RESUMEN
INTRODUCTION: Vaccinations are an essential aspect of preventive medicine. In October 2021, the pneumococcal conjugate vaccine-20 (PCV-20) and PCV-15 were authorized for use in adults by the U.S. FDA. In 2022, the Advisory Committee on Immunization Practices (ACIP) subsequently published updated pneumococcal vaccination recommendations that incorporate both PCV-20 and PCV-15. Pneumococcal vaccination is effective in reducing pneumococcal disease, particularly in high-risk patient groups such as those with chronic lung disease; however, the updated dosing schedule for pneumococcal vaccinations can be quite confusing, especially if patients have previously received "older" vaccinations, such as pneumococcal polysaccharide vaccine-23 or PCV-13. The purpose of this quality improvement project was to increase providers' knowledge of current ACIP pneumococcal vaccination recommendations, including indications and dosing schedule, and to improve pneumococcal vaccination rates among eligible adults and children. MATERIALS AND METHODS: Focused education sessions were presented to primary care and subspecialty residents, fellows, and staff at Brooke Army Medical Center and Wilford Hall Ambulatory Surgical Center regarding current ACIP pneumococcal vaccination recommendations. Sessions included information about PCV-15 and PCV-20 vaccines, indications for vaccination, and dosing schedules. Subjective knowledge of updated ACIP pneumococcal vaccination recommendations was assessed among primary care and subspecialty residents, fellows, and staff via an anonymous survey both pre- and post-intervention. Number of PCV-20 vaccinations given and estimated vaccination rates of patients aged 19 to 64 years with asthma were assessed pre- and post-intervention over a 6 month time span. RESULTS: Of surveyed providers, only 9% discussed vaccinations at every visit and 11% did not discuss vaccinations at all. There was a statistically significant increase in providers' knowledge of pneumococcal vaccination guidelines for children post-intervention (P = .01) but no statistically significant increase in knowledge for guidelines for adults, for patients that have received prior pneumococcal vaccines, or in overall confidence in recommending pneumococcal vaccines. There was a 17% increase in the number of PCV-20 vaccinations given post-intervention (198 pre-intervention, 232 post-intervention). The estimated PCV-20 vaccination rate for adults aged 19 to 64 years with asthma increased from 14.9% pre-intervention to 19.5% post-intervention (P = .33). CONCLUSIONS: There is a significant knowledge gap regarding ACIP pneumococcal vaccination recommendations among military providers and a low pneumococcal vaccination rate for adults aged 19 to 64 years with asthma at Joint Base-San Antonio MTFs. Focused education sessions were effective in increasing providers' knowledge of updated pneumococcal vaccination recommendations, confidence in recommending vaccines, total number of pneumococcal vaccinations given, and estimated pneumococcal vaccination rate for adults with asthma. The validity of conclusions drawn from our data were limited because of discordant numbers of survey respondents as well as potentially inaccurate estimates of pneumococcal vaccination rates pre- and post-intervention. Despite this, the results warrant continued education of pneumococcal vaccines, indications, and dosing schedules.
