Persistent dysexecutive syndrome after pneumococcal meningitis complicated by recurrent ischemic strokes:A case report

Meningitis is a possible complication of pneumococcal infection concerning acute otitis media and sinusitis.It might compromise cognitive function,both for the infection itself and the vascular events that sometimes follow the acute phase.CASE SUMMARY Here we describe the case of a 32-year-old female patient admitted to the emergency room due to extensive pneumococcal meningitis as a consequence of sinus outbreak.She presented with extensive laminar ischemic damage in the acute phase,resulting in severe cognitive and behavioural impairment.Four years of follow-up,through neuropsychological assessments and neuroradiological investigations,demonstrated the presence of subsequent vascular events,3 months and 2 years after onset.CONCLUSION The case is discussed in light of scientific knowledge of the long-term outcomes of this pathology in order to potentially improve diagnosis and promote better outcomes.

Effectiveness of 7-valent pneumococcal conjugate vaccine: A meta-analysis of post-marketing studies

AIM:To investigate the 7-valent pneumococcalconjugate vaccine(PCV7)effectiveness.METHODS:A systematic literature review of studies which evaluated the effectiveness of PCV7 vaccine was performed searching the keyword"heptavalent pneumococcal conjugate vaccine"in PubM ed and Scopus until March 16,2013.The selection of potential eligible articles was done by two researchers independently on the basis of abstract and title and only post-marketing studies were included in the systematic review.Data extraction was carried out by two researchers with respect to invasive pneumococcal diseases due to both all and vaccine serotypes in pre-vaccine and postvaccine periods in children less than 5 years.Results of studies which were considered suitable for meta-analysis were combined by means of relative risk(RR)with95%CI.Vaccine effectiveness was calculated as(1-RR)×100.Heterogeneity was assessed by I2 and a random effects model was used to combine data in the case of heterogeneity.RevM an 5 was used to pool data.RESULTS:On the whole,757 eligible papers were identified from the literature search in PubM ed and Scopus.Of them,62 were finally considered in the systematic review and 38 were included in the meta-analysis.In all post-marketing studies included in the systematic review the incidence of invasive pneumococcal diseases due to vaccine serotypes declined significantly with the exception of few studies showing stability or a slight,but not significant,increase.Furthermore most of studies highlighted also a reduction in the incidence of invasive pneumococcal diseases due to all serotypes.With regards to meta-analysis,a random effects model was used to combine data because of the high heterogeneity.Data combination showed that the effectiveness of PCV7in reducing invasive pneumococcal diseases due to vaccine serotypes and to all serotypes was 84%(95%CI:74%-90%)and 53%(95%CI:46%-59%)respectively.These results are confirmatory with respect to the efficacy of PCV7 against invasive pneumococcal diseasesdue to vaccine serotypes.CONCLUSION:PCV7 implementation determines a significant decrease of invasive pneumococcal diseases.

Impact of the Pneumococcal Heptavalent Conjugated Vaccine on <i>Streptococcus pneumoniae</i>Nasopharyngeal Carriage and Antimicrobial Susceptibility in Children 2-5-Year-Old in Beijing, China

