The relative invasive disease potential of Streptococcus pneumoniae among children after PCV introduction: A systematic review and meta-analysis
Balsells, Evelyn; Dagan, Ron; Yildirim, Inci; Gounder, Prabhu P.; Steens, Anneke; Muñoz-Almagro, Carmen; Mameli, Chiara; Kandasamy, Rama; Givon Lavi, Noga; Daprai, Laura; van der Ende, Arie; Trzciński, Krzysztof; Nzenze, Susan A.; Meiring, Susan; Foster, Dona; Bulkow, Lisa R.; Rudolph, Karen; Valero-Rello, Ana; Ducker, Struan; Vestrheim, Didrik Frimann; von Gottberg, Anne; Pelton, Stephen I.; Zuccotti, Gian Vincenzo; Pollard, Andrew J.; Sanders, Elisabeth A.M.; Campbell, Harry; Madhi, Shabir A.; Nair, Harish; Kyaw, Moe H.
(2018) Journal of Infection, volume 77, issue 5, pp. 368 - 378
(Article)
Abstract
Objectives: Burden of pneumococcal disease depends on the prevalence and invasive disease potential of serotypes. We aimed to estimate the invasive disease potential of serotypes in children under 5 years of age by combining data from different settings with routine immunisation with pneumococcal conjugate vaccines (PCV). Methods: We conducted a
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systematic review, supplemented by unpublished data, to identify data on the frequency of pneumococcal serotypes in carriage and invasive pneumococcal disease (IPD). We estimated the invasive disease potential of serotypes as the ratio of IPD in relation to carriage (odds ratio and 95%CI) compared with 19A (reference serotype) by meta-analysis. We report results based on a random effects model for children aged 0–23, 24–29, and 0–59 months and by invasive clinical syndromes. Results: In comparison with 19A, serotypes 1, 7F, and 12F had a significantly higher invasive disease potential in children aged 0–23 and 0–59 months for all IPD and clinical syndromes (OR > 5). Several non-vaccine types (NVTs) (6C, 15A, 15BC, 16F, 23B, in these two age groups) had a lower invasive disease potential than 19A (OR 0.1–0.3). NVTs 8, 12F, 24F, and 33F were at the upper end of the invasiveness spectrum. Conclusions: There is substantial variation among pneumococcal serotypes in their potential to cause IPD and disease presentation, which is influenced by age and time after PCV introduction. Surveillance of IPD and carriage is critical to understand the expected effectiveness of current PCVs (in the longer term) and guide the development of future vaccines.
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Keywords: Invasive disease potential, Meta-analysis, Pneumococcal conjugate vaccine, Serotype, Streptococcus pneumoniae, Microbiology (medical), Infectious Diseases
ISSN: 0163-4453
Publisher: W.B. Saunders Ltd
Note: Funding Information: We would like to thank Dana Bruden from the Centers for Disease Control and Prevention (CDC), Anchorage, AK, USA for her assistance re-analysing primary data and her valuable comments on the manuscript. Funding Information: EB, HC and HN are employees of the University of Edinburgh and funding for this study was provided via an agreement between Sanofi Pasteur and the University. MHK is an employee of Sanofi Pasteur. AP reports grants from Pfizer for collection of primary data used in this meta-analysis, outside the submitted work; and that he is Chair of UK Department of Health's Joint Committee on Vaccination and Immunisation and a member of WHO's SAGE committee. AvG reports grants from Pfizer, other from Pfizer, Sanofi and Novartis, outside the submitted work. AvdE reports grants from Pfizer, grants from National Institute of Public Health and the Environment, during the conduct of the study; grants from Pfizer, other from GSK, other from Pfizer, outside the submitted work. CMA reports grants from Pfizer, personal fees from GSK, outside the submitted work. KT reports grants from Pfizer outside the submitted work. RK reports funding from a Pfizer Investigator Initiated Research grant and support from NIHR Oxford Biomedical Research Centre, during the conduct of the UK carriage study. ES reports research grants from Pfizer and GSK outside the submitted work. SP reports membership of the advisory boards for Merck, Pfizer, Sequiris, consultancy activities for Pfizer, including projects at PAI, Brookline, MA, grants from Pfizer, payment for lectures by J&J and Pfizer, and royalties, all outside the submitted work. AV, AS, DFV, DF, PG, LB, LD, CM, NG, RD, SD, SM, IY, ZV have nothing to disclose. No financial support in any form from Sanofi Pasteur was given to AP, AvG, AvdE, KT, RK, KR, SP, AV, AS, CMA, DFV, DF, ES, PG, LB, LD, CM, NG, RD, SD, SAM, SM, SN, IY, GZ for this work. Funding Information: This work was supported financially by Sanofi Pasteur. Publisher Copyright: © 2018 The British Infection Association
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