Prevention of Antibiotic-Nonsusceptible Invasive Pneumococcal Disease With the 13-Valent Pneumococcal Conjugate Vaccine.

BACKGROUND Antibiotic-nonsusceptible invasive pneumococcal disease (IPD) decreased substantially after the US introduction of the pediatric 7-valent pneumococcal conjugate vaccine (PCV7) in 2000. However, rates of antibiotic-nonsusceptible non-PCV7-type IPD increased during 2004-2009. In 2010, the 13-valent pneumococcal conjugate vaccine (PCV13) replaced PCV7. We assessed the impact of PCV13 on antibiotic-nonsusceptible IPD rates. METHODS We defined IPD as pneumococcal isolation from a normally sterile site in a resident from 10 US surveillance sites. Antibiotic-nonsusceptible isolates were those intermediate or resistant to ≥1 antibiotic classes according to 2012 Clinical and Laboratory Standards Institute breakpoints. We examined rates of antibiotic nonsusceptibility and estimated cases prevented between observed cases of antibiotic-nonsusceptible IPD and cases that would have occurred if PCV13 had not been introduced. RESULTS From 2009 to 2013, rates of antibiotic-nonsusceptible IPD caused by serotypes included in PCV13 but not in PCV7 decreased from 6.5 to 0.5 per 100 000 in children aged <5 years and from 4.4 to 1.4 per 100 000 in adults aged ≥65 years. During 2010-2013, we estimated that 1636 and 1327 cases of antibiotic-nonsusceptible IPD caused by serotypes included in PCV13 but not PCV7 were prevented among children aged <5 years (-97% difference) and among adults aged ≥65 years (-64% difference), respectively. Although we observed small increases in antibiotic-nonsusceptible IPD caused by non-PCV13 serotypes, no non-PCV13 serotype dominated among antibiotic-nonsusceptible strains. CONCLUSIONS After PCV13 introduction, antibiotic-nonsusceptible IPD decreased in multiple age groups. Continued surveillance is needed to monitor trends of nonvaccine serotypes. Pneumococcal conjugate vaccines are important tools in the approach to combat antibiotic resistance.

[1]  S. Schrag,et al.  US outpatient antibiotic prescribing variation according to geography, patient population, and provider specialty in 2011. , 2015, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[2]  W. Schaffner,et al.  Effect of use of 13-valent pneumococcal conjugate vaccine in children on invasive pneumococcal disease in children and adults in the USA: analysis of multisite, population-based surveillance. , 2015, The Lancet. Infectious diseases.

[3]  S. Richter,et al.  Changes in Pneumococcal Serotypes and Antimicrobial Resistance after Introduction of the 13-Valent Conjugate Vaccine in the United States , 2014, Antimicrobial Agents and Chemotherapy.

[4]  Á. Gentile.  [U.S. hospitalizations for pneumonia after a decade of pneumococcal vaccination]. , 2014, Archivos argentinos de pediatria.

[5]  Anthony S Fauci,et al.  The perpetual challenge of antimicrobial resistance. , 2014, JAMA.

[6]  M. Hackel,et al.  Serotype prevalence and antibiotic resistance in Streptococcus pneumoniae clinical isolates among global populations. , 2013, Vaccine.

[7]  C. Whitney.  More evidence for use of pneumococcal conjugate vaccines , 2013, The Lancet.

[8]  W. Schaffner,et al.  Prevention of antibiotic-nonsusceptible Streptococcus pneumoniae with conjugate vaccines. , 2012, The Journal of infectious diseases.

[9]  R. Aungst,et al.  Healthy People 2020 , 2013, American Journal of Kidney Diseases.

[10]  M. Haber,et al.  Outpatient antibiotic prescribing and nonsusceptible Streptococcus pneumoniae in the United States, 1996-2003. , 2011, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[11]  C. Whitney,et al.  Shifting genetic structure of invasive serotype 19A pneumococci in the United States. , 2011, The Journal of infectious diseases.

[12]  T. Lieu,et al.  Healthcare utilization and cost of pneumococcal disease in the United States. , 2011, Vaccine.

[13]  D. Monnet,et al.  Increase in Pneumococcus Macrolide Resistance, USA , 2010, Emerging Infectious Diseases.

[14]  W. Schaffner,et al.  Sustained reductions in invasive pneumococcal disease in the era of conjugate vaccine. , 2010, The Journal of infectious diseases.

[15]  T. Cherian,et al.  Burden of disease caused by Streptococcus pneumoniae in children younger than 5 years: global estimates , 2009, The Lancet.

[16]  T. Marrie,et al.  Serotypes and antimicrobial susceptibilities of invasive Streptococcus pneumoniae pre- and post-seven valent pneumococcal conjugate vaccine introduction in Alberta, Canada, 2000-2006. , 2009, Vaccine.

[17]  R. Dagan.  Impact of pneumococcal conjugate vaccine on infections caused by antibiotic-resistant Streptococcus pneumoniae. , 2009, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[18]  J. Treanor,et al.  Differential effects of pneumococcal vaccines against serotypes 6A and 6C. , 2008, The Journal of infectious diseases.

[19]  W. Schaffner,et al.  Population snapshot of emergent Streptococcus pneumoniae serotype 19A in the United States, 2005. , 2008, The Journal of infectious diseases.

[20]  Clinical,et al.  Performance Standards for Antimicrobial Susceptibility Testing; Eighteenth Informational Supplement , 2008 .

[21]  Susan S. Huang,et al.  Emergence of 19A as Virulent and Multidrug Resistant Pneumococcus in Massachusetts Following Universal Immunization of Infants With Pneumococcal Conjugate Vaccine , 2007, The Pediatric infectious disease journal.

[22]  J. Burke,et al.  Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America Guidelines for Developing an Institutional Program to Enhance Antimicrobial Stewardship , 2007 .

[23]  S. Madhi,et al.  The impact of a 9-valent pneumococcal conjugate vaccine on the public health burden of pneumonia in HIV-infected and -uninfected children. , 2005, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[24]  S. Obaro,et al.  Efficacy of nine-valent pneumococcal conjugate vaccine against pneumonia and invasive pneumococcal disease in The Gambia: randomised, double-blind, placebo-controlled trial , 2005, The Lancet.

[25]  W. Thompson,et al.  The Burden of Community-Acquired Pneumonia in Seniors: Results of a Population-Based Study , 2004, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[26]  E. Lewis,et al.  Effectiveness of heptavalent pneumococcal conjugate vaccine in children younger than five years of age for prevention of pneumonia , 2002, The Pediatric infectious disease journal.

[27]  R J Little,et al.  Causal effects in clinical and epidemiological studies via potential outcomes: concepts and analytical approaches. , 2000, Annual review of public health.

[28]  A. Schuchat,et al.  Mortality from invasive pneumococcal pneumonia in the era of antibiotic resistance, 1995-1997. , 2000, American journal of public health.