uk public health aspects impact of the pneumococcal vaccination programme l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
UK public health aspects: Impact of the pneumococcal vaccination programme PowerPoint Presentation
Download Presentation
UK public health aspects: Impact of the pneumococcal vaccination programme

Loading in 2 Seconds...

play fullscreen
1 / 33

UK public health aspects: Impact of the pneumococcal vaccination programme - PowerPoint PPT Presentation


  • 104 Views
  • Uploaded on

UK public health aspects: Impact of the pneumococcal vaccination programme. Jim McMenamin, Eisin Shakir, Arlene Reynolds Health Protection Scotland. What am I going to cover?. Background re pneumonia

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'UK public health aspects: Impact of the pneumococcal vaccination programme' - ulmer


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
uk public health aspects impact of the pneumococcal vaccination programme

UK public health aspects: Impact of the pneumococcal vaccination programme

Jim McMenamin, Eisin Shakir, Arlene Reynolds

Health Protection Scotland

what am i going to cover
What am I going to cover?
  • Background re pneumonia
  • Background re clinical spectrum of pneumococcal disease & why burden so difficult to quantify
  • Invasive Pneumococcal Disease (IPD)
  • Impact of the Pneumococcal Conjugate Vaccination Programme on IPD
slide3
Pneumonia may be deadly, especially for children
  • More than 1.5 million children die from pneumonia each year.1
  • Pneumonia is the leading cause of death among children under 5 years of age worldwide.2
  • One child dies from pneumonia every 20 seconds.  That’s 4,300 young lives lost every day.3

Most children who die of pneumonia live in developing countries

  • An estimated 98% of children who die of pneumonia live in developing countries.4
  • For every 1 child that dies of pneumonia in a developed country, more than 2000 children die of pneumonia in developing countries.4

1. Black R, Cousens S, Johnson H, et al. Global, regional, and national causes of child mortality in 2008: a systemic analysis. Lancet. 2010; 375:1969-87.

2. World Health Organization. World Health Statistics 2009. Geneva: World Health Organization; 2008. http://www.who.int/whosis/whostat/EN_WHS09_Full.pdf. Accessed September 6, 2009.

3. Black R, Cousens S, Johnson H, et al. Global, regional, and national causes of child mortality in 2008: a systemic analysis. Lancet. 2010; 375:1969-87.

4. World Health Organization. World health statistics 2006. Geneva: World Health Organization; 2006. http://www.who.int/whosis/whostat2006.pdf. Accessed September 6, 2009.

slide4
What is pneumonia?
  • Pneumonia is an infection of the lungs
  • It causes cough and fever and can make breathing difficult.
  • Severe pneumonia can be deadly.

Who is most at risk?

  • In developing countries, children under 5 and especially under 2 years of age are at risk, especially in the poorest communities.1
  • In developed countries the elderly are often at highest risk.
  • Tobacco smoke and other indoor air pollution can also increase chances of being more susceptible to pneumonia.2,3
  • Some children and adults are at greater risk because they have other illnesses, such as HIV/AIDS.4,5 People with HIV stand a much greater chance of dying from pneumonia than those who do not have HIV.6
  • Children who are poorly nourished can also have weakened immune systems, putting them at higher risk of contracting pneumonia.7

1 UNICEF/WHO. Pneumonia: the Forgotten Killer of Children. Geneva: 2006. 2 U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2006. 3 Smith KR, Sarnet JM, Romieu I, Bruce N. Indoor air pollution in developing countries and acute lower respiratory infections in children. Thorax. 2000; 55:518-32. 4 SA Madhi, L Kuwanda, C Cutland and KP Klugman. The impact of a 9-valent pneumococcal conjugate vaccine on the public health burden of pneumonia in HIV-infected and –uninfected children. Clin Infect Dis. 2005; 40:1511-1518. 5 Feldman C. Pneumonia associated with HIV infection. Curr Opin Infect Dis. 2005; 18(2):165-70.