Streptococcus pneumoniae is a primary cause of illness and death among children younger than 5 years in China. The heptavalent pneumococcal conjugate vaccine (PCV7) was the only conjugated vaccine (PCV) available in China from 2008 to 2013. This randomized, controlled, open-label study conducted at 46 Beijing clinics involved 3281 healthy 2-5-year-old Chinese children, randomized 1:1 to receive one dose of the S. pneumoniae heptavalent conjugated vaccine (PCV7) (n = 1643) or Haemophilus influenzae type b conjugate vaccine (Hib) (n = 1638). The main objective of this study was to investigate the impact of PCV7 against that of Hib vaccination in the nasopharyngeal S. pneumoniae colonization in healthy Chinese children. Nasopharyngeal (NP) samples for culture, serotyping and antimicrobial susceptibility testing were collected before vaccination and at Day 60 and 180 post-vaccination. A total 3281 children were enrolled in the study. Demographic characteristics were similar among both study groups: 1641 children received PCV7. Before immunization, S. pneumoniae was isolated in 338 and 360 children in the PCV7 (144 PCV7 isolates) and Hib groups (145 PCV7 isolates), respectively. At Day 180, PCV7 vaccination was more effective than Hib vaccination in reduction NP carriage (20.2% [P = 0.052]) and new acquisition (19.0% [P = 0.066]). When reductions in NP carriage and new acquisition of PCV7 VT plus 6A was analyzed, reduction in the PCV7 vaccinated group achieved statistical significance (P = 0.034 and P = 0.042 versus Hib, respectively). NP carriage of NVT increased in both groups (P = 0.305 between study groups at Day 180). PCV7 decreased NP carriage of non-susceptible VT to amoxicillin (P = 0.000), ceftriaxone (P = 0.047) and MDR (P = 0.024) versus Hib. PCV7 vaccination in Chinese children 2 to 5 years of age was more effective than vaccination with Hib in the reduction of S. pneumoniae nasopharyngeal carriage, new acquisition and non-susceptible isolates.

Safety of a 13-Valent Pneumococcal Conjugate Vaccine in Elderly Adults Previously Immunized with a 23-Valent Pneumococcal Polysaccharide Vaccine: An Open-Label Trial

An open-label, multicenter study was conducted to describe the safety of the 13-valent pneumococcal conjugate vaccine (PCV13) in 1049 individuals aged ≥68 years, who had previously been immunized with the unconjugated 23-valent pneumococcal polysaccharide vaccine (PPSV23). In addition, the safety profile of PCV13 in this study was compared, in a post-hoc descriptive analysis, to that observed in other elderly populations, who had received PCV13 or PPSV23 as part of other completed studies. Local (56.6%) and systemic reactions (58.4%) were very common, but were mainly mild, and of short duration (mean: 1.3 - 4.6 days). There were no related serious adverse events (AEs) within 1 month after PCV13. 123 days after PCV13 and 94 days after a nonstudy influenza vaccine, a case of transient Guillain-Barré syndrome occurred, which the investigator assessed as possibly related to the vaccination. Reactogenicity observed in this study population was generally similar to that of other elderly study populations with PPSV23-preimmunized adults, and with PPSV23-naive adults. Reactogenicity was less common in this study than that observed in PPSV23-preimmunized adults who were revaccinated with PPSV23 rather than a subsequent dose of PCV13. There were no related serious AEs reported after PCV13 and PPSV23 in these comparator studies. Conclusion: PCV13 may be administered safely to older adults previously immunized with PPSV23. (ClinicalTrials. gov Identifier: NCT00500266)

Pneumococcal disease in adult solid organ transplantation recipients

In solid organ transplant(SOT) recipients, Streptococcus pneumoniae can cause substantial morbidityand mortality ranging from non-invasive to invasive diseases, including pneumonia, bacteremia, and meningitis, with a risk of invasive pneumococcal disease 12 times higher than that observed in non-immunocompromised patients. Moreover, pneumococcal infection has been related to graft dysfunction. Several factors have been involved in the risk of pneumococcal disease in SOT recipients, such as type of transplant, time since transplantation, influenza activity, and nasopharyngeal colonization. Pneumococcal vaccination is recommended for all SOT recipients with 23-valent pneumococcal polysaccharides vaccine. Although immunological rate response is appropriate, it is lower than in the rest of the population, decreases with time, and its clinical efficacy is variable. Booster strategy with 7-valent pneumococcal conjugate vaccine has not shown benefit in this population. Despite its relevance, there are few studies focused on invasive pneumococcal disease in SOT recipients. Further studies addressing clinical, microbiological, and epidemiological data of pneumococcal disease in the transplant setting as well as new strategies for improving the protection of SOT recipients are warranted.

Characteristics of Invasive Pneumococcal Disease in Young Children before the Introduction of PCV13 in Lombardy, Italy

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.

Potential carrier priming effect in Australian infants after 7-valent pneumococcal conjugate vaccine introduction

AIM:To investigate evidence of clinical protection in infants after one dose of 7-valent pneumococcal conjugate vaccine(7vPCV) owing to carrier priming.METHODS:Using Australian National Notifiable Diseases Surveillance System data,we conducted a descriptive analysis of cases of vaccine type invasive pneumococcal disease(VT-IPD) during "catch-up" years,when 7vPCV was carrier primed by prior administration of DTPa vaccine.We compared the number of VT-IPD cases occurring 2-9 wk after a single dose of 7vPCV(carrier primed),with those < 2 wk post vaccination,when no protection from 7vPCV was expected yet.Further comparison was conducted to compare the occurrence of VT-IPD cases vs non-VT-IPD cases after a single carrier-primed dose of 7vPCV.RESULTS:We found four VT-IPD cases occurring <2 wk after one carrier primed dose of 7vPCV while only one case occurred 2-9 wk later.Upon further comparison with the non-VT-IPD cases that occurred after one carrier primed dose of 7vPCV,two cases were detected within 2 wk,whereas seven occurred within2-9 wk later;suggesting a substantial level of protection from VT-IPD occurring from 2 wk after carrier-primed dose of 7vPCV.CONCLUSION:This data suggest that infants may benefit from just one dose of 7vPCV,likely through enhanced immunity from carrier priming effect.If this is proven,an adjusted 2-dose schedule(where the first dose of PCV is not given until after DTPa) may be sufficient and more cost-effective.

Impact of Seven Valent Pneumococcal Conjugate Vaccine on Nasopharyngeal Carriage in Young Children in Okinawa, Japan

In Japan, the heptavalent pneumococcal conjugate vaccine (PCV7) became available in February 2010 and was subsidized by the national funding system from May 2011 in Okinawa, after which it was incorporated into the national immunization practice (NIP) in April 2013 using a 3 + 1 schedule for all infants. We conducted an annual survey in 2012 to determine the effect of PCV7 on nasopharyngeal colonization by pneumococcal serotypes and to analyze the risk factors for colonization in infants. Nasopharyngeal swabs for pneumococcal isolation and serotyping were obtained from infant 2 to 22 months of age before and after PCV7 immunization among 4 clinics in Okinawa, Japan. Between January 2012 and December 2012, nasopharyngeal swabs for bacterial cultures were obtained among 782 infants aged 2 to 22 months old and demographic data was obtained among 725 participant infants. Among the 725 evaluable infants, 193 pneumococcal strains were detected in 180 infants for an overall nasopharyngeal carriage of 24.8%. The main capsular serotypes isolated were 6C (16.1%), 19A (12.4%) and 15B (9.8%). Carriage of PCV7 serotypes accounted for 21.8% (42/193). The result of multivariate data analysis showed the pneumococcal carriage rate of non-PCV7 serotypes was significantly (P < 0.001) high in infant with siblings and daycare attendance. On the other hand, the result of multivariate data analysis showed that carriage rate of PCV7 serotype had only significantly high risk in infant with siblings and did not have a significant risk dependent on age and daycare attendance. Carriage PCV7 serotypes increased in the presence of other siblings, while PCV7 vaccination was shown to eliminate daycare attendance as a risk. The results of this study demonstrates that PCV7 vaccination decrease the overall nasopharyngeal carriage of PCV7 serotypes in vaccinated children including children at risk such as children attending day-care centers.

