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Invasive Pneumococcal Disease in UK Children <1 Year of Age in the Post–13-Valent Pneumococcal Conjugate Vaccine Era: What Are the Risks Now?

Kent, A; Makwana, A; Sheppard, CL; Collins, S; Fry, NK; Heath, PT; Ramsay, M; Ladhani, SN (2019) Invasive Pneumococcal Disease in UK Children <1 Year of Age in the Post–13-Valent Pneumococcal Conjugate Vaccine Era: What Are the Risks Now? Clin Infect Dis, 69 (1). pp. 84-90. ISSN 1537-6591 https://doi.org/10.1093/cid/ciy842
SGUL Authors: Heath, Paul Trafford

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Abstract

Background Invasive pneumococcal disease (IPD) has declined significantly since the introduction of pneumococcal conjugate vaccines (PCVs). It is not known whether certain infant populations remain at higher risk of IPD in countries with established 13-valent PCV (PCV13) programs. We aimed to describe the epidemiology, clinical characteristics, serotype distribution, and outcomes of IPD in infants, and to estimate the relative risk of PCV13-type, non-PCV13-type, and overall IPD in premature infants compared to term infants during a 4-year period after the PCV13 program was established. Methods This was a prospective, enhanced national surveillance of laboratory-confirmed IPD in England in infants aged <1 year diagnosed during 2013–2016. Results There were 517 cases of IPD (incidence: 19/100000 infants). Incidence was significantly higher in premature infants compared with those born at term (49/100000 vs 17/100000; incidence rate ratio [IRR], 2.87; P < .001), with infants born before 28 weeks’ gestation having the highest incidence (150/100000; IRR, 8.8; P < .001). Of the 454 IPD cases with serotyped isolates, most were caused by non-PCV13 serotypes (369 cases, 71.4%), with 85 cases (16.4%) due to PCV13 serotypes. There were 31 deaths (case fatality rate [CFR], 6.2% [95% confidence interval, 4.3%–8.6%]). Premature infants did not have a higher CFR than term infants (P = .62). Conclusions IPD incidence in infants remains lower than rates reported prior to PCV7 introduction in England. The risk of IPD remains significantly higher in premature infants compared to infants born at term, for both PCV13 and non-PCV13 serotypes. Any changes to the infant PCV13 immunization schedule may disproportionally affect premature infants.

Item Type: Article
Additional Information: This is a pre-copyedited, author-produced version of an article accepted for publication in Clinical Infectious Diseases following peer review. The version of record Alison Kent, Ashley Makwana, Carmen L Sheppard, Sarah Collins, Norman K Fry, Paul T Heath, Mary Ramsay, Shamez N Ladhani, Invasive Pneumococcal Disease in UK Children <1 Year of Age in the Post–13-Valent Pneumococcal Conjugate Vaccine Era: What Are the Risks Now?, Clinical Infectious Diseases, Volume 69, Issue 1, 1 July 2019, Pages 84–90 is available online at: https://doi.org/10.1093/cid/ciy842
Keywords: 06 Biological Sciences, 11 Medical And Health Sciences, Microbiology
SGUL Research Institute / Research Centre: Academic Structure > Infection and Immunity Research Institute (INII)
Journal or Publication Title: Clin Infect Dis
ISSN: 1537-6591
Language: eng
Dates:
DateEvent
1 July 2019Published
3 October 2018Published Online
28 September 2018Accepted
Publisher License: Publisher's own licence
PubMed ID: 30281069
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/110260
Publisher's version: https://doi.org/10.1093/cid/ciy842

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