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Streptococcus pneumoniae is an important cause of community-acquired pneumonia (CAP) in Japan. Here, we report the serotype distribution and antimicrobial susceptibility of cultured pneumococcal isolates from Japanese adults aged ≥18 years with CAP. This was a prospective, population-based, active surveillance study conducted in Goto City, Japan from December 2015 to November 2020. Pneumococcal isolates from sterile sites (blood and pleural fluid) and non-sterile sites (sputum and bronchoalveolar lavage) were cultured as part of the standard of care. S. pneumoniae were serotyped using the Quellung reaction. Antimicrobial susceptibility was tested using microdilution and interpreted according to the Clinical and Laboratory Standards Institute criteria. Isolates resistant to erythromycin were phenotyped using the triple-risk test and genotyped by polymerase chain reaction. A total of 156 pneumococcal isolates were collected (138 from sputum, 15 from blood, and 3 from bronchoalveolar lavage) from 1992 patients. Of these, 142 were non-duplicate isolates from unique patients and were included in the analyses. Serotypes contained within the 13-valent pneumococcal conjugate vaccine (PCV13) (including 6C), PCV15 (including 6C), and PCV20 (including 6C and 15C) were detected in 39 (27%), 45 (32%), and 80 (56%) of 142 isolates, respectively. The most common serotypes were 35B (12%), 11A (11%), and 3 (11%). Multidrug resistance (MDR) was detected in 96/142 (68%) isolates. Of the 96 MDR isolates, 31, 32, and 59% were PCV13, PCV15, and PCV20 serotypes, respectively; the most common MDR serotypes were 35B (16%), 6C, 10A, and 15A (9% each), and 3 and 11A (8% each). A total of 119 isolates were resistant to macrolides; 41 (35%) had an M phenotype, 53 (45%) had an iMcLS phenotype, and 25 (21%) had a cMLS phenotype. In conclusion, pneumococcal serotypes 35B, 11A and 3 were most frequently associated with pneumonia and antimicrobial resistance was common among pneumococcal isolates from adults with CAP in Goto City, Japan. Implementing higher-valency PCVs May help reduce vaccine-type CAP among Japanese adults. [ABSTRACT FROM AUTHOR]

Objectives: This study examines the recommendation behaviors and influencing factors for the 13-valent Pneumococcal Conjugate Vaccine (PCV13) among 3579 Chinese healthcare workers (HCWs), including 1775 pediatric care providers (Peds-PCPs) and 1804 primary care providers (PCPs). Data were collected from May to July 2023 through a national cross-sectional survey using a structured questionnaire, distributed across hospitals providing pediatric services in five provincial-level administrative divisions. Methods: The sociodemographic data, vaccine knowledge, and recommendation practices were analyzed using Pearson's chi-square test, Wilcoxson rank-sum test, and multivariate logistic regression. Results show that while PCPs are more likely to recommend PCV13, vaccine hesitancy persists among Peds-PCPs. Logistic regression revealed that higher influenza vaccination intention, salary, vaccine consultation frequency, familiarity with immunization, work ethic, and flexible schedules positively impacted HCWs' recommendation behavior. Results: Factors influencing Peds-PCPs' recommendations include vaccine training (OR: 1.470, CI: 1.049–2.509), safety recognition (OR: 1.986, CI: 1.163–3.391), concern over rejection (OR = 1.274, CI: 1.076–1.508) and vaccine cost (OR = 1.203, CI: 1.023–1.414). For PCPs, influencing factors were the perceived susceptibility of children to pneumonia (OR = 2.185, CI: 1.074–4.445), acceptance of herd immunity (OR: 1.717, CI: 1.101–2.677), and belief that parents with better family conditions are more likely to accept vaccine recommendations (OR = 1.229, CI: 1.024–1.477).  Conclusion: This survey underscores the need for tailored interventions to address differing perceptions and enhance confidence in the safety and efficacy of vaccines among HCWs, particularly Peds-PCPs. [ABSTRACT FROM AUTHOR]

Pneumococcal vaccination schedules are traditionally assessed based on the antibody response. The Memory B Cell (MBC) response has been less studied, despite its role in the magnitude and longevity of protection. We compared the immune response to different vaccination schedules with the 13-valent Pneumococcal Conjugate Vaccine (PCV13) and investigated the relationship between MBCs and the antibody response. Total and pneumococcal serotype (PS)-specific MBCs, their subsets and PS-specific IgG antibodies induced by a 3 + 0 (group A), 2 + 1 (group B) or 3 + 1 (group C) schedule in healthy infants were studied before and 1 month after the last PCV13. The relatively immature IgM+IgD+ MBC subset was the predominant subset in all groups but was larger in group A compared to group B and group C, indicating that age might be a significant parameter of the composition of the MBC pool. PS-specific MBCs at baseline were higher in group A, but they increased significantly only in the groups receiving the booster schedules (groups B and C). PS-specific IgM-only MBCs at baseline positively corelated with the antibody response and the PS-specific swIg MBCs post-immunization. Our findings illustrate the importance of a booster dose for the enrichment of PS-specific immunological memory. IgM-only MBCs and swIg MBCs may serve as additional correlates of vaccine-induced protection. [ABSTRACT FROM AUTHOR]

Objectives The 13-valent (PCV13) and 10-valent (PCV10) pneumococcal conjugate vaccines missed non-inferiority for certain 7-valent (PCV7) serotypes in immunogenicity trials. This study examines the population-level IPD case trends for these serotypes.Methods We identified six countries with national IPD surveillance data that introduced PCV13 (Canada, Germany, Israel, Italy, South Africa, and the United States) and three with PCV10 (Finland, Brazil, and the Netherlands). We extracted country-specific annual IPD case counts for PCV7 serotypes that missed non-inferiority and met non-inferiority (6B + 23F and PCV7 minus [6B + 23F] serotypes for PCV10 countries; 6B +9V + 23F, and PCV7 minus [6B +9V + 23F] serotypes for PCV13 countries) in clinical trials. Case count data for each country were plotted for observed serotype trends in different age groups (

ABSTRACTIntroduction Lower respiratory tract infection is one of the leading causes of morbidity and mortality all over the world, with a substantial impact on healthcare costs. In Egypt, local consensus on its burden, diagnosis, and vaccination is scarce. This expert opinion is the first to address the local recommendations for vaccinating adults against respiratory infection. It sheds light on the growing need to understand the barriers and underpublicized concept of adult vaccination in Egypt.Areas covered A collaborative multidisciplinary panel from Egypt developed an expert opinion-based suggestions/points, including epidemiology, microbiology, and highlights on vaccination in Egypt, as well as challenges and recommendations regarding adult vaccination.Expert opinion Adult vaccinations against respiratory infections are now recommended for high-risk people by all healthcare regulatory bodies. However, it was acknowledged that there may be hesitancy and concerns among patients; in addition, healthcare professionals’ awareness about vaccination guidelines and benefits needs improvement. There are several strategies that could be implemented to enhance vaccine adherence in Egypt. These approaches encompass conducting community education programs, addressing the concerns of patients, and enhancing awareness among healthcare professionals through education, policy changes, and periodical reminders in each healthcare setting.

Introduction Pneumococcal diseases pose a significant public health concern in India, with substantial morbidity and mortality, with the elderly and those with coexisting medical conditions being most at risk. Pneumococcus was also seen to be one of the main reasons for co-infection, pneumonia and complications in COVID. Current guidelines recommend vaccination for specific adult populations, but there is a lack of uniformity and guidance on risk stratification, prioritisation and optimal timing. Methods Nation Against Pneumococcal Infections – Expert Panel Opinion (NAP-EXPO) is a panel convened to review and update recommendations for adult pneumococcal vaccination in India. The panel of 23 experts from various medical specialties engaged in discussions and evidence-based reviews, discussed appropriate age for vaccination, risk stratification for COPD and asthma patients, vaccination strategies for post-COVID patients, smokers and diabetics, as well as methods to improve vaccine awareness and uptake. Outcome The NAP-EXPO recommends the following for adults: All healthy individuals 60 years of age and above should receive the pneumococcal vaccine; all COPD patients, regardless of severity, high-risk asthma patients, post-COVID cases with lung fibrosis or significant lung damage, should be vaccinated with the pneumococcal vaccine; all current smokers and passive smokers should be educated and offered the pneumococcal vaccine, regardless of their age or health condition; all diabetic individuals should receive the pneumococcal vaccine, irrespective of their diabetes control. Strategies to improve vaccine awareness and uptake should involve general practitioners (GPs), primary health physicians (PHPs) and physicians treating patients at high risk of pneumococcal disease. Advocacy campaigns should involve media, including social media platforms. Conclusion These recommendations aim to enhance pneumococcal vaccination coverage among high-risk populations in India in order to ensure a reduction in the burden of pneumococcal diseases, in the post-COVID era. There is a need to create more evidence and data to support the recommendations that the vaccine will be useful to a wider range of populations, as suggested in our consensus.

