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3.
Pan Afr Med J ; 32: 203, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31312315

RESUMO

Pneumococcal meningitis is a global scourge. It is a major cause of morbidity and mortality. In Morocco, 13-valent pneumococcal conjugate vaccine (PCV13) was introduced into the National Immunization Program in October 2010 according to the immunization schedule 2 + 1 and replaced by PCV10 in July 2012, according to the same schedule. Despite the use of the PCV13, which is essential in the fight against pneumococcal disease, the emergence of new non-vaccine serotypes always results in meningitis in children, causing serious sequelae. We report the case of an infant vaccinated with two doses of PCV13 with meningitis caused by Streptococcus pneumoniae serotype 7a. The peculiarity of this case study lies in pneumococcal meningitis due to Streptococcus pneumoniae serotype 7a not included in the PCV13 in an infant immunized by 2 doses of PCV13. We here insist on the need and the importance of an observatory for pneumococcal meningitis and of a wide epidemiological study in order to determine the serotypes in Morocco after the introduction of PCV13 and then of PCV10.


Assuntos
Meningite Pneumocócica/diagnóstico , Vacinas Pneumocócicas/administração & dosagem , Streptococcus pneumoniae/isolamento & purificação , Humanos , Lactente , Masculino , Meningite Pneumocócica/microbiologia , Meningite Pneumocócica/prevenção & controle , Marrocos , Vacinas Pneumocócicas/imunologia , Sorotipagem , Streptococcus pneumoniae/imunologia , Vacinação
4.
BMC Infect Dis ; 19(1): 605, 2019 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-31291902

RESUMO

BACKGROUND: Streptococcus pneumoniae is a major cause of pneumonia, meningitis, and other serious infections among children in India. India introduced the 13-valent pneumococcal conjugate vaccine (PCV) in several states in 2017, and is expected to expand to nationwide coverage in the near future. To establish a baseline for measuring the impact of PCV in India, we assessed overall and serotype-specific nasopharyngeal carriage in two pediatric populations. METHODS: A cross-sectional study was conducted in Palwal District, Haryana, from December 2016 to July 2017, prior to vaccine introduction. Children 2-59 months of age with clinical pneumonia seeking healthcare and those in the community with no clear illness were targeted for enrollment. A nasopharyngeal swab was collected and tested for pneumococcus using conventional culture and sequential multiplex PCR. Isolates were tested for antimicrobial resistance using an E test. Children were considered colonized if pneumococcus was isolated by culture or PCR. The prevalence of pneumococcal and serotype-specific colonization was compared between groups of children using log-binomial regression. RESULTS: Among 601 children enrolled, 91 had clinical pneumonia and 510 were community children. The proportion colonized with S. pneumoniae was 74.7 and 54.5% among children with clinical pneumonia and community children, respectively (adjusted prevalence ratio: 1.38; 95% confidence interval: 1.19, 1.60). The prevalence of PCV13 vaccine-type colonization was similar between children with clinical pneumonia (31.9%) and community children (28.0%; p = 0.46). The most common colonizing serotypes were 6A, 6B, 14, 19A, 19F, and 23F, all of which are included in the PCV13 vaccine product. Antimicrobial resistance to at least one drug was similar between isolates from children with clinical pneumonia (66.1%) and community children (61.5%; p = 0.49); while resistance to at least two drugs was more common among isolates from children with clinical pneumonia (25.8% vs. 16.4%; p = 0.08). Resistance for all drugs was consistently higher for PCV13 vaccine-type serotypes compared to non-vaccine serotypes in both groups. CONCLUSION: This study provides baseline information on the prevalence of serotype-specific pneumococcal colonization among children prior to the introduction of PCV in India. Our results suggest a role for pneumococcal vaccines in reducing pneumococcal colonization and antimicrobial resistant isolates circulating in India.


Assuntos
Portador Sadio/microbiologia , Infecções Pneumocócicas/microbiologia , Vacinas Pneumocócicas/imunologia , Streptococcus pneumoniae/imunologia , Antibacterianos/farmacologia , Portador Sadio/epidemiologia , Pré-Escolar , Estudos Transversais , Farmacorresistência Bacteriana , Feminino , Humanos , Índia/epidemiologia , Lactente , Masculino , Testes de Sensibilidade Microbiana , Nasofaringe/microbiologia , Infecções Pneumocócicas/epidemiologia , Prevalência , Sorogrupo , Streptococcus pneumoniae/efeitos dos fármacos , Streptococcus pneumoniae/genética , Vacinas Conjugadas
5.
BMC Infect Dis ; 19(1): 510, 2019 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-31182036

