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Background: The 23-valent pneumococcal polysaccharide vaccine (PPV23) is recommended for UK older adults, but how age moderates effectiveness is unclear. Methods: Three annual cohorts of primary-care patients aged≥65y from the Clinical Practice Research Datalink selected from 2003–5 created a natural experiment (n = 324,804), reflecting the staged introduction of the vaccine. The outcome was symptoms consistent with community-acquired pneumococcal pneumonia (CAP) requiring antibiotics or hospitalisation. We used the prior event rate ratio (PERR) approach to address bias from unmeasured confounders. Results: Vaccinated patients had higher rates of CAP in the year before vaccination than their controls, indicating the potential for confounding bias. After adjustment for confounding using the prior event rate ratio (PERR) method, PPV23 was estimated to be effective against CAP for two years after vaccination in all age sub-groups with hazard ratios (95% confidence intervals) of 0.86 (0.80 to 0.93), 0.74 (0.65 to 0.85) and 0.65 (0.57 to 0.74) in patients aged 65–74, 75–79 and 80+ respectively in the 2005 cohort. Age moderated the effect of vaccination with predicted risk reductions of 8% at 65y and 29% at 80y. Conclusions: PPV23 is moderately effective at reducing CAP among UK patients aged≥65y, in the two years after vaccination. Vaccine effectiveness is maintained, and may increase, in the oldest age groups in step with increasing susceptibility to CAP. [ABSTRACT FROM AUTHOR]

Background: Changes over the last 5 years (2013-18) in the serotypes implicated in adult pneumococcal pneumonia and the patient groups associated with vaccine-type disease are largely unknown.Methods: We conducted a population-based prospective cohort study of adults admitted to two large university hospitals with community-acquired pneumonia (CAP) between September 2013 and August 2018. Pneumococcal serotypes were identified using a novel 24-valent urinary monoclonal antibody assay and from blood cultures. Trends in incidence rates were compared against national invasive pneumococcal disease (IPD) data. Persons at risk of vaccine-type pneumonia (pneumococcal conjugate vaccine (PCV)13 and pneumococcal polysaccharide vaccine (PPV)23) were determined from multivariate analyses.Findings: Of 2934 adults hospitalised with CAP, 1075 (36.6%) had pneumococcal pneumonia. The annual incidence of pneumococcal pneumonia increased from 32.2 to 48.2 per 100 000 population (2013-18), predominantly due to increases in PCV13non7-serotype and non-vaccine type (NVT)-serotype pneumonia (annual incidence rate ratio 1.12, 95% CI 1.04 to 1.21 and 1.19, 95% CI 1.10 to 1.28, respectively). Incidence trends were broadly similar to IPD data. PCV13non7 (56.9% serotype 3) and PPV23non13 (44.1% serotype 8) serotypes were identified in 349 (32.5%) and 431 (40.1%) patients with pneumococcal pneumonia, respectively. PCV13-serotype pneumonia (dominated by serotype 3) was more likely in patients in the UK pneumococcal vaccination clinical risk group (adjusted OR (aOR) 1.73, 95% CI 1.31 to 2.28) while PPV23-serotype pneumonia was more likely in patients outside the clinical risk group (aOR 1.54, 95% CI 1.13 to 2.10).Interpretation: The incidence of pneumococcal CAP is increasing, predominantly due to NVT serotypes and serotype 3. PPV23-serotype pneumonia is more likely in adults outside currently identified clinical risk groups. [ABSTRACT FROM AUTHOR]