Aims: To collect all available evidence on the effect of diabetes mellitus (DM) as a risk factor for pneumococcal disease incidence and related complications, and on the efficacy/effectiveness of vaccines in patients with DM. Methods: Two distinct systematic searches on MEDLINE, Cochrane, ClinicalTrials.gov and EMBASE databases were performed, one for each meta-analysis, collecting all observational (cohort and case–control) studies and randomized clinical trials performed on humans up to June 1st, 2023. Results: We retrieved 36 observational studies comparing risk for pneumococcal disease and related complications in people with or without DM, and 11 studies (1 randomized clinical trial and 10 observational studies) assessing conjugated and polysaccaridic vaccines efficacy/effectiveness on preventing such outcomes. People with DM were at higher risk for Invasive Pneumococcal Disease (unadjusted OR 2.42 [2.00; 2.92]); Case-Fatality Rate (unadjusted OR 1.61 [1.25; 2.07], Pneumococcal pneumonia (unadjusted OR 2.98 [2.76; 3.22), and Intensive care unit admission for pneumococcal disease (unadjusted OR 2.09 [1.20; 3.66]). In diabetic individuals vaccinated with conjugated vaccine, incidence of pneumonia specific for vaccine type in a clinical trial (OR 0.237 [0.008; 0.704]), and hospitalization for overall pneumonia during the year following the polysaccharide vaccination in observational studies (unadjusted OR 0.63 [0.45–0.89]) were significantly lower in comparison with unvaccinated DM subjects, with no significant differences for other outcomes. Conclusions: People with diabetes mellitus are at higher risk for less favourable course of pneumococcal disease and should be therefore targeted in vaccination campaigns; more evidence needs to be collected on vaccination outcomes in people with diabetes. [ABSTRACT FROM AUTHOR]

Background: Multiple factors, such as less complex U.S. adult pneumococcal recommendations that could increase vaccination rates, childhood pneumococcal vaccination indirect effects that decrease adult vaccination impact, and increased vaccine hesitancy (particularly in underserved minorities), could diminish the cost‐effectiveness of programs to increase pneumococcal vaccination in older adults. Prior analyses supported the economic favorability of these programs. Methods: A Markov model compared no vaccination and current recommendations (either 20‐valent pneumococcal conjugate vaccine [PCV20] alone or 15‐valent pneumococcal conjugate vaccine plus the 23‐valent pneumococcal polysaccharide vaccine [PCV15/PPSV23]) without or with programs to increase vaccine uptake in Black and non‐Black 65‐year‐old cohorts. Pre‐pandemic population‐ and serotype‐specific pneumococcal disease risk and illness/vaccine costs came from U.S. databases. Program costs were $2.19 per vaccine‐eligible person and increased absolute vaccination likelihood by 7.5%. Delphi panel estimates and trial data informed vaccine effectiveness values. Analyses took a healthcare perspective, discounting at 3%/year over a lifetime time horizon. Results: Uptake programs decreased pneumococcal disease overall. In Black cohorts, PCV20 without program cost $216,805 per quality‐adjusted life year (QALY) gained compared with no vaccination; incremental cost‐effectiveness was $245,546/QALY for PCV20 with program and $425,264/QALY for PCV15/PPSV23 with program. In non‐Black cohorts, all strategies cost >$200,000/QALY gained. When considering the potential indirect effects from childhood vaccination, all strategies became less economically attractive. Increased vaccination with less complex strategies had negligible effects. In probabilistic sensitivity analyses, current recommendations with or without programs were unlikely to be favored at thresholds <$200,000/QALY gained. Conclusion: Current U.S. pneumococcal vaccination recommendations for older adults were unlikely to be economically reasonable with or without programs to increase vaccine uptake. Alternatives to current pneumococcal vaccines that include pneumococcal serotypes associated with adult disease should be considered. See related Editorial by Melissa K. Andrew in this issue. [ABSTRACT FROM AUTHOR]

Pneumococcal vaccination (PV) is effective in preventing vaccine-type pneumococcal diseases. This study investigated the changes in PV uptake and its determinants before, during, and after the Coronavirus Disease 2019 (COVID-19) pandemic among community-living older adults aged ≥65 years in Hong Kong, China. Three rounds of random telephone surveys were conducted every two years from May 2019 to October 2023. Multivariate logistic regression models were fitted to examine the between-round differences in PV uptake rate and factors associated with PV uptake in each round. This study included 1563 participants. The standardized PV uptake rate in Round 1, 2, and 3 was 17.3%, 28.3%, and 35.5%, respectively. A significant difference in the PV uptake rate was found between Rounds 2 and 1 (p = 0.02), but not between Rounds 3 and 2 (p = 0.98). Perceived barriers, cue to action and self-efficacy, were significant determinants of PV uptake in all rounds. Perceived benefits were significant determinants of PV uptake in the first and second rounds, but not in the third round. Continuous monitoring of PV uptake and its determinants, and evaluating and adjusting the PV program, might contribute to the success of such a vaccination program in the post-pandemic era. [ABSTRACT FROM AUTHOR]

Introduction: Pneumococcal diseases pose a significant public health concern in India, with substantial morbidity and mortality, with the elderly and those with coexisting medical conditions being most at risk. Pneumococcus was also seen to be one of the main reasons for co‑infection, pneumonia and complications in COVID. Current guidelines recommend vaccination for specific adult populations, but there is a lack of uniformity and guidance on risk stratification, prioritisation and optimal timing. Methods: Nation Against Pneumococcal Infections – Expert Panel Opinion (NAP‑EXPO) is a panel convened to review and update recommendations for adult pneumococcal vaccination in India. The panel of 23 experts from various medical specialties engaged in discussions and evidence‑based reviews, discussed appropriate age for vaccination, risk stratification for COPD and asthma patients, vaccination strategies for post‑COVID patients, smokers and diabetics, as well as methods to improve vaccine awareness and uptake. Outcome: The NAP‑EXPO recommends the following for adults: All healthy individuals 60 years of age and above should receive the pneumococcal vaccine; all COPD patients, regardless of severity, high‑risk asthma patients, post‑COVID cases with lung fibrosis or significant lung damage, should be vaccinated with the pneumococcal vaccine; all current smokers and passive smokers should be educated and offered the pneumococcal vaccine, regardless of their age or health condition; all diabetic individuals should receive the pneumococcal vaccine, irrespective of their diabetes control. Strategies to improve vaccine awareness and uptake should involve general practitioners (GPs), primary health physicians (PHPs) and physicians treating patients at high risk of pneumococcal disease. Advocacy campaigns should involve media, including social media platforms. Conclusion: These recommendations aim to enhance pneumococcal vaccination coverage among high‑risk populations in India in order to ensure a reduction in the burden of pneumococcal diseases, in the post‑COVID era. There is a need to create more evidence and data to support the recommendations that the vaccine will be useful to a wider range of populations, as suggested in our consensus. [ABSTRACT FROM AUTHOR]

Background Streptococcus pneumoniae vaccination effectiveness (VE) in individuals with reduced kidney function is unknown. We estimated pneumococcal conjugate vaccine (PCV13), pneumococcal polysaccharide vaccine (PPSV23), and combined PCV13 and PPSV23 effectiveness against pneumococcal disease in individuals with and without reduced estimated glomerular filtration rate (eGFR). Methods All eligible individuals (case and controls) were adults (aged ≥18 years) hospitalized within the Geisinger Health System and required to have S. pneumoniae urinary antigen testing (i.e. test-negative design). Vaccination records were obtained from the electronic health record and statewide vaccination registry. After controlling for the probability of receiving a pneumococcal vaccine, we used multivariable logistic regression models to estimate the odds ratios (ORs) of vaccination between those who did and did not meet the S. pneumoniae case definition. VE was calculated as (1 – OR) × 100%. Results There were 180 cases and 3889 controls (mean age 69 years, female 48%, white 97%, mean eGFR 71 mL/min/1.73 m2). The adjusted population PCV13 VE was 39% (95% CI 13%–58%), and combination PCV13 and PPSV23 was 39% (95% CI 12%–58%). PPSV23 VE was –3.7% (95% CI –57% to 32%). Stratified by eGFR, adjusted PCV13 VE was consistent in eGFR ≥60 [VE 38% (95% CI 2.9%–61%)] and 30–59 [VE 61% (95% CI 24%–80%)] without significant interaction. VE was not calculable for eGFR <30 due to small sample size. Conclusion PCV13 vaccination was associated with reduced risk of S. pneumoniae hospitalization in individuals with a reduced eGFR (30–59 mL/min/1.73 m2). [ABSTRACT FROM AUTHOR]

