Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Apr 6;12(4):e0175224.
doi: 10.1371/journal.pone.0175224. eCollection 2017.

Decrease of invasive pneumococcal disease (IPD) in adults after introduction of pneumococcal 13-valent conjugate vaccine in Spain

Jordi Càmara  1 , José María Marimón  2   3 , Emilia Cercenado  3   4 , Nieves Larrosa  5 , María Dolores Quesada  3   6 , Dionísia Fontanals  7 , Meritxell Cubero  1   3 , Emilio Pérez-Trallero  2   3 , Asunción Fenoll  8 , Josefina Liñares  1   3 , Carmen Ardanuy  1   3
Affiliations

Decrease of invasive pneumococcal disease (IPD) in adults after introduction of pneumococcal 13-valent conjugate vaccine in Spain

Jordi Càmara et al. PLoS One. .

Abstract

A prospective laboratory-based multicenter study that collected all adult invasive pneumococcal disease (IPD) episodes from 6 Spanish hospitals before (2008-2009) and after (2012-2013). The 13-valent pneumococcal conjugate vaccine (PCV13) licensure was conducted in order to analyze the impact of PCV13 introduction for children on adult IPD. A total of 1558 IPD episodes were detected. The incidence of IPD decreased significantly in the second period by -33.9% (95% CI, -40.3% to -26.8%). IPD due to PCV7 serotypes (-52.7%; 95% CI, -64.2% to -37.5%) and to PCV13 additional serotypes (-55.0% 95% CI, -62.0% to -46.7%) significantly decreased whereas IPD due to non-PCV13 serotypes remained stable (1.0% 95% CI, -12.9% to 17.2%). IPD due to all PCV13 additional serotypes significantly declined with the exception of serotype 3 (-11.3%; 95%CI -35.0% to 21.1%). IPD due to two non-PCV13 serotypes varied: serotype 6C that rose (301.6%; 95%CI, 92.7% to 733.3%, p<0.001), related to the expansion of ST3866C, and serotype 8 that decreased (-34.9%, 95%CI, -57.1 to -1.2, p = 0.049), related to a decline of the ST638. The recombinant clone ST652111A (variant of ST1569V) increased in frequency. The decrease of serotype 19A IPD was linked to a fall in those antibiotic susceptible clones. In the last period, rates of penicillin- and cefotaxime-resistance remained under 10% and 4%, respectively. Adult IPD decreased after the PCV13 introduction in Spain due to herd protection. The spread of multidrug resistant clones (ST3866C, ST652111A) related to non-PCV13 serotypes needs further surveillance.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: C.A., A.F. and J.L. have received funding from Pfizer, unrelated to the present study. All other authors declare no conflicts of interest. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Regional changes in IPD by serotype group.
Dots expressed the percentage of change and lines the limits of 95% CI. The decrease of IPD due to PCV7 and PCV13 additional serotypes was more noticeable in Madrid (the only region that included universal children vaccination with PCV13) than in the Basque Country or Catalonia.
Fig 2
Fig 2. Incidence of invasive pneumococcal disease by serotype and by period.
Asterisks indicate serotypes with statistically significant changes (p≤0.05). All p values were ≤ 0.001 with the exception of serotypes 4 (0.012) and 8 (0.049).
See this image and copyright information in PMC

References

    1. GBD 2015 Mortality and Causes of Death Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016; 388:1459–1544. 10.1016/S0140-6736(16)31012-1 - DOI - PMC - PubMed
    1. Whitney CG, Farley MM, Hadler J, Harrison LH, Bennett NM, Lynfield R, et al. Decline in invasive pneumococcal disease after the introduction of protein-polysaccharide conjugate vaccine. N.Engl.J.Med. 2003; 348:1737–1746. 10.1056/NEJMoa022823 - DOI - PubMed
    1. Ardanuy C, Tubau F, Pallares R, Calatayud L, Dominguez MA, Rolo D, et al. Epidemiology of invasive pneumococcal disease among adult patients in barcelona before and after pediatric 7-valent pneumococcal conjugate vaccine introduction, 1997–2007. Clin.Infect.Dis. 2009; 48:57–64. 10.1086/594125 - DOI - PubMed
    1. Kyaw MH, Lynfield R, Schaffner W, Craig AS, Hadler J, Reingold A, et al. Effect of introduction of the pneumococcal conjugate vaccine on drug-resistant Streptococcus pneumoniae. N.Engl.J.Med. 2006; 354:1455–1463. 10.1056/NEJMoa051642 - DOI - PubMed
    1. Pai R, Moore MR, Pilishvili T, Gertz RE, Whitney CG, Beall B. Postvaccine genetic structure of Streptococcus pneumoniae serotype 19A from children in the United States. J.Infect.Dis. 2005; 192:1988–1995. 10.1086/498043 - DOI - PubMed

Substances