6 SA Madhi, K Petersen, A Madhi, A Wasas and KP Klugman. Impact of human immunodeficiency virus type I on the disease spectrum of Streptococcus pneumoniae in South African children. Pedatr Infect Dis J. 2000; 19:1131-1147.

7 Fishman SM, Caulfield LE, de Onix M, Blossner M, Hyder AA, Mullany L, et al,. Childhood and maternal underweight. In: Ezzati M, et al WHO; 2004.

slide5
What causes pneumonia?
  • Many organisms can cause pneumonia.
  • Globally, bacteria such as Hib and pneumococcus are estimated to cause more than 50% of pneumonia deaths in children under 5 years of age.8
  • Viruses and fungi can also cause pneumonia infections.9

How is pneumonia diagnosed?

  • In resource-poor settings, pneumonia can be diagnosed by the symptoms it causes, including cough, fever and difficulty or fast breathing.10
  • Chest X-rays and laboratory tests can also diagnose pneumonia, but these tools are often unavailable in developing countries, especially in remote rural communities, making it more difficult to diagnose and treat pneumonia.

How is pneumonia prevented and treated?

  • Some pneumonia can often be prevented with vaccines against Hib and pneumococcus.11
  • Measles and pertussis (whooping cough) infections can result in pneumonia complications, so vaccinating against these childhood diseases can prevent some pneumonia cases.12
  • Inexpensive antibiotics can effectively treat pneumonia at the community level.13

8 In settings where these vaccines are not used. O’Brien K, Wolfoson L, Watt J, et al,. Burden of Disease caused by Streptococcus pneumoniae in children younger than 5 years: global estimates. Lancet. 2009; 374:893-902. 9 Mandell Lionel A, Wunderink Richard. Pneumonia. In: Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, Loscalzo J. Harrison’s Principles of Internal Medicine (17th ed.) New York: McGraw-Hill, 2008. http://www.accessmedicine.com. Accessed September 7, 2009. 10 World Health Organization and UNICEF. Integrated Managemenet of Childhood Illness Handbook. Geneva: World Health Organization, 2005. 11 Mahdi SA, Levine OS, Hajjeh R, Mansoor OD, Cherian T. Vaccines to prevent pneumonia and improve child survival. Bull World Health Organ. 2008; 86:365-72. 12 Mahdi SA, Levine OS, Hajjeh R, Mansoor OD, Cherian T. Vaccines to prevent pneumonia and improve child survival. Bull World Health Organ. 2008; 86:365-72. 13 Sazawal S, Black RE, Pneumonia Case Management Trials Group. Effect of pneumonia case management on mortality in neonates, infants, and pre-school children: a meta-analysis of community based trials. Lancet Infect Dis. 2003; 3:547-56.

slide8

Summary of pneumonia vaccine effectiveness with either conjugate Hib or PCV

Source WHO Health Bulletin 2008; CI, confidence interval;DBRCT, double-blind randomized controlled trial; HibCV, Haemophilus influenzae type b conjugate vaccine; PCV, pneumococcal conjugate vaccine; USA, United States of America; VAR, vaccine attributable reduction per 1000 child years of observation; VE, vaccine efficacy based against radiologically confirmed pneumonia by use of per-protocol analysis when available.a All the studies evaluating PCV, as well as the HibCV studies in Indonesia and Bangladesh, used the WHO recommendations for interpreting and reporting on chest radiographs.23b The study from Colombia used an algorithm score which included radiologically confirmed pneumonia as one of the criteria.

invasive pneumococcal disease ipd
Invasive Pneumococcal Disease (IPD)
  • Identification of S. pneumoniae in a normally sterile site by culture;
  • Or, identification of S. pneumoniae DNA in CSF or pleural fluid by dual target PCR;
  • (Or, reference laboratory identification of S. pneumoniae capsular polysaccharide and serotype-specific antigen in CSF or pleural fluid.)
slide11