[Display omitted] • Implementation of PCV 10 has significantly reduced the hospitalisation rate among the vaccinated group of children. • Significant indirect effect of vaccination was observed also in older age groups. • The data show that the introduction of national vaccinations is an effective intervention in the public health. Vaccination against pneumococci is currently the most effective method of protection against pneumococcal infections. The aim of the study was to analyse changes in hospitalisations and in-hospital deaths due to pneumonia before (2009–2016) and after (2017–2020) the introduction of PCV 10 vaccinations in the National Immunisation Programme in Poland. Data on hospitalisations related to community acquired pneumonia (CAP) in the years 2009–2020 were obtained from the Nationwide General Hospital Morbidity Study. Analyses were made in the age groups: <2, 2–3, 4–5, 6–19, 20–59, 60+ years in 2009–2016 and 2017–2020. Overall, there were 1,503,105 CAP-related hospitalisations in 2009–2020, 0.7% of which were caused by Streptococcus pneumoniae infections. Children <2 years of age were the most frequently hospitalised for CAP per 100,000 population, followed by patients aged 2–3, 4–5 and 60+ years. In the years 2009–2016, the percentage of CAP hospital admissions increased significantly, and after the year 2017, it decreased significantly in each of the age groups (p<0.001). In the years 2009–2016, a significant increase in hospitalisations for Streptococcus pneumoniae infections was observed in the age groups <2, 2–3 and 4–5 years (p<0.05). A significant reduction in hospitalisations was observed in the age groups <2, 20–59 and 60+ in 2017–2020 (p<0.05). In the years 2009–2020, there were 84,367 in-hospital deaths due to CAP, 423 (0.5%) of which due to Streptococcus pneumoniae , with patients mainly aged 60+. Implementation of the PCV vaccination programme has effectively decreased the incidence of CAP hospitalisations, including children <2 years of age. The group that is most at risk of death are persons aged 60+. The results of our study can be useful in evaluating the vaccine efficacy and benefits, and they can be an essential part of public health policy. Effective prevention strategies for CAP should be implemented in different age groups. [ABSTRACT FROM AUTHOR]

Necrotizing pneumonia (NP) is a serious and rare disease in children. Pediatric data on NP are limited and the impact of the 13-valent pneumococcal conjugate vaccine has been very poorly evaluated. We conducted a retrospective study at Toulouse University Hospital between 2008 and 2018. Children who presented with thin-walled cavities in the areas of parenchymal consolidation on imaging were included in the study. The incidence of NP did not decrease during this period. Bacterial identification occurred in 56% of cases (14/25) and included six cases of Streptococcus pneumoniae , five of Staphylococcus aureus , two of Streptococcus pyogenes , and one of Streptococcus viridans. Streptococcus pneumoniae NP are more frequently associated with empyema/parapneumonic effusion compared to S. aureus NP (p = 0.02). Patients with S. pyogenes NP more often required volume expansion than did S. pneumoniae cases (p = 0.03). When comparing children born before and after implementation of the 13-valent pneumococcal conjugate vaccine, we identified a relative modification of the bacterial epidemiology, with an increase in the proportion of S. pyogenes NP and S. aureus NP and a decrease in the proportion of NP caused by S. pneumoniae. Future studies are needed to assess the epidemiology of NP in children. Continued surveillance of identified pneumococcal serotypes is essential to document epidemiological changes in the coming years. [ABSTRACT FROM AUTHOR]

To provide information about which pneumococcal vaccine could have greater coverage in Colombia. This is a retrospective analysis of patients diagnosed with invasive pneumococcal disease (IPD) between 2015 and 2019 in Bogotá, Colombia. We compared the theoretical serotype coverage of the available anti-pneumococcal vaccines (i.e., PCV-10, PCV-10 SII, PCV-13, PCV-15, PCV-20, PCV-21, PCV24, PPSV-23) and the non-vaccine-covered serotypes stratified by age. 690 IPD cases were included. In children ≤5 y/o, of the approved vaccines PCV-20 showed the most theoretical protection (71.3 % [149/209]), while in adults aged 18–64 y/o was PCV-20 (61.8 % [164/265]), and in those ≥65 y/o was PPSV-23 (58.1 % [100/172]) followed by PCV-20 (55.2 % [95/172]). The non-covered serotypes represented one-third of the cohort (33.9 % [234/690]), being 6C (20.5 % [48/234]), 15A (12.8 % [30/234]), and 23A (11.5 % [27/234]) the most prevalent. Introducing PCV-20 for children and PCV-20 along with a PPSV-23 booster in adults may reduce IPD frequency in all ages in Colombia. The inclusion of non-covered serotypes is required for future vaccines. [ABSTRACT FROM AUTHOR]

OBJECTIVE: There is a need to increase patient and clinician awareness on the effectiveness of pneumococcal vaccination in at-risk groups. The aim of the study was to evaluate the effect of reminders for physicians and patients using the vaccination tracking system created in the hospital information management system (HIMS) on the vaccination rate, and the effect of pneumococcal vaccination on pneumonia-related hospitalization and mortality over a 12-month period. MATERIAL AND METHODS: This prospective observational cohort study was undertaken during a 2-year period in 3 tertiary care centers. Patients were followed up for 12 months following vaccination, and hospital admissions and mortality were recorded via HIMS. During the campaign, HIMS transmitted pneumococcal immunization reminder messages in accordance with guideline recommendations to physicians' computers and patients' mobile phones. Educational posters on pneumococcal vaccination were posted in outpatient clinics. Regular seminars on the evidence for pneumococcal vaccination were organized. All patients who were hospitalized during the follow-up period for chronic obstructive pulmonary disease (COPD), asthma, lung cancer, or pneumonia were analyzed in relation to their vaccination history regarding clinical outcomes. RESULTS: A total of 29 530 patients were included in the study. During the study period, the annual vaccination rate increased by 74.4% and reached 4.8% in 3 hospitals (P = .001). The rates were 3.9% in patients older than 65 years without comorbidities and 5.2% in those with COPD and asthma (P = .002). In pneumococcal vaccine recipients, pneumonia-related hospital mortality was lower (relative risk (RR) = 0.19, CI 0.09-0.35, P < .001). CONCLUSION: It is possible to raise the rate of pneumococcal vaccination through awareness campaigns. Individuals with COPD and asthma are more willing to receive pneumococcal vaccination. Among patients hospitalized for pneumonia, prior pneumococcal vaccination is associated with lower mortality. [ABSTRACT FROM AUTHOR]

Pneumococcal vaccination schedules are traditionally assessed based on the antibody response. The Memory B Cell (MBC) response has been less studied, despite its role in the magnitude and longevity of protection. We compared the immune response to different vaccination schedules with the 13-valent Pneumococcal Conjugate Vaccine (PCV13) and investigated the relationship between MBCs and the antibody response. Total and pneumococcal serotype (PS)-specific MBCs, their subsets and PS-specific IgG antibodies induced by a 3 + 0 (group A), 2 + 1 (group B) or 3 + 1 (group C) schedule in healthy infants were studied before and 1 month after the last PCV13. The relatively immature IgM+IgD+ MBC subset was the predominant subset in all groups but was larger in group A compared to group B and group C, indicating that age might be a significant parameter of the composition of the MBC pool. PS-specific MBCs at baseline were higher in group A, but they increased significantly only in the groups receiving the booster schedules (groups B and C). PS-specific IgM-only MBCs at baseline positively corelated with the antibody response and the PS-specific swIg MBCs post-immunization. Our findings illustrate the importance of a booster dose for the enrichment of PS-specific immunological memory. IgM-only MBCs and swIg MBCs may serve as additional correlates of vaccine-induced protection.

Objectives: This study examines the recommendation behaviors and influencing factors for the 13-valent Pneumococcal Conjugate Vaccine (PCV13) among 3579 Chinese healthcare workers (HCWs), including 1775 pediatric care providers (Peds-PCPs) and 1804 primary care providers (PCPs). Data were collected from May to July 2023 through a national cross-sectional survey using a structured questionnaire, distributed across hospitals providing pediatric services in five provincial-level administrative divisions. Methods: The sociodemographic data, vaccine knowledge, and recommendation practices were analyzed using Pearson’s chi-square test, Wilcoxson rank-sum test, and multivariate logistic regression. Results show that while PCPs are more likely to recommend PCV13, vaccine hesitancy persists among Peds-PCPs. Logistic regression revealed that higher influenza vaccination intention, salary, vaccine consultation frequency, familiarity with immunization, work ethic, and flexible schedules positively impacted HCWs’ recommendation behavior. Results: Factors influencing Peds-PCPs’ recommendations include vaccine training (OR: 1.470, CI: 1.049–2.509), safety recognition (OR: 1.986, CI: 1.163–3.391), concern over rejection (OR = 1.274, CI: 1.076–1.508) and vaccine cost (OR = 1.203, CI: 1.023–1.414). For PCPs, influencing factors were the perceived susceptibility of children to pneumonia (OR = 2.185, CI: 1.074–4.445), acceptance of herd immunity (OR: 1.717, CI: 1.101–2.677), and belief that parents with better family conditions are more likely to accept vaccine recommendations (OR = 1.229, CI: 1.024–1.477). Conclusion: This survey underscores the need for tailored interventions to address differing perceptions and enhance confidence in the safety and efficacy of vaccines among HCWs, particularly Peds-PCPs.