Effect of 7 and 13-Valent Pneumococcal Conjugate Vaccines Different Number of Doses for Pneumonia Control in 2008 and 2010 Birth Cohort Children

The 7-valent pneumococcal conjugate vaccine (PCV) was introduced in Uruguay in March 2008. In April 2010, it was replaced by PCV13. Surveillance of both vaccines was performed on hospitalized children with consolidated pneumonia. The effect of different number of vaccine doses was evaluated in 2008 and 2010 birth cohorts vaccinated with PCV7 and PCV13 respectively. The study aims to estimate the effects of PCV7 and PCV13 different number of doses on consolidated pneumonia, through the study of hospitalized children from 2008 and 2010 birth cohorts. Vaccination records of every child were available providing precise vaccination data;therefore a new approach was used to estimate PCVs effect. Incidence rate was calculated for each year of the study and for the different number of vaccine doses used each year. Exposure was calculated as person per year and rate ratio values determined the decrease of consolidated pneumonias. This decrease in percentage was estimated as the difference between the incidence with no vaccine and the incidence of every one of the doses. Incidence rate ratio revealed significant values for the three vaccine doses of PCVs for both cohorts. Upon comparing incidences, significant reduction percentages of consolidated pneumonia admissions were found. The reduction percentage of consolidated pneumonia for fully vaccinated (3 doses) patients was 69.3% and 84.6 % for PCV7 and PCV13, respectively. These results confirm that PCV7 and PCV13 are highly effective for reducing pediatric hospitalizations due to consolidated pneumonia, as reported by other national publications and demonstrated by international researchers.

Persistence of Pleural Effusions and Empyemas after Pneumococcal Conjugate Vaccine Implementation in Uruguay

In Uruguay a post pneumococcal conjugate vaccine implementation surveillance of hospitalized children with pneumonia showed an increase of complicated pneumonias, while uncomplicated pneumonias decreased. Out of 151 pleural effusions, 62 were empyemas requiring drainage, the rest of cases were treated with antibiotics with a favorable outcome. Patient’s vaccinated status varied. Pneumococcal etiology was poorly documented. The few identified sero-types were 1 and 3, a fact that urges PCV13 use for their control.

Isolation and characterization of human polyreactive pneumococcal polysaccharide antibodies

Natural antibodies serve as the body’s first line of defense against pneumococcal challenge. Polyreactive human pneumococcal polysaccharide IgG antibodies have not been extensively studied. We analyzed human polyreactive antibodies that bind multiple pneumococcal polysaccharides, including PPS14 and PPS23F. These antibodies were isolated from single pneumococcal polysaccharide specific B cells allowing for the analysis of human immunoglobulins with natively paired variable regions. Although isolated individually, these antibodies demonstrated similar characteristics. Most antibodies possessed a variable light chain with a CDR3 length made up of nine amino acids and relatively high number of flexible amino acids in combined VH/VL. While these antibodies were polyreactive and structurally alike, kinetic analysis revealed unique KD values. Variable chains are responsible for antigen recognition whereas antibody fine specificity is affected by isotype structure. To investigate the contribution of the constant region of these isotypes and their effect on antibody avidity to pneumococcal polysaccharide, the polyreactive variable regions were expressed as IgG1 or IgG2 and subjected to kinetic analysis. The IgG1 antibodies uniformly had a stronger avidity to PPS14 and PPS23F compared to IgG2. To further document the importance of the constant region in antibody avidity and fine specificity, analysis of antibody F(ab)’2 fragment binding to PPS14 and PPS23F resulted in similar KD values. These studies suggest that antigen recognition by polyreactive antibodies is determined by a conserved variable light chain CDR3 length and longer, more flexible variable heavy CDR3s when compared to pneumococcal polysaccha-ride-specific sequences while differences in specific avidities are modulated by antibody isotype.