RESUMO

BACKGROUND: Pneumococcal infections are major causes of morbidity and mortality worldwide. We use routine hospital admissions data and time-series modelling analysis to estimate the impact of the seven and thirteen valent pneumococcal conjugate vaccines (PCV7 and PCV13) on hospital admissions due to pneumococcal disease in England. METHODS: Hospital admissions for pneumococcal meningitis, bacteraemia and pneumonia between January 1, 2003 and December 31, 2015 were identified from the national Hospital Episode Statistics database for all age groups in England. We model the impact of pneumococcal vaccination using interrupted time series analysis. Hospital admissions prior to vaccine introduction were extrapolated to predict the expected number of admissions in the absence of pneumococcal vaccines. Admissions avoided over time were estimated by comparing the fitted interrupted time series and the expected model for no vaccination in a Bayesian framework. RESULTS: Overall, there were 43,531 (95% credible interval (CrI): 36486-51,346) fewer hospital admissions due to bacteraemia, meningitis and pneumonia in England during the period from 2006 to 2015 than would have been expected if pneumococcal vaccines had not been implemented, with the majority of hospital admissions avoided due to pneumonia. Among young children reductions in meningitis were more common, while among adults reductions in pneumonia admissions were relatively more important, with no evidence for reduced bacteraemia and meningitis among older adults. We estimated that 981 (95% CrI: 391-2018), 749 (95% CrI: 295-1442) and 1464 (95% CrI: 793-2522) bacteraemia, meningitis and pneumonia related hospital admissions, respectively, were averted in children < 2 years of age. CONCLUSIONS: Substantial reductions in hospital admissions for bacteraemia, meningitis and pneumonia in England were estimated after the introduction of childhood vaccination, with indirect effects being responsible for most of the hospital admissions avoided.


Assuntos
Hospitalização/estatística & dados numéricos , Infecções Pneumocócicas/diagnóstico , Vacinas Pneumocócicas/imunologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Inglaterra/epidemiologia , Feminino , Humanos , Lactente , Análise de Séries Temporais Interrompida , Masculino , Meningite Pneumocócica/diagnóstico , Meningite Pneumocócica/epidemiologia , Pessoa de Meia-Idade , Infecções Pneumocócicas/epidemiologia , Pneumonia/diagnóstico , Pneumonia/epidemiologia , Vacinação , Vacinas Conjugadas/imunologia , Adulto Jovem
6.
J Med Microbiol ; 68(6): 903-909, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31090535

RESUMO

PURPOSE: To prevent severe invasive pneumococcal infection, pneumococcal conjugate vaccines (PCVs) were introduced in Japan in 2010, and in 2013 a pneumococcal 13-valent conjugate vaccine (PCV13) was included in the routine vaccination schedule for infants. In this study, we analysed the antimicrobial susceptibilities and capsular types of pneumococci isolated from non-invasive patient sites from 2007 to 2016 to assess the impact of the introduction of PCV13. METHODOLOGY: A total of 618 pneumococcal isolates collected at a teaching hospital from 2007 to 2016 were used. These isolates were characterized by capsular typing, multilocus sequence typing and antimicrobial susceptibility testing. RESULTS: Capsular typing indicated that, after the introduction of the PCV, the proportion of PCV13 serotypes decreased (P<0.01), while non-PCV13 serotypes became diverse. In particular, increases in 22 F, 15A and 23A were noted among non-PCV13 serotypes. Regarding antimicrobial susceptibility, the non-susceptibility rate to penicillin of pneumococci that showed higher minimum inhibitory concentrations (MICs) than the susceptibility breakpoint decreased, and pneumococci tended to become susceptible. However, all type 23A pneumococci and 77.8  % of type 15A pneumococci showed the reverse trend, with low susceptibility to penicillin. Furthermore, all 15A and 23A isolates had macrolide resistance genes. CONCLUSION: These data suggest that PCVs can prevent infections caused by PCV serotypes. However, since non-PCV13-type pneumococci, in particular 15A and 23A, which have acquired multidrug resistance, have already emerged over time, the development of a novel vaccine targeting a broader spectrum of pneumococci is warranted.