Background: Pneumococcal disease continues to be a large source of morbidity and mortality despite the availability of effective prevention via immunisation and treatment measures. Aim: To assess the impact of a pharmacist‐led opportunistic inpatient pneumococcal vaccination intervention on overall 13‐valent pneumococcal conjugate vaccine (13vPCV) rates in eligible hospitalised subacute patients, aged 70 years and above. Method: This study was a pre‐ and post‐intervention study conducted across two study sites at Monash Health, a large metropolitan health service in Victoria, Australia. Phase 1 (pre‐intervention, August–October 2022) involved auditing the vaccine‐eligibility of patients on admission and subsequent administration during inpatient stay. Phase 2 (intervention phase, October–December 2022) implemented the pharmacist‐led opportunistic inpatient pneumococcal vaccine intervention. Following screening, identified vaccine‐eligible patients were recommended to the treating physician via verbal discussion and Microsoft Teams for consideration of vaccination administration in hospital. The proportion of eligible patients vaccinated was compared between the pre‐intervention and intervention groups. This project was exempt for ethics approval due to the local policy requirements that constitute research by the Monash Health Human and Research Ethics Committee (Reference no: RES‐22‐0000‐454Q). The justification for this ethics exemption was as follows: the project complies with the National Health and Medical Research Council's Ethical considerations in quality assurance and evaluation activities; auditing the percentage of vaccine‐eligible and non‐vaccinated patients did not require written consent per local requirements; and it is standard practice to obtain verbal consent, followed by documentation on electronic medical records, for inpatient vaccinations. Informed consent was obtained from participants via verbal consent after the distribution of written medical information on the 13vPCV, as well as verbal information provided by the medical team. Results: A total of 360 patients were included in the study. Overall, 139 (77.2%) patients in the pre‐intervention and 143 (79.4%) patients in the intervention phase were eligible for vaccination (non‐vaccinated with age indication). The proportion of patients receiving inpatient 13vPCV was higher in the intervention group compared to the pre‐intervention group (43.4 vs 2.2%, p < 0.001). Conclusion: The results indicate that incorporating a pharmacist‐led opportunistic inpatient pneumococcal vaccination intervention can significantly increase pneumococcal vaccination in hospital. [ABSTRACT FROM AUTHOR]

Coeliac disease (CD) is associated with hyposplenism, an acquired impairment of spleen function associated with reduced IgM memory B cells and increased susceptibility to serious pneumococcal infection. Little is known about the immune implications of hyposplenism in CD or the optimal pneumococcal vaccination strategy. In this study, the immune effects of hyposplenism in CD, and the accuracy of screening approaches and protective responses induced by two different pneumococcal vaccines were examined. Active and treated CD cohorts, and healthy and surgically splenectomised controls underwent testing for the presence of Howell–Jolly bodies and pitted red cells, spleen ultrasound, and immune assessment of IgM memory B cell frequency and IgM memory B cell responses to T cell-dependent (TD) or T cell-independent (TI) stimulation. Responses following conjugate (TD) and polysaccharide (TI) pneumococcal vaccination were compared using ELISA and opsonophagocytic assays. Although hyposplenism is rare in treated CD (5.1%), functional B cell defects are common (28–61%) and are not detected by current clinical tests. Conjugate pneumococcal vaccination induced superior and sustained protection against clinically relevant serotypes. Clinical practice guidelines in CD should recommend routine pneumococcal vaccination, ideally with a conjugate vaccine, of all patients in lieu of hyposplenism screening. [ABSTRACT FROM AUTHOR]

• We investigated pneumococcal vaccination-related factors using administrative data. • The population was the eligible persons for routine pneumococcal vaccination. • Vaccination coverage was approximately 30% for the entire eligible population. • Individual factors such as health check-up participation were the primary factors. To investigate individual and environmental vaccination-related factors among the older adults in Japan, using administrative data. We conducted a cohort study and included people who reached the relevant age (≥65 years) for routine pneumococcal vaccination of older adults between April 2015 and March 2020. Monthly data of residents in the two municipalities from April 2014 to March 2020 and vaccination records from April 2015 to March 2020 were used. We defined five cohorts according to the year in which routine vaccinations were available. Each cohort was followed for a total of two years, with the first year being the "baseline period" and second year being the "vaccine follow-up period." Pneumococcal vaccination data was extracted from vaccination records at "first dose." Age, sex, socioeconomic status, comorbidities, hospital visit history, hospitalization history, Specific Health Check-ups participation, and information on contracted hospitals for pneumococcal vaccination were used as covariates. A multivariate logistic regression model was used to investigate the relationship between pneumococcal vaccination and vaccination-related factors. Odds ratios (OR) and 95 % confidence intervals (95 % CI) were calculated. Analysis included 17,991 patients. Vaccination coverage was 33.6 % for all subjects. Multivariate analysis found the following as significant vaccination-related factors: female (OR: 1.18, 95 % CI: 1.11–1.26), not low income (1.76, 1.17–2.76), hospital visits: ≥once/month (1.27, 1.19–1.35), and Specific Health Check-ups participation (2.10, 1.95–2.27). No significant results were found for hospitals that contracted pneumococcal vaccination. Individual factors, such as sex and Specific Health Check-ups participation, were found to be important factors affecting pneumococcal vaccination among older adults in Japan. Environmental factors, such as the characteristics of residential areas, should be evaluated in further investigations. [ABSTRACT FROM AUTHOR]

Current guidelines for vaccination in allogeneic hematopoietic stem cell transplant (HCT) recipients recommend initiation of pneumococcal vaccination series three to six months post-HCT, with most data supporting initiation at six months due to a more robust immune response. This single-center, retrospective, observational chart review aimed to evaluate the impact of initiating the pneumococcal vaccine series at three months post-HCT compared to six months post-HCT. The primary endpoints were defined as a percentage of patients with a serologic response of >1 and >1.3 µg/mL for over 50% of the defined serotypes. Outcomes showed no difference in immunologic response between the two groups. [ABSTRACT FROM AUTHOR]

We report a case of a 62-year-old female presenting with shortness of breath, who was subsequently diagnosed with Austrian syndrome. The patient had a complicated clinical course, including invasive central nervous system pneumococcal disease, pneumococcal bacteremia, and mitral valve vegetation with possible leaflet perforation. Despite aggressive treatment, her condition continued to worsen. We will discuss the clinical features of this disease, approaches to diagnosis and treatment, and outcomes in light of this rare condition. [ABSTRACT FROM AUTHOR]

Pneumococcal vaccination (PV) is effective in preventing vaccine-type pneumococcal diseases. This study investigated the changes in PV uptake and its determinants before, during, and after the Coronavirus Disease 2019 (COVID-19) pandemic among community-living older adults aged ≥65 years in Hong Kong, China. Three rounds of random telephone surveys were conducted every two years from May 2019 to October 2023. Multivariate logistic regression models were fitted to examine the between-round differences in PV uptake rate and factors associated with PV uptake in each round. This study included 1563 participants. The standardized PV uptake rate in Round 1, 2, and 3 was 17.3%, 28.3%, and 35.5%, respectively. A significant difference in the PV uptake rate was found between Rounds 2 and 1 (p = 0.02), but not between Rounds 3 and 2 (p = 0.98). Perceived barriers, cue to action and self-efficacy, were significant determinants of PV uptake in all rounds. Perceived benefits were significant determinants of PV uptake in the first and second rounds, but not in the third round. Continuous monitoring of PV uptake and its determinants, and evaluating and adjusting the PV program, might contribute to the success of such a vaccination program in the post-pandemic era.

Abstract Pneumococcal pneumonia remains a significant global public health issue. Malaysia has recently added the 10 valent pneumococcal conjugate vaccine to its national immunisation programme. Data on pneumococcal serotype epidemiology is vital for informing national vaccination policy. However, there remains a lack of representative population-based pneumococcal surveillance in Malaysia to help both the assessment of vaccine effectiveness in the country and to shape future vaccine policy. This review explores the history of pneumococcal vaccination, the burden of pneumococcal disease in Malaysia, and offers an insight into the prospects for reducing pneumococcal disease in Malaysia.