Associations between Pneumococcal Vaccinationand Adverse Outcomes in Patients with Suspected Acute Coronary Syndrome

Background: Although pneumococcal vaccination prevents the most common pneumonia of bacterial etiology, its associations without comes of Acute Coronary Syndrome (ACS) are unknown. Methods: This is a prospective cohort study of 1436 patients hospitalized with suspected ACS/non-ST elevation MI that were eligible for pneumococcal vaccination. Primary outcomes were death and subsequent Myocardial Infarction (MI) within 6-months of the index hospitalization. We used Cox regression to assess associations between pneumococcal vaccination and outcomes, adjusting for influenza vaccination and relevant clinical covariates. We also utilized propensity scores to adjust for potential confounding. Results: Overall, 937 (65.3%) patients received pneumococcal vaccination either prior to or during the index hospitalization. Unvaccinated patients had higher mortality (26.9% vs. 7.9%;p < 0.001) and non-significantly higher frequency of subsequent MI (7.4% vs. 3.5%;p = 0.06).Compared to patients who did not receive either pneumococcal or influenza vaccination, the unadjusted Hazard Ratio (HR) of death was significantly lower for those who received only pneumococcal vaccination (HR = 0.13;95% CI 0.07 - 0.23) or both vaccinations (HR = 0.66, 95% CI 0.47 - 0.92), and significantly higher for patients who received only influenza vaccination (HR = 1.88, 95% CI 1.33 - 2.64). The corresponding HRs and 95% CIs for subsequent MI were 0.58 (95% CI 0.32 - 1.03) for pneumococcal vaccination only, 0.41 (95% CI 0.21 - 0.80) for both vaccinations and 0.97 (95% CI 0.48 - 1.95) for influenza vaccination alone. These remained unchanged after covariate or propensity score adjustment. Conclusions: Among patients hospitalized with suspected ACS, pneumococcal vaccination, with or without influenza vaccination, was associated with significantly lower risk of mortality within 6 months.

Safety and Tolerability of a 13-Valent Pneumococcal Conjugated Vaccine Distributed in the Public Immunization Program of the Municipality of Campos dos Goytacazes, Rio de Janeiro, Brazil

From september to december, 2010, we have assessed the frequency and occurrence of adverse events to Pneumo-coccal conjugated 13-valent vaccine (PCV-13) in the Public vaccination program of the municipality of Campos dos Goytacazes, State of Rio de Janeiro, the unique city in Brazil that has introduced this vaccine in it’s immunization schedule. This study analyzed 1001 toddlers who have received PCV-13 at 3, 5 and 7 months and a booster dose at 12 months. We observed a total of 514 local and systemic events in 303 subjects (30.2% of 1001 infants). The most reported systemic events were irritability (18.8%) and fever or = 38.5°C (8.8%), loss of appetite (8.4%). Erythema (11.2%) and local pain (9.4%) were the most reported local events. Other events reported were diarrhea (6.2%), increased sleep (5.1%), edema and induration (4.8%), decreased sleep (4.3%), vomiting (1.4%), eruption (1.2%) urticaria (0.8%), prurience (0.8%), lymphadenopathy (0.2%) and hypersensitivity reaction (0.2%). There wasn’t any reported case of convulsion or Hospital admission. When stratified by each dose, irritability (systemic) and erythema (local) were the most common events reported at the first and fourth dose, although fever < 38.5°C (systemic) and pain (local) were the most common at second and third doses. Results were close to those encountered in product monograph. In our study, PCV-13 was secure in pneumococcal disease prevention and well tolerated.

Pneumococcal infection transmission between family members with congenital asplenia: A case report

BACKGROUND Asplenia,the lack of a spleen,can be congenital and increases susceptibility to severe infections caused by encapsulated bacteria,such as Streptococcus pneumoniae(S.pneumoniae).We report two cases of severe pneumococcal infection in two asplenic family members living in the same household.CASE SUMMARY Patient 1,a 38-year-old man with a history of congenital hepatitis B infection and hypospadias,was brought to our emergency department with complaints of cyanosis,cough,and edema of his limbs.He was clinically diagnosed as hyposplenic with overwhelming pneumococcal sepsis.He was admitted to the intensive care unit and was administered antibiotics and catecholaminergic therapy but died 2 h after admission.Patient 2,a 63-year-old woman with a history of type 2 diabetes,was brought to our emergency department one month after admission of Patient 1.She was diagnosed as asplenic with overwhelming pneumococcal sepsis.History-taking revealed that she was the mother of Patient 1 and the two had lived in the same household.She was admitted to the intensive care unit and was rapidly provided antibiotics and catecholaminergic intervention but died one day after admission.CONCLUSION Pneumococcal bacteremia caused by virulent S.pneumoniae may be transmitted within households.All residents of households where individuals with pneumococcal bacteremia are living should be educated about the risk of transmissibility.Family members of patients with congenital asplenia/hyposplenia,all family members should be examined to assess their splenic function.

