for the treatment of community-acquired pneumonia. However, Streptococcus pneumoniae, the most common etiologic agent of community-acquired pneumonia, has become increasingly resistant to beta-lactams over the past decade. The results of several studies suggest that penicillins remain effective for streptococcal pneumonia when the infecting pathogen has a minimal inhibitory concentration (MIC) /=4 microgram/mL, increased rates of mortality (for patients who survive their first 4 days of hospitalization) may occur. Currently, 3.5%-7.8% of S. pneumoniae clinical isolates have MICs that fall in this latter class, but these rates may rise in the future. The clinical relevance of in vitro resistance may be related to at least 3 factors: concordance of antimicrobial therapy, severity of illness, and virulence.