Background Pneumonia is a leading cause of death worldwide. It is a particularly serious burden in older people, as they tend to have a weakened immune response. Identifying the role of oral self-care and pneumococcal vaccination in healthy, independent older people can aid pneumonia prevention among them. This study investigated the associations between oral self-care, pneumococcal vaccination, and pneumonia experience among independent older people. Methods This cross-sectional study used data from the 2016 Japan Gerontological Evaluation Study. We used machine learning to examine the association between oral self-care and the experience of pneumonia over the previous year, stratified by pneumococcal vaccination. The covariates were sex, age, years of education, equivalent annual income, medical history of stroke, oral health status (choking, dryness, number of teeth), and smoking status. The analysis included 17 217 independent older people aged 65 and over. Results The prevalence of pneumonia experienced among those who brushed their teeth once or less per day was 4.5% and 5.3% for those with and those without pneumococcal vaccinations, respectively. In the unvaccinated group, the odds ratio of pneumonia experience for those who brushed their teeth once or less a day was 1.57 (95% confidence interval: 1.15–2.14) compared to those who brushed their teeth 3 or more times a day. By contrast, there was no significant association between the frequency of toothbrushing and the experience of pneumonia among people who received pneumococcal vaccination. Conclusions Oral care influenced the experience of pneumonia among independent older people who did not receive pneumococcal vaccination. [ABSTRACT FROM AUTHOR]

Background: Pneumococcal pneumonia is an important cause of morbidity and mortality amongst patients with inflammatory arthritis. Vaccination is recommended by the National Institute for Health and Care Excellence (NICE) but it remains unclear how vaccine efficacy is impacted by different immunosuppressive agents. Our objective was to compare the chance of a seroconversion following vaccination against pneumococcus in patients with inflammatory arthritis to that in the general population, as well as to compare the chance of seroconversion across different targeted therapies. Methods: We searched MEDLINE, Embase and the Cochrane Library databases from inception until 20 June 2023. We included randomized controlled trials and observational studies. Aggregate data were used to undertake a pairwise meta-analysis. Our primary outcome of interest was vaccine seroconversion. We accepted the definition of serological response reported by the authors of each study. Results: Twenty studies were identified in the systematic review (2807 patients) with ten reporting sufficient data to be included in the meta-analysis (1443 patients). The chance of seroconversion in patients receiving targeted therapies, relative to the general population, was 0.61 (95% CI 0.35 to 1.08). The reduced odds of response were skewed strongly by the effects of abatacept and rituximab with no difference between patients on TNF inhibitors (TNFis) or IL-6 inhibition and healthy controls. Within different inflammatory arthritis populations the findings remained consistent, with rituximab having the strongest negative impact on vaccine response. TNF inhibition monotherapy was associated with a greater chance of vaccine response compared with methotrexate (2.25 (95% CI 1.28 to 3.96)). JAK inhibitor (JAKi) studies were few in number and did not present comparable vaccine response endpoints to include in the meta-analysis. The information available does not suggest any significant detrimental effects of JAKi on vaccine response. Conclusion: This updated meta-analysis confirms that, for most patients with inflammatory arthritis, pneumococcal vaccine can be administered with confidence and that it will achieve comparable seroconversion rates to the healthy population. Patients on rituximab were the group least likely to achieve a response and further research is needed to explore the value of multiple-course pneumococcal vaccination schedules in this population. [ABSTRACT FROM AUTHOR]

Abstract Introduction This study estimates the annual population-level impact of 13-valent pneumococcal conjugate vaccine (PCV13) infant national immunization programs (NIPs) on vaccine-type and non-vaccine type invasive pneumococcal disease (IPD) incidence across all ages using national surveillance data. Methods We identified countries (Australia, Canada, England and Wales, Israel, and the US) with national IPD active surveillance data that introduced the seven-valent PCV (PCV7) followed by PCV13, which also reported annual serotype- and age group-specific incidence. We extracted IPD incidence by serotype groupings [PCV13 minus PCV7 (PCV13-7) serotypes; PCV13-7 serotypes excluding serotype 3; non-PCV13 serotypes; and the 20-valent (PCV20) minus PCV13 (PCV20-13) serotypes] and by age groups (

Background The Belgian Superior Health Council (SHC) preferentially recommended the 20-valent pneumococcal conjugate vaccine (PCV20) for adults aged ≥65 years, immunocompromised patients, and patients aged ≥50 years suffering from conditions that increase their risk for pneumococcal infections. The objective of this paper is to present the cost-utility of PCV20 compared to no vaccination and the alternative sequence of PCV15 followed by the 23-valent pneumococcal polysaccharide vaccine (PPV23) in this population. Research Design and Methods The analysis employed a static Markov model capturing lifetime risk of pneumococcal infections, associated disutility, mortality and costs from different healthcare payer perspectives. Results Results indicated use of PCV20 among Belgian older and at-risk adults is highly cost-effective compared to no vaccination, with an incremental cost per quality-adjusted life-year (QALY) of €4,164. Compared to the sequential regimen (PCV15+PPV23), PCV20 vaccination is a cost-saving strategy. Subgroup analysis indicated PCV20 vaccination of at-risk adults aged 65-84 years would also be cost-saving from the national healthcare perspective. Conclusion Based on current knowledge, this analysis suggests that access to PCV20 should be proposed in all adults recommended for vaccination by the SHC as PCV20 prevents additional hospitalizations and deaths caused by pneumococcal infection at an affordable cost.

Pneumococcal pneumonia remains a significant global public health issue. Malaysia has recently added the 10 valent pneumococcal conjugate vaccine to its national immunisation programme. Data on pneumococcal serotype epidemiology is vital for informing national vaccination policy. However, there remains a lack of representative population-based pneumococcal surveillance in Malaysia to help both the assessment of vaccine effectiveness in the country and to shape future vaccine policy. This review explores the history of pneumococcal vaccination, the burden of pneumococcal disease in Malaysia, and offers an insight into the prospects for reducing pneumococcal disease in Malaysia. [ABSTRACT FROM AUTHOR]

Patients with Chronic Lymphocytic Leukemia (CLL) have a 29- to 36-fold increased risk of invasive pneumococcal disease (IPD) compared to healthy adults. Therefore, most guidelines recommend vaccination with the 13-valent pneumococcal conjugated vaccine (PCV13) followed 2 months later by the 23-valent polysaccharide vaccine (PPSV23). Because both CLL as well as immunosuppressive treatment have been identified as major determinants of immunogenicity, we aimed to assess the vaccination schedule in untreated and treated CLL patients. We quantified pneumococcal IgG concentrations against five serotypes shared across both vaccines, and against four serotypes unique to PPSV23, before and eight weeks after vaccination. In this retrospective cohort study, we included 143 CLL patients, either treated (n = 38) or naive to treatment (n = 105). While antibody concentrations increased significantly after vaccination, the overall serologic response was low (10.5%), defined as a ≥4-fold antibody increase against ≥70% of the measured serotypes, and significantly influenced by treatment status and prior lymphocyte number. The serologic protection rate, defined as an antibody concentration of ≥1.3 µg/mL for ≥70% of serotypes, was 13% in untreated and 3% in treated CLL patients. Future research should focus on vaccine regimens with a higher immunogenic potential, such as multi-dose schedules with higher-valent T cell dependent conjugated vaccines. [ABSTRACT FROM AUTHOR]

Currently, the 13-valent pneumococcal conjugate vaccine (PCV13) is administered under a 1+1 (1 primary dose) pediatric schedule in the United Kingdom (UK). Higher-valency PCVs, 15-valent PCV (PCV15), or 20-valent PCV (PCV20) might be considered to expand serotype coverage. We evaluated the cost-effectiveness of PCV20 or PCV15 using either a 2+1 (2 primary doses) or 1+1 schedule for pediatric immunization in the UK. Using a dynamic transmission model, we simulated future disease incidence and costs under PCV13 1+1, PCV20 2+1, PCV20 1+1, PCV15 2+1, and PCV15 1+1 schedules from the UK National Health Service perspective. We prospectively estimated disease cases, direct costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio. Scenario analyses were performed to estimate the impact of model assumptions and parameter uncertainty. Over a five-year period, PCV20 2+1 averted the most disease cases and gained the most additional QALYs. PCV20 2+1 and 1+1 were dominant (cost-saving and more QALYs gained) compared with PCV15 (2+1 or 1+1) and PCV13 1+1. PCV20 2+1 was cost-effective (GBP 8110/QALY) compared with PCV20 1+1. PCV20 was found cost-saving compared with PCV13 1+1, and PCV20 2+1 was cost-effective compared with PCV20 1+1. Policymakers should consider the reduction in disease cases with PCV20, which may offset vaccination costs. [ABSTRACT FROM AUTHOR]

Pneumococcal immunization is recommended in dialysis patients. We aimed to estimate pneumococcal vaccination coverage among patients who initiate dialysis in France, and its association with mortality. Data were extracted from two prospective national databases, merged using a deterministic linkage method: renal epidemiology and information network (REIN) registry, which includes all patients on dialysis and kidney transplants recipients in France, and the national health insurance information system (SNIIRAM) which collects individual data on health expenditure reimbursement, including vaccines. We enrolled all patients who initiated chronic dialysis in 2015. Data on health status at dialysis initiation, dialysis modalities, and pneumococcal vaccine prescribed from 2 years before to 1 year after dialysis start were collected. Univariate and multivariate Cox proportional hazard models were used to assess one-year all-cause mortality. Among the 8,294 incident patients included, 1,849 (22.3 %) received at least one pneumococcal vaccine before (n = 542, 6.5 %), or after (n = 1,307, 15.8 %) dialysis start, as follows: 13-valent pneumococcal conjugated vaccine (PCV13) followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23), n = 938 (50.7 %); only PPSV23, n = 650 (35.1 %); or only PCV13, n = 261 (14.1 %). Vaccinated patients were younger (mean, 66.5 ± 14.8 years vs. 69.0 ± 14.9 years, P ≤ 0.001), more likely to suffer from glomerulonephritis (17.0 % vs. 11.0 %, P ≤ 0.001), and less likely to start dialysis in emergency (27.2 % vs. 31.1 %, P = 0.001). On multivariate analysis, patients who received PCV13 and PPSV23, or only PCV13 were less likely to die (respectively, HR = 0.37; 95 %CI 0.28–0.51, and HR = 0.35; 95 %CI 0.19–0.65). Pneumococcal immunization with PCV13 followed by PPSV23, or with PCV13 alone, but not with PPSV23 alone, is independently associated with decreased one year-mortality in patients who start dialysis. [ABSTRACT FROM AUTHOR]

