The Epidemiology and Burden of Pneumococcal Disease. Thomas Cherian

Transcription

1 The Epidemiology and Burden of Pneumococcal Disease Thomas Cherian

2 Diseases caused by Streptococcus pneumoniae (Pneumococcus) Pneumonia Otitis Sinusitis NP carriage Febrile bacteraemia Meningitis Arthritis Peritonitis Osteomyelitis Invasive pneumococcal disease 2

3 NP colonization occurs earlier in lower socioeconomic settings Proportion colonized (%) Papua New Guinea Australian Aborigines India Costa Rica Israeli Jews Sweden & Finland Age (months) O Brien et al. Pediatr Infect Dis J. 3; 22(2): e1-11 3

4 Surveillance for laboratory confirmed disease only provides part of the picture Culture positive Spn disease Identified by surveillance for invasive disease Culture negative meningitis and pneumonia Additional cases preventable with vaccination 4

5 Incidence of IPD Incidence < 2 years Incidence < 5 years Incidence/ 1, children Finland Chile USA Kenya The Gambia Bangladesh - urban Bangladeshrural Sources: Robinson KA JAMA 1; Davidson M JID 1994; O Dempsey TJ PIDJ 1996; Levine MM PIDJ 1998; Eskola J JAMA 1992; Berkley NEJM 5; Brooks Am J Trop Med Hyg 7; Arifeen SE CID 9 5

6 Invasive Pneumococcal Disease Rates, by Age, USA Rate per 1, persons < > 65 Months Available at: Age Years 6

7 Age distribution of pneumococcal meningitis cases (Bangladesh, India) Russel F et al. PCV-schedules-session-nov11.pdf 7

8 Pneumococcus is a significant cause of bacterial meningitis Percent of isolates Mozambique (1) Vietnam (11) Burkina Faso (12) Pneumococcus Hib Meningococcus In low-income countries about 45% of people with pneumococcal meningitis die, compared to 29% with Hib meningitis and 8% with meningococcal meningitis 1 Peltola H. Clin Inf Dis 1; 32: Ciana G, Parmar N, et al. J Trop Pediatr 1995; 41: Tram TT, Thinh LQ, et al. Ped Inf Dis J 1998; 17(9 Suppl): S192-S du Chatelet IP, Traore Y, et al. Clin Inf Dis 5; 4:

9 Proportion of meningitis caused by pneumococcus Proportion of CSF specimens positive for S. pneumoniae, culture, latex or Binax ICT, children <5 y.o. 3.% 25.%.% 15.% Binax ICT Latex Culture 21.6% 17.2% 17.4% 16.2% 16.2% 1.% 5.%.% Bangladesh (n=356) Pakistan (n=274) Burkina Faso (n=121) Asia Kenya (n=66) Africa Nigeria (n=37) 9

10 Serotypes causing IPD in India, Nepal & Sri Lanka (n = 735) % % Vaccine Type C u m m l a t i v e 14 6A/B/C/D 19F 23F 9A/V 18A/B/C/F A/F 3 19A 15B/C 2 23A 8 47F 12A 22A/F 11A/D 25F 38 9N/L 13 15A 16 19B 39 1A 17F 19C 23B 24F C 33F 34 35, F 11C 15 16A 16 F 24B B 35B 35C PCV7 PCV1 PCV13 NVT Vaccine Type Cummlative Data for the period of

11 Differences in serotype prevalence between India, Nepal & Sri Lanka 18 INDIA 1 9 NEPAL 16 8 % Vaccine Types A/B/C/D 14 19F 18A/B/C/F 23F 9A/V 7A/F 19A 15B/C 27 11A/D 22A/F 33C 33F A PCV7 PCV1 PCV13 NVT 1F 16 F 17F 19B 19F 23A 24B 24F 47F 9N/L % C u m m l a t i v e % Vaccine Types % C u m m l a t i v e 18 Vaccine Type Cummlative A/V 18A/B/C/F 23F 19F 6A/B/C/D 7A/F PCV7 PCV1 PCV13 NVT 9 Vaccine Type Cummlative 19A 12A 25F B 23A 23B 47F A 15A 1A % Vaccine Types % C u m m l a t i v e SRI LANKA F 6A/B/C/D 23F 9A/V 18A/B/C/F 19A 15B/C 23A 47F A/D 15A 22A/F C 16A 17F 19C 33B 35,42 35C 9N/L PCV7 PCV1 PCV13 NVT Vaccine Type Cummlative 11