Assuntos
Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/imunologia , Streptococcus pneumoniae/imunologia , Antibacterianos/farmacologia , Cápsulas Bacterianas/imunologia , Técnicas de Tipagem Bacteriana , Portador Sadio , DNA Girase/genética , DNA Topoisomerase IV/genética , Hospitais de Ensino , Humanos , Japão/epidemiologia , Testes de Sensibilidade Microbiana , Tipagem de Sequências Multilocus , Penicilinas/farmacologia , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/microbiologia , Sorogrupo , Sorotipagem , Streptococcus pneumoniae/genética , Vacinas Conjugadas/imunologia
7.
Int J Infect Dis ; 85: 1-6, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31096052

RESUMO

OBJECTIVES: The aim of this study was to estimate the impact of antimicrobial resistance (AMR) in secondary pneumococcal pneumonia infections on global mortality during the 2009 influenza pandemic, to estimate future pandemic mortality risk and to inform pandemic preparedness. METHODS: Risk analysis modelling was conducted using a multivariate risk formula. Literature reviews were conducted to generate global central estimates for each of the parameters of the risk formula in relation to the 2009 influenza pandemic, secondary pneumococcal pneumonia, rates of AMR, and pneumococcal vaccine efficacy as a component of pandemic preparedness. RESULTS: Global Streptococcus pneumoniae AMR was estimated at 21.8% to 27.6%, and contributed to 1.8% to 2.3% of deaths during the 2009 influenza pandemic. When directly applied to mortality due to multidrug resistance, pneumococcal vaccination could potentially prevent 1277 to 3754 deaths and could have reduced mortality from multidrug-resistant S. pneumoniae to 1% to 1.2%. CONCLUSIONS: AMR in secondary pneumococcal infections contributed towards a small percentage of the global mortality during the 2009 influenza pandemic. Increased S. pneumoniae AMR could result in a three- to four-fold rise in mortality due to secondary pneumococcal infections in future influenza pandemics. Pneumococcal vaccination has an important role in preventing pneumococcal co-infections and combating AMR in all populations, and should be considered a key component of influenza pandemic preparedness or early action plans.


Assuntos
Antibacterianos/farmacologia , Coinfecção/mortalidade , Farmacorresistência Bacteriana , Influenza Humana/complicações , Pneumonia Pneumocócica/mortalidade , Streptococcus pneumoniae/efeitos dos fármacos , Adolescente , Adulto , Coinfecção/tratamento farmacológico , Coinfecção/epidemiologia , Coinfecção/microbiologia , Feminino , Humanos , Vacinas contra Influenza/administração & dosagem , Vacinas contra Influenza/efeitos adversos , Influenza Humana/epidemiologia , Influenza Humana/prevenção & controle , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Vacinas Pneumocócicas/administração & dosagem , Vacinas Pneumocócicas/genética , Vacinas Pneumocócicas/imunologia , Pneumonia Pneumocócica/epidemiologia , Pneumonia Pneumocócica/etiologia , Pneumonia Pneumocócica/microbiologia , Streptococcus pneumoniae/genética , Streptococcus pneumoniae/fisiologia , Vacinação , Adulto Jovem
9.
Microbiol Spectr ; 7(2)2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30977464

RESUMO

The polysaccharide capsule of Streptococcus pneumoniae is the dominant surface structure of the organism and plays a critical role in virulence, principally by interfering with host opsonophagocytic clearance mechanisms. The capsule is the target of current pneumococcal vaccines, but there are 98 currently recognised polysaccharide serotypes and protection is strictly serotype-specific. Widespread use of these vaccines is driving changes in serotype prevalence in both carriage and disease. This chapter summarises current knowledge on the role of the capsule and its regulation in pathogenesis, the mechanisms of capsule synthesis, the genetic basis for serotype differences, and provides insights into how so many structurally distinct capsular serotypes have evolved. Such knowledge will inform ongoing refinement of pneumococcal vaccination strategies.


Assuntos
Cápsulas Bacterianas/fisiologia , Polissacarídeos Bacterianos/fisiologia , Streptococcus pneumoniae/fisiologia , Animais , Cápsulas Bacterianas/genética , Cápsulas Bacterianas/imunologia , Cápsulas Bacterianas/metabolismo , Humanos , Vacinas Pneumocócicas/administração & dosagem , Vacinas Pneumocócicas/imunologia , Polissacarídeos Bacterianos/biossíntese , Polissacarídeos Bacterianos/genética , Polissacarídeos Bacterianos/imunologia , Streptococcus pneumoniae/imunologia , Streptococcus pneumoniae/metabolismo , Streptococcus pneumoniae/patogenicidade
10.
Int J STD AIDS ; 30(5): 472-478, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30999829

RESUMO

Invasive pneumococcal diseases (IPDs) remain a significant cause of morbidity and mortality in human immunodeficiency virus (HIV)-positive individuals despite the widespread use of highly active antiretroviral therapy (HAART) and availability of pneumococcal vaccines. The aim of this study was to measure temporal trends in incidence and risk factors for IPD (defined as culture of Streptococcus pneumoniae from blood, cerebrospinal fluid or both) in a cohort of HIV-positive patients attending an ambulatory HIV care centre in Dublin, Ireland over a 10-year period 2006-2015. Incidence of IPD was determined as events per 100,000 person-years' follow-up. Poisson regression was used to assess linear trend in incidence over time. A nested case-control study (four controls per case) was undertaken to assess risk factors for IPD. Forty-seven episodes of IPD were identified in 42 HIV-positive individuals (median [IQR] age 38 years [33-43], 69% male, 86% injecting drug users (IDUs), median CD4 T-cell count 213 cells/mm3) over 16,008 person-years' follow-up (overall incidence rate 293/100,000 person-years). Three patients had two episodes and one patient had three episodes of IPD during the study period. The overall case fatality rate was 15% (95% confidence interval [CI] 4-24%). The incidence of IPD per 100,000 person-years decreased from 728 (95% CI, 455-1002), to 242 (95% CI, 120-365) to 82 (95% CI, 40-154) in calendar periods 2006-2008, 2009-2012 and 2013-2015, respectively (p < 0.01 for linear trend). Older age (p = 0.02), male gender (p = 0.05), detectable HIV viral load (p < 0.01) and non-receipt of pneumococcal vaccine (p = 0.03) were associated with IPD while IDU as risk of acquisition of HIV was of borderline significance (p = 0.06). HIV-positive individuals remain at greater risk of IPD compared to the general population. Pneumococcal vaccine should be seen as a priority to ensure optimal protection for HIV-positive patients.


Assuntos
Terapia Antirretroviral de Alta Atividade , Infecções por HIV/tratamento farmacológico , Soropositividade para HIV/complicações , Infecções Pneumocócicas/epidemiologia , Streptococcus pneumoniae/isolamento & purificação , Abuso de Substâncias por Via Intravenosa/complicações , Adulto , Terapia Antirretroviral de Alta Atividade/métodos , Estudos de Casos e Controles , Feminino , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Humanos , Incidência , Irlanda/epidemiologia , Masculino , Infecções Pneumocócicas/complicações , Infecções Pneumocócicas/diagnóstico , Vacinas Pneumocócicas/administração & dosagem , Vacinas Pneumocócicas/imunologia , Fatores de Risco , Abuso de Substâncias por Via Intravenosa/epidemiologia
11.
Expert Opin Drug Saf ; 18(4): 253-259, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30907170

RESUMO

INTRODUCTION: The introduction of pneumococcal conjugate vaccines (PCVs) in the routine immunization program has resulted in a significant decline in invasive pneumococcal diseases (IPD) around the world. Preterm infants are a special group at a high risk of invasive infection by encapsulated bacteria. However, their slow growth accrual and prolonged hospital stay frequently lead to delays in immunization, which contributes to their risk for severe infections. Areas covered: Authors reviewed the published immunogenicity and safety of the use of PCVs in preterm infants. Expert opinion: PCVs are safe and effective for use in low birth weight and in-hospital preterm infants. Local and systemic reactions are similar for both term and preterm populations. Reports were inconsistent on the risk of apnea, therefore hospitalized extremely premature infants should be kept under observation for at least 48 h after immunization.


Assuntos
Recém-Nascido Prematuro , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/administração & dosagem , Humanos , Imunização/métodos , Programas de Imunização , Imunogenicidade da Vacina , Recém-Nascido , Vacinas Pneumocócicas/efeitos adversos , Vacinas Pneumocócicas/imunologia , Vacinas Conjugadas/administração & dosagem
12.
BMC Infect Dis ; 19(1): 227, 2019 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-30836941

RESUMO

BACKGROUND: There is great interest in the use of reduced dosing schedules for pneumococcal conjugate vaccines, a strategy premised on maintaining an acceptable level of protection against disease and carriage of the organism. We asked about the practicality of measuring differential effectiveness against carriage in a population with and without widespread use of the vaccine for infants. METHODS: We adapted an existing transmission-dynamic, individual-based stochastic model fitted to the prevaccine epidemiology of pneumococcal carriage in the United States, and compared the observed vaccine-type carriage prevalence in different arms of a simulated trial with one, two, or three infant doses plus a 12-month booster. Using these simulations, we calculated vaccine efficacy that would be estimated at different times post-enrollment in the trial and calculated required sample sizes to see a difference in carriage prevalence. RESULTS: In a pneumococcal conjugate vaccine (PCV)-naïve population, the difference in vaccine-type (VT) pneumococcal carriage prevalence between trial arms was less than 7% and varied with sampling time. In a population already receiving routine PCV administration, VT pneumococcal prevalence is nearly indistinguishable between trial arms. Relative efficacy of different dosing schedules was strongly dependent on the time between enrollment and sampling, with maximal prevalence differences reached 1-3 years post-enrollment. Moreover, vaccine efficacy estimates were typically slightly higher in trials in communities already receiving vaccination. Despite this, much larger sample sizes-by more than an order of magnitude-are required for a vaccine trial conducted in a population receiving routine PCV administration as compared to in a PCV-naïve population. CONCLUSIONS: These findings highlight some underappreciated aspects of clinical trials of pneumococcal conjugate vaccines with efficacy endpoints, such as the context- and time-dependence of efficacy estimates. They support the wisdom of conducting comparative dose schedule trials of conjugate vaccine effects on carriage in vaccine-naïve populations.


Assuntos
Portador Sadio/imunologia , Imunidade Coletiva , Infecções Pneumocócicas/imunologia , Vacinas Pneumocócicas/imunologia , Simulação por Computador , Relação Dose-Resposta Imunológica , Feminino , Humanos , Lactente , Modelos Imunológicos , Infecções Pneumocócicas/prevenção & controle , Prevalência , Tamanho da Amostra , Streptococcus pneumoniae , Vacinas Conjugadas/imunologia
13.
Biomed Res Int ; 2019: 3427174, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30895191

RESUMO

Carriage of pneumococcus is considered as the precursor for development of pneumococcal disease. In sub-Saharan Africa, very little research has been done on the pneumococcus in relation to people with HIV infection in the era of pneumococcal conjugate vaccines. This study investigated pneumococcal carriage among HIV/AIDS patients in southern Ghana to determine the prevalence, risk factors, serotypes and antibiotic resistance of the organism. This was a cross sectional study involving 245 HIV/AIDS patients recruited from Korle Bu Teaching Hospital and Princess Marie Louis Hospital in Accra from November 2016 to March 2017. Epidemiological data on demographic, household and clinical features of the study participants were collected. Nasopharyngeal (NP) swabs were also collected from the study participants and cultured for Streptococcus pneumoniae; the isolates were serotyped by latex agglutination and Quellung reaction. Antimicrobial disc susceptibility was performed on the isolates, and antibiotics tested included tetracycline, erythromycin, cotrimoxazole, levofloxacin, oxacillin and ceftriaxone. Prevalence of pneumococcal carriage among the study participants was 11% (95% CI: 7.4 to 15.6); carriage among children and adults was 25% (95% CI: 14% to 38.9%) and 7.3% (95% CI: 4% to 11.9%) respectively. School attendance (p=0.001) and history of pneumococcal disease in the past year (p=0.001) were significantly associated with pneumococcal carriage. The most prevalent pneumococcal serotypes carried by the study participants were 19A (15.4%) and 23F (15.4%). Serotype coverage of the various pneumococcal vaccines were PCV10 (23.1%), PCV13 (42.3%) and PPV23 (50%). The prevalence of pneumococcal multidrug resistance was 18.5%. In conclusion, pneumococcal carriage among HIV-infected children was three-fold higher compared to carriage among HIV-infected adults. Pneumococcal carriage among both HIV-infected children and adults in the study area tends to be characterized by a predominance of non-vaccine serotypes and a considerable level of multidrug resistance.


Assuntos
Portador Sadio/epidemiologia , Portador Sadio/imunologia , Infecções por HIV/imunologia , Infecções por HIV/microbiologia , Vacinas Pneumocócicas/imunologia , Streptococcus pneumoniae/fisiologia , Vacinas Conjugadas/imunologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Resistência Microbiana a Medicamentos , Características da Família , Feminino , Gana/epidemiologia , Infecções por HIV/epidemiologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Sorogrupo , Streptococcus pneumoniae/isolamento & purificação , Adulto Jovem
14.
BMC Infect Dis ; 19(1): 168, 2019 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-30770718

RESUMO

BACKGROUND: The etiology and epidemiology of acute otitis media (AOM) are poorly understood in China. This study aimed to describe the etiology of AOM and the phenotypic and molecular characteristics of AOM-causing Streptococcus pneumoniae (S.pneumoniae) recovered from Chinese children. METHODS: A retrospective study was conducted to enrol patients younger than 18 years diagnosed as AOM. Middle ear fluid specimens were collected then cultured for bacterial pathogens. All S.pneumoniae isolates were tested for antibiotic susceptibility, serotypes, virulence genes, antibiotic resistant determinants and sequence types. RESULTS: The dominant otopathogen among AOM children was S.pneumoniae (54.4%). Among S.pneumoniae isolates, there were 97.3, 97.3 and 75.7% isolates resistant to erythromycin, tetracycline and trimethoprim-sulfamethoxazole, respectively. There was 72.8% S.pneumoniae with multidrug resistance. The dominant sequence types (STs) were ST271 and ST320, whereas the prevailing serotypes were 19F and 19A. The 7-valent and 13-valent pneumococcal conjugate vaccine (PCV) coverage among AOM children were 73.0 and 94.6%, respectively. Additionally, we found that CC271 expressed more of mef(A/E) (P < 0.001), pspA (P = 0.022) and sipA (P < 0.001) than non-CC271 isolates. CONCLUSION: The high prevalence of international multidrug-resistant clone (Taiwan19F-14) in China necessitates continued dedication to expand PCV13 immunization and better control of antibiotic use in China.


Assuntos
Otite Média/microbiologia , Infecções Pneumocócicas/microbiologia , Streptococcus pneumoniae/isolamento & purificação , Adolescente , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , China/epidemiologia , Farmacorresistência Bacteriana , Feminino , Humanos , Lactente , Masculino , Testes de Sensibilidade Microbiana , Infecções Pneumocócicas/tratamento farmacológico , Infecções Pneumocócicas/epidemiologia , Vacinas Pneumocócicas/imunologia , Prevalência , Estudos Retrospectivos , Sorogrupo , Streptococcus pneumoniae/efeitos dos fármacos , Streptococcus pneumoniae/genética , Vacinas Conjugadas/imunologia , Virulência/genética
15.
Aging Clin Exp Res ; 31(3): 421-423, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30737649

RESUMO

Recently, the National Immunization Plan (NIP) in Italy has highlighted the importance of immunization practices also for adults, including vaccinations against influenza, Pneumococcus (PNO) and HZ. In response to the NIP, the Calabria region decided to offer HZ vaccination to the two cohorts of 65- and 70-year-old subjects. We at the Reggio Calabria Local Health Services, concentrated our efforts on addressing all the above-mentioned shortcomings and, as a first measure, we addressed the convenience problem by scheduling the HZ vaccine administration during the same visit as the pneumococcal vaccination (PCV13 vaccine). The adhesion rates were satisfactory in both cohorts-such high levels of vaccine coverage for HZ and PCV13 had never been reached before in our region and are still among the highest in Italy. However, the main result was undoubtedly the significantly high rate of PCV13 and HZ vaccine co-administration without safety problems.


Assuntos
Vacina contra Herpes Zoster/imunologia , Vacinação , Idoso , Feminino , Humanos , Programas de Imunização , Itália , Masculino , Vacinas Pneumocócicas/imunologia
16.
Microb Pathog ; 129: 206-212, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30772476

RESUMO

Streptococcus pneumoniae infection is associated with very high morbidity and mortality throughout the world. Vaccines are an effective measure for the reduction of S. pneumoniae infection. In particular, protein vaccines are attracting increasing attention because of their good immunogenicity and wide coverage of serotypes. Therefore, identifying effective protein vaccine targets is important for protein vaccine development. SP0148 is a promising protein vaccine target for S. pneumoniae and is capable of reducing S. pneumoniae colonization in the nasopharynx of mice through the IL-17A pathway. However, the protective effects of SP0148 in fatal pneumococcal infection have not been evaluated. This study used subcutaneous and nasal immunization routes to systematically evaluate the protective effects of the SP0148 protein in fatal pneumococcal infection. Subcutaneous and nasal mucosal immunization with recombinant SP0148 protein produced effective immune protection against infection with a lethal dose of S. pneumoniae and significantly prolonged survival time and increased the survival rate of mice. Furthermore, nasal immunization with SP0148 induced mouse splenocytes to secrete high levels of the cytokines IFN-γ and IL-17A. Both recombinant SP0148 protein and its antiserum inhibited the adhesion of S.pneumoniae D39 to A549 human lung epithelial cells in a dose-dependent manner. In summary, SP0148 induced mice to produce protective immune responses to fatal S. pneumoniae infection, and our results could contribute to the accumulating data on the use of SP0148 protein vaccines.


Assuntos
Antígenos de Bactérias/imunologia , Proteínas de Bactérias/imunologia , Vacinas Pneumocócicas/imunologia , Pneumonia Pneumocócica/prevenção & controle , Streptococcus pneumoniae/imunologia , Células A549 , Administração Intranasal , Animais , Anticorpos Antibacterianos/sangue , Antígenos de Bactérias/genética , Aderência Bacteriana , Proteínas de Bactérias/genética , Modelos Animais de Doenças , Células Epiteliais/microbiologia , Feminino , Humanos , Injeções Subcutâneas , Interferon gama/metabolismo , Interleucina-17/metabolismo , Leucócitos Mononucleares/imunologia , Camundongos Endogâmicos C57BL , Vacinas Pneumocócicas/administração & dosagem , Vacinas Pneumocócicas/genética , Streptococcus pneumoniae/fisiologia , Análise de Sobrevida , Vacinas de Subunidades/administração & dosagem , Vacinas de Subunidades/genética , Vacinas de Subunidades/imunologia , Vacinas Sintéticas/administração & dosagem , Vacinas Sintéticas/genética , Vacinas Sintéticas/imunologia
17.
Med Microbiol Immunol ; 208(2): 215-226, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30707297