Pneumococcal disease is a major cause of morbidity/mortality worldwide, and vaccination is an important measure in its prevention. Despite European children being vaccinated with pneumococcal conjugate vaccines (PCVs), pneumococcal infections are still a major cause of morbidity/mortality in adults with risk conditions and their vaccination might be an important prevention strategy. New PCVs have been approved, but information is lacking on their potential impact in European adults. In our review, we searched PubMed, MEDLINE, and Embase for studies on the additional PCV20 serotypes (concerning incidence, prevalence, disease severity, lethality, and antimicrobial resistance) in European adults, between January 2010 and April 2022, having included 118 articles and data from 33 countries. We found that these serotypes have become more prevalent in both invasive and non-invasive pneumococcal disease (IPD and NIPD), representing a significant proportion of cases (serotypes 8, 12F, 22F) and more serious disease and/or lethality (10A, 11A, 15B, 22F), showing antimicrobial resistance (11A, 15B, 33F), and/or affecting more vulnerable individuals such as the elderly, immunocompromised patients, and those with comorbidities (8, 10A, 11A, 15B, 22F). The relevance of pneumococcal adult carriers (11A, 15B, 22F, and 8) was also identified. Altogether, our data showed an increase in the additional PCV20 serotypes' prevalence, accounting for a proportion of approximately 60% of all pneumococcal isolates in IPD in European adults since 2018/2019. Data suggest that adults, as older and/or more vulnerable patients, would benefit from vaccination with higher-coverage PCVs, and that PCV20 may address an unmet medical need. [ABSTRACT FROM AUTHOR]

Abstract The Middle East and North Africa (MENA) region has the second-highest rate of increase in diabetes, especially in KSA, Egypt, and UAE. Diabetes accounts for a significant economic burden in terms of the cost of treatment, the management of complications, disability, and the loss of productivity. Diabetic adults have an increased susceptibility to infections due to the presence of hyperglycemia. The risk of pneumonia is higher in patients with diabetes. Pneumonia caused by Streptococcus pneumoniae (pneumococcal infections) is the most frequent cause of hospitalization in KSA, which also increases the risk of mortality in diabetic patients. The annual planned pilgrimage to Mecca, KSA, is one of the largest frequent religious gatherings globally, and outbreaks of infectious diseases are of great concern. This review will discuss the pneumococcal infection outbreak and prevention in patients with diabetes in KSA. Also, it will gather information discussed by a scientific advisory board held in Riyadh in 2020 covering the current understanding of pneumococcal disease prevention in diabetic patients and recommendations to overcome barriers facing vaccination.

Relevance. Pneumococcal infection (PI) is one of the leading causes of disability and death of older people worldwide. In the Astrakhan region, as in other regions of the Russian Federation, there is a low coverage of pneumococcal vaccination (PV) and amounts to 1.3% of the adult population. This study reflects the regional problem of PV, an evaluation of its effectiveness in reducing exacerbations and the development of community-acquired pneumonia (CAP) in patients with COPD. The impact of pneumococcal infection (PI) in the development of pneumonia turned out in the period of the COVID-19 pandemic so far to be the most significant.Aim of this work was to evaluate the level of doctor’s awareness in the issues of pneumococcal vaccination, as well as the results of its implementation in patients with COPD during COVID-19 pandemic.Materials and methods. The study was conducted in the form of a survey in the period from October 2021 to February 2022. A survey was conducted through a questionnaire poll in polyclinics and pulmonology departments of multidisciplinary hospitals in Astrakhan. A total of 201 doctors and 173 patients suffering from COPD participated in the study. The doctors' responses were compared with the results of the survey conducted in 2018.Results. This study shows that 26% of the surveyed patients with COPD were vaccinated with pneumococcal vaccine. Analysis of clinical effects after vaccination shows that exacerbations of COPD were absent during the year in 51.1% of vaccinated patients, and 35.2% in non-vaccinated group. The prevalence of CAP in vaccinated patients was 13.3% vs 32.4% in patients who did not receive vaccination.Conclusion. This study showed a significant level of clinical efficacy of PV, characterized by a reduced incidence of COPD exacerbations and the development of VP in vaccinated patients, as well as a lower number of hospitalizations. Vaccinated patients reported mild severity of coronavirus infection, which determines the high prospects for further PV research as one of the important measures to counteract the COVID-19 pandemic. The problem of awareness in specialists about pneumococcal vaccination requires further improvement of educational programs on the relevant topic in the framework of continuing medical education.

Abstract Background Despite recommendations from the German Standing Committee on Vaccination (STIKO), pneumococcal vaccination coverage remains low in vulnerable populations. This study estimated the pneumococcal vaccination coverage rate (VCR) and timing among individuals aged 16–59 years in Germany who were recommended to receive pneumococcal vaccination, according to STIKO. Methods A retrospective cohort analysis was conducted using the German InGef database. Individuals aged 16 to 59 years diagnosed with at least one “at-risk” (chronic disease) or “high-risk” (e.g., immunocompromising) condition considered to be at-risk of pneumococcal infection were identified at the time of first diagnosis, between January 1, 2016 and December 31, 2018, and followed up until December 31, 2019. The percentage of cumulative pneumococcal VCR with 95% confidence interval (CI) was reported for each calendar year of follow-up. Results There were 334,292 individuals followed for a median of 2.38 (interquartile range (IQR) 1.63–3.13) person years. For individuals aged 16–59 years diagnosed with an incident risk condition in 2016, pneumococcal VCR increased from 0.44% (95% CI 0.41–0.48) in 2016 to 1.24% (95% CI 1.18–1.30) in 2019. In 2019, VCRs were higher in individuals with high-risk conditions compared with at-risk conditions (2.24% (95% CI 2.09–2.40) vs. 0.90% (95% CI 0.85–0.96)). In 2019, VCRs were higher in individuals aged 50 to 59 years compared with individuals aged 16 to 49 years (2.25% (95% CI 2.10–2.41) vs. 0.90% (95% CI 0.84–0.96)). Similar trends were observed in individuals with newly diagnosed risk conditions identified in 2017 and in 2018. Older age, influenza vaccination and increasing number of risk conditions increased the likelihood of pneumococcal vaccination. Median time to vaccination from diagnosis of the risk condition was shorter for high-risk conditions (369.5 days (IQR 155.8–702.0)) compared to at-risk conditions (435.5 days (IQR 196.3–758.8)). Conclusion Despite recommendations from STIKO, pneumococcal vaccination coverage remains very low and with long delays in vulnerable individuals aged 16–59 in Germany. Further efforts are required to increase immunization levels and shorten time to vaccination among individuals 16–59 years of age developing conditions with higher susceptibility to pneumococcal infection.

OBJECTIVE: It is known that inpatient hospital costs are much higher than outpatient services. It was aimed to investigate the effect of pneumococcal vaccination on hospitalizations. MATERIAL AND METHODS: The direct hospitalization costs, length of stay, and factors of the vaccinated and unvaccinated patients in the same hospital during the 12-month follow-up of the patients who received pneumococcal vaccine between November 15, 2018, and November 15, 2020, in 3 chest diseases and thoracic surgery training and research hospitals were analyzed by obtaining Hospital Information Management System records. Data were collected with Statistical Package for the Social Sciences version 23 program (IBM Corp.; Armonk, NY, USA), and statistical evaluation was made. RESULTS: The mean age of 800 hospitalized patients, of whom 400 were unvaccinated and 400 were vaccinated, was 68.48 ± 11.97. There was no significant difference in the mean age of vaccinated and unvaccinated patients (P > .05). Five hundred sixty-six patients (70.8%) were aged 65 and over. Two hundred eighty (51.2%) of men were vaccinated and 120 (47.2%) of women were vaccinated, and there was no significant difference (P > .05). The mean hospital stay of these patients was 11.01 days, and those in the vaccinated group had an average mean hospital stay of 9.11 days and those in the unvaccinated group had a mean hospital stay less than 12.91 days (P < .001). Total 1-year hospitalization costs were $501.653.53 and the cost per person was calculated as $627.07. The cost per capita for the vaccinated group was $550.52, which was lower than the average cost of the unvaccinated group ($703.62) (P < .05). When comparing the status of being vaccinated, comorbidity, mortality, mean length of stay, chronic obstructive pulmonary disease, and heart disease were found to be statistically significant (P < .05). CONCLUSION: In our study, it was revealed that vaccination of patients hospitalized in chest disease hospitals with the pneumococcal vaccine reduced the average length of hospital stay by 41.7% and the cost of hospitalization by 27.8%. [ABSTRACT FROM AUTHOR]

