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1.
BMJ Case Rep ; 14(1)2021 Jan 06.
Artículo en Inglés | MEDLINE | ID: mdl-33408111

RESUMEN

We present a case of a 75-year-old woman with Austrian syndrome: pneumonia, meningitis and endocarditis all due to Streptococcus pneumoniae Transoesophageal echocardiogram demonstrated a large mitral valve vegetation with severe mitral regurgitation. She was treated with intravenous ceftriaxone and listed for surgical repair of her mitral valve. Preoperatively, she developed an idiosyncratic drug-induced agranulocytosis secondary to ceftriaxone, which resolved on cessation of the medication. However, while awaiting neutrophil recovery, she developed an acute deterioration, becoming critically unwell. This deterioration was multifactorial, with acute decompensated heart failure alongside COVID-19. After multidisciplinary discussion, she was considered too unwell for surgery and palliated.


Asunto(s)
Agranulocitosis/inducido químicamente , Ceftriaxona/efectos adversos , Endocarditis Bacteriana/epidemiología , Meningitis Bacterianas/epidemiología , Infecciones Neumocócicas/epidemiología , Anciano , Agranulocitosis/epidemiología , Antibacterianos/efectos adversos , Comorbilidad , Ecocardiografía Transesofágica , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/microbiología , Femenino , Humanos , Meningitis Bacterianas/microbiología , Pandemias , Infecciones Neumocócicas/microbiología , Streptococcus pneumoniae/aislamiento & purificación , Síndrome
4.
BMC Infect Dis ; 21(1): 45, 2021 Jan 10.
Artículo en Inglés | MEDLINE | ID: mdl-33423657

RESUMEN

BACKGROUND: The Taiwanese national 23-valent pneumococcal polysaccharide vaccine (PPV23) program in adults ≥75 years of age and the 13-valent pneumococcal conjugate vaccine (PCV13) program for children were implemented in 2008 and 2013, respectively. In this study we evaluated PPV23 vaccine effectiveness (PPV23VE) in the elderly, with regard to both direct protection from the vaccine itself and the indirect protection conferred by PCV13 immunization in children. METHODS: The incidence of invasive pneumococcal disease (IPD) in Taiwan from July 2008 to June 2016 was collected from IPD surveillance data. A comparison of IPD incidence with a nationwide vaccination registry allowed an estimation of PPV23VE by the screening and indirect cohort methods. RESULTS: The incidence of IPD in adults ≥75 years of age ranged from 13.9 per 100,000 inhabitants during the period July 2008-June 2013 to 10.4 per 100,000 inhabitants between July 2013 and June 2016 (relative risk [RR]: 0.75; 95% confidence interval [95% CI]: 0.67-0.85). According to the screening method, PPV23VE against death within 30 days of IPD onset, all IPD, and PPV23-serotype IPD was 32.5% (95% CI: 17.5-44.7%), 33.9% (95% CI: 25.2-41.5%) and 43.4% (95% CI: 34.4-51.2%), respectively. PPV23VE with the indirect cohort method was 39.0% (95% CI: 15.5-55.9%) for all PPV23 serotypes and 71.5% (95% CI: 44.2-85.4%) for 11 serotypes included in PPV23 but not in PCV13. During the period July 2008-June 2012, PPV23VE against PPV23-serotype IPD was 55.1% (95% CI: 27.2-72.3%). CONCLUSIONS: PPV23 is able to prevent IPD and 30-day fatality in adults 75 years of age and older due to a combination of direct effects from PPV23 and indirect effects from PCV13. It might confer higher protection against PPV23-serotype IPD before the introduction of PCV13 program in children.


Asunto(s)
Infecciones Neumocócicas/prevención & control , Vacunas Neumococicas/administración & dosificación , Streptococcus pneumoniae/inmunología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Estudios de Cohortes , Femenino , Humanos , Programas de Inmunización , Masculino , Persona de Mediana Edad , Infecciones Neumocócicas/epidemiología , Infecciones Neumocócicas/microbiología , Evaluación de Programas y Proyectos de Salud , Sistema de Registros , Streptococcus pneumoniae/clasificación , Streptococcus pneumoniae/genética , Taiwán/epidemiología , Adulto Joven
5.
Rev. cuba. salud pública ; 46(3): e1582, jul.-set. 2020. tab, graf
Artículo en Español | LILACS, CUMED | ID: biblio-1144552

RESUMEN

Introducción: El cálculo de la carga económica de las enfermedades neumocócicas en niños de edad preescolar en el nivel primario de salud en Cuba contribuye a visualizar la necesidad de buscar vías para prevenir su padecimiento. Objetivo: Estimar la carga económica de la enfermedad neumocócica en niños de edad preescolar en el Policlínico Docente de Playa en el 2016. Métodos: Se realizó un estudio descriptivo transversal. Para estimar la carga económica se aplicó el enfoque del costo de la enfermedad sobre la base de la incidencia, desde la perspectiva institucional. Para calcular el costo de atención por paciente se empleó el método de costeo paciente tipo. Resultados: La otitis media aguda fue la enfermedad de mayor incidencia, con el 49 por ciento de los casos seguida por la neumonía con el 47 por ciento. El costo esperado de la enfermedad fue entre 47,97 CUP y 103,38 CUP para la otitis media aguda, de entre 83,99 CUP y 194,94 CUP para la neumonía y entre 105,69 CUP y 189,97 CUP para la meningitis y la sepsis. Dentro de los procesos, las visitas al hogar presentaron el mayor gasto y dentro de las partidas, el salario. La enfermedad neumocócica representó una carga económica de 8849,15 CUP para el área de salud estudiada. Conclusiones: La enfermedad neumocócica en niños no presenta alto nivel de incidencia en el área del Policlínico Docente de Playa, pero representa una carga económica para los servicios de salud en el primer nivel de atención. Estos costos son susceptibles a disminuir con la introducción de la vacuna antineumocócica conjugada(AU)


Introduction: Calculation of the economic burden caused by pneumococcal diseases in pre-school age children in the primary health care of Cuba contributes to visualize the need for finding ways to prevent them. Objective: To estimate the economic burden caused by the pneumococcal disease in pre-school age children from Playa Teaching Policlinic during 2016. Methods: It was conducted a descriptive cross-sectional study. For estimating the economic burden, it was used the approach of cost of the disease based on the incidence and from the institutional perspective. For calculating the cost of the care per patient, it was used the method of cost-patient-type. Results: Acute otitis media was the disease with higher incidence with 49 percent of the cases, followed by pneumonia with 47 percent . The expected cost by diseases was among 47,97 CUP (Cuban peso) and 103,38 CUP for acute otitis media; among 83,99 CUP and 194,94 CUP for pneumonia; and among 105,69 CUP and 189,97 CUP for meningitis and sepsis. Within the processes, home visits showed the higher expense, and among the entries, it was the salary. Pneumococcal disease represented an economic burden of 8849,15 CUP for the studied health area. Conclusions: Pneumococcal disease in children does not represent a high level of incidence in the area of Playa Teaching Policlinic, but it represents an economic burden for health services in the primary care level. These costs are likely to decrease with the introduction of the pneumococcal conjugate vaccine(AU)


Asunto(s)
Humanos , Masculino , Femenino , Preescolar , Infecciones Neumocócicas/epidemiología , Atención Primaria de Salud , Costo de Enfermedad
6.
PLoS One ; 15(8): e0237247, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32790696

RESUMEN

Streptococcus pneumoniae is one of the leading causes of death worldwide. It disseminates through colonizers and causes serious infections. Aims of this study are to determine pneumococcal carriage rate, resistance, serotype distribution, and coverage of pneumococcal conjugate vaccines from children attending day care centers from Irbid and Madaba in Jordan. Nasopharyngeal swabs were collected from day care centers (DCCs) of healthy Jordanian children 2-4 years of age from four regions of Madaba (n = 596), and from eastern Irbid (n = 423). Swabs were cultivated on Columbia blood agar base supplemented with 5% sheep blood and incubated for 18-24 hours at 37°C with 5% CO2. Alpha-hemolytic isolates were tested for optochin sensitivity and bile solubility for identification. Isolates were analyzed for antimicrobial susceptibility by the Vitek2 system and E-test (BioMérieux). Serotyping was performed using the Neufeld Quellung method. A total of 341 pneumococcal strains were isolated from 1019 nasopharyngeal (NP) samples of healthy children attending DCCs for two winter seasons from 2017-2019. Carriage rate in eastern Irbid for both seasons was 29.6% and for Madaba 37.9%. Resistance rates for Irbid and Madaba, respectively, were as follows: Penicillin (86.3%; 94.4%), erythromycin (57.0%; 78.2%), clindamycin (30.8%; 47.2%), trimethoprim-sulfamethoxazole (68.6%; 86.6%), and tetracycline (45.7%; 51.9%). Predominant serotypes for Irbid were 19F (20.8%), 23F (12.0%), 6A (10.4%), and 6B (9.6%); whereas for Madaba were 19F (24.5%), 14 (7.4%), 6A (6.9%) and 23F (6.5%). Serotype coverage of the thirteen valent pneumococcal conjugate vaccine (PCV13) was about 65% for both regions. Over 96% of isolates with PCV13 serotypes in this study were resistant to penicillin with the exception of serotypes 3 and 5. As a conclusion resistance and carriage rates among the age group 2 to 4 years reached an alarming rate especially among vaccine types, which can be controlled by pneumococcal conjugate vaccination strategies.


