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      Effectiveness of 23-Valent Pneumococcal Polysaccharide Vaccine against Invasive Pneumococcal Disease in Adults, Japan, 2013–2017

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          Abstract

          The decline in the proportion of pneumococcal conjugate vaccine (PCV)–covered serotypes among adult invasive pneumococcal disease (IPD) patients might change the overall effectiveness of the 23-valent pneumococcal polysaccharide vaccine (PPSV23) because its effectiveness differs according to serotype. Using the indirect cohort method, we calculated the effectiveness of PPSV23 against IPD among adults in Japan to assess the impact of the national pediatric PCV program. Clinical and epidemiologic information and pneumococcal isolates were collected from IPD patients >20 years of age through enhanced IPD surveillance during April 2013–December 2017. Adjusted effectiveness against PPSV23-serotype IPD was 42.2%. Despite a substantial decline in the proportion of 13-valent PCV serotypes during the study period (45% to 31%), the change in effectiveness for PPSV23-serotype IPD was limited (47.1% to 39.3%) and only marginal in the elderly population (39.9% to 39.4%). The pediatric PCV program had limited impact on PPSV23 effectiveness against IPD in adults.

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          Effect of use of 13-valent pneumococcal conjugate vaccine in children on invasive pneumococcal disease in children and adults in the USA: analysis of multisite, population-based surveillance.

          Matthew R. Moore, Ruth Link-Gelles, William Schaffner … (2015)
          In 2000, seven-valent pneumococcal conjugate vaccine (PCV7) was introduced in the USA and resulted in dramatic reductions in invasive pneumococcal disease (IPD) and moderate increases in non-PCV7 type IPD. In 2010, PCV13 replaced PCV7 in the US immunisation schedule. We aimed to assess the effect of use of PCV13 in children on IPD in children and adults in the USA.
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            Revisiting pneumococcal carriage by use of broth enrichment and PCR techniques for enhanced detection of carriage and serotypes.

            Maria da Gloria Carvalho, Fabiana C. Pimenta, Delois Jackson … (2010)
            The measurement of pneumococcal carriage in the nasopharyngeal reservoir is subject to potential confounders that include low-density and multiple-strain colonization. To compare different methodologies, we picked a random sampling of 100 nasopharyngeal specimens recovered from infants less than 2 years of age who were previously assessed for pneumococcal carriage and serotypes by a conventional method that used direct plating from the transport/storage medium (50 specimens were culture negative and 50 specimens were culture positive for pneumococci). We used a broth enrichment approach and a conventional PCR approach (with and without broth enrichment) to determine pneumococcal carriage and serotypes, and the results were compared to the initial conventional culture-based results. Additionally, we used a lytA-targeted real-time PCR for pneumococcal detection. Broth enrichment for both the culture-based and the PCR-based methods enhanced the isolation of pneumococci and detection of serotype diversity, with the most effective serotype deduction method being one that used broth enrichment prior to sequential multiplex PCR. Similarly, we also found that broth enrichment followed by the lytA-specific real-time PCR was the most sensitive for the detection of apparent pneumococcal carriage. The broth enrichment, conventional multiplex PCR, and real-time PCR approaches used in this study were effective in detecting pneumococcal carriage in the 50 specimens that were negative by conventional direct plating from transport medium (range of numbers of positive specimens, 8/50 to 22/50 [16 to 44%]), and the three different serotyping approaches that used broth enrichment increased the number of serotype identifications from the 100 specimens (12 to 29 additional serotype identifications to be positive). A PCR-based approach that employed a broth enrichment step appeared to best enhance the detection of mixed serotypes and low-density pneumococcal carriage.
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              Pneumococcal Conjugate and Plain Polysaccharide Vaccines Have Divergent Effects on Antigen-Specific B Cells