Introduction: This study estimates the annual population-level impact of 13-valent pneumococcal conjugate vaccine (PCV13) infant national immunization programs (NIPs) on vaccine-type and non-vaccine type invasive pneumococcal disease (IPD) incidence across all ages using national surveillance data. Methods: We identified countries (Australia, Canada, England and Wales, Israel, and the US) with national IPD active surveillance data that introduced the seven-valent PCV (PCV7) followed by PCV13, which also reported annual serotype- and age group-specific incidence. We extracted IPD incidence by serotype groupings [PCV13 minus PCV7 (PCV13-7) serotypes; PCV13-7 serotypes excluding serotype 3; non-PCV13 serotypes; and the 20-valent (PCV20) minus PCV13 (PCV20-13) serotypes] and by age groups (< 2 years, 2–4 years, 5–17 years, 18–34 years, 35–49 years, 50–64 years, and ≥ 65 years). For each country, we calculated the annual relative change in IPD incidence (percent change), and the corresponding incidence rate ratio (IRR), for 7 years post introduction compared to the year prior to PCV13 program initiation. Results: PCV13-7 vaccine-type IPD incidence consistently decreased over time following introduction of PCV13 across countries, reaching an approximate steady state after 3–4 years in ages < 5 years, with roughly 60–90% decrease (IRRs = 0.1–0.4) and after 4–5 years in ages ≥ 65 years with approximately 60–80% decrease (IRRs = 0.2–0.4). Incidence declines were more substantial for the PCV13-7 grouping when excluding serotype 3. Non-PCV13 serotype incidence was variable by country and age group, ranging from virtually no serotype replacement compared to the PCV7 period across ages in the US to increases for other countries ranging from 10 to 204% (IRRs = 1.10–3.04) in children < 5 years and 41% to 123% (IRRs = 1.41–2.23) in ages ≥ 65 years. Conclusions: Countries with longstanding PCV13 infant NIPs have observed substantial direct and indirect benefits, which are demonstrated in this study by the reduction in PCV13-7 IPD incidence compared to PCV7 period in all age groups. Over time, non-PCV13 serotypes have emerged in response to the reduction of incidence of PCV13-unique serotypes. Higher-valent PCVs are needed to address this emerging pneumococcal disease burden as well as the direct vaccination of both pediatric and adult populations against the most prevalent circulating serotypes. [ABSTRACT FROM AUTHOR]

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Objective: A combination of 13-valent pneumococcal conjugate vaccine (PCV13) and 23-valent pneumococcal polysaccharide vaccine (PPSV23) is currently recommended for adults with systemic lupus erythematosus (SLE). However, data on the immunogenicity elicited by sequential pneumococcal vaccination in this patient population are scarce. In this study, we compared short-term antibody responses to both PCV13/PPSV23 (≥8-week interval) and PPSV23/PCV13 (≥12-month interval) vaccination strategies in pneumococcal vaccine-naive adults with SLE. Methods: This longitudinal, open-label, quasi-randomized study was performed in a single-center cohort of adults (18 years or older) with SLE. In both vaccination groups, blood samples were collected immediately before administering the first dose of the pneumococcal vaccine (timepoint T0), 4–6 weeks after the priming dose (T1), and 4–6 weeks after the booster dose (T2). We focused on the 12 shared serotypes between PCV13 and PPSV23, and compared the following immunogenicity outcomes between the groups at T2: anti-pneumococcal antibody geometric mean concentration (ApAb GMC), fold increase in ApAb levels (FI-ApAb), overall seroprotection rate, and overall seroconversion rate. The protective level for each pneumococcal serotype was set at 1.3 μg/mL. We used the multi-analyte immunodetection method to determine serum levels of ApAbs. Results: Thirty-four patients with SLE were screened between April 2019 and January 2020, and 16 of them (mean age: 39.4 years, 87.5% female, and 100% on immunosuppressants) had evaluable immunogenicity results at T2. The median time elapsed between the pneumococcal vaccinations was 56 days in the PCV13/PPSV23 group (n = 11 patients) and 16 months in the PPSV23/PCV13 group (n = 5 patients). Priming with PCV13 (PCV13/PPSV23 group), as opposed to PPSV23 (PPSV23/PCV13 group), yielded significantly better results regarding FI-ApAb, overall seroconversion rate, and overall seroprotection rate 4–6 weeks after each pneumococcal vaccination. A trend toward augmented ApAb GMC in the patients who received the PCV13/ PPSV23 sequence was also observed. No relevant safety issues were identified with sequential pneumococcal vaccination. Conclusion: The PCV13-priming PPSV23-boost strategy in adults with SLE induced greater antibody responses for most immunogenicity outcomes than those elicited by the PPSV23/PCV13 strategy. [ABSTRACT FROM AUTHOR]

Background: Despite current recommendation, vaccination coverage (VC) for patients with heart failure (HF) remains far too limited. Aims: To evaluate the VC of HF patients followed in our hospital center and investigate the barriers to vaccination and the ways to address them. Methods: This was a cross-sectional monocentric descriptive study conducted between December 2019 and January 2021 at the University Hospital of Montpellier, France. Patients with HF history hospitalized in cardiology unit (CU) and patients in a HF telemonitoring program (TP) were included. An interview was conducted by a pharmacist to find out the patient's vaccination status against influenza and pneumococcus. For non-vaccinated patients, opinion and willingness to be vaccinated were also obtained. Results: Data from 335 patients were collected (185 in CU, 150 in TP). The mean age was 69.3 years and the proportion of males was 72%. About 65% were vaccinated against influenza in the last year (60% in CU, 72% in TP, p = 0.022) and 22% were up to date with pneumococcal vaccination (11% in CU, 35% in TP, p

Coeliac disease (CD) is associated with hyposplenism, an acquired impairment of spleen function associated with reduced IgM memory B cells and increased susceptibility to serious pneumococcal infection. Little is known about the immune implications of hyposplenism in CD or the optimal pneumococcal vaccination strategy. In this study, the immune effects of hyposplenism in CD, and the accuracy of screening approaches and protective responses induced by two different pneumococcal vaccines were examined. Active and treated CD cohorts, and healthy and surgically splenectomised controls underwent testing for the presence of Howell–Jolly bodies and pitted red cells, spleen ultrasound, and immune assessment of IgM memory B cell frequency and IgM memory B cell responses to T cell-dependent (TD) or T cell-independent (TI) stimulation. Responses following conjugate (TD) and polysaccharide (TI) pneumococcal vaccination were compared using ELISA and opsonophagocytic assays. Although hyposplenism is rare in treated CD (5.1%), functional B cell defects are common (28–61%) and are not detected by current clinical tests. Conjugate pneumococcal vaccination induced superior and sustained protection against clinically relevant serotypes. Clinical practice guidelines in CD should recommend routine pneumococcal vaccination, ideally with a conjugate vaccine, of all patients in lieu of hyposplenism screening.

Streptococcus pneumoniae is a major pathogen in the pediatric population causing life-threatening infections ranging from pneumonia and meningitis to sepsis, and it is now a vaccine-preventable infection. Recently, pneumococcus is emerging as a cause of multidrug-resistant infection, resistant to ≥3 classes of antibiotics. Here, we discuss a case of ventricular empyema in a toddler due to S. pneumoniae. He was not vaccinated against pneumococcus. He had ventriculitis, ventricular empyema, and obstructive hydrocephalus. He was managed with external ventricular drainage of pus, followed by a ventriculoperitoneal shunt, and received 6 weeks of intravenous antibiotics, followed by oral antibiotics. He recovered with residual neurological sequelae and showed an improvement on follow-up visits.

Background: At present, because of indirect effects derived from routine childhood immunisation, clinical benefits vaccinating adults with the 23-valent pneumococcal polysaccharide vaccine (PPsV23) and/or the 13-valent pneumococcal conjugate vaccine (PCV13) are uncertain. This study investigated clinical effectiveness for both PPsV23/PCV13 in preventing pneumonia among Catalonian adults during an earlier 2-year period post-PCV13 free (publicly funded) approval for infants. Methods: We conducted a Population-based cohort study involving 2,059,645 adults ≥ 50 years in Catalonia, Spain, who were followed between 01/01/2017–31/12/2018. Primary outcomes were hospitalisation from pneumococcal pneumonia (PP) or all-cause pneumonia (ACP) and main explanatory variable was PCV13/PPsV23 vaccination status. Cox regression models were used to estimate vaccination effectiveness adjusted by age/sex and underlying-risk conditions. Results: Cohort members were followed for 3,958,528 person-years (32,328 PCV13-vaccinated, 1,532,186 PPsV23-vaccinated), observing 3592 PP (131 in PCV13-vaccinated vs 2476 in PPsV23-vaccinated) and 24,136 ACP (876 in PCV13-vaccinated vs 17,550 in PPsV23-vaccinated). Incidence rates (per 100,000 person-years) were 90.7 for PP (394.2 in PCV13-vaccinated vs 161.6 in PPsV23-vaccinated) and 609.7 for ACP (2636.3 in PCV13-vaccinated vs 1145.4 in PPsV23-vaccinated). The PCV13 was associated with an increased risk of PP (hazard ratio [HR]: 1.24; 95% CI: 1.00–1.52; p = 0.046) and ACP (HR: 1.38; 95% CI: 1.28–1.49; p