Asunto(s)
Infecciones Neumocócicas/diagnóstico , Streptococcus pneumoniae/aislamiento & purificación , Animales , Antibacterianos/uso terapéutico , Preescolar , Farmacorresistencia Bacteriana , Femenino , Humanos , Jordania/epidemiología , Masculino , Infecciones Neumocócicas/tratamiento farmacológico , Infecciones Neumocócicas/epidemiología , Estaciones del Año , Serotipificación , Ovinos , Streptococcus pneumoniae/clasificación , Streptococcus pneumoniae/efectos de los fármacos
7.
BMC Infect Dis ; 20(1): 479, 2020 Jul 06.
Artículo en Inglés | MEDLINE | ID: mdl-32631331

RESUMEN

BACKGROUND: The study aimed to assess whether gastrointestinal (GI) symptoms at admission are associated with increased short-term mortality in patients with invasive pneumococcal disease (IPD). METHODS: We included all patients with IPD at Aker University Hospital in Oslo, Norway, from 1993 to 2008. Clinical data were registered. Survival data were retrieved from official registries. We used Cox regression and Kaplan-Meier curve to compare mortality within 28 days of admission in patients with and without GI symptoms. RESULTS: Four hundred sixteen patients were included. Of these, 108 patients (26%) presented with GI symptoms, and 47 patients (11%) with GI symptoms only. Patients with GI symptoms were younger (p < 0.001) and had less cardiovascular disease (p < 0.001), pulmonary disease (p = 0.048), and cancer (p = 0.035) and received appropriate antibiotic treatment later. After adjusting for risk factors, we found an increased hazard ratio of 2.28 (95% CI 1.31-3.97) in patients presenting with GI symptoms. In patients with GI symptoms only there was an increased hazard ratio of 2.24 (95% CI 1.20-4.19) in univariate analysis, which increased to 4.20 (95% CI 2.11-8.39) after multivariate adjustment. Fewer patients with GI symptoms only received antibiotics upon admission. CONCLUSIONS: A large proportion of IPD patients present with GI symptoms only or in combination with other symptoms. GI symptoms in IPD are associated with increased short-term mortality.


Asunto(s)
Enfermedades Gastrointestinales/epidemiología , Enfermedades Gastrointestinales/microbiología , Infecciones Neumocócicas/epidemiología , Infecciones Neumocócicas/mortalidad , Streptococcus pneumoniae/inmunología , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Comorbilidad , Femenino , Enfermedades Gastrointestinales/tratamiento farmacológico , Hospitalización , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Noruega/epidemiología , Infecciones Neumocócicas/tratamiento farmacológico , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Estudios Retrospectivos , Factores de Riesgo , Streptococcus pneumoniae/aislamiento & purificación , Resultado del Tratamiento , Adulto Joven
8.
Int J Infect Dis ; 98: 486-493, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32663603

RESUMEN

OBJECTIVES: We aimed to determine the incidence and relative risk (RR) of invasive pneumococcal disease (IPD) in patients with asplenia/hyposplenism, using a nationwide population-based database. METHODS: From 2009 to 2018, all claimed cases of newly diagnosed asplenia/hyposplenism in the National Health Insurance Service in South Korea were included. The incidence and RR of IPD in asplenia/hyposplenism patients were investigated using the Korean Center for Disease Control criteria. RESULTS: Fifty-seven IPD cases were identified among 21,376 patients with 82,748 person-years of exposure. The cumulative 8-year IPD incidence was 0.5%; 45.6% of the infections occurred within two years after an asplenia/hyposplenism diagnosis. The age-standardised incidence rate was 104.5 per 100,000 person-years (95% confidence interval [CI], 103.6-105.4). Patients aged <5 years had a 15.1-times higher risk of IPD than those aged ≥60 years (95% CI: 5.8-39.5, p < 0.0001). The RR of IPD was 32.0 times higher in patients with asplenia/hyposplenism than in the general population (95% CI, 21.7-47.0); the standardized incidence ratio was 17.9(95% CI, 11.8-26.0). CONCLUSIONS: This large population-based study highlights the high IPD incidence rate and RR in Korean patients with asplenia/hyposplenism. Increased awareness and effective prevention strategies are needed for these high-risk populations, especially children aged <5 years.