Methods

  • Link enhanced surveillance (SPIDER) data to death (GRO) and hospitalisation (SMR01 based on specified pneumococcal ICD9 & ICD10 codes) data
    • Death, prior medical conditions and clinical manifestations
    • DoB, sex, surname, forename, CHI number
  • Retrospective linkage 2002 to 2006
  • Complete dataset pre PCV-7and post PPV-23
    • microbiology, clinical presentation, comorbidity, mortality
  • Highly specialised and labour intensive exercise
background
Background

Previous data linkage study

“IPD in Scotland, 1999-2001: Use of record linkage to explore associations between patients and disease in relation to future vaccination policy”

Kyaw et al, CID 2003:37

what did 1999 2001 linkage tell us
What did 1999-2001 linkage tell us?
  • 11.0 cases per 100,000 1999-2001
  • 1582 (92.2%) cases linked
  • <5yrs meningitis more likely
  • 5+yrs pneumonia and septicaemia more likely
  • Incidence high in those with underlying medical conditions
results 2008

3515 IPD cases sent to ISD

3393 IPD cases

Results 2008

122 duplicates

409 unable to link

2984 (88%) linked to GRO

incidence
Incidence

Mean incidence 13.4 per 100,000

Highest in < 1year (52.6) 1 year (48.1) and >65s (34.8)

impact of pcv
Impact of PCV
  • IPD = Isolation of Streptococcus pneumoniae from blood, CSF or other sterile site (e.g. joint fluid)
  • Notifiable disease (but only since new PH act)
  • SPIDER surveillance scheme since 1999
  • Two vaccines available
    • PPV-23 in 65+ years (& At risk groups)
    • PCV-7 (2006) then PCV-13 (2010) in childhood immunisation schedule data
  • Enhanced surveillance since 2006
  • Impact of vaccination?
the pneumococcal conjugate vaccine pcv prevenar
The pneumococcal conjugate vaccine (PCV) Prevenar™

The 7 valent conjugate vaccine (Prevenar 7™) contains 7 serotypes:

14, 18C, 19F, 23F, 4, 6B , 9V

The 13 valent conjugate vaccine (Prevenar 13 ™) contains an additional 6 serotypes:

1, 3, 5, 6A, 7F, 19A

Over 90 serotypes of Streptococcus pneumoniae exist

childhood immunisation uptake rates pcv7
Childhood immunisation uptake rates: PCV7

Source: http://www.isdscotland.org/isd/1987.html

childhood immunisation uptake rates pcv720
Childhood immunisation uptake rates: PCV7

Source: http://www.isdscotland.org/isd/1987.html

seasonality of ipd
Seasonality of IPD

Infections peak in winter coinciding with flu season

slide22

Introduction of PPV-23

Introduction of PCV

  • Approx 600-700 cases per year,
  • Approx 11-15 cases per 100,000 population
  • PPV-23 introduced in 2003, PCV-7 introduced in September 2006
ipd under 5 s 1999 2009
IPD Under 5’s 1999-2009
  • Large reduction in numbers in vaccination age group in 2007
  • Slight increase in 2008/2009
  • Most common serogroups: 7F (6 cases) and 3 (4 cases)
ipd by age group 1999 2009
IPD by age group 1999-2009
  • Dramatic reduction in incidence on targeted age group
pcv7 types trends with age group
PCV7 Types trends with age group

Reduction in coverage particularly in target age group

12% of cases in 2009 caused by PCV-7 serotypes

conclusion re pcv vaccination impact
Conclusion re PCV vaccination Impact
  • Dramatic effect of PCV7 in reducing IPD
    • Under 5’s + indirectly leading to reduction in other age groups (change in carriage…)
    • Overall reduction in total IPD cases
    • Some evidence of serogroup replacement
    • Too early to say what impact will be of PCV13 but likely further reduction in under 5’s (?will there also be an indirect effect on other age groups)
what did i cover
What did I cover?
  • Background re pneumonia
  • Background re clinical spectrum of pneumococcal disease & why burden so difficult to quantify
  • Invasive Pneumococcal Disease (IPD)
  • Impact of the Pneumococcal Conjugate Vaccination Programme on IPD