12 The image part with relationship ID rid2 was not found in the file. Figure: Distribution of Meningitis and Non-meningitis Cases with Their Vaccine Coverage (7-13) P C V B 23F 7F 19F 18C 6A 4 9V 19A 2 12A 18F A 12F 1F 33F 34 7B 1A 11A 11F 13 15A 15F 16F 17F 23A 24F 25F 28A 33B 35B 35F 22F C 6C Nonmenin Meningitis Culture Positive Meningitis Culture Negative Non-meningitis (N= 15) (Meningitis (N=336) PCV-1 Coverage Meningitis 44% Non-Meningitis 47% Overall 45% Source: S K Saha, personal communication

13 All Countries (India, Nepal, Sri Lanka) by Year % Vaccine Type A/B/C/D 19F 23F 9A/V 18A/B/C/F A/F 3 19A.9 PCV7 PCV1 PCV13 NVT

14 Figure: PCV-1 Coverage for IPD Cases in Bangladesh, % 7% PCV-1 PCV-1 Coverage Meningitis 44% Non-Meningitis 47% Overall 45% 6% 57% 54% 5% 47% 4% 39% 4% 38% PCV-1 3% 29% % 1% % Source: Samir Saha 14

15 Incidence of pneumonia Outcome and age range (months) India (cases per 1 child-years) Neighboring countries (per 1) Developing countries globally (per 1) ALRI , ALRI Severe ALRI Severe ALRI Severe ALRI Severe ALRI Severe ALRI , 31, 79 15

16 S. pneumoniae The Most Common Cause of Bacterial Pneumonia 6 % of bacterial isolates Percent of aspirates S. pneumoniae H. influenzae Other bacteria Papua New Guinea (1) The Gambia (2) Zimbabwe (3) The Gambia (4) 1 Shann F, Gratten M, Germer S, et al. Lancet. 1984; 2(842): Wall RA, Corrah PT, Mabey DC, Greenwood BM. Bull World Health Org. 1986; 64(4): Ikeogu MO. Arch Dis Child. 1989; 64(8):17. 4 Forgie IM, Campbell H, Lloyd-Evans N, et al. Pediatr Infect Dis J. 1992; 11(6):

17 Lung aspirate studies from S Asia Author Year N No. pos S pneumo H inf S aureus Others Sinha Hughes Hughes Kalra Tewari Prakash Patwari All studies (48%) 36 (13%) 21 (8%) 36 (13) 44 (16) Source: Vuori-Holopainen E, Peltola H. CID 1 Included older children 17

18 Proportion of pneumonia attributable to pneumococcus, based on vaccine impact data 6% 5% 4% 3% Clinical Pneumonia Severe Pneumonia CXR+ Pneumonia 33% % 21% 1% 8% % -1% -% -3% Clinical Pneumonia NCKP South Africa Gambia Philippines Severe Pneumonia NCKP South Africa Gambia Philippines CXR+ Pneumonia NCKP South Africa Gambia Philippines 18

19 Causes of death in children, 1 Liu et al. Lancet 12 19

20 Pneumonia mortality trends, SEAR Liu et al. Lancet 12

21 Etiology - bacterial probe studies Country and age range (months) India -47 Pakistan -59 Pakistan -59 Bangladesh -23 Nepal -59 Study design Case-control, village randomized Observational, community based Observational, hospital based Case-control, village randomized Observational, community based Outcome measure Fatal pneumonia 54% Fatal ALRI 55% ARI case fatality rate Outcome-specific mortality reduction 51% Fatal pneumonia 54% Fatal ARI 69% 21

22 Country Estimates of pneumococcal deaths (WHO, 8 unofficial) Pneumococcal deaths Pneumonia Meningitis NPNM Total Bangladesh Bhutan India Maldives Nepal Pakistan Sri Lanka TOTAL

23 Top 1 high burden countries Population size vs mortality rate 15 Under 5 population (million) Feb/8 analysis China India Nigeria Pakistan Ethiopia DR Congo Bangladesh Uganda Angola Afghanistan Pneumococcal deaths per 1, children under 5 years 23

24 Summary Pneumococcus is an important cause of serious disease in children, especially pneumonia and meningitis. Establishing pneumococcal etiology of childhood pneumonia is a challenge and limits the ability to get a direct estimation of burