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Dynamic changes in paediatric invasive pneumococcal disease after sequential switches of conjugate vaccine in Belgium: a national retrospective observational study.
Desmet, Stefanie; Lagrou, Katrien; Wyndham-Thomas, Chloé; Braeye, Toon; Verhaegen, Jan; Maes, Piet; Fieuws, Steffen; Peetermans, Willy E; Blumental, Sophie.
Afiliación
  • Desmet S; National Reference Centre for Streptococcus pneumoniae, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium. Electronic address: stefanie.desmet@uzleuven.be.
  • Lagrou K; National Reference Centre for Streptococcus pneumoniae, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.
  • Wyndham-Thomas C; Department Epidemiology of Infectious Diseases, Sciensano, Brussels, Belgium.
  • Braeye T; Department Epidemiology of Infectious Diseases, Sciensano, Brussels, Belgium; Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Hasselt University, Hasselt, Belgium.
  • Verhaegen J; National Reference Centre for Streptococcus pneumoniae, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.
  • Maes P; Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.
  • Fieuws S; Interuniversity Institute for Biostatistics and Statistical Bioinformatics, KU Leuven, University of Leuven and Universiteit Hasselt, Leuven, Belgium.
  • Peetermans WE; Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.
  • Blumental S; Hôpital Universitaire des Enfants Reine Fabiola, Unité de Maladies Infectieuses Pédiatriques, Université Libre de Bruxelles, Brussels, Belgium.
Lancet Infect Dis ; 2020 Jul 20.
Artículo en Inglés | MEDLINE | ID: mdl-32702303
ABSTRACT

BACKGROUND:

Ten-valent and 13-valent pneumococcal conjugate vaccines (PCVs) have shown important benefits by decreasing invasive pneumococcal disease caused by vaccine serotypes. Belgium had an uncommon situation with sequential use of PCV7, PCV13, and PCV10 in the childhood vaccination programmes between 2007 and 2018. We aimed to analyse the changes in incidence of invasive pneumococcal disease and serotype distribution in children throughout this period.

METHODS:

Streptococcus pneumoniae isolates were obtained from patients with invasive pneumococcal disease in Belgium between 2007 and 2018 by the national laboratory-based surveillance. Paediatric invasive pneumococcal disease incidence, serotype distribution, and antimicrobial susceptibility were analysed in periods during which PCV7 (2009-10), PCV13 (2013-14), both PCV13 and PCV10 (2015-16), and PCV10 (2017-18) were used. Incidence rates and trends were compared. Vaccination status was collected. For a subset of serotype 19A isolates, multilocus sequence type was identified.

FINDINGS:

After a decrease in PCV7 serotype invasive pneumococcal disease was observed during the PCV7 period, total paediatric invasive pneumococcal disease incidence significantly declined during the PCV13 period (-2·6% monthly, p<0·0001). During the PCV13-PCV10 period (2015-16), the lowest mean in paediatric invasive pneumococcal disease incidence was achieved, but the incidence increased again during the PCV10 period (2017-18), especially in children younger than 2 years (+1·7% monthly; p=0·028). This increase was mainly due to a significant rise in serotype 19A invasive pneumococcal disease incidence in the PCV10 period compared with the PCV13 period (p<0·0001), making serotype 19A the predominant serotype in paediatric invasive pneumococcal disease in the PCV10 period. Genetic diversity within the 2017-18 serotype 19A collection was seen, with two predominant clones, ST416 and ST994, that were infrequently observed before PCV10 introduction. In 2018, among children younger than 5 years with invasive pneumococcal disease who were correctly vaccinated, 37% (37 of 100) had PCV13 serotype invasive pneumococcal disease, all caused by serotype 19A and serotype 3.

INTERPRETATION:

After a significant decrease during the PCV13 period, paediatric invasive pneumococcal disease incidence increased again during the PCV10 period. This observation mainly resulted from a significant increase of serotype 19A cases. During the PCV10 period, dominant serotype 19A clones differed from those detected during previous vaccine periods. Whether changes in epidemiology resulted from the vaccine switch or also from natural evolution remains to be further elucidated.

FUNDING:

The Belgian National Reference is funded by the Belgian National Institute for Health and Disability Insurance and the whole genome sequencing by an investigator-initiated research grant from Pfizer.
Texto completo: Disponible Colección: Bases de datos internacionales Contexto en salud: Agenda de Salud Sostenible para las Américas Tema en salud: Objetivo 10: Enfermedades transmisibles Base de datos: MEDLINE Tipo de estudio: Estudio observacional / Estudio pronóstico / Factores de riesgo Idioma: Inglés Asunto de la revista: Enfermedades Transmisibles Año: 2020 Tipo del documento: Artículo

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Texto completo: Disponible Colección: Bases de datos internacionales Contexto en salud: Agenda de Salud Sostenible para las Américas Tema en salud: Objetivo 10: Enfermedades transmisibles Base de datos: MEDLINE Tipo de estudio: Estudio observacional / Estudio pronóstico / Factores de riesgo Idioma: Inglés Asunto de la revista: Enfermedades Transmisibles Año: 2020 Tipo del documento: Artículo