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Infecciones Neumocócicas , Vacunas Neumococicas , Humanos , Vacunas Neumococicas/administración & dosificación , Vacunas Neumococicas/uso terapéutico , Vacunas Neumococicas/normas , Infecciones Neumocócicas/prevención & control , Vacunación/estadística & datos numéricos , Vacunación/métodos , Vacunación/normas , Adulto , Mejoramiento de la Calidad , Masculino , Persona de Mediana Edad , Esquemas de Inmunización , Hospitales Militares/estadística & datos numéricos , Hospitales Militares/normasRESUMEN
BACKGROUND: The PCV13 immunization demonstration program began in October 2017 in Indonesia. The aim of this study is to assess the dynamic changes of pneumococcal serotype before and after PCV13 administration, with two primary and one booster doses. METHODS: The prospective cohort study was conducted as a follow up study measuring the impact of PCV13 demonstration program by the Indonesian Ministry of Health in Lombok Island, West Nusa Tenggara, Indonesia, from March 2018 to June 2019. The subjects were two-month-old healthy infants who were brought to the primary care facility for routine vaccination and followed until 18 months of age. We use convenience sampling method. There were 115 infants in the control group and 118 infants in the vaccine group, and the PCV immunization was given on a 2+1 schedule. Nasopharyngeal (NP) swabs were collected four times during the vaccination periods by trained medical staff. Specimens were analyzed by culture methods to detect S. pneumonia colonization and multiplex polymerase chain reaction (mPCR) to determine serotype. The most frequently detected serotypes will be named as dominant serotypes. Descriptive analysis of demographic characteristics, the prevalence of overall and serotype colonization, and the distribution of serotypes were performed. The prevalence of both cohort groups were compared using chi-square test. Statistical significance was set at p < 0.05. RESULTS: Two hundred and thirty three infants age two months old were recruited, with 48.9% of the subjects were male and 51.1% of the subjects were female. Sociodemographic data in both cohort groups were relatively equal. Nasopharyngeal pneumococcal colonization before PCV13 administration occurred in 19.1% of the control and 22.9% of the vaccine group. The prevalence increased with increasing age in both groups. The prevalence of VT serotypes in control groups aged 2 months, 4 months, 12 months, and 18 months was 40.9%, 44.2%, 53.8%, and 54.3%, respectively, and in the vaccine group, 25.9%, 40.4%, 38.0%, and 22.6%, respectively. The most common VT serotypes in both groups were 6A/6B, 19F, 23F, and 14. The prevalence of VT serotypes decreased significantly compared to non-vaccine type serotypes after three doses of the PCV13 vaccine (p < 0.001). Another notable change was the decline in prevalence of serotype 6A/6B after PCV13 administration using the 2+1 schedule. CONCLUSIONS: This study shows lower prevalence of VT and 6A/6B serotypes in the nasopharynx among children who were PCV13 vaccinated compared with those who were unvaccinated. The result from this study will be the beginning of future vaccine evaluation in larger population and longer period of study.
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Infecciones Neumocócicas/prevención & control , Vacunas Neumococicas/normas , Vacunación/estadística & datos numéricos , Preescolar , Femenino , Humanos , Indonesia , Lactante , Masculino , Mucosa Nasal/microbiología , Infecciones Neumocócicas/epidemiología , Vacunas Neumococicas/inmunología , Vacunas Neumococicas/uso terapéutico , Streptococcus pneumoniae/inmunología , Streptococcus pneumoniae/aislamiento & purificación , Streptococcus pneumoniae/patogenicidad , Vacunación/métodosRESUMEN
No disponible
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Humanos , Anciano , Anciano de 80 o más Años , Vacunas Neumococicas/normas , Vacunas Neumococicas/economía , Factores de Edad , Vacunas Conjugadas/normas , Vacunas Conjugadas/economía , España , Cobertura de VacunaciónAsunto(s)
Vacunas Neumococicas/normas , Neumonía Neumocócica/diagnóstico , Neumonía Neumocócica/tratamiento farmacológico , Neumonía Neumocócica/prevención & control , Guías de Práctica Clínica como Asunto , Vacunas Conjugadas/normas , Humanos , Vacunas Neumococicas/administración & dosificación , Vacunas Conjugadas/administración & dosificaciónRESUMEN
BACKGROUND: Of over 90 serotypes of Streptococcus pneumoniae, only seven were included in the first pneumococcal conjugate vaccine (PCV). While PCV reduced the disease incidence, in part because of a herd immunity effect, a replacement effect was observed whereby disease was increasingly caused by serotypes not included in the vaccine. Dynamic transmission models can account for these effects to describe post-vaccination scenarios, whereas economic evaluations can enable decision-makers to compare vaccines of increasing valency for implementation. AIM: The aim of this review was to examine epidemiological and economic models and their assumptions for their potential contributions to future research and immunisation policy. SOURCES: Pubmed, Scopus, Ovid, ISI Web of Knowledge, Centre of Reviews and Dissemination (CRD) databases were searched. CONTENT: Twenty-three dynamic transmission models and 21 economic models were retrieved and reviewed. Published models employed various templates, revealing several key uncertainties regarding the biology and epidemiology of pneumococcal infection. While models suggested that PCVs will reduce the burden of disease, the extent to which they are predicted to do so depended on various assumptions regarding features of pneumococcal infection and epidemiology that governed PCV cost-effectiveness as well. Such features include the duration of protection and competitive interactions between serotypes, which are unclear at present, but which directly relate to herd immunity and serotype replacement. IMPLICATIONS: Economic evaluations are not typically based on transmission dynamic models and hence omit indirect herd immunity effects. The two tools could be used in conjunction to inform decision-makers on vaccine implementation, but so far there have been few attempts to build economic evaluations on transmission dynamic models, and none in this field. Future directions for research could include studies to evaluate key parameters for the models involving herd immunity, serotype competition and the natural history of infection.