Background: In October 2017, the United Kingdom Joint Committee on Vaccination and Immunisation (JCVI) recommended removal of one primary dose of the 13-valent pneumococcal conjugate vaccine (PCV13) from the existing 2+1 schedule (2, 4, 12 months). We conducted a mathematical modelling study to investigate the potential impact of a 1+1 (3, 12 month) schedule on invasive pneumococcal disease (IPD) and pneumococcal community-acquired pneumonia (CAP). Our results and those from a 1+1 immunogenicity study formed the key evidence reviewed by JCVI.Methods and Findings: We developed age-structured, dynamic, deterministic models of pneumococcal transmission in England and Wales to describe the impact on IPD of 7-valent PCV (PCV7; introduced in 2006) and PCV13 (introduced in 2010). Key transmission and vaccine parameters were estimated by fitting to carriage data from 2001/2002 and post-PCV IPD data to 2015, using vaccine coverage, mixing patterns between ages, and population data. We considered various models to investigate potential reasons for the rapid increase in non-PCV13 (non-vaccine serotype [NVT]) IPD cases since 2014. After searching a large parameter space, 500 parameter sets were identified with a likelihood statistically close to the maximum and these used to predict future cases (median, prediction range from 500 parameter sets). Our findings indicated that the emergence of individual NVTs with higher virulence resulting from ongoing replacement was likely responsible; the NVT increase was predicted to plateau from 2020. Long-term simulation results suggest that changing to a 1+1 schedule would have little overall impact, as the small increase in vaccine-type IPD would be offset by a reduction in NVT IPD. Our results were robust to changes in vaccine assumptions in a sensitivity analysis. Under the base case scenario, a change to a 1+1 schedule in 2018 was predicted to produce 31 (6, 76) additional IPD cases over five years and 83 (-10, 242) additional pneumococcal-CAP cases, with together 8 (-2, 24) additional deaths, none in children under 15 years. Long-term continuation with the 2+1 schedule, or changing to a 1+1, was predicted to sustain current reductions in IPD cases in under-64-year-olds, but cases in 65+-year-olds would continue to increase because of the effects of an aging population. Limitations of our model include difficulty in fitting to past trends in NVT IPD in some age groups and inherent uncertainty about future NVT behaviour, sparse data for defining the mixing matrix in 65+-year-olds, and the methodological challenge of defining uncertainty on predictions.Conclusions: Our findings suggest that, with the current mature status of the PCV programme in England and Wales, removing one primary dose in the first year of life would have little impact on IPD or pneumococcal CAP cases or associated deaths at any age. A reduction in the number of priming doses would improve programmatic efficiency and facilitate the introduction of new vaccines by reducing the number of coadministered vaccines given at 2 and 4 months of age in the current UK schedule. Our findings should not be applied to other settings with different pneumococcal epidemiology or with immature programmes and poor herd immunity. [ABSTRACT FROM AUTHOR]

Background: Pneumococcal conjugate vaccines (PCVs) have substantially reduced the incidence of invasive pneumococcal disease caused by vaccine serotypes; however, replacement disease with non-PCV serotypes remains a concern. We describe the population effect of the seven-valent and 13-valent PCVs (PCV7 and PCV13) on invasive pneumococcal disease in England and Wales.Methods: Using national invasive pneumococcal disease surveillance data for 2016/17, we compared incidence rate ratios (IRRs) against pre-PCV13 (2008/09-2009/10) and pre-PCV7 (2000/01-2005/06) baselines. We also estimated the number of invasive pneumococcal disease cases prevented since the introduction of PCVs.Findings: In 2016/17, overall invasive pneumococcal disease incidence (9·87 cases per 100 000; 5450 cases) across all age groups was 37% lower (IRR 0·63, 95% CI 0·60-0·65) than pre-PCV7 incidence (14·79 per 100 000; 8167 cases) and 7% lower (0·93; 0·89-0·97) than pre-PCV13 incidence (10·13 per 100 000; 5595 cases). By 2016/17, PCV7-type invasive pneumococcal disease incidence across all age groups had decreased by 97% (0·24 per 100 000; 0·03, 0·02-0·04) compared with the pre-PCV7 period, whereas additional PCV13-type invasive pneumococcal disease decreased by 64% (1·66 per 100 000; 0·36, 0·32-0·40) since the introduction of PCV13. Invasive pneumococcal disease incidence due to non-PCV13 serotypes doubled (7·97 per 100 000; 1·97, 1·86-2·09) since the introduction of PCV7, and accelerated since 2013/14-especially serotypes 8, 12F, and 9N, which were responsible for more than 40% of invasive pneumococcal disease cases by 2016/17. Invasive pneumococcal disease incidence in children younger than 5 years remained stable since 2013/14, with nearly all replacement disease occurring in adults. We estimated 38 366 invasive pneumococcal disease cases were prevented in the 11 years since the introduction of PCV7.Interpretation: Both PCV7 and PCV13 have had a major effect in reducing the burden of invasive pneumococcal disease in England and Wales; however, rapid increases in some non-PCV13 serotypes are compromising the benefits of the programme.Funding: Public Health England. [ABSTRACT FROM AUTHOR]

Abstract: Significant changes have recently been made to the UK childhood immunisation schedule to introduce protection against pneumococcal disease and improve protection against Haemophilus influenzae type b and meningococcus group C. From September 2008, a new primary immunisation programme against cervical cancer will be introduced for adolescent girls. In the future, we may see the introduction of licensed rotavirus vaccines against infant gastroenteritis and broader use of varicella, influenza and hepatitis B vaccines. Higher valency meningococcal conjugate vaccines, vaccines against meningococcus group B disease and vaccines against respiratory viruses are available, approaching licensure or in clinical trials in children in the UK. [Copyright &y& Elsevier]

