Prevention of Antibiotic-Nonsusceptible Streptococcus pneumoniae With Conjugate Vaccines

Journal of Infectious Diseases, Feb 2012

Background. Streptococcus pneumoniae (pneumococcus) caused approximately 44000 US invasive pneumococcal disease (IPD) cases in 2008. Antibiotic nonsusceptibility complicates IPD treatment. Using penicillin susceptibility breakpoints adopted in 2008, we evaluated antibiotic-nonsusceptible IPD trends in light of the introductions of a 7-valent pneumococcal conjugate vaccine (PCV7) in 2000 and a 13-valent pneumococcal conjugate vaccine (PCV13) in 2010. Methods. IPD cases were defined by isolation of pneumococcus from a normally sterile site in individuals residing in Active Bacterial Core surveillance (ABCs) areas during 1998–2008. Pneumococci were serotyped and tested for antibiotic susceptibility using broth microdilution. Results. During 1998–2008, ABCs identified 43198 IPD cases. Penicillin-nonsusceptible strains caused 6%–14% of IPD cases, depending on age. Between 1998–1999 and 2008, penicillin-nonsusceptible IPD rates declined 64% for children aged <5 years (12.1–4.4 cases per 100000), and 45% for adults aged ≥65 (4.8–2.6 cases per 100000). Rates of IPD nonsusceptible to multiple antibiotics mirrored these trends. During 2007–2008, serotypes in PCV13 but not PCV7 caused 78%–97% of penicillin-nonsusceptible IPD, depending on age. Conclusions. Antibiotic-nonsusceptible IPD rates remain below pre-PCV7 rates for children <5 and adults ≥65 years old. PCV13 vaccines hold promise for further nonsusceptibility reductions.

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Prevention of Antibiotic-Nonsusceptible Streptococcus pneumoniae With Conjugate Vaccines

Lee M. Hampton () 0 5 6 Monica M. Farley 0 4 William Schaffner 0 11 Ann Thomas 0 10 Arthur Reingold 0 9 Lee H. Harrison 0 8 Ruth Lynfield 0 13 Nancy M. Bennett 0 12 Susan Petit 0 7 Kenneth Gershman 0 2 Joan Baumbach 0 3 Bernard Beall 0 5 James Jorgensen 0 1 Anita Glennen 0 13 Elizabeth R. Zell 0 5 Matthew Moore 0 5 0 Received 11 March 2011; accepted 16 September 2011; electronically published 7 December 2011. Presented in part: 7th International Conference on Emerging Infectious Diseases , Atlanta, Georgia , 11-14 July 2010. Respiratory Disease Branch, Centers for Disease Control and Prevention , 1600 Clifton Rd, MS A-24, Atlanta, GA 30329 1 University of Texas , San Antonio 2 Colorado Department of Public Health and Environment , Denver 3 New Mexico Department of Health , Santa Fe 4 Emory University School of Medicine and Veterans Affairs Medical Center , Atlanta, Georgia 5 Respiratory Disease Branch, Centers for Disease Control and Prevention 6 Epidemic Intelligence Service 7 Connecticut Department of Public Health , Hartford 8 Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland 9 The School of Public Health, University of California , Berkeley 10 Health Division, Oregon Public Health Division , Portland 11 Department of Preventive Medicine, Vanderbilt University School of Medicine , Nashville, Tennessee 12 University of Rochester , New York 13 Minnesota Department of Health , St. Paul Background. Streptococcus pneumoniae (pneumococcus) caused approximately 44 000 US invasive pneumococcal disease (IPD) cases in 2008. Antibiotic nonsusceptibility complicates IPD treatment. Using penicillin susceptibility breakpoints adopted in 2008, we evaluated antibiotic-nonsusceptible IPD trends in light of the introductions of a 7-valent pneumococcal conjugate vaccine (PCV7) in 2000 and a 13-valent pneumococcal conjugate vaccine (PCV13) in 2010. Methods. IPD cases were defined by isolation of pneumococcus from a normally sterile site in individuals residing in Active Bacterial Core surveillance (ABCs) areas during 1998-2008. Pneumococci were serotyped and tested for antibiotic susceptibility using broth microdilution. Results. During 1998-2008, ABCs identified 43 198 IPD cases. Penicillin-nonsusceptible strains caused 6%-14% of IPD cases, depending on age. Between 1998-1999 and 2008, penicillin-nonsusceptible IPD rates declined 64% for children aged ,5 years (12.1-4.4 cases per 100 000), and 45% for adults aged $65 (4.8-2.6 cases per 100 000). Rates of IPD nonsusceptible to multiple antibiotics mirrored these trends. During 2007-2008, serotypes in PCV13 but not PCV7 caused 78%-97% of penicillin-nonsusceptible IPD, depending on age. Conclusions. Antibiotic-nonsusceptible IPD rates remain below pre-PCV7 rates for children ,5 and adults $65 years old. PCV13 vaccines hold promise for further nonsusceptibility reductions. Streptococcus pneumoniae (pneumococcus) caused approximately 63 000 invasive pneumococcal disease (IPD) cases annually in the late 1990s in the United States, leading to about 6100 deaths [1]. During the first 7 years after the introduction in the United States of a 7-valent pneumococcal conjugate vaccine (PCV7) for Prevention of S. pneumoniae With Conjugate Vaccines d JID 2012:205 (1 February) d 401 - children, an estimated 211 000 fewer cases of IPD occurred among all ages than would have occurred without the vaccine [2]; however, approximately 44 000 IPD cases continue to occur annually [3]. Antibiotic resistance and intermediate susceptibility, together termed nonsusceptibility, complicate management of pneumococcal disease [46]. Despite increasing during the 1990s [7], the incidence of antibiotic-nonsusceptible IPD in the United States fell following the introduction of PCV7 [8, 9]. The 7 serotypes covered by PCV7 accounted for 78% of nonsusceptible serotypes in 1998 [7], and the incidence rate of these serotypes decreased 78% among children aged ,2 years by 2001 [9]. However, by 2003, the incidence of antibiotic-nonsusceptible IPD in children aged ,5 years was increasing again [8], coinciding with the emergence of serotypes not included in PCV7, particularly serotype 19A [10]. A new 13-valent pneumococcal conjugate vaccine (PCV13) [11] could help reverse the rise in antibiotic-nonsusceptible IPD, depending in part on the proportion of antibiotic-nonsusceptible IPD caused by PCV13 serotypes. Rates and proportions of antibiotic-nonsusceptible IPD depend on the definition of antibiotic nonsusceptibility used. In 2008, the Clinical and Laboratory Standards Institute (CLSI) established new, higher minimum inhibitory concentration (MIC) breakpoints for defining pneumococcal susceptibility to parenterally administered penicillin when treating pneumococcal disease other than meningitis [1214]. The breakpoints for orally administered penicillin and for parenterally administered penicillin for the treatment of meningitis did not change [12, 13]. Since penicillin is the drug of choice for (...truncated)


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Lee M. Hampton, Monica M. Farley, William Schaffner, Ann Thomas, Arthur Reingold, Lee H. Harrison, Ruth Lynfield, Nancy M. Bennett, Susan Petit, Kenneth Gershman, Joan Baumbach, Bernard Beall, James Jorgensen, Anita Glennen, Elizabeth R. Zell, Matthew Moore. Prevention of Antibiotic-Nonsusceptible Streptococcus pneumoniae With Conjugate Vaccines, Journal of Infectious Diseases, 2012, pp. 401-411, 205/3, DOI: 10.1093/infdis/jir755