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Análisis Costo-Beneficio , Modelos Económicos , Infecciones Neumocócicas/transmisión , Vacunas Neumococicas/economía , Vacunas Neumococicas/normas , Técnicas de Apoyo para la Decisión , Humanos , Inmunidad Colectiva , Infecciones Neumocócicas/prevención & control , Serogrupo , Streptococcus pneumoniae , Vacunación/legislación & jurisprudencia , Vacunación/tendencias , Vacunas Conjugadas/economía , Vacunas Conjugadas/normasRESUMEN
Pneumonia is a major cause of morbidity and mortality in the United States. Therefore, prevention of pneumococcal pneumonia by administering effective and well-tolerated vaccines is an important goal, especially in the immunocompromised patients who are at an increased risk of infections. At a large Midwestern Veterans Affairs Rheumatology Clinic, an internal audit revealed a baseline immunization rate of 3%. Through the Lean Six Sigma approach, the investigators sought to increase the rate to 70%. An interprofessional approach incorporating provider education, reinforcement at the point of care, and workflow simplification was sequentially implemented. Lean Six Sigma tools, including process mapping, voice of the customer, and statistical process control charts were utilized. These interventions increased the percentage of eligible patients receiving vaccinations from 3% (n = 19/687) to 23% (n = 11/48) and decreased the vaccine administration time from 15 to 7 minutes. No adverse reactions were reported. This was balanced by an increase in appointment time by 4 minutes in those who received vaccines. The Lean Six Sigma approach was critical to reducing waste and improving value for patients and providers by increasing pneumococcal vaccination rates among the immunocompromised veteran population in a Midwestern Veterans Affairs Rheumatology Clinic.
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Instituciones de Atención Ambulatoria/normas , Infecciones Neumocócicas/prevención & control , Vacunas Neumococicas/normas , Guías de Práctica Clínica como Asunto , Medicina Preventiva/normas , Vacunación/estadística & datos numéricos , Vacunación/normas , Veteranos/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Instituciones de Atención Ambulatoria/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Medio Oeste de Estados Unidos , Vacunas Neumococicas/administración & dosificación , Medicina Preventiva/estadística & datos numéricos , Reumatología/normas , Reumatología/estadística & datos numéricos , Estados Unidos , United States Department of Veterans Affairs/normas , United States Department of Veterans Affairs/estadística & datos numéricosRESUMEN
ACIP no longer recommends routine use of PCV13 in immunocompetent adults ≥ 65 years. Three simple statements summarize guidance on intervals to follow when administering both PCV13 and PPSV23.
