The relative invasive disease potential of Streptococcus pneumoniae among children after PCV introduction: A systematic review and meta-analysis - 24/08/18

Doi : 10.1016/j.jinf.2018.06.004

Evelyn Balsells ^a,^⁎ , Ron Dagan ^b, Inci Yildirim ^c,^d,^e, Prabhu P. Gounder ^f, Anneke Steens ^g,^h, Carmen Muñoz-Almagro ^i,^j,^k, Chiara Mameli ^l, Rama Kandasamy ^m, Noga Givon Lavi ^b, Laura Daprai ⁿ, Arie van der Ende ^o, Krzysztof Trzciński ^p, Susan A. Nzenze ^q,^w, Susan Meiring ^r, Dona Foster ^s, Lisa R. Bulkow ^f, Karen Rudolph ^f, Ana Valero-Rello ^i,^j, Struan Ducker ^a, Didrik Frimann Vestrheim ^g, Anne von Gottberg ^r,^t, Stephen I. Pelton ^u, GianVincenzo Zuccotti ^l, Andrew J. Pollard ^m, Elisabeth A.M. Sanders ^p,^v, Harry Campbell ^a, Shabir A. Madhi ^q,^r,^w, Harish Nair ^a,^x,^{^{1
Joint authors in this position.}}, Moe H. Kyaw ^y,^{^{1
Joint authors in this position.}}
^a Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Medical School, Teviot Place, Edinburgh, UK
^b Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
^c Division of Infectious Diseases, Department of Pediatrics, School of Medicine, Emory University, Atlanta, GA, USA
^d Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
^e Center for Childhood Infections and Vaccines, Atlanta, GA, USA
^f Arctic Investigations Program, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), US Centers for Disease Control and Prevention (CDC), Anchorage, AK, USA
^g Department of Vaccine Preventable Diseases, Norwegian Institute of Public Health, Oslo, Norway
^h Faculty of Medicine, University of Oslo, Oslo, Norway
ⁱ Institut de Recerca Pediatrica, Departament de Microbiologia Molecular, Hospital Sant Joan de Deu, Barcelona, Spain
^j CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
^k School of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain
^l Department of Pediatrics, V.Buzzi Children's Hospital, University of Milan, Milan, Italy
^m Oxford Vaccine Group, Department of Paediatrics, University of Oxford and NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
ⁿ Unit of Microbiology, Fondazione IRCCS Cá Granda Ospedale Maggiore Policlinico, Milano, Italy
^o Academic Medical Center, Department of Medical Microbiology and the Netherlands Reference Laboratory for Bacterial Meningitis, Amsterdam, The Netherlands
^p Department of Pediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
^q Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa
^r National Institute for Communicable Diseases: Division of the National Health Laboratory Service, Johannesburg, South Africa
^s NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
^t School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
^u Department of Pediatrics, Boston Medical Center, Boston, MA, USA
^v The National Institute for Public Health and The Environment, Bilthoven, The Netherlands
^w Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
^x Public Health Foundation of India, New Delhi, India
^y Sanofi Pasteur, Swiftwater, PA, USA

^⁎Corresponding author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Friday 24 August 2018

Highlights

•	The post-PCV invasive disease potential of 25 pneumococcal serotypes was estimated.
•	The invasive disease potential of non-vaccine types, except 12F, are lower than 19A.
•	Age and disease presentation influence the invasive disease potential of serotypes.
•	Knowledge of invasive disease potential is valuable to assess and design vaccines.
•	Due to the diversity, surveillance of serotypes in carriage and IPD is critical.

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Summary

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 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 : Streptococcus pneumoniae, Serotype, Invasive disease potential, Pneumococcal conjugate vaccine, Meta-analysis