Asunto(s)
Síndrome de Heterotaxia/complicaciones , Infecciones Neumocócicas/epidemiología , Infecciones Neumocócicas/etiología , Enfermedades del Bazo/complicaciones , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Humanos , Incidencia , Lactante , Masculino , Persona de Mediana Edad , Infecciones Neumocócicas/microbiología , Enfermedades de Inmunodeficiencia Primaria , República de Corea/epidemiología , Factores de Riesgo , Bazo/anomalías , Adulto Joven
9.
BMC Infect Dis ; 20(1): 423, 2020 Jun 17.
Artículo en Inglés | MEDLINE | ID: mdl-32552726

RESUMEN

BACKGROUND: Streptococcus pneumoniae infections can lead to severe morbidity and mortality, especially in patients with invasive pneumococcal disease (IPD). This study evaluated factors associated with pneumococcal disease, pneumococcal vaccine effectiveness, and risk factors for all-cause mortality in hospitalised adults with pneumococcal disease in Singapore. METHODS: Retrospective case-control study of patients tested for pneumococcal disease with streptococcal urinary antigen testing and at least one sterile site culture, during their admission to a tertiary hospital in Singapore from 2015 to 2017. Patients were defined as cases of IPD or non-IPD, or as controls, based on laboratory results and clinical diagnoses. Multivariable models were constructed to determine factors associated with IPD/non-IPD, and risk factors for mortality from pneumococcal disease. Vaccine effectiveness against IPD/non-IPD was estimated using a variation of the test-negative design. RESULTS: We identified 496 pneumococcal disease cases, of whom 92 (18.5%) had IPD. The mean age of cases was 69.1 ± 15.4 years, and 65.5% were male. Compared with controls (N = 9181), IPD patients were younger (mean age 61.5 ± 16.3 years, vs 72.2 ± 16.1 years in controls; p < 0.001) and with less co-morbidities [median Charlson's score 1 (IQR 0-4), vs 3 (1-5) in controls; p < 0.001]. IPD patients also had the highest proportions with intensive care unit (ICU) admission (20.7%), inpatient mortality (26.1%) and longest median length of stay [9 (IQR 8-17) days]. On multivariable analysis, IPD was negatively associated with prior pneumococcal vaccination (adjusted relative risk ratio = 0.20, 95%CI 0.06-0.69; p = 0.011). Risk factors for mortality among pneumococcal disease patients were ICU admission, diagnosis of IPD, age ≥ 85 years and Charlson's score > 3. CONCLUSION: Patients with pneumococcal disease (especially IPD) were younger and had less co-morbidities than controls, but had higher risk of severe clinical outcomes and mortality. Pneumococcal vaccination effectiveness against IPD was estimated to be about 80%, and should be encouraged among high-risk patients.


Asunto(s)
Hospitalización , Infecciones Neumocócicas/epidemiología , Infecciones Neumocócicas/prevención & control , Vacunas Neumococicas/inmunología , Streptococcus pneumoniae/inmunología , Vacunación , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Morbilidad , Infecciones Neumocócicas/mortalidad , Infecciones Neumocócicas/orina , Estudios Retrospectivos , Factores de Riesgo , Singapur/epidemiología , Centros de Atención Terciaria , Resultado del Tratamiento
10.
Med Clin (Barc) ; 155(6): 249-253, 2020 09 25.
Artículo en Inglés, Español | MEDLINE | ID: mdl-32586667

RESUMEN

PURPOSE: Influenza virus infection is associated with a high disease burden. COVID-19 caused by SARS-CoV-2 has become a pandemic outbreak since January 2020. Taiwan has effectively contained COVID-19 community transmission. We aimed to validate whether fighting COVID-19 could help to control other respiratory infections in Taiwan. METHOD: We collected week-case data of severe influenza, invasive Streptococcus pneumoniae disease and death toll from pneumonia among 25 calendar weeks of the influenza season for four years (2016-2020), which were reported to Taiwan CDC. Trend and slope differences between years were compared. RESULT: A downturn trend of severe influenza, invasive S. pneumoniae disease and the death toll from pneumonia per week in 2019/2020 season and significant trend difference in comparison to previous seasons were noted, especially after initiation of several disease prevention measures to fight potential COVID-19 outbreak in Taiwan. CONCLUSIONS: Fighting COVID-19 achieved collateral benefits on significant reductions of severe influenza burden, invasive S. pneumoniae disease activity, and the death toll from pneumonia reported to CDC in Taiwan.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/prevención & control , Gripe Humana/prevención & control , Pandemias/prevención & control , Infecciones Neumocócicas/prevención & control , Neumonía Viral/prevención & control , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Humanos , Gripe Humana/epidemiología , Gripe Humana/transmisión , Infecciones Neumocócicas/epidemiología , Infecciones Neumocócicas/transmisión , Neumonía Viral/epidemiología , Neumonía Viral/transmisión , Estudios Retrospectivos , Taiwán/epidemiología
11.
Eur J Clin Invest ; 50(10): e13319, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32535894