RESUMO

Streptococcuspneumoniae, or pneumococcus, is a major respiratory-tract pathogen that causes high levels of mortality and morbidity in infants and elderly individuals. Despite the development of various capsular polysaccharide vaccines to prevent pneumococcal disease, it remains epidemic. Pneumococcal surface protein A (PspA) is a highly immunogenic surface protein existing in all strains of S. pneumoniae, and it can elicit immunizing protection against pneumococcal infection. In our previous studies, a fusion protein (PsaA-PspA23), consisting of PspA and pneumococcal surface antigen A (PsaA), displayed greater immunogenicity and provided better protection in mice against S. pneumoniae strains than either PsaA or PspA. In this study, the fusion protein PsaA-PspA23, together with PspA4, was formulated with four adjuvants Al(OH)3, MF59, AS03, and AS02, and subsequently subjected to dose optimization and immunological evaluation for determination of the antibody titers, bacterial burden, survival rates, and levels of cytokines in mice. All vaccines with high adjuvant doses displayed higher antigen-specific immunoglobulin G (IgG) titers. Bacterial burdens were notably decreased to different extents in the lungs and blood of mice immunized with the antigen and various adjuvants. Among these adjuvants, AS02 provided outstanding protection against challenge with pathogenic bacteria from different families and clades; it also induced high titers of IgG1 and IgG2a. Moreover, only AS02 elicited high levels of cytokines, such as TNF-α, IFN-γ, IL-2, and IL-4. These results suggest that PsaA-PspA23 and PspA4 formulated with AS02 may potentially be used as a subunit vaccine against deadly pneumococcal infection.


Assuntos
Adesinas Bacterianas/imunologia , Adjuvantes Imunológicos/administração & dosagem , Proteínas de Bactérias/imunologia , Lipoproteínas/imunologia , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/imunologia , Adesinas Bacterianas/genética , Animais , Anticorpos Antibacterianos/sangue , Carga Bacteriana , Proteínas de Bactérias/genética , Citocinas/análise , Modelos Animais de Doenças , Feminino , Lipoproteínas/genética , Camundongos Endogâmicos BALB C , Vacinas Pneumocócicas/administração & dosagem , Vacinas Pneumocócicas/genética , Proteínas Recombinantes de Fusão/genética , Proteínas Recombinantes de Fusão/imunologia , Análise de Sobrevida , Vacinas Sintéticas/administração & dosagem , Vacinas Sintéticas/genética , Vacinas Sintéticas/imunologia
18.
PLoS One ; 14(2): e0212022, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30753210

RESUMO

Nowadays, more than 95 different Streptococcus pneumoniae serotypes are known, being less than one third responsible for the majority of severe pneumococcal infections. After the introduction of conjugate vaccines, a change in the epidemiology of the serotypes causing invasive pneumococcal disease has been observed making the surveillance of circulating serotypes especially relevant. Some recent studies have used matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) technology to identify the most frequent pneumococcal serotypes that cause invasive disease. The objectives of this study were to evaluate the efficacy of previously described discriminatory peaks determined by MALDI-TOF MS for the identification of serotypes 6B, 19F, 19A and 35B using reference and clinical isolates and to try to identify other discriminatory peaks for serotypes 11A, 19F and 19A using transformed pneumococcal strains. Most of the proposed peaks defined in the literature for the identification of serotypes 6B, 19F, 19A, 35B were not found in the spectra of the 10 reference isolates nor in those of the 60 clinical isolates tested corresponding to these four serotypes. The analysis and comparison of the mass spectra of genetically modified pneumococci (transformed strains) did not allow the establishment of new discriminatory peaks for serotypes 11A, 19F, and 19A. MALDI-TOF MS in the usual range of 2,000 to 20,000 m/z did not prove to be a valid technique for direct S. pneumoniae serotyping.


