5th Regional Pneumococcal Symposium São Paulo, Brazil 5 6 March PDF

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5th Regional Pneumococcal Symposium São Paulo, Brazil 5 6 March 2013 Current Understanding of Adult Pneumococcal Disease Epidemiology in Latin America and the Caribbean A collaborative project between:

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5th Regional Pneumococcal Symposium São Paulo, Brazil 5 6 March 2013 Current Understanding of Adult Pneumococcal Disease Epidemiology in Latin America and the Caribbean A collaborative project between: Sabin Vaccine Institute (Sabin), Washington, DC Pan American Health Organization (PAHO), Washington, DC International Vaccine Access Center at Johns Hopkins (JHU s IVAC), Baltimore, MD Centers for Disease Control and Prevention (CDC), Atlanta, GA Background Global impact of S pneumoniae in children 5 yrs. 14,5 million cases every year of serious pneumococcal disease. 860,000 deaths per year. LAC Impact of S pneumoniae in children 5yrs. 980,000-1,500,000 cases every year 12,000-28,000 deaths every year. O Brien et al 2009 Valenzuela et al 2009 Background Impact of S pneumoniae infection in older children and adults have been less studied in developing countries. However, some syndromes associated to pneumococcus, i.e. p pneumonia are an important cause of disease and death in older children and older adults in developing countries. There are potential interventions to prevent partially the burden of disease by S pneumoniae: Polysaccharyde pneumococcal vaccines. New conjugate vaccines. Flu vaccination. Welte T et al Thorax 2012;67:71-79 Background More data is available from developed countries. Jansen A et al Invasive pneumococcal disease in the Netherlands. Vaccine 27 (17) Main Objective: Overview of the Study To estimate the burden of invasive and non-invasive pneumococcal disease (mortality, morbidity and disability) in the 5 years of age and older population in Latin America and the Caribbean (LAC), using secondary data from published and unpublished studies as well as national surveillance databases Specific Objectives: Overview of the Study 1. Describe the incidence rates of invasive and non-invasive pneumococcal pneumonia by age groups in the LAC region 2. Describe the serogroup distribution of Streptococcus pneumoniae isolates by age groups and syndrome in the LAC region 3. Describe the case fatality rates, mortality and morbidity associated to S. pneumoniae by age groups and syndrome in the LAC region 4. Describe the trends of antimicrobial resistance of invasive S. pneumoniae isolates in people 5 years of age and older in the LAC region 5. Assess the potential serotype coverage of different conjugate and polysaccharide pneumococcal vaccines by age groups in the LAC region 6. Analyze the knowledge gap on the epidemiology of pneumococcal disease for people 5 years of age and older in the LAC region Methods: Review of the Literature This study reviewed secondary epidemiological information from two main sources. 1. Published data on S. pneumoniae occurring in the 5 years of age and older population obtained from the AGEDD Project s literature search ( ), and an updated CDC literature search ( ) Included Articles: Incidence of invasive pneumococcal disease and non invasive pneumonia Clinical presentation of invasive pneumococcal disease (meningitis, pneumonia, sepsis, bacteremia) Serotype distribution, and antimicrobial resistance of invasive S. pneumoniae isolates Mortality and Case Fatality Rates (CFR) of pneumococcal disease Morbidity and sequelae of pneumococcal disease Excluded Articles: Case reports Articles without relevant data Inclusion/Exclusion Criteria Studies with fewer than 10 pneumococcal isolates Incidence rates based on period of surveillance of less than 12 months Methods 2. Review of SIREVA reports Information on serotypes distribution was analyzed by country, age, syndrome. Comparisons of serotype distribution before and after universal child vaccination was done for Brazil and Uruguay. Main Findings IPD incidence data: 4 studies. Brazil: 1 study. Novaes et al Chile: 3 studies. Lagos et al Maldonado et al Inostroza et al 2007 Summary of IPD incidence Country Author Time period Novaes et Brazil (All) al Chile (Santiago) Chile (Santiago) Chile (Temuco) Lagos et al Maldonado et al Inostroza et al Age group (years) 5-9 y y y y y y y y y Incidence rate (10 5 ) 2.7 ( ) y y y y y 60.0 Hospitalized IPD and pneumococcal pneumonia median incidence. Brazil Pneumococcal meningitis incidence Country Author Time period Novaes et Brazil (All) al Brazil (Salvador) Brazil (Campinas) Menezes et al Weiss et al Age group (years) 5-9 y y y y y y y y 0.6 Incidence rate / y 0.7 (06-08) 5-19y y y 2.1 Cuba (all) Cuba (all) Dickinson & Perez Dickinson & Perez y y y y y y 0.6 Proportion of S pneumoniae in CAP. 9 hospital based studies. 1 retrospective. Years Range of S pneumoniae:5-32% Studies using urine test detected the highest proportion. Proportion of S pneumoniae in CAP. Proportion of S pneumoniae in meningitis 5 studies. 4 retrospective. Years Range of S pneumoniae:3-64% Proportion of S pneumoniae in meningitis Case Fatality Rate IPD 5 papers CFR: 0-35% CAP: Case Fatality Rate 15 papers. CFR 0-35%. Older age was the most important factor. Meningitis 18 studies. CFR 8-58%. Case Fatality Rate Distribution of serotypes. LAC Source: SIREVA reports Distribution of serotypes by countries and syndrome. LAC Source: SIREVA reports Distribution of serotypes by age groups Source: SIREVA reports Distribution of serotypes by syndrome Source: SIREVA reports Distribution of serotypes before and after vaccination. 5 yrs. Brazil Universal vaccination from 2010 Source: SIREVA reports Distribution of serotypes before and after vaccination. 5 yrs. Uruguay Universal vaccination from 2008 Source: SIREVA reports Conclusions There is paucity of data on incidence of IPD and pneumococcal diseases in LAC. Incidence studies are concentrated in Brazil and Chile. Studies used a variety of study designs and methods, limiting the ability to make any comparisons between the data. SIREVA data suggest changes in % of PCV serotypes in older children and adults after universal vaccination in children 5 yrs. Analysis of data are still on going Recommendations Need to strengthen surveillance for older children and adults to better understand the burden of disease. Conduct population based studies using more sensitive methods. Urine test?. For SIREVA data, obtaining specific disaggregated data on serotypes not contained in conjugated vaccines also would help. Acknowledgements Fernando de la Hoz Restrepo Universidad Nacional de Colombia Carlos Castaneda Universidad Nacional de Colombia Marcelo Kuperman Instituto Balseiro Eitan Berezin Santa Casa de São Paulo School of Medicine Angela Gentile Hospital de Niños Dr. Ricardo Gutiérrez Maria Hortal Programa de Desarrollo de las Ciencias Básicas Rosanna Lagos Centro para Vacunas en Desarrollo-Chile Cristiana Nascimento-Carvalho Federal University of Bahia School of Medicine Ciro A. de Quadros Sabin Vaccine Institute Ana F. Carvalho Sabin Vaccine Institute Lúcia Helena de Oliveira Pan American Health Organization Jennifer D. Loo Centers for Disease Control and Prevention Jennifer R. Verani Centers for Disease Control and Prevention Cristina R. Garcia International Vaccine Access Center
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