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Medicina Familiar y Comunitaria/normas , Esquemas de Inmunización , Huésped Inmunocomprometido , Infecciones Neumocócicas/prevención & control , Vacunas Neumococicas/normas , Guías de Práctica Clínica como Asunto , Vacunas Conjugadas/normas , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Vacunas Neumococicas/administración & dosificación , Vacunas Conjugadas/administración & dosificaciónRESUMEN
Each year millions of pilgrims perform the annual Hajj from more than 180 countries around the world. This is one of the largest mass gathering events and may result in the occurrence and spread of infectious diseases. As such, there are mandatory vaccinations for the pilgrims such as meningococcal vaccines. The 2019 annual Hajj will take place during August 8-13, 2019. Thus, we review the recommended and mandated vaccinations for the 2019 Hajj and Umrah. The mandatory vaccines required to secure the visa include the quadrivalent meningococcal vaccine for all pilgrims, while yellow fever, and poliomyelitis vaccines are required for pilgrims coming from countries endemic or with disease activity. The recommended vaccines are influenza, pneumococcal, in addition to full compliance with basic vaccines for all pilgrims against diphtheria, tetanus, pertussis, polio, measles, and mumps. It is imperative to continue surveillance for the spread of antimicrobial resistance and occurrence of all infectious diseases causing outbreaks across the globe in the last year, like Zika virus, MDR-Typhoid, Nipah, Ebola, cholera, chikungunya and Middle East Respiratory Syndrome Coronavirus.
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Guías como Asunto , Islamismo , Vacunación Masiva/normas , Vacunas Meningococicas/normas , Vacunas Neumococicas/normas , Viaje , Humanos , Arabia SauditaAsunto(s)
Geriatría/normas , Servicios de Salud para Ancianos/normas , Inmunización/normas , Factores de Edad , Anciano , Australia , Consenso , Femenino , Vacuna contra el Herpes Zóster/administración & dosificación , Vacuna contra el Herpes Zóster/normas , Humanos , Esquemas de Inmunización , Vacunas contra la Influenza/administración & dosificación , Vacunas contra la Influenza/normas , Masculino , Nueva Zelanda , Vacunas Neumococicas/administración & dosificación , Vacunas Neumococicas/normas , Toxoide Tetánico/administración & dosificación , Toxoide Tetánico/normasRESUMEN
Background: No head-to-head studies are currently available comparing pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) with 13-valent pneumococcal conjugate vaccine (PCV-13). This study explored the feasibility of using network meta-analysis (NMA) to conduct an indirect comparison of the relative efficacy or effectiveness of the two vaccines.Methods: A systematic literature search was conducted for published randomized controlled trials (RCTs) and non-RCT studies reporting data on vaccine efficacy or effectiveness against invasive pneumococcal disease in children aged <5 years receiving 7-valent pneumococcal conjugate vaccine (PCV-7), PHiD-CV or PCV-13. Study quality was evaluated using published scales. NMA feasibility was assessed by considering whether a connected network could be constructed by examining published studies for differences in study or patient characteristics that could act as potential treatment effect modifiers or confounding variables.Results: A total of 26 publications were included; 2 RCTs (4 publications), 7 indirect cohort studies, and 14 case-control studies (15 publications). Study quality was generally good. The RCTs could not be connected in a network as there was no common comparator. The studies differed considerably in design, dose number, administration schedules, and subgroups analyzed. Reporting of exposure status and subject characteristics was inconsistent.Conclusion: NMA to compare the relative efficacy or effectiveness of PHiD-CV and PCV-13 is not feasible on the current evidence base, due to the absence of a connected network across the two RCTs and major heterogeneity between studies. NMA may be possible in future if sufficient RCTs become available to construct a connected network.