Increased Susceptibility to Pneumococcal Disease in Sjogren Syndrome Patients

Susceptibility to pneumococcal infections in Sj?gren syndrome (SS)―an autoimmune inflammatory disease―patients is not well known, although these patients frequently develop respiratory diseases. The relative risk of developing pneumococcal disease in SS patients versus diabetes mellitus type 2 (DM-2) patients, matched by age, gender, and length of enrolment was studied. From January 1998 to September 2013 the records of Donostia University Hospital were analyzed, which among other patient’s data includes: number and type of hospital admissions and number and type of laboratory determinations. Streptococcus pneumoniae isolates of the same serotype causing recurrent infections were characterized by PFGE. The study comprised 127 patients in the SS group (69 primary and 58 secondary) and 127 in the DM-2 group as control. In 12 SS patients, (9.4%) 22 pneumococcal disease episodes were detected. Two patients (1.6%) with a single episode each one were observed among DM-2 patients, p = 0.01, RR for SS patients 6 (95% CI 1.4 to 26.3). No differences could be demonstrated between the two groups of patients in infections caused by Staphylococcus aureus or Streptococcus agalactiae. Most pneumococcal serotypes in SS patients belonged to the 13-valent (50%) and 23-valent (75%) anti-pneumococcal vaccine. SS patients are associated with and increased risk of suffering from pneumococcal disease. Vaccination should be considered in this group of patients.

Influenza and pneumococcal vaccination coverage and associated factors in patients hospitalized with acute exacerbations of COPD in China:Findings from real-world data

Background:Influenza and pneumococcal vaccination are a priority in patients with chronic obstructive pulmonary disease(COPD).However,limited information is available on vaccination coverage among patients with acute exacerbations of COPD(AECOPD)in China.This study aimed to determine the rates and associated factors of influenza and pneumococcal vaccination in patients hospitalized with AECOPD.Methods:Baseline data from a national,multicenter,hospital-based study that included adult inpatients with AECOPD between 2017 and 2021 were analyzed.The outcomes of interest were the influenza vaccination in the past year and the pneumococcal vaccination in the past 5 years.To ensure national representativeness,rates were weighted according to the distribution of hospital levels and types enrolled in this study.Multivariable Poisson regression based on mixed-effects models were used to determine the associated factors.The independent variables included the region and hospital features where the participants were located,sociodemographic characteristics(age,sex,rural/urban residence,education,etc.),and clinical indicators(COPD disease history,lung function parameters,comorbidities,etc.).The treatment profiles of the vaccinated and unvaccinated participants were compared.Results:Of 6949 eligible participants,the weighted rates of influenza/pneumococcal,influenza,and pneumococcal vaccination were 2.72%(95%confidence interval[CI]:2.34%-3.10%),2.09%(95%CI:1.76%-2.43%),and 1.25%(95%CI:0.99%-1.51%),respectively.In multivariable models,age≥60 years(60-69 years,odds ratio[OR]:1.90,95%CI:1.11-3.25;≥80 years,OR:2.00,95%CI:1.06-3.78),geographical regions(Northern China relative to Eastern China,OR:5.09,95%CI:1.96-13.21),urban residence(OR:1.69,95%CI:1.07-2.66),a higher education level(junior high school,OR:1.77,95%CI:1.21-2.58;senior high school or above,OR:2.61,95%CI:1.69-4.03),former smoking(OR:1.79,95%CI:1.15-2.79),and regular inhaled medication treatment(OR:3.28,95%CI:2.29-4.70)were positively associated with vaccination.Patients who had experienced severe exacerbations in the past year were less likely to be vaccinated(OR:0.65,95%CI:0.45-0.96).Compared with unvaccinated participants,vaccinated participants adhered better to pharmacological and non-pharmacological treatment.Conclusions:Influenza and pneumococcal vaccination coverage are extremely low.Urgent measures are necessary to increase vaccination coverage among inpatients with AECOPD in China.

