WJV  Vol.2 No.3 , August 2012
Characteristics of Invasive Pneumococcal Disease in Young Children before the Introduction of PCV13 in Lombardy, Italy
Abstract: An active surveillance system of invasive pneumococcal disease (IPD) started on September 2008 in Lombardy, Italy, among children aged less than 60 months and admitted for suspicion of IPD at emergency room of ten hospitals. This study examined the clinical characteristics of children enrolled up to December 2010, that is just before the introduction in this region of voluntary mass vaccination, free of charge, based on the 13-valent pneumococcal conjugate vaccine (PCV13). Two hundred fifty one children were suspected and 20 were confirmed as having IPD, based on isolation of Streptococcus pneumoniae from blood. Thirty-nine percent of children had received pneumococcal vaccination previously, and full vaccination with three doses of hepta-valent vaccine (PCV7) had been administered in 21.4%. Co-morbidity conditions were more frequent in children with confirmed than non-confirmed IPD (10.0% vs. 0.9%). The annual incidence rate of confirmed IPD was 28.6/100,000 (binomial 95% confidence interval, 18.6 to 44.1/100,000. Among confirmed IPD children, 11 exhibited pneumonia with bacteremia, 6 bacteremia without focus, 2 septicemia, 1 meningitis. Seventeen (85%) isolates were identified, and nine serotypes. The overall serotype coverage was 29.4% for PCV7 and 82.3% for PCV13. In non-vaccinated children, the coverage of PCV7 and PCV13 was 41.7% and 75.0%, respectively. Non-vaccine serotypes 12B, 15C, and 23B were identified. Antibiotic resistance was found in seven children, that is against penicillin (serotype 15C), erythromycin (14, 19A, 19F), tetracycline (15C, 19F), chloramphenicol (23F), and trimethoprim-sulfamethoxazole (23F). Two of these children had received antibiotic therapy (penicillin or azithromycin) during the week before hospital admission. The coverage vaccination rate in Lombardy was relatively low during the surveillance period and serotype distribution widespread. The introduction of PCV13 and a mass vaccination program in young children might impact positively on invasive pneumococcal disease in this surveilled population. Active long-term surveillance of non-vaccine serotypes is required wordwide.
Cite this paper: G. Radaelli, E. Riva and M. Giovannini, "Characteristics of Invasive Pneumococcal Disease in Young Children before the Introduction of PCV13 in Lombardy, Italy," World Journal of Vaccines, Vol. 2 No. 3, 2012, pp. 143-150. doi: 10.4236/wjv.2012.23018.

[1]   World Health Organization (WHO), “Position Paper on Pneumococcal Vaccines,” The Weekly Epidemiological Record, Vol. 14, No. 87, 2012, pp. 129-144.

[2]   M. C. Thigpen, C. G. Whitney, N. E. Messonnier, E. R. Zell, R. Lynfield, J. L. Hadler, L. H. Harrison, M. M. Farley, A. Reingold, N. M. Bennett, A. S. Craig, W. Schaffner, A. Thomas, M. M. Lewis, E. Scallan, A. Schuchat and Emerging Infections Programs Network, “Bacterial Meningitis in the United States, 1998-2007,” The New England Journal of Medicine, Vol. 361, No. 21, 2011, pp. 2016-2025. doi:10.1056/NEJMoa1005384

[3]   M. Deloria-Knoll, K. L. O’Brien, E. Henkle, E. Lee, J. P. Watt, N. McCall and P. Mangtani, “Global Literature Review of Haemophilus influenzae Type b and Streptococcus pneumoniae Invasive Disease among Children Less than Five Years of Age, 1980-2005,” 2009.

[4]   K. L. O’Brien, L. J. Wolfson, J. P. Watt, E. Henkle, M. Deloria-Knoll, N. McCall, E. Lee, K. Mulholland, O. S. Levine, T. Cherian and Hib and Pneumococcal Global Burden of Disease Study Team, “Burden of Disease Caused by Streptococcus pneumoniae in Children Younger than 5 Years: Global Estimates,” Lancet, Vol. 374, No. 9693, 2009, pp. 893-902. doi:10.1016/S0140-6736(09)61204-6

[5]   T. Pilishvili, C. Lexau, M. M. Farley, J. Hadler, L. H. Harrison, N. M. Bennett, A. Reingold, A. Thomas, W. Schaffner, AS Craig, PJ Smith, BW Beall, CG Whitney, M. R. Moore and Active Bacterial Core Surveillance/ Emerging Infections Program Network, “Sustained Reductions in Invasive Pneumococcal Disease in the Era of Conjugate Vaccine,” Journal of Infectious Diseases, Vol. 201, No. 1, 2010, pp. 32-41. doi:10.1086/648593

[6]   D. J. Isaacman, E. D. McIntosh and R. R. Reinert, “Burden of Invasive Pneumococcal Disease and Serotype Distribution among Streptococcus pneumoniae Isolates in Young Children in Europe: Impact of the 7-Valent Pneumococcal Conjugate Vaccine and Considerations for Future Conjugate Vaccines,” International Journal of Infectious Diseases, Vol. 14, No. 3, 2010, pp. e197-e209.