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Metaanálisis en Red , Infecciones Neumocócicas/prevención & control , Vacunas Neumococicas/normas , Potencia de la Vacuna , Estudios de Casos y Controles , Preescolar , Análisis Costo-Beneficio , Estudios de Factibilidad , Haemophilus influenzae , Humanos , Lactante , Vacunas Neumococicas/inmunología , Ensayos Clínicos Controlados Aleatorios como Asunto , Vacunas Conjugadas/inmunología , Vacunas Conjugadas/normasRESUMEN
BACKGROUND: Pneumococcal conjugate vaccines (PCVs) have had a well-documented impact on the incidence of invasive pneumococcal disease (IPD). However, declines in IPD due to vaccine-targeted serotypes have been partially offset by increases in IPD due to nonvaccine serotypes (NVTs). The goal of this study was to quantify serotype-specific changes in the incidence of IPD that occurred in different age groups, with or without certain comorbidities, following the introduction of 7-valent pneumococcal conjugate vaccine (PCV7) and 13-valent pneumococcal conjugate vaccine (PCV13) in the childhood vaccination program in Denmark. METHODS: We used nationwide surveillance data for IPD and a hierarchical Bayesian regression framework to estimate changes in the incidence of IPD associated with the introduction of PCV7 (2007) and PCV13 (2010) while controlling for serotype-specific epidemic cycles and unrelated secular trends. RESULTS: Following the introduction of PCV7 and PCV13 in children, the net impact of serotype replacement varied considerably by age group and comorbidities. Differences in the magnitude of serotype replacement were due to variations in the incidence of NVTs in the different risk groups before the introduction of PCVs. The relative increases in the incidence of IPD caused by specific NVTs did not differ appreciably between risk groups in the postvaccination period. Serotype replacement offset a greater proportion of the benefit of PCVs in strata in which the NVTs comprised a larger proportion of cases prior to the introduction of the vaccines. CONCLUSIONS: These findings could help to predict the impact of next-generation PCVs in specific risk groups.
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Vacuna Neumocócica Conjugada Heptavalente/normas , Programas de Inmunización , Infecciones Neumocócicas/prevención & control , Vacunas Neumococicas/normas , Adolescente , Adulto , Anciano , Teorema de Bayes , Niño , Preescolar , Dinamarca , Vacuna Neumocócica Conjugada Heptavalente/administración & dosificación , Humanos , Vigilancia Inmunológica , Incidencia , Persona de Mediana Edad , Infecciones Neumocócicas/microbiología , Vacunas Neumococicas/administración & dosificación , Sistema de Registros , Serogrupo , Streptococcus pneumoniae/inmunología , Adulto JovenRESUMEN
OBJECTIVE: Guidelines for vaccination of cochlear implant (CI) recipients have been promulgated and updated by the Center for Disease Control and Prevention (CDC) to mitigate bacterial meningitis risk. The objective of this study was to survey current CI specialists on: 1) knowledge of current CDC CI recipient immunization recommendations, and 2) impediments to implementation of those guidelines. METHODS: A survey to assess knowledge of the CI recipient vaccination guidelines was administered to the American Academy of Otolaryngology-Head and Neck surgery (AAO-HNS), the American Cochlear Implant Alliance (ACIA), and the American Neurotology Society (ANS). The members of the AAO-HNS and ACIA were invited to participate in the survey via an e-mail. The members of the ANS were polled during a session of their fall meeting. RESULTS: A total of 256 individuals participated: 64 from AAO, 59 from ACIA, and 133 from ANS. Participants reported knowledge of the vaccination guidelines as high among all groups and statistically similar. The survey indicated that the participants noted difficulty in obtaining age-group-specific immunizations. Vaccination status was not consistently reported. CONCLUSION: Cochlear implant providers have high awareness of vaccination guidelines but less detailed knowledge of age-specific recommendations. Obtaining age-specific vaccines is a challenge, as is consistent documentation of vaccination. Future efforts should be focused on improving knowledge of age-specific recommendations, easing access of age-specific vaccines, and improving documentation. LEVEL OF EVIDENCE: NA. Laryngoscope, 128:2145-2152, 2018.