The objectives of this study were to describe a series of children with invasive pneumococcal disease (IPD), evaluate the proportion with defined risks for pneumococcal disease and to assess the impact of the new UK pneumococcal vaccination schedule in preventing IPD. We conducted a review of case notes of children aged 0–16 years admitted to a large district general/teaching hospital in East Birmingham from September 1993-December 2004. Fifty-six children were identified with IPD; case notes were available for 54 children (55 episodes). The median age at diagnosis was 15 months (inter-quartile range 8–37.5 months). Only 14 (26%) had pre-existing risk factors for developing IPD. A significant age difference was found between those with co-existing risk factors and those without (median 37 months vs. 11 months; P<0.05). Twenty-one (72%) of the cases where serotypes were known, had serotypes covered by the 7-valent conjugate pneumococcal vaccine and 28 (97%) covered by the polysaccharide vaccine. However most would not have benefited from the polysaccharide vaccine since 32 (59%) were less than 2 years of age at the time of the episode of IPD. Targeted pneumococcal vaccination might prevent less than 26% of cases of IPD in children. Incorporating the conjugate pneumococcal vaccine into the universal vaccination program might prevent 70% of IPD in children. [ABSTRACT FROM AUTHOR]

Presents a question and answer advisory related to the administration of medical care in Great Britain. Treatment for a patient with coronary infarct and mild angina; Association of lobar pneumonia and jaundice; Effect of progestogen on pregnant women.

Determines whether antimicrobials increase the carriage rate of penicillin resistant pneumococcal pneumonia in children. Research design; Setting; Outcome measures; Factors associated with carriage of penicillin resistant pneumococci. INSET: Key messages (highlights of the study)..

The article discusses an outbreak of Streptococcus pneumonia serotype 1 pneumonia at several schools in Great Britain. It is stressed that health care personnel and teachers should report suspected outbreaks of serotype 1 pnuemococcal disease early. Details of several cases of pneumococcal pneumonia reported in young school children in 2006 are provided. It is noted that none of the infected children had previously received the 7-valent pneumococcal conjugate vaccine. The need for the introduction of a vaccine that includes serotype 1 antigen is discussed.

Pneumonia is the sixth largest cause of death in the UK. It is usually caused by Streptococcus pneumoniae, which healthy individuals can carry in their nose without symptoms of disease. Antimicrobial resistance further increases mortality and morbidity associated with pneumococcal infection, although few studies have analysed resistance in naturally circulating pneumococcal isolates in adult populations. Here, we report on the resistome and associated mobile genetic elements within circulating pneumococcus isolated from adult volunteers enrolled in the experimental human pneumococcal colonisation (EHPC) research program at the Liverpool School of Tropical Medicine, UK. Pneumococcal isolates collected from 30 healthy asymptomatic adults who had volunteered to take part in clinical research were screened for antibiotic susceptibility to erythromycin and tetracycline, and whole-genome sequenced. The genetic context of resistance to one or both antibiotics in four isolates was characterised bioinformatically, and any association of the resistance genes with mobile genetic elements was determined. Tetracycline and macrolide resistance genes [tet(M), erm(B), mef(A), msr(D)] were detected on known Tn916-like integrative and conjugative elements, namely Tn6002 and Tn2010, and tet(32) was found for the first time in S. pneumoniae located on a novel 50 kb genomic island. The widespread use of pneumococcal conjugate vaccines impacts on serotype prevalence and transmission within the community. It is therefore important to continue to monitor antimicrobial resistance (AMR) genes present in both vaccine types and non-vaccine types in response to contemporary antimicrobial therapies and characterise the genetic context of acquired resistance genes to continually optimise antibiotic therapies. [ABSTRACT FROM AUTHOR]

Presents tips and advisories in managing pneumococcal vaccination program in Great Britain. Basic facts and information about pneumococcal disease; Identification of people at risk and eligible for vaccination; Significance of teamwork as an important practice for practical nurses; Assessment of the vaccine supplies, documentation, and financial benefits.

The article presents the case of a 22-month-old male infant who died after suffering from pneumococcal sepsis in Great Britain. The patient was admitted after suffering from diarrhoea and vomiting and died after six hours. His medical history records showed that he previously had pneumococcal infection. The results of his medical examination revealed that he had asplenia. A discussion about asplenia is offered.

Opinion. Comments on a British study which proposed lobar pneumonia to be an occupational disease among welders. Relation between excess mortality from pneumonia and occupation in various metal-working jobs; Implication on the assessment of health benefits for welders.

The article discusses a report by the All-Party Parliamentarian Group on Pneumococcal Disease Prevention in the Developing World designed to raise awareness about pneumococcal disease. Topics contained in the report are discussed including a request for Great Britain's government to give pneumococcal disease an equal standing to that of HIV and malaria in its policies and statements. The author comments on the need for a powerful advocacy group.

The article focuses on a survey conducted by the Health Protection Agency (HPA) which revealed that the number of invasive pneumococcal disease (IPD) cases in British children has fallen by almost 50% since the introduction of the pneumococcal conjugate vaccine (PCV) in September 2006. The HPA team reviewed patient blood samples and worked closely with general practitioners (GP) and pediatricians to determine the immunisation histories of the patients surveyed.

Reports on the awareness campaign on pneumococcal diseases in Great Britain as of June 2002. Statistics on mortality from pneumococcal disease; Availability of vaccine against the disease; Manifestation of the disease.