RESUMEN

BACKGROUND: Little is known about the incidence and risk of intensive care unit (ICU)-acquired bloodstream infections (BSI) in critically ill patients with coronavirus disease 2019 (COVID-19). MATERIALS AND METHODS: This retrospective, single-centre study was conducted in Northern Italy. The primary study objectives were as follows: (a) to assess the incidence rate of ICU-acquired BSI and (b) to assess the cumulative risk of developing ICU-acquired BSI. RESULTS: Overall, 78 critically ill patients with COVID-19 were included in the study. Forty-five episodes of ICU-acquired BSI were registered in 31 patients, with an incidence rate of 47 episodes (95% confidence interval [CI] 35-63) per 1000 patient-days at risk. The estimated cumulative risk of developing at least one BSI episode was of almost 25% after 15 days at risk and possibly surpassing 50% after 30 days at risk. In multivariable analysis, anti-inflammatory treatment was independently associated with the development of BSI (cause-specific hazard ratio [csHR] 1.07 with 95% CI 0.38-3.04 for tocilizumab, csHR 3.95 with 95% CI 1.20-13.03 for methylprednisolone and csHR 10.69 with 95% CI 2.71-42.17 for methylprednisolone plus tocilizumab, with no anti-inflammatory treatment as the reference group; overall P for the dummy variable = 0.003). CONCLUSIONS: The incidence rate of BSI was high, and the cumulative risk of developing BSI increased with ICU stay. Further study will clarify if the increased risk of BSI we detected in COVID-19 patients treated with anti-inflammatory drugs is outweighed by the benefits of reducing any possible pro-inflammatory dysregulation induced by SARS-CoV-2.


Asunto(s)
Antiinflamatorios/uso terapéutico , Anticuerpos Monoclonales Humanizados/uso terapéutico , Bacteriemia/epidemiología , Candidemia/epidemiología , Infecciones por Coronavirus/tratamiento farmacológico , Infección Hospitalaria/epidemiología , Metilprednisolona/uso terapéutico , Neumonía Viral/tratamiento farmacológico , Anciano , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Enfermedad Crítica , Enterobacter aerogenes , Infecciones por Enterobacteriaceae/epidemiología , Enterococcus faecalis , Enterococcus faecium , Femenino , Infecciones por Bacterias Grampositivas/epidemiología , Humanos , Incidencia , Unidades de Cuidados Intensivos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Pandemias , Infecciones Neumocócicas/epidemiología , Neumonía Viral/epidemiología , Modelos de Riesgos Proporcionales , Infecciones por Pseudomonas/epidemiología , Pseudomonas aeruginosa , Estudios Retrospectivos , Factores de Riesgo , Infecciones Estafilocócicas/epidemiología , Staphylococcus aureus , Streptococcus pneumoniae
12.
Int J Infect Dis ; 98: 113-120, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32562849

RESUMEN

BACKGROUND: Streptococcus pneumoniae remains a major contributor to childhood infections and deaths globally. In Cameroon, the 13-valent pneumococcal conjugate vaccine (PCV13) was introduced in July 2011, using a 3-dose Expanded programme on immunization (EPI) schedule administered to infants at 6, 10 and 14 weeks of age. To evaluate PCV13 effects, we assessed pneumococcal nasopharyngeal colonization and serotype distribution among Cameroonian children after PCV13 introduction. METHODS: Nasopharyngeal (NP) swabs were collected from eligible children aged 24-36 months in two cross-sectional surveys conducted from March to July: in 2013 (PCV13-unvaccinated), and in 2015 (PCV13-vaccinated). Using a systematic World Health Organization (WHO) cluster coverage sampling technique in 40 communities, NP swabs collected were processed following WHO recommendations. Standard bacterial culture techniques were used for the isolation of S. pneumoniae from gentamicin-blood agar plates and identification using optochin susceptibility testing. Serotyping was performed using sequential multiplex polymerase chain reaction, supplemented with Quellung test. RESULTS: Among the PCV13-vaccinated children, overall pneumococcal carriage prevalence was 61.8% (426/689) and PCV13 vaccine-type carriage prevalence was 18.0% (123/689). Eleven out of the 13 vaccine serotypes were detected in the vaccinated children. The most common serotypes were 19F (4.5%, 31/689) and 15B/C (7.3%, 50/689). CONCLUSION: In Cameroon, four years after infant vaccination nearly all of the PCV13-serotypes continued to circulate in the population. This suggests that the direct and indirect effects of the vaccination programme have not resulted in expected low levels of vaccine-type transmission. Continuous monitoring is needed to assess the long term effects of the PCV13 on nasopharyngeal carriage and disease.