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Implantación Coclear/efectos adversos , Adhesión a Directriz , Meningitis Bacterianas/prevención & control , Otolaringología/normas , Complicaciones Posoperatorias/prevención & control , Vacunación/psicología , Adulto , Actitud del Personal de Salud , Implantación Coclear/psicología , Implantes Cocleares/efectos adversos , Implantes Cocleares/psicología , Femenino , Conocimientos, Actitudes y Práctica en Salud , Vacuna Neumocócica Conjugada Heptavalente/normas , Humanos , Masculino , Meningitis Bacterianas/microbiología , Meningitis Bacterianas/psicología , Persona de Mediana Edad , Vacunas Neumococicas/normas , Complicaciones Posoperatorias/microbiología , Complicaciones Posoperatorias/psicología , Encuestas y Cuestionarios , Estados Unidos , Vacunación/normasRESUMEN
OBJECTIVES: Current strategies to prevent adult pneumococcal disease have been recently reviewed in Italy. We did a postlicensure study to estimate the direct vaccine effectiveness (VE) of the 13-valent pneumococcal conjugate vaccine (PCV13) against adult pneumococcal community-acquired pneumonia (pCAP). STUDY DESIGN: Between 2013 and 2015, a 2-year prospective cohort study of adults with CAP was conducted in the Apulia region of Italy where the average vaccine uptake of PCV13 was 32% among adults ≥65 years. The test-negative design was used to estimate VE against all episodes of confirmed pCAP and vaccine-type (VT)-CAP. VE in a subgroup of patients managed in the community was also estimated using a matched case-control design. VE was calculated as one minus the OR times 100%. RESULTS: The overall VE of PCV13 was 33.2% (95% CI -106.6% to 82%) against pCAP irrespective of serotype and 38.1% (95% CI -131.9% to 89%) against VT-CAP in the cohort of adults ≥65 years. The VE was 42.3% (95% CI -244.1% to 94.7%) against VT-CAP in the age group at higher vaccine uptake. For the subgroup of cases managed in the community, the overall VE against disease due to any pneumococcal strain was 88.1% (95% CI 4.2% to 98.5%) and 91.7% (95% CI 13.1% to 99.2%) when we controlled for underlying conditions. CONCLUSIONS: Although our results are non-significant, PCV13 promises to be effective against all confirmed pCAP already with modest levels of uptake in the population of adults ≥65 years of age. Larger studies are needed to confirm the direct vaccine benefits.
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Vacunas Neumococicas/normas , Neumonía Neumocócica/prevención & control , Adulto , Anciano , Estudios de Casos y Controles , Infecciones Comunitarias Adquiridas/prevención & control , Femenino , Humanos , Italia , Masculino , Persona de Mediana Edad , Neumonía Neumocócica/epidemiología , Neumonía Neumocócica/inmunología , Prevalencia , Estudios Prospectivos , Estaciones del Año , Streptococcus pneumoniae/inmunología , Vacunas ConjugadasAsunto(s)
Infecciones Neumocócicas/prevención & control , Vacunas Neumococicas , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Humanos , Infecciones Neumocócicas/complicaciones , Vacunas Neumococicas/normas , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina/normas , Mejoramiento de la CalidadRESUMEN
OBJECTIVE: Molecular characterization of Streptococcus pneumoniae isolates recovered in the Czech Republic from previously vaccinated patients diagnosed with invasive pneumococcal disease caused by vaccine serotypes in 2012-2014. The target group were children under five years of age. MATERIAL AND METHODS: S. pneumoniae strains are referred to the National Reference Laboratory for Streptococcal Infections (NRL) from all over the Czech Republic. Pneumococcal vaccine failure was identified based on the international definition. The NRL routinely performs identification and typing of isolates using both conventional and molecular methods. To characterize in more detail eight isolates from cases of pneumococcal vaccine failure, multilocus sequence typing (MLST) was used. RESULTS: In 2012-2014, eight S. pneumoniae strains were recovered from children under five years of age diagnosed with vaccine failure. The strains were assigned to serotypes 1 (n = 4), 14 (n = 2), and 3 (n = 2). Serotype 1 isolates were of one sequence type, ST306, which is typical for serotype 1. Similarly, serotype 14 was exclusively of ST124, which is often linked to serotype 14 in the Czech Republic, although in other geographical areas, other STs are often found. Serotype 3 is highly heterogeneous, which is also reflected in multiple STs found in it. We identified a clonal complex comprising ST505 and ST124. ST124 is for the first time reported in S. pneumoniae of serotype 3 in the world. CONCLUSION: Results are presented of a pilot project conducted in the Czech Republic and focused on molecular characterization of S. pneumoniae strains recovered from cases of pneumococcal vaccine failure in children under five years of age. The data obtained are helpful in improving the surveillance of IPD in the Czech Republic.