[7]   M. Pulido and F. Sorvillo, “Declining Invasive Pneumococcal Disease Mortality in the United States, 1990-2005,” Vaccine, Vol. 28, No. 4, 2010, pp. 889-892. doi:10.1016/j.vaccine.2009.10.121

[8]   E. C. Dinleyici and Z. A. Yargic, “Current Knowledge regarding the Investigational 13-Valent Pneumococcal Conjugate Vaccine,” Expert Review of Vaccines, Vol. 8, No. 9, 2009, pp. 977-986. doi:10.1586/erv.09.68

[9]   L. A. Hicks, L. H. Harrison, B. Flannery, J. L. Hadler, W. Schaffner, A. S. Craig, D. Jackson, A. Thomas, B. Beall, R. Lynfield, A. Reingold, M. M. Farley and C. G. Whitney, “Incidence of Pneumococcal Disease Due to Non-Pneumococcal Conjugate Vaccine (PCV7) Serotypes in the United States during the Era of Widespread PCV7 Vaccination, 1998-2004,” Journal of Infectious Diseases, Vol. 196, No. 9, 2007, pp. 1346-1354. doi:10.1086/521626

[10]   E. D. McIntosh and R. R. Reinert, “Global Prevailing and Emerging Pediatric Pneumococcal Serotypes,” Expert Review of Vaccines, Vol. 10, No. 1, 2011, pp. 109-129. doi:10.1586/erv.10.145

[11]   F. D’Ancona, S. Salmaso, A. Barale, D. Boccia, P. L. Lopalco, C. Rizzo, M. Monaco, M. Massari, V. Demicheli, A. Pantosti and Italian PNC-Euro Working Group, “Incidence of Vaccine Preventable Pneumococcal Invasive Infections and Blood Culture Practices in Italy,” Vaccine, Vol. 23, No. 19, 2005, pp. 2494-2500. doi:10.1016/j.vaccine.2004.10.037

[12]   L. Tarallo, F. Tancredi, G. Schito, A. Marchese, A. Bella and Italian Pneumonet Group, “Active Surveillance of Streptococcus pneumoniae Bacteremia in Italian Children,” Vaccine, Vol. 24, No. 47-48, 2006, pp. 6938-6943. doi:10.1016/j.vaccine.2006.05.012

[13]   S. Tardivo, A. Poli, T. Zerman, R. D’Elia, G. Chiamenti, E. Torri, A. Bonetti, E. Pedevilla, P. Pancheri, P. Lubrano, R. Savastano, G. Meneghelli and G. Romano, “Invasive Pneumococcal Infections in Infants up to Three Years of Age: Results of a Longitudinal Surveillance in North-East Italy,” Annali di Igiene, Vol. 21, No. 6, 2009, pp. 619-628.

[14]   P. Durando, P. Crovari, F. Ansaldi, L. Sticchi, C. Sticchi, V. Turello, L. Marensi, R. Giacchino, A. Timitilli, R. Carloni, C. Azzari, G. Icardi and Collaborative Group for Pneumococcal Vaccination in Liguria, “Universal Childhood Immunisation against Streptococcus pneumoniae: the Five-Year Experience of Liguria Region, Italy,” Vaccine, Vol. 27, No. 25-26, 2009, pp. 3459-3462. doi:10.1016/j.vaccine.2009.01.052

[15]   A. Marchese, S. Esposito, E. Coppo, G. A. Rossi, A. Tozzi, M. Romano, L. Da Dalt, G. C. Schito and N. Principi, “Detection of Streptococcus Pneumoniae and Identification of Pneumococcal Serotypes by Real-Time Polymerase Chain Reaction Using Blood Samples from Italian children ≤ 5 Years of Age with Community-Acquired Pneumonia.,” Microbial Drug Resistance, Vol. 17, No. 3, 2011, pp. 419-424. doi:10.1089/mdr.2011.0031

[16]   C. Azzari, M. Moriondo, M. Cortimiglia, C. Valleriani, C. Canessa, G. Indolfi, S. Ricci, F. Nieddu, M. de Martino, M. Resti and the Italian Group for the Study of Invasive Pneumococcal Disease, “Potential Serotype Coverage of Three Pneumococcal Conjugate Vaccines against Invasive Pneumococcal Infection in Italian children,” Vaccine, Vol. 30, No. 16, 2012, pp. 2701-2705. doi:10.1016/j.vaccine.2011.12.008

[17]   Italian Ministry of Health, “National Vaccine Plan 2012-2014,” ?Piano Nazionale Prevenzione Vaccinale 2012-2014, in Italian?, 2012.