              Elizabeth A. Clutterbuck, Rajeka Lazarus, Ly-Mee Yu … (2012)
              Background.  A 23-valent unconjugated pneumococcal polysaccharide vaccine (23vP), routinely administered at the age of 65, has limited effectiveness, and revaccination induces attenuated antibody responses. It is not known whether pneumococcal polysaccharide-protein conjugated vaccines (PCV), although highly effective in infants, offer any immunological advantages over 23vP in adults. Methods.  We immunized adults with schedules combining both PCV and 23vP and investigated B-cell responses to establish whether PCV7 (a 7-valent PCV) induced T-dependent responses in adults, to assess the role of memory B cells in 23vP-induced antibody hyporesponsiveness, and to identify the B-cell subtypes involved. Results.  A single dose of PCV7 induced significant increases in serotype-specific memory B-cell populations in peripheral blood indicating a T-dependent response. Conversely, immunization with 23vP resulted in a decrease in memory B-cell frequency. Furthermore, memory B-cell responses to subsequent immunization with PCV7, when given after 23vP, were attenuated. Notably, B1b cells, a subset important in protecting mice against pneumococci, were also depleted following immunization with 23vP in humans. Conclusions.  This study indicates that PCV7 may have an immunological advantage over 23vP in adults and that 23vP-induced depletion of memory and B1b-cell subsets may provide a basis for antibody hyporesponsiveness and the limited effectiveness of 23vP. Clinical Trials Registration. ISRCTN: 78768849.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Emerg Infect Dis
                Journal ID (iso-abbrev): Emerging Infect. Dis
                Journal ID (publisher-id): EID
                Title: Emerging Infectious Diseases
                Publisher: Centers for Disease Control and Prevention
                ISSN (Print): 1080-6040
                ISSN (Electronic): 1080-6059
                Publication date (Print): October 2020
                Volume: 26
                Issue: 10
                Pages: 2378-2386
                Affiliations
                [1]National Institute of Infectious Diseases, Tokyo, Japan (R. Shimbashi, M. Suzuki, B. Chang, K. Tanaka-Taya, T. Matsui, T. Sunagawa, K. Oishi);
                [2]Tohoku University Graduate School of Medicine, Miyagi, Japan (R. Shimbashi, M. Suzuki, K. Oshima);
                [3]Kurume University School of Medicine, Fukuoka, Japan (H. Watanabe);
                [4]Niigata Prefectural Shibata Hospital, Niigata, Japan (Y. Tanabe);
                [5]Sapporo Medical University School of Medicine, Hokkaido, Japan (K. Kuronuma);
                [6]National Hospital Organization Mie National Hospital, Mie, Japan (T. Maruyama);
                [7]Yamagata Saisei Hospital, Yamagata, Japan (H. Takeda);
                [8]Nara Medical University, Nara, Japan (K. Kasahara);
                [9]Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan (J. Fujita);
                [10]Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan (J. Nishi);
                [11]Kochi Medical School, Kochi University, Kochi, Japan (T. Kubota);
                [12]Toyama Institute of Health, Toyama, Japan (K. Oishi)
                Author notes
                Address for correspondence: Motoi Suzuki, Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku, Tokyo 162-8640, Japan; email: mosuzuki@ 123456niid.go.jp
                Article
                Publisher ID: 19-1531
                DOI: 10.3201/eid2610.191531
                PMC ID: 7510723
                PubMed ID: 32946721
                SO-VID: b84b4dfb-6ed9-4898-8452-378829bc3c5b
                History
                Categories
                Subject: Research
                Subject: Research
                Subject: Effectiveness of 23-Valent Pneumococcal Polysaccharide Vaccine against Invasive Pneumococcal Disease in Adults, Japan, 2013–2017

                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: ppsv23,23-valent pneumococcal polysaccharide vaccine,ipd,invasive pneumococcal disease,vaccine effectiveness,indirect cohort method,indirect effect,respiratory diseases,vaccine-preventable diseases,japan
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: ppsv23, 23-valent pneumococcal polysaccharide vaccine, ipd, invasive pneumococcal disease, vaccine effectiveness, indirect cohort method, indirect effect, respiratory diseases, vaccine-preventable diseases, japan

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