The Middle East and North Africa (MENA) region has the second-highest rate of increase in diabetes, especially in KSA, Egypt, and UAE. Diabetes accounts for a significant economic burden in terms of the cost of treatment, the management of complications, disability, and the loss of productivity. Diabetic adults have an increased susceptibility to infections due to the presence of hyperglycemia. The risk of pneumonia is higher in patients with diabetes. Pneumonia caused by Streptococcus pneumoniae (pneumococcal infections) is the most frequent cause of hospitalization in KSA, which also increases the risk of mortality in diabetic patients. The annual planned pilgrimage to Mecca, KSA, is one of the largest frequent religious gatherings globally, and outbreaks of infectious diseases are of great concern. This review will discuss the pneumococcal infection outbreak and prevention in patients with diabetes in KSA. Also, it will gather information discussed by a scientific advisory board held in Riyadh in 2020 covering the current understanding of pneumococcal disease prevention in diabetic patients and recommendations to overcome barriers facing vaccination. [ABSTRACT FROM AUTHOR]

• The caregiving burden is negatively associated with influenza vaccination among older adults. • The caregiving burden is not associated with pneumococcal vaccination among oldder adults. • Having a family physician mitigates the negative effect on influenza vaccination and it enhances both influenza and pneumococcal vaccinations among older adults. Influenza and pneumonia tend to be severe in older adults; thus, vaccination is necessary to prevent these illnesses. Vaccination is especially important for older family caregivers (OFCs) not only to prevent them from becoming ill, but also to prevent secondary infections in the family care receivers (FCRs), who are mostly frail older adults and have a higher risk of severe illness. Thus, we investigated whether caregiving burdens were associated with the vaccinations among older adults. We used cross-sectional data from the Japan Gerontological Evaluation Study (JAGES), which was conducted in 64 Japanese municipalities from November 2019 to January 2020. The target population consisted of 26,177 individuals aged 65 years or older who were independent and did not need public long-term care. The primary outcome was the uptakes of either or both influenza and pneumococcal vaccinations. Multinomial logistic regressions were performed, setting those who underwent neither vaccinations as the reference group. Among the participants, 23.3 %, 25.8 %, 9.4 %, or 41.5 % underwent neither, only influenza, only pneumococcal, or the both vaccinations, respectively. The caregiving frequency, time length in a day, or dementia of FCR were negatively associated with influenza vaccination (caregiving almost every day: relative risk ratio {RRR}: 0.39, 95 % confident interval {95 % CI} [0.24–0.63]; caregiving almost all day: 0.44, 95 % CI: 0.23–0.85; caregiving for FCR: RRR:0.55, 95 % CI: 0.34–0.91). On the other hand, those caregiving burdens were not associated with pneumococcal only or the both vaccinations. Having a family physician mitigated all the negative effect of the caregiving burdens on the vaccinations. Our results suggest that the caregiving burden is a barrier to influenza vaccination but not to pneumococcal vaccination and that having a physician mitigates the negative effect regardless of the burden kind. [ABSTRACT FROM AUTHOR]

The Belgian Superior Health Council (SHC) preferentially recommended the 20-valent pneumococcal conjugate vaccine (PCV20) for adults aged ≥65 years, immunocompromised patients, and patients aged ≥50 years suffering from conditions that increase their risk for pneumococcal infections. The objective of this paper is to present the cost-utility of PCV20 compared to no vaccination and the alternative sequence of PCV15 followed by the 23-valent pneumococcal polysaccharide vaccine (PPV23) in this population. The analysis employed a static Markov model capturing lifetime risk of pneumococcal infections, associated disutility, mortality, and costs from different healthcare payer perspectives. Results indicated use of PCV20 among Belgian older and at-risk adults is highly cost-effective compared to no vaccination, with an incremental cost per quality-adjusted life-year (QALY) of €4,164. Compared to the sequential regimen (PCV15+PPV23), PCV20 vaccination is a cost-saving strategy. Subgroup analysis indicated PCV20 vaccination of at-risk adults aged 65–84 years would also be cost-saving from the national healthcare perspective. Based on current knowledge, this analysis suggests that access to PCV20 should be proposed in all adults recommended for vaccination by the SHC as PCV20 prevents additional hospitalizations and deaths caused by pneumococcal infection at an affordable cost. Pneumococcal infections cause a high burden on infected patients and society. Vaccination of patients at risk of severe infection has been recommended for decades, but uptake of pneumococcal vaccines in adults has historically been low in Belgium, where patients have borne the vaccine costs and the recommended vaccination schedule required the sequential administration of two vaccines. A single PCV20 dose is recommended as the preferred vaccine for adults at risk due to age or other factors in Belgium as it is expected to provide lasting protection against more types of disease-causing pneumococcal bacteria as well as being simpler to administer than alternatives requiring multiple injections. Uptake is expected to improve with the recent reimbursement of the new PCV20 vaccine, though reimbursement covers only a portion of the recommended population. This paper presents a detailed analysis of the PCV20 cost-effectiveness in all adults at increased risk of severe pneumococcal disease, including immunocompromised adults younger than 65 years. Our analysis captures and compares the lifetime risk of pneumococcal disease and associated healthcare costs in an unvaccinated cohort, a cohort vaccinated with the alternative recommendation of PCV15 and PPV23 vaccines and a cohort vaccinated with PCV20. This cost-effectiveness analysis indicates that use of PCV20 will help decrease the number of pneumococcal disease cases, hospitalizations, and premature deaths at an affordable healthcare cost: PCV20 is a cost-effective option compared to no vaccination and a cost-saving option compared to the sequential regimen PCV15 followed by PPV23 in the Belgian adult population recommended for pneumococcal vaccination. [ABSTRACT FROM AUTHOR]

Objective: An increased risk of invasive pneumococcal disease (IPD) has been reported in children with asthma before the introduction of pneumococcal vaccines (PVs). However, the evidence is limited after PV entered the routine immunization schedule. We aimed to investigate whether pediatric allergists recommend additional PV (aPV) to asthmatic children and if so whether there are any asthmas-pecific risk factors they consider. We also wanted to determine any changes in their recommendations during the COVID-19 pandemic. Materials and Methods: A questionnaire was e-mailed to all members of the Academy of Pediatric Allergy and Asthma in Turkey. The questionnaire was filled online and consisted of 14 questions. Results: The questionnaire was e-mailed to 220 members. The response rate was 56.3% and 60.5% of PA recommended aPV. The most frequent asthma specific factors for aPV were severe asthma (70.2%), long term oral corticosteroid use (65.3%) and frequent exacerbations / hospitalizations (62.9%). COVID-19 pandemic increased the rate of questions asked to PA about aPV for asthmatic children compared to previous periods (75.8 vs 33.9%) (p<0.001) and %27 of PA changed their recommendations in favor of aPV during pandemic. Conclusion: Asthmatic children is not infrequent. Severe asthma and related factors seem to be the leading reasons to recommend aPV for asthmatic children. The aPV recommendation by PA is increased during COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

The aim of the article is the evaluation of the economic damage (ED) because of the absence of pneumococcal vaccination as a leading risk factor for the development of community-acquired pneumonia (CAP) and acute exacerbations of а chronic obstructive pulmonary disease (COPD).Materials and methods. The method of attributive statistics was used for the first time to assess the ED of the vaccination absence as an independent risk factor contributing to the development of CAP and COPD exacerbations in the Astrakhan region for the period of 2015–2019. To do this, at the beginning of the study based on the literature data, a relative risk of COPD complications associated with the absence of pneumococcal vaccination was determined. Using it as a risk factor, prevalence rates (a proportion of non-vaccinated patients with COPD), the population attributable risk (PAR) was calculated. Further, the annual economic damage (ED) from the development of CAP and COPD exacerbations was determined. To assess the cost-effectiveness of the COPD complications prevention, vaccination costs of newly registered patients were calculated and the ratio of these costs to the average annual ED was determined.Results. A decrease in the non-vaccinated patients’ proportion corresponds to the decrease in the total ED from COPD complications: from 13.16 million rubles to 6.06 million rubles during the observation period. The calculations showed that due to the increase in the vaccinated patients’ proportion over a five-year observation period, the ED from the CAP development decreased by 2.1 times, from exacerbations of COPD – by 2.3 times. The vaccination costs of newly diagnosed COPD cases amounted to 0.63 million rubles. Thus, to prevent the annual ED of 3.24 million rubles, the sum for the state to spend, should be 5.2 times as small.Conclusion. A study on the evaluation of the ED due to the risk factor (RF), the pneumococcal vaccination absence, showed that its elimination reduces the risk of acute COPD exacerbations and the development of CAP, as well the ED, as associated with them. Reducing the economic costs of the health care system with significantly lower vaccination costs, makes this preventive measure economically viable.