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Infecciones Neumocócicas , Streptococcus pneumoniae , Niño , Preescolar , República Checa/epidemiología , Humanos , Lactante , Tipificación de Secuencias Multilocus , Proyectos Piloto , Infecciones Neumocócicas/epidemiología , Infecciones Neumocócicas/microbiología , Vacunas Neumococicas/normas , Serotipificación , Streptococcus pneumoniae/genéticaRESUMEN
Streptococcus pneumoniae is an important cause of community-acquired pneumonia and pneumococcal conjugate vaccines (PCVs) may reduce this burden. This study's goal was to analyse trends in lower respiratory tract infections (LRTI) hospitalisations before and during a routine vaccination programme targeting all newborns with PCV was started in the province of Quebec, Canada in December 2004. The study population included hospital admissions with a main diagnosis of LRTI among 6-59 month-old Quebec residents from April 2000 to December 2014. Trends in proportions and rates were analysed using Cochran-Armitage tests and Poisson regression models. We observed a general downward trend in all LTRI hospitalisations rate: from 11·55/1000 person-years in 2000-2001 to 9·59/1000 in 2013-2014, a 17·0% reduction, which started before the introduction of PCV vaccination. Downward trends in hospitalisation rates were more pronounced for all-cause of pneumonia (minus 17·8%) than for bronchiolitis (minus 15·4%). There was also a decrease in the mean duration of hospital stay. There was little evidence that all-cause pneumonia decreased over the study period due mainly to the introduction of PCVs. Trends may be related to changes in clinical practice. This study casts doubt on the interpretation of ecological analyses of the implementation of PCV vaccination programmes.
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Hospitalización/estadística & datos numéricos , Vacunas Neumococicas/administración & dosificación , Infecciones del Sistema Respiratorio/epidemiología , Vacunación/estadística & datos numéricos , Preescolar , Infecciones Comunitarias Adquiridas/epidemiología , Infecciones Comunitarias Adquiridas/microbiología , Infecciones Comunitarias Adquiridas/prevención & control , Humanos , Programas de Inmunización/estadística & datos numéricos , Lactante , Vacunas Neumococicas/normas , Quebec/epidemiología , Infecciones del Sistema Respiratorio/microbiología , Infecciones del Sistema Respiratorio/prevención & control , Estudios Retrospectivos , Vacunas Conjugadas/administración & dosificación , Vacunas Conjugadas/normasRESUMEN
A new pneumococcal conjugate vaccine is currently undergoing advanced clinical evaluation prior to its planned introduction in Cuba. The implementation of the pneumococcal vaccination strategy has been designed with consideration of the need to maximize both its direct and indirect effects. A novel approach is suggested, which addresses preschool children as the first-line target group to generate herd immunity in infants and to have an impact on transmission at the community level. The clinical evaluation pipeline is described herein, including evaluations of effectiveness, cost-effectiveness, and impact. The scientific contribution of the Cuban strategy could support a paradigm shift from individual protection to a population effect based on a rigorous body of scientific evidence.
