[Epidemiological features of invasive pneumococcal disease before and after the introduction of pneumococcal conjugate vaccine in Gran Canaria (Canary Islands)]. / Aspectos epidemiológicos de la enfermedad neumocócica invasiva antes y después del uso de la vacuna neumocócica conjugada en Gran Canaria.

INTRODUCTION: The introduction of pneumococcal conjugate vaccine (PCV-7) has modified the epidemiology of invasive pneumococcal disease (IPD). Our aim was to investigate the epidemiological features of IPD before and after implementing the use of PCV-7. METHODS: All invasive Streptococcus pneumoniae strains isolated in our hospital from 2000 to 2006 were included. Serotypes were identified and antibiograms were performed in all cases. Data obtained before (2000-2001) and after (2004-2006) authorization of PCV-7 use in Spain were compared. RESULTS: There were 241 cases of IPD. None of the patients with IPD aged 2 years or younger had received PCV-7. PCV-7 coverage in children aged 5 or younger was about 48%. There was a non-significant increase in the incidence of IPD in children (from 53.8 to 57.8 cases/100 000 population), with no change in adults. When IPD incidence was adjusted by the number of blood samples collected, there was a non-significant decrease in both children and adults. Since PCV-7 came on the market, there has been a decrease in vaccine serotypes and an increase in non-vaccine serotypes. The emergent serotypes since that time include 3, 6A, 15, and 19A. Penicillin resistance decreased significantly (p<0.001) from the pre-vaccine period (87.3%) to 2003 (13.8%), and later rose from 2003 through 2006 (41.7%). Erythromycin resistance showed no changes during the study. CONCLUSIONS: The incidence of IPD in children aged 2 years and younger in Gran Canaria has not decreased despite the introduction of PCV-7. However, there has been a reduction in the number of cases related to vaccine serotypes and a significant decrease in penicillin resistance. In contrast, non-vaccine serotype IPD cases have increased. Universal vaccination and the use of new polyvalent vaccines may enhance these effects.

Aspectos epidemiológicos de la enfermedad neumocócica invasiva antes y después del uso de la vacuna neumocócica conjugada en Gran Canaria / Epidemiological features of invasive pneumococcal disease before and after the introduction of pneumococcal conjugate vaccine in Gran Canaria (Canary Islands)

Introducción: la comercialización de la vacuna neumocócica conjugada (PCV-7) ha modificado la epidemiología de la enfermedad neumocócica invasiva (ENI). Nuestro objetivo fue conocer la epidemiología de la ENI antes y después de su uso. Métodos: se incluyeron todas las cepas de Streptococcus pneumoniae causantes de ENI de 2000 a 2006. Se realizó serotipado y antibiograma. Se compararon los datos obtenidos antes (2000¿2001) y después (2004¿2006) de la comercialización de PCV-7. Resultados: hubo 241 casos de ENI. Ningún paciente menor de 2 años con ENI estaba vacunado. La cobertura vacunal en menores de 5 años fue del 48%. Hubo un incremento no significativo de ENI en niños (de 53,8 a 57,8 casos por 100.000 habitantes), manteniéndose invariable en adultos. Al corregir la incidencia según el número de hemocultivos, se observó un descenso no significativo, tanto en niños como en adultos. Tras la comercialización de PCV-7 hubo un descenso de los serotipos vacunales y un aumento de los no vacunales. Los serotipos emergentes tras la vacuna fueron: 3, 6A, 15 y 19A. La resistencia a penicilina descendió significativamente (p<0,001) desde el período prevacunal (87,3%) hasta 2003 (13,8%), y posteriormente aumentó (41,7% en 2006). La resistencia a eritromicina no varió durante el estudio. Conclusiones: la incidencia de ENI en menores de 2 años en Gran Canaria no ha disminuido a pesar de la vacuna PCV-7. Los casos debidos a serotipos vacunales han disminuido, así como la resistencia a penicilina. En cambio, han aumentado los casos debidos a serotipos no vacunales emergentes. La estrategia de vacunación universal y la adopción de nuevas vacunas polivalentes podrían potenciar estos efectos (AU)

Introduction: The introduction of pneumococcal conjugate vaccine (PCV-7) has modified the epidemiology of invasive pneumococcal disease (IPD). Our aim was to investigate the epidemiological features of IPD before and after implementing the use of PCV-7. Methods: All invasive Streptococcus pneumoniae strains isolated in our hospital from 2000 to 2006 were included. Serotypes were identified and antibiograms were performed in all cases. Data obtained before (2000¿2001) and after (2004¿2006) authorization of PCV-7 use in Spain were compared. Results: There were 241 cases of IPD. None of the patients with IPD aged 2 years or younger had received PCV-7. PCV-7 coverage in children aged 5 or younger was about 48%. There was a non-significant increase in the incidence of IPD in children (from 53.8 to 57.8 cases/100 000 population), with no change in adults. When IPD incidence was adjusted by the number of blood samples collected, there was a non-significant decrease in both children and adults. Since PCV-7 came on the market, there has been a decrease in vaccine serotypes and an increase in non-vaccine serotypes. The emergent serotypes since that time include 3, 6A, 15, and 19A. Penicillin resistance decreased significantly (p<0.001) from the pre-vaccine period (87.3%) to 2003 (13.8%), and later rose from 2003 through 2006 (41.7%). Erythromycin resistance showed no changes during the study. Conclusions: The incidence of IPD in children aged 2 years and younger in Gran Canaria has not decreased despite the introduction of PCV-7. However, there has been a reduction in the number of cases related to vaccine serotypes and a significant decrease in penicillin resistance. In contrast, non-vaccine serotype IPD cases have increased. Universal vaccination and the use of new polyvalent vaccines may enhance these effects (AU)