[18]   L. J. Baraff, J. W. Bass, G. R. Fleisher, J. O. Klein, G. H. McCracken Jr., K. R. Powell and D. L. Schriger, “Practice Guideline for the Management of Infants and Children 0 to 36 Months of Age with Fever without Source; Agency for Health Care Policy and Research,” Annals of Emergency Medicine, Vol. 22, No. 7, 1993, pp. 1198-2210. doi:10.1016/S0196-0644(05)80991-6

[19]   Centers for Disease Control and Prevention, “Case Definitions for Infectious Conditions under Public Health Surveillance,” MMWR Recommendations and Reports, Vol. 46, No. 10, 1997, pp. 1-55.

[20]   Centers for Disease Control and Prevention, “Manual for the Surveillance of Vaccine-Preventable Diseases. Chapter 11: Pneumococcal,” 4th Edition, Centers for Disease Control and Prevention, Atlanta, 2008.

[21]   World Health Organization, “International Classification of Diseases,” 9th Revision, World Health Organization, Geneva, 1980.

[22]   Clinical and Laboratory Standards Institute, “Performance Standards for Antimicrobial Susceptibility Testing; Nineteenth Informational Supplement; M100-S19,” Clinical and Laboratory Standards Institute, Wayne, 2009.

[23]   S. I. Aguiar, M. J. Brito, J. Gon?alo-Marques, J. Melo-Cristino and M. Ramirez, “Serotypes 1, 7F and 19A Became the Leading Causes of Pediatric Invasive Pneumococcal Infections in Portugal after 7 Years of Heptavalent Conjugate Vaccine Use,” Vaccine, Vol. 28, No. 32, 2010, pp. 5167-5173. doi:10.1016/j.vaccine.2010.06.008

[24]   B. A. Kendall, K. K. Dascomb, R. R. Mehta, E. O. Mason, K. Ampofo, D. J. Pombo, A. T. Pavia and C. L. Byington, “Streptococcus pneumoniae Serotypes in Utah Adults at the End of the PCV7 Era,” Vaccine, Vol. 29, No. 4, 2011, pp. 9123-9126. doi:10.1016/j.vaccine.2011.10.009

[25]   Istituto Superiore di Sanità, ICONA Working Group, “ICONA 2008: National Vaccination Coverage Survey among Children and Adolescents,” 2009.

[26]   Centers for Disease Control and Prevention, “Active Bacterial Core Surveillance Report, Emerging Infections Program Network, Streptococcus pneumoniae, 2010,” 2012.

[27]   Istituto Superiore di Sanità, “Data on Surveillance Data of Invasive Bacterial Diseases—Updating February 24, 2012,” [Dati di Sorveglianza Delle Malattie Batteriche Invasive— Aggiornati al 24 Febbraio 2012, in Italian]. 2010.

[28]   K. K. Hsu, K. M. Shea, A. E. Stevenson, S. I. Pelton and Massachusetts Department of Public Health, “Changing Serotypes Causing Childhood Invasive Pneumococcal Disease: Massachusetts, 2001-2007,” The Pediatric Infectious Disease Journal, Vol. 29, No. 4, 2010, pp. 289-293.

[29]   Y. C. Hsieh, P. Y. Lin, C. H. Chiu, Y. C. Huang, K. Y. Chang, C. H. Liao, N. C. Chiu, Y. C. Chuang, P. Y .Chen, S. C. Chang, J. W. Liu, M. Y. Yen, J. H. Wang, C. Y. Liu and T. Y. Lin, “National Survey of Invasive Pneumococcal Diseases in Taiwan under Partial PCV7 Vaccination in 2007: Emergence of Serotype 19A with High Invasive Potential,” Vaccine, Vol. 27, No. 40, 2009, pp. 5513-5518. doi:10.1016/j.vaccine.2009.06.091

[30]   S. L. Kaplan, W. J. Barson, P. L. Lin, S. H. Stovall, J. S. Bradley, T. Q. Tan, J. A. Hoffman, L. B. Givner and E. O. Mason Jr., “Serotype 19A Is the Most Common Serotype Causing Invasive Pneumococcal Infections in Children,” Pediatrics, Vol. 125, No. 3, 2010, pp. 429-436. doi:10.1542/peds.2008-1702

[31]   C. G. Grijalva and S. I. Pelton, “A Second-Generation Pneumococcal Conjugate Vaccine for Prevention of Pneumococcal Diseases in Children,” Current Opinion in Pediatrics, Vol. 23, No. 1, 2011, pp. 98-104. doi:10.1097/MOP.0b013e328341d1f5

[32]   T. Avni, N. Mansur, L. Leibovici and M. Paul, “PCR Using Blood for Diagnosis of Invasive Pneumococcal Disease: Systematic Review and Meta-Analysis,” Journal of Clinical Microbiology, Vol. 48, No. 2, 2010, pp. 489-496. doi:10.1128/JCM.01636-09