13-Valent pneumococcal conjugate vaccines vaccination innovative strategy in Weifang City,China:a case study

The World Health Organization(WHO)prioritizes pneumococcal disease as a vaccine-preventable disease and recommends the inclusion of pneumococcal conjugate vaccines(PCV)in national immunization programs worldwide.However,PCV is not included in the National Immunization Program in China and has low vaccination coverage due to its high cost.To address this,Weifang City implemented an innovative strategy for a 13-valent PCV(PCV13)on June 1,2021.This strategy aimed to provide one dose of PCV13 free of charge for children aged 6 months to 2 years in registered households and to adopt a commercial insurance model with one dose of PCV13 free of charge in 2023 for children over 2 years old.The Health Commission of Weifang and other departments conducted a comprehensive investigation and considered various factors,such as vaccine efectiveness,safety,accessibility,vaccine price,and immunization schedules,for eligible children(under 5 years old).Stakeholder opinions were also solicited before implementing the policy.The Commission negotiated with various vaccine manufacturers to maximize its negotiating power and reduce vaccine prices.The implementation plan was introduced under the Healthy Weifang Strategy.Following the implementation of this strategy,the full course of vaccination coverage increased signifcantly from 0.67 to 6.59%.However,vaccination coverage is still lower than that in developed countries.Weifang’s PCV13 vaccination innovative strategy is the frst of its kind in Chinese mainland and is an active pilot of non-immunization program vaccination strategies.To further promote PCV13 vaccination,Weifang City should continue to implement this strategy and explore appropriate fnancing channels.Regions with higher levels of economic development can innovate the implementation of vaccine programs,broaden fnancing channels,improve accessibility to vaccination services,and advocate for more localities to incorporate PCV13 into locally expanded immunization programs or people-benefting projects.A monitoring and evaluation system should also be established to evaluate implementation efects.

Accelerating Pneumococcal Conjugate Vaccine introductions in Indonesia:key learnings from 2017 to 2022

Despite high pneumococcal disease and economic burden in Indonesia and interest to introduce pneumococcal conjugate vaccine (PCV), there were challenges in establishing a comprehensive strategy to accelerate and enable the introduction in country in the early 2010s. Starting in 2017, Clinton Health Access Initiative and partners supported the government of Indonesia with evidence-based decision-making and implementation support for introducing PCV into the routine immunization program. Indonesia has since accelerated PCV roll out, with nationwide reach achieved in 2022. On the path to PCV introduction, several challenges were observed that impacted decision making on whether and on how to optimally roll out PCV, resulting in significant introduction delays;including (1) a complex country context with a devolved government structure, fragmented domestic funding streams, and an imminent transition out of major immunization donor (Gavi) support;(2) strong preference to use domestically sourced products, with limited experience accessing global pooled procurement mechanism including for vaccines;and (3) concerns around programmatic feasibility and sustainability. This case study documents key insights into the challenges experienced and how those were systematically addressed to accelerate new vaccine introduction in Indonesia, with support from local and global stakeholders over time. The learnings would be beneficial for other countries yet to introduce critical new vaccines, in particular those with similar archetype as Indonesia e.g., middle-income countries with domestic manufacturing capacity and/or countries recently transitioning out of Gavi support.

