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Clin Infect Dis. 2016 Jan 15;62(2):139-47. doi: 10.1093/cid/civ803. Epub 2015 Sep 9.

Invasive Pneumococcal Disease Among Immunocompromised Persons: Implications for Vaccination Programs.

Author information

1
Mount Sinai Hospital.
2
Mount Sinai Hospital University of Toronto.
3
Mackenzie Health, Richmond Hill Southlake Regional Health Centre, Newmarket.
4
National Microbiology Laboratory, Winnipeg.
5
University of Toronto University Health Network.
6
St. Joseph's Health Centre.
7
University of Toronto Rouge Valley Health System.
8
University of Toronto St. Joseph's Health Centre.
9
The Scarborough Hospital.
10
University of Toronto St. Michael's Hospital.
11
Toronto East General Hospital.
12
University of Toronto Halton Healthcare Services, Oakville.
13
Alberta Provincial Public Health Laboratory, Edmonton.
14
University of Toronto The Hospital for Sick Children, Toronto, Canada.

Abstract

BACKGROUND:

In 2012/2013, a single dose of 13-valent pneumococcal conjugate vaccine (PCV13) was recommended for immunocompromised adults in the United States and Canada. To assess the potential benefits of this recommendation, we assessed the serotype-specific burden of invasive pneumococcal disease (IPD) among immunocompromised individuals.

METHODS:

From 1995 to 2012, population-based surveillance for IPD was conducted in Metropolitan Toronto and Peel Region, Canada. Disease incidence and case fatality were measured in immunocompromised populations over time, and the contribution of different serotypes determined.

RESULTS:

Overall, 2115/7604 (28%) episodes of IPD occurred in immunocompromised persons. IPD incidence was 12-fold higher (95% confidence interval [CI], 8.7-15) in immunocompromised compared to immunocompetent persons; the case fatality rate was elevated in both younger (odds ratio [OR] 1.8) and older (OR 1.3) adults. Use of immunosuppressive medications was associated with a 2.1-2.7 fold increase in the risk of IPD. Five years after PPV23 program implementation, IPD incidence had declined significantly in immunocompromised adults (IRR 0.57, 95% CI, .40-.82). Ten years after pediatric PCV7 authorization, IPD due to PCV7 serotypes had decreased by 90% (95% CI, 77%-96%) in immunocompromised persons of all ages. In 2011/2012, 37% of isolates causing IPD in immunocompromised persons were PCV13 serotypes and 27% were PPV23/not PCV13 serotypes.

CONCLUSIONS:

Immunocompromised individuals comprised 28% of IPD. Both PPV23 and herd immunity from pediatric PCV7 were associated with reductions in IPD in immunocompromised populations. PCV13 vaccination of immunocompromised adults may substantially reduce the residual burden until herd immunity from pediatric PCV13 is fully established.

KEYWORDS:

IPD; immunocompromised; pneumococcal vaccine

PMID:
26354970
DOI:
10.1093/cid/civ803
[Indexed for MEDLINE]

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