Asunto(s)
Nasofaringe/microbiología , Infecciones Neumocócicas/prevención & control , Vacunas Neumococicas/administración & dosificación , Streptococcus pneumoniae/inmunología , Camerún/epidemiología , Portador Sano/epidemiología , Portador Sano/inmunología , Portador Sano/microbiología , Preescolar , Estudios Transversales , Femenino , Humanos , Programas de Inmunización , Esquemas de Inmunización , Masculino , Infecciones Neumocócicas/epidemiología , Infecciones Neumocócicas/inmunología , Infecciones Neumocócicas/microbiología , Vacunas Neumococicas/inmunología , Prevalencia , Serogrupo , Serotipificación , Streptococcus pneumoniae/genética , Streptococcus pneumoniae/crecimiento & desarrollo , Streptococcus pneumoniae/aislamiento & purificación , Vacunación
13.
Artículo en Inglés | MEDLINE | ID: mdl-32418510

RESUMEN

The number of notified cases of invasive pneumococcal disease (IPD) in the second quarter of 2019 was higher than the previous quarter as well as the second quarter of 2018. Following the July 2011 replacement of the 7-valent pneumococcal conjugate vaccine (7vPCV) in the childhood immunisation program with the 13-valent pneumococcal conjugate vaccine (13vPCV), there was an initial relatively rapid decline in disease due to the additional six serotypes covered by the 13vPCV across all age groups, however more recently this decline is no longer evident. Over this period the number of cases due to the eleven serotypes additionally covered by the 23-valent pneumococcal polysaccharide vaccine (23vPPV), and also those serotypes not covered by any available vaccine, has been increasing steadily across all age groups.


Asunto(s)
Infecciones Neumocócicas/epidemiología , Infecciones Neumocócicas/prevención & control , Vacunas Neumococicas/inmunología , Vigilancia de la Población , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Australia , Niño , Preescolar , Notificación de Enfermedades , Humanos , Lactante , Recién Nacido , Persona de Mediana Edad , Vacunas Neumococicas/administración & dosificación , Streptococcus pneumoniae/inmunología , Factores de Tiempo , Adulto Joven
14.
Artículo en Inglés | MEDLINE | ID: mdl-32418512

RESUMEN

The number of notified cases of invasive pneumococcal disease (IPD) in the third quarter of 2019 was higher than in the previous quarter, but lower than in the third quarter of 2018. Following the July 2011 replacement of the 7-valent pneumococcal conjugate vaccine (7vPCV) in the childhood immunisation program with the 13-valent pneumococcal conjugate vaccine (13vPCV), there was an initial relatively rapid decline in disease due to the additional six serotypes covered by the 13vPCV across all age groups, however more recently this decline is no longer evident. Over this period the number of cases due to the eleven serotypes additionally covered by the 23-valent pneumococcal polysaccharide vaccine (23vPPV), and also those serotypes not covered by any available vaccine, has been increasing steadily across all age groups.


Asunto(s)
Infecciones Neumocócicas/epidemiología , Infecciones Neumocócicas/prevención & control , Vacunas Neumococicas/inmunología , Vigilancia de la Población , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Australia , Niño , Preescolar , Notificación de Enfermedades , Humanos , Lactante , Recién Nacido , Persona de Mediana Edad , Vacunas Neumococicas/administración & dosificación , Serogrupo , Streptococcus pneumoniae/clasificación , Streptococcus pneumoniae/inmunología , Factores de Tiempo , Adulto Joven
15.
Epidemiol Infect ; 148: e187, 2020 05 18.
Artículo en Inglés | MEDLINE | ID: mdl-32418558

RESUMEN

Surveillance of new cases of invasive pneumococcal disease (IPD) in Italy was started in 2007 by the Ministry of Health (MoH). In 2012, pneumococcal childhood vaccination was introduced at the national level and, in 2017, for citizens aged 65 years and over. We describe here IPD epidemiology in Italy over the past 10 years investigating the impact of the vaccine programme on disease burden. Reports of IPD cases, data on serotype and vaccination coverage (VC) data were obtained from MoH annual reports, for the period 2007-2017. IPD notification rate and proportion by year, region, age and serotype were calculated. In 2007, 525 cases were reported (rate 0.88/100 000), rising to 1703 cases (rate 2.82/100 000) in 2017. The distribution of IPD cases by age group over time registered the largest share among individuals aged 65 years and over. A decreasing trend in notification rate was observed among those aged 0-4 years. During the same period, the 24-month VC increased, ranging from 80.9% to 96.7% in 2017. Molecular data indicated re-emergence of PPSV23-specific serotypes and non-vaccine serotypes. We observed an increase in IPD notifications during 2007-2017, likely due to an improved surveillance system, at least in some regions, with the relative quota of IPD notifications decreasing among vaccinated children cohorts. Further strengthening of IPD surveillance system, including molecular and vaccine coverage data, would be needed to assess and inform pneumococcal vaccination strategies in Italy.