Adherence to Advisory Committee on Immunization Practices in diabetes mellitus patients in Saudi Arabia:A multicenter retrospective study

BACKGROUND Patients with diabetes mellitus(DM)are predisposed to an increased risk of infection signifying the importance of vaccination to protect against its potentially severe complications.The Centers for Disease Control and Prevention/Advisory Committee on Immunization Practices(CDC/ACIP)issued immunization recommendations to protect this patient population.AIM To assess the adherence of patients with DM to the CDC/ACIP immunization recommendations in Saudi Arabia and to identify the factors associated with the vaccine adherence rate.METHODS An observational retrospective study conducted in 2023 was used to collect data on the vaccination records from 13 diabetes care centers in Saudi Arabia with 1000 eligible patients in phase I with data collected through chart review and 709 patients in phase II through online survey.RESULTS Among participants,10.01%(n=71)had never received any vaccine,while 85.89%(n=609)received at least one dose of the coronavirus disease 2019(COVID-19)vaccine,and 34.83%(n=247)had received the annual influenza vaccine.Only 2.96%(n=21),2.11%(n=15),and 1.12%(n=8)received herpes zoster,tetanus,diphtheria,and pertussis(Tdap),and human papillomavirus(HPV)vaccines,respectively.For patients with DM in Saudi Arabia,the rate of vaccination for annual influenza and COVID-19 vaccines was higher compared to other vaccinations such as herpes zoster,Tdap,pneumococcal,and HPV.Factors such as vaccine recommendations provided by family physicians or specialists,site of care,income level,DM-related hospitalization history,residency site,hemoglobin A1c(HbA1c)level,and health sector type can significantly influence the vaccination rate in patients with DM.Among non-vaccinated patients with DM,the most reported barriers were lack of knowledge and fear of side effects.This signifies the need for large-scale research in this area to identify additional factors that might facilitate adherence to CDC/ACIP vaccine recommendations in patients with DM.CONCLUSION In Saudi Arabia,patients with DM showed higher vaccination rates for annual influenza and COVID-19 vaccines compared to other vaccinations such as herpes zoster,Tdap,pneumococcal,and HPV.Factors such as vaccine recommendations provided by family physicians or specialists,the site of care,income level,DM-related hospitalization history,residency site,HbA1c level,and health sector type can significantly influence the vaccination rate in patients with DM.

Novel polysaccharide-protein conjugates provide an immunogenic 13-valent pneumococcal conjugate vaccine for S.pneumoniae

Pneumonia remains the single leading cause of childhood death worldwide.Despite the commercial availability of multiple pneumococcal conjugate vaccines(PCVs),high dosage cost and supply shortages prevent PCV delivery to much of the developing world.The current work presents high-yield pneumococcal conjugates that are immunogenic in animals and suitable for use in human vaccine development.The 13-valent pneumococcal conjugate vaccine(PCV-13)investigated in this research incorporated serotypes 1,3,4,5,6A,6B,7F,9V,14,18C,19A,19F,and 23F.Pneumococcal polysaccharides(PnPSs)and CRM197 carrier protein were produced and purified in-house,and used to prepare PnPS-CRM conjugates using unique,cyanide-free,in vacuo glycation conjugation methods.In vitro characterization confirmed the generation of higher molecular weight PnPS-CRM conjugates low in free protein.In vivo animal studies were performed to compare PnuVax's PCV-13 to the commercially available PCV-13,Prevnar®13(Pfizer,USA).A boost dose was provided to all groups post-dose 1 at t?14 days.Post-dose 2 results at t?28 days showed that all 13 serotypes in PnuVax's PCV-13 were boostable.Per serotype IgG GMCs demonstrated that PnuVax's PCV-13 is immunogenic for all 13 serotypes,with 10 of the 13 serotypes statistically the same or higher than Prevnar®13 post-dose 2.As a result,the novel polysaccharideprotein conjugates developed in this work are highly promising for use in human PCV development.The in vacuo conjugation technique applied in this work could also be readily adapted to develop many other conjugate vaccines.