TY - JOUR
T1 - Dynamics of Severe and Non-severe Invasive Pneumococcal Disease in Young Children in Israel Following PCV7/PCV13 Introduction
AU - Israel Bacteremia and Meningitis Active Surveillance Group
AU - Glikman, Daniel
AU - Dagan, Ron
AU - Barkai, Galia
AU - Averbuch, Diana
AU - Guri, Alex
AU - Givon-Lavi, Noga
AU - Ben-Shimol, Shalom
AU - Amir, Jacob
AU - Aviner, Shraga
AU - Bachinski, Ahuva
AU - Bar-Meir, Maskit
AU - Bar-Yochai, Avihu
AU - Benedikt, Ilana
AU - Bernstein, Rita
AU - Brosh-Nissimov, Tal
AU - Elias, Nael
AU - Engelhard, Dan
AU - Ephros, Moshe
AU - Gottesman, Giora
AU - Grisaru-Soen, Galia
AU - Kassis, Imad
AU - Keller, Nathan
AU - Korenman, Zina
AU - Leskes, Hannah
AU - Luder, Anthony
AU - Megged, Orli
AU - Miron, Dan
AU - Mor, Meirav
AU - Peretz, Avi
AU - Rubinstein, Uri
AU - Schlesinger, Yechiel
AU - Schwartz, David
AU - Shalit, Itamar
AU - Somekh, Eli
AU - Srugo, Isaac
AU - Stein, Michal
AU - Yeshayahu, Yonatan
AU - Zbriger, Alvira
AU - Zucker, Miriam
N1 - Publisher Copyright:
Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2018/10/1
Y1 - 2018/10/1
N2 - Background: The introduction of the pneumococcal conjugated vaccines (PCVs) resulted in a substantial reduction of invasive pneumococcal disease (IPD) rates. However, impact on nonsevere IPD (mostly occult bacteremia) has not yet been fully elucidated. We assessed severe and nonsevere IPD (SIPD and NSIPD, respectively) rate dynamics in children < 5 years in Israel before and after PCV7/PCV13 implementation. Methods: A prospective, population-based, nationwide surveillance. All IPD episodes recorded from 1999 through 2015 were included. NSIPD was defined as IPD episodes without meningitis, pneumonia or mastoiditis in a child with a favorable outcome (not hospitalized or hospitalized in a nonintensive care unit < 5 days, without mortality). Three subperiods were defined: pre-PCV (1999–2008), PCV7 (2010–2011) and PCV13 (2013–2015). Incidence rate ratios (IRRs) were calculated. Results: Overall, 4,457 IPD episodes were identified; 3,398 (76.2%) SIPD, 1,022 (22.9%) NSIPD and 37 (0.8%) unknown. In 90% of NSIPD episodes, no focus was identified. In the PCV7 period, NSIPD rates significantly declined by 52%, while SIPD rates declined less prominently by 24%. Following PCV13 introduction, compared with the PCV7 period, NSIPD rates declined nonsignificantly by 17% while SIPD rates declined significantly further by an additional 53%. These trends resulted in overall reductions (comparing PCV13 and pre-PCV periods) of NSIPD and SIPD of 60% (IRR = 0.4; 0.32–0.51) and 64% (IRR = 0.36; 0.32–0.42), respectively. Conclusions: Following PCV7/PCV13 introduction, SIPD and NSIPD rates substantially declined, with differences in rate-dynamics, alluding to differences in serotype distribution between the 2 groups. Future surveillance is warranted when considering modification in treatment protocols for suspected occult bacteremia/NSIPD cases.
AB - Background: The introduction of the pneumococcal conjugated vaccines (PCVs) resulted in a substantial reduction of invasive pneumococcal disease (IPD) rates. However, impact on nonsevere IPD (mostly occult bacteremia) has not yet been fully elucidated. We assessed severe and nonsevere IPD (SIPD and NSIPD, respectively) rate dynamics in children < 5 years in Israel before and after PCV7/PCV13 implementation. Methods: A prospective, population-based, nationwide surveillance. All IPD episodes recorded from 1999 through 2015 were included. NSIPD was defined as IPD episodes without meningitis, pneumonia or mastoiditis in a child with a favorable outcome (not hospitalized or hospitalized in a nonintensive care unit < 5 days, without mortality). Three subperiods were defined: pre-PCV (1999–2008), PCV7 (2010–2011) and PCV13 (2013–2015). Incidence rate ratios (IRRs) were calculated. Results: Overall, 4,457 IPD episodes were identified; 3,398 (76.2%) SIPD, 1,022 (22.9%) NSIPD and 37 (0.8%) unknown. In 90% of NSIPD episodes, no focus was identified. In the PCV7 period, NSIPD rates significantly declined by 52%, while SIPD rates declined less prominently by 24%. Following PCV13 introduction, compared with the PCV7 period, NSIPD rates declined nonsignificantly by 17% while SIPD rates declined significantly further by an additional 53%. These trends resulted in overall reductions (comparing PCV13 and pre-PCV periods) of NSIPD and SIPD of 60% (IRR = 0.4; 0.32–0.51) and 64% (IRR = 0.36; 0.32–0.42), respectively. Conclusions: Following PCV7/PCV13 introduction, SIPD and NSIPD rates substantially declined, with differences in rate-dynamics, alluding to differences in serotype distribution between the 2 groups. Future surveillance is warranted when considering modification in treatment protocols for suspected occult bacteremia/NSIPD cases.
KW - Bacteremia without focus
KW - Children
KW - Occult bacteremia
KW - Pneumococcal conjugate vaccine (PCV)
UR - http://www.scopus.com/inward/record.url?scp=85058980001&partnerID=8YFLogxK
U2 - 10.1097/INF.0000000000002100
DO - 10.1097/INF.0000000000002100
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C2 - 29750768
AN - SCOPUS:85058980001
SN - 0891-3668
VL - 37
SP - 1048
EP - 1053
JO - Pediatric Infectious Disease Journal
JF - Pediatric Infectious Disease Journal
IS - 10
ER -