Asunto(s)
Infecciones Neumocócicas/epidemiología , Infecciones Neumocócicas/prevención & control , Vacunas Neumococicas/inmunología , Vacunación/estadística & datos numéricos , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Humanos , Lactante , Italia/epidemiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto Joven
16.
Medicine (Baltimore) ; 99(18): e20145, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32358404

RESUMEN

Infection due to Streptococcus pneumoniae (SP) requiring hospitalization is common. However, recent clinical studies describing patient characteristics and outcomes for SP infection in adults requiring hospitalization are lacking. Our goal was to evaluate patient characteristics, contemporary antibiotic resistance, and clinical outcomes among hospitalized adults with SP infections.A retrospective cohort study was conducted at Barnes-Jewish Hospital (1350 beds) in St. Louis, Missouri, USA for years 2012 through 2016. During the study period, 358 hospitalized adults, excluding those with meningitis, were identified with SP infection. Forty-four patients (12.3%) died within 30 days of the identification of their infection. Among these infections, 99 (27.7%) were assessed to be hospital-acquired and 259 (72.3%) were community-onset infections. The majority of infections involved the respiratory tract (88.5%). Azithromycin resistance was the most common antibiotic resistance at 51.4%, followed by enteral penicillin resistance (45.3%), trimethoprim-sulfamethoxazole (34.1%), second-generation cephalosporin (cefuroxime) (30.7%), and meropenem (22.6%). There were 70 isolates (19.6%) classified as multidrug resistant. Independent predictors of hospital mortality included increasing weight in 1-kilogram increments (adjusted odds ratio [AOR], 1.02; 95% CI, 1.01 - 1.02; P = .048), increasing Charlson Comorbidity Index scores (AOR, 1.31; 95% CI, 1.21 - 1.42; P = .001), and the presence of septic shock (AOR, 3.89; 95% CI, 2.31 - 6.57; P = .009). The median [interquartile range] hospital length of stay was 8.1 days [4.5 days, 16.8 days].Hospitalized patients with infection attributed to SP have significant 30-day mortality and use of hospital resources. Antibiotic resistance is common among isolates associated with infection. Determinants of mortality are primarily severity of illness, underlying comorbidities and increasing patient weight. Efforts to improve the treatment and prevention of SP infections are needed.


Asunto(s)
Antibacterianos/uso terapéutico , Farmacorresistencia Microbiana , Hospitalización/estadística & datos numéricos , Infecciones Neumocócicas/epidemiología , APACHE , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Infecciones Comunitarias Adquiridas , Comorbilidad , Infección Hospitalaria , Farmacorresistencia Bacteriana Múltiple , Femenino , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Infecciones Neumocócicas/mortalidad , Estudios Retrospectivos , Factores Sexuales , Choque Séptico/epidemiología , Resultado del Tratamiento
18.
F1000Res ; 92020.
Artículo en Inglés | MEDLINE | ID: mdl-32411353

RESUMEN

The introduction of pneumococcal conjugate vaccines (PCVs) 7 and 13 into national childhood immunization programs in the US in 2000 and 2010, respectively, proved to be remarkably successful in reducing infant mortality due to invasive pneumococcal disease (IPD), resulting in widespread uptake of these vaccines. Secondary herd protection of non-vaccinated adults against IPD has proven to be an additional public health benefit of childhood immunization with PCVs, particularly in the case of the vulnerable elderly who are at increased risk due to immunosenescence and underlying comorbidity. Despite these advances in pneumococcal immunization, the global burden of pneumococcal disease, albeit of unequal geographic distribution, remains high. Reasons for this include restricted access of children living in many developing countries to PCVs, the emergence of infection due to non-vaccine serotypes of the pneumococcus, and non-encapsulated strains of the pathogen. Emerging concerns affecting the elderly include the realization that herd protection conferred by the current generation of PCVs (PCV7, PCV10, and PCV13) has reached a ceiling in many countries at a time of global population aging, compounded by uncertainty surrounding those immunization strategies that induce optimum immunogenicity and protection against IPD in the elderly. All of the aforementioned issues, together with a consideration of pipeline and pending strategies to improve access to, and serotype coverage of, PCVs, are the focus areas of this review.