Assuntos
Infecções Pneumocócicas/virologia , Streptococcus pneumoniae/classificação , Técnicas de Tipagem Bacteriana , Humanos , Tipagem Molecular , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/imunologia , Sorotipagem , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz , Streptococcus pneumoniae/genética , Vacinas Conjugadas/imunologia
19.
PLoS One ; 14(2): e0211712, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30707730

RESUMO

After pneumococcal conjugate vaccine (PCV) implementation, the number of acute otitis media (AOM) episodes has decreased, but AOM still remains among the most common diagnoses in childhood. From 2% to 17% of cases of AOM feature spontaneous perforation of the tympanic membrane (SPTM). The aim of this study was to describe the bacteriological causes of SPTM 5 to 8 years years after PCV13 implementation, in 2010. From 2015 to 2018, children with SPTM were prospectively enrolled by 41 pediatricians. Middle ear fluid was obtained by sampling spontaneous discharge. Among the 470 children with SPTM (median age 20.8 months), no otopathogen was isolated for 251 (53.4% [95% CI 48.8%;58.0%]): 47.1% of infants and toddlers, 68.3% older children (p<0.001). Among children with isolated bacterial otopathogens (n = 219), non-typable Haemophilus influenzae (NTHi) was the most frequent otopathogen isolated (n = 106, 48.4% [95% CI 41.6%;55.2%]), followed by Streptoccocus pyogenes (group A streptococcus [GAS]) (n = 76, 34.7% [95% CI 28.4%;41.4%]) and Streptococcus pneumoniae (Sp) (n = 61, 27.9% [95% Ci 22.0%;34.3%]). NTHi was frequently isolated in infants and toddlers (53.1%), whereas the main otopathogen in older children was GAS (52.3%). In cases of co-infection with at least two otopathogens (16.9%, n = 37/219), NTHi was frequently involved (78.4%, n = 29/37). When Sp was isolated, PCV13 serotypes accounted for 32.1% of cases, with serotype 3 the main serotype (16.1%). Among Sp strains, 29.5% were penicillin-intermediate and among NTHi strains, 16.0% were ß-lactamase-producers. More than 5 years after PCV13 implementation, the leading bacterial species recovered from AOM with SPTM was NTHi for infants and toddlers and GAS for older children. In both age groups, Sp was the third most frequent pathogen and vaccine serotypes still played an important role. No resistant Sp strains were isolated, and the frequency of ß-lactamase-producing NTHi did not exceed 16%.


Assuntos
Otite Média/etiologia , Otite Média/microbiologia , Perfuração da Membrana Timpânica/etiologia , Adolescente , Antibacterianos/uso terapêutico , Bactérias/imunologia , Criança , Pré-Escolar , Feminino , Haemophilus influenzae/isolamento & purificação , Humanos , Lactente , Masculino , Otite Média com Derrame/etiologia , Otite Média com Derrame/microbiologia , Infecções Pneumocócicas/complicações , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/imunologia , Sorogrupo , Perfuração Espontânea/etiologia , Perfuração Espontânea/microbiologia , Streptococcus pneumoniae/isolamento & purificação , Streptococcus pyogenes/isolamento & purificação , Membrana Timpânica/microbiologia , Perfuração da Membrana Timpânica/microbiologia , Vacinas Conjugadas/imunologia
20.
PLoS One ; 14(2): e0212295, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30779801

RESUMO

BACKGROUND: Despite the widespread implementation of the pneumococcal conjugate vaccine, Streptococcus pneumoniae remains the leading cause of severe pneumonia associated with mortality among children less than 5 years of age worldwide, with the highest mortality rates recorded in Africa and Asia. However, information on the effectiveness and prevalence of vaccine serotypes post-roll out remains scarce in most African countries. Hence, this systematic review aimed to describe what is known about the decline of childhood invasive pneumococcal disease post-introduction of the pneumococcal conjugate vaccine in Africa. METHODS: This systematic review included articles published between 2009 and 2018 on the implementation of the pneumococcal conjugate vaccine in Africa. We searched PubMed, Scopus and African Index Medicus for articles in English. Studies on implementation programmes of pneumococcal conjugate vaccine 10/13, with before and after data from different African countries, were considered eligible. The review followed the procedures published in PROSPERO (ID = CRD42016049192). RESULTS: In total, 2,280 studies were identified through electronic database research, and only 8 studies were eligible for inclusion in the final analysis. Approximately half (n = 3) of these studies were from South Africa. The overall decline in invasive pneumococcal disease ranged from 31.7 to 80.1%. Invasive pneumococcal diseases caused by vaccine serotypes declined significantly, the decline ranged from 35.0 to 92.0%. A much higher decline (55.0-89.0%) was found in children below 24 months of age. Of all vaccine serotypes, the relative proportions of serotypes 1, 5 and 19A doubled following vaccine roll out. INTERPRETATION: Following the introduction of the pneumococcal conjugate vaccine, a significant decline was observed in invasive pneumococcal disease caused by vaccine serotypes. However, data on the effectiveness in this region remain scarce, meriting continued surveillance to assess the effectiveness of pneumococcal vaccination to improve protection against invasive pneumococcal disease.


Assuntos
Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/imunologia , Vacinas Conjugadas/imunologia , Bases de Dados Factuais , Humanos , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/imunologia , Prevalência , Sorogrupo , África do Sul/epidemiologia
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