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Inmunidad Colectiva , Infecciones Neumocócicas/prevención & control , Vacunas Neumococicas , Vacunación/normas , Preescolar , Análisis Costo-Beneficio , Cuba , Humanos , Lactante , Nasofaringe/microbiología , Infecciones Neumocócicas/epidemiología , Vacunas Neumococicas/economía , Vacunas Neumococicas/inmunología , Vacunas Neumococicas/normas , Streptococcus pneumoniae/inmunología , Streptococcus pneumoniae/aislamiento & purificación , Vacunación/economía , Vacunas Conjugadas/economía , Vacunas Conjugadas/inmunología , Vacunas Conjugadas/normasRESUMEN
BACKGROUND: Clinical vaccine failure is the occurence of the specific vaccine-preventable disease in an appropriately and fully vaccinated person after enough time has elapsed for protection against the antigens of the vaccine to develop. Fully immunized cases with pneumoccal vaccine may sometimes develop a complicated pneumonia with empyema caused by a vaccine serotype. CASE REPORT: A 2 year-old male patient was admitted with the complaints of fever. On the basis of findings and laboratory results, the patient was diagnosed as having empyema. He was successfully treated with parenteral antibiotics and chest tube drainage. The pleural fluid culture and hemoculture of the patient yielded penicillin-susceptible pneumococci and the isolate was identified as serotype 9V. The patient had been vaccinated with a 13-valent pneumococcal conjugate vaccine according to the Turkish national immunization schedule at 2, 4, 6 and 12 months of age. His medical history and basic immunological profile were inconsistent with a primary immunodeficiency. CONCLUSION: The failure of the PCV13 vaccine may results in a complicated pneumonia with empyema. It is important to investigate serotypes of pneumococci in these cases to determine other possible vaccine failures due to PCV13 and to study the underlying mechanisms.
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Empiema/etiología , Vacunas Neumococicas/normas , Streptococcus pneumoniae/patogenicidad , Preescolar , Humanos , Masculino , Vacunas Neumococicas/farmacología , Vacunas Neumococicas/uso terapéutico , Serogrupo , Infecciones Estreptocócicas/epidemiología , Infecciones Estreptocócicas/fisiopatología , Turquía/epidemiologíaRESUMEN
Actualmente 2 vacunas antineumocócicas están disponibles para uso en adultos: la «clásica» vacuna neumocócica polisacárida tricosavalente (VNP23) y la «nueva» vacuna neumocócica conjugada tridecavalente (VNC13). La principal ventaja de la VNC13 sería su potencial mejor inmunogenicidad, siendo sus principales inconvenientes el elevado coste y la baja cobertura de serotipos en comparación con la VNP23. Las evidencias actualmente disponibles apoyan las siguientes recomendaciones básicas: a)en los adultos con más alto riesgo (básicamente inmunocompromiso y/o asplenia) se recomienda la vacunación dual con ambas vacunas; b)en los sujetos con riesgo elevado (básicamente personas > 65 años y pacientes de 15-64 años con enfermedad pulmonar o cardiaca crónica, diabetes y/o alcoholismo) se recomienda la vacunación simple con VNP23 (dosis única en primovacunados ≥ 65 años; revacunación a los 5-10 años en el caso de primovacunados antes de los 65 años), y c) en el resto de adultos (riesgo normal/bajo) no se recomienda la vacuna
There are currently two anti-pneumococcal vaccines available for use in adults: the classical 23-valent polysaccharide pneumococcal vaccine (PPV23) and the new 13-valent pneumococcal conjugate vaccine (PCV13). The main advantage of the PCV13 is the potentially better immunogenicity, with its major disadvantages being the higher cost and the lower serotype-coverage than the PPV23. The currently available scientific evidence supports the following basic recommendations: (I) among adults with greatest risk (basically asplenia and immunocompromised), a dual vaccination (PCV13+PPV23) is recommended; (II) among adults with increased risk (basically persons > 65 years-old and patients 15-64 years with chronic pulmonary or heart disease, diabetes and/or alcoholism), a single vaccination with PPV23 is recommended (single dose in primo-vaccinated > 65 years; re-vaccination at 5-10 years in those primo-vaccinated < 65 years-old); and (III) in the rest of adults (risk normal/low) vaccination is not recommended
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Infecciones Neumocócicas/epidemiología , Infecciones Neumocócicas/inmunología , Infecciones Neumocócicas/prevención & control , Neumonía Neumocócica/inmunología , Vacunas Neumococicas/inmunología , Vacunas Neumococicas/uso terapéutico , Vacunas Neumococicas/administración & dosificación , Vacunas Neumococicas/normas , Indicadores de MorbimortalidadRESUMEN
Immunizations protect individual persons and contribute to public health by reducing morbidity and mortality associated with common infectious diseases. In this Practice Pearl, we review guidelines for adult immunizations and recent and potential changes in vaccines.