Asunto(s)
Infecciones Neumocócicas , Humanos , Infecciones Neumocócicas/epidemiología , Infecciones Neumocócicas/prevención & control , Vacunas Neumococicas , Serogrupo , Streptococcus pneumoniae , Vacunación , Vacunas Conjugadas
19.
Euro Surveill ; 25(17)2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32372757

RESUMEN

BackgroundSeveral studies have investigated a possible association between respiratory infection and acute myocardial infarction (MI). As both influenza and pneumococcal infections are vaccine preventable, understanding the populations affected by virus-induced cardiovascular complications is important to guide public health and clinical practice.AimThis observational study aimed to quantify the association between laboratory-confirmed respiratory bacteria or virus infections and risk of first MI or stroke, by using self-controlled case series (SCCS) analysis of anonymised linked electronic Danish health records.MethodsThe SCCS method was used to determine the relative incidence of the first event of MI and stroke occurring within 28 days after laboratory-confirmed respiratory infections compared with the baseline time period.ResultsIn the age and season adjusted analyses for first acute MI, the incidence ratios (IR) of a MI event occurring during the risk period were significantly elevated following a Streptococcus pneumoniae infection with values of 20.1, 11.0 and 4.9 during 1-3, 4-7 and 8-14 days, respectively and following respiratory virus infection with values of 15.2, 4.5 and 4.4 during 1-3, 8-14 and 15-28 days, respectively. The significantly elevated IRs for stroke following an S. pneumoniae infection were 25.5 and 6.3 during 1-3 and 8-14 days, respectively and following respiratory virus infection 8.3, 7.8 and 6.2 during 1-3, 4-7 and 8-14 days, respectively.ConclusionThis study suggested a significant cardiovascular event triggering effect following infection with S. pneumoniae and respiratory viruses (mainly influenza), indicating the importance of protection against vaccine-preventable respiratory infections.


Asunto(s)
Gripe Humana/complicaciones , Infarto del Miocardio/etiología , Infecciones Neumocócicas/complicaciones , Infecciones del Sistema Respiratorio/complicaciones , Accidente Cerebrovascular/etiología , Adulto , Anciano , Anciano de 80 o más Años , Dinamarca/epidemiología , Femenino , Humanos , Incidencia , Gripe Humana/epidemiología , Masculino , Persona de Mediana Edad , Infarto del Miocardio/epidemiología , Infecciones Neumocócicas/epidemiología , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/microbiología , Infecciones del Sistema Respiratorio/virología , Accidente Cerebrovascular/epidemiología
20.
PLoS One ; 15(4): e0231041, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32236150

RESUMEN

This study describes predictors of pneumococcal nasopharyngeal carriage and density in Fiji. We used data from four annual (2012-2015) cross-sectional surveys, pre- and post-introduction of ten-valent pneumococcal conjugate vaccine (PCV10) in October 2012. Infants (5-8 weeks), toddlers (12-23 months), children (2-6 years), and their caregivers participated. Pneumococci were detected and quantified using lytA qPCR, with molecular serotyping by microarray. Logistic and quantile regression were used to determine predictors of pneumococcal carriage and density, respectively. There were 8,109 participants. Pneumococcal carriage was negatively associated with years post-PCV10 introduction (global P<0.001), and positively associated with indigenous iTaukei ethnicity (aOR 2.74 [95% CI 2.17-3.45] P<0.001); young age (infant, toddler, and child compared with caregiver participant groups) (global P<0.001); urban residence (aOR 1.45 [95% CI 1.30-2.57] P<0.001); living with ≥2 children <5 years of age (aOR 1.42 [95% CI 1.27-1.59] P<0.001); low family income (aOR 1.44 [95% CI 1.28-1.62] P<0.001); and upper respiratory tract infection (URTI) symptoms (aOR 1.77 [95% CI 1.57-2.01] P<0.001). Predictors were similar for PCV10 and non-PCV10 carriage, except PCV10 carriage was negatively associated with PCV10 vaccination (0.58 [95% CI 0.41-0.82] P = 0.002) and positively associated with exposure to household cigarette smoke (aOR 1.21 [95% CI 1.02-1.43] P = 0.031), while there was no association between years post-PCV10 introduction and non-PCV10 carriage. Pneumococcal density was positively associated with URTI symptoms (adjusted median difference 0.28 [95% CI 0.16, 0.40] P<0.001) and toddler and child, compared with caregiver, participant groups (global P = 0.008). Predictors were similar for PCV10 and non-PCV10 density, except infant, toddler, and child participant groups were not associated with PCV10 density. PCV10 introduction was associated with reduced the odds of overall and PCV10 pneumococcal carriage in Fiji. However, after adjustment iTaukei ethnicity was positively associated with pneumococcal carriage compared with Fijians of Indian Descent, despite similar PCV10 coverage rates.


Asunto(s)
Portador Sano/epidemiología , Infecciones Neumocócicas/epidemiología , Adolescente , Adulto , Factores de Edad , Portador Sano/microbiología , Niño , Preescolar , Estudios Transversales , Femenino , Fiji/epidemiología , Humanos , Lactante , Modelos Logísticos , Masculino , Infecciones Neumocócicas/etiología , Infecciones Neumocócicas/microbiología , Infecciones Neumocócicas/prevención & control , Vacunas Neumococicas/uso terapéutico , Factores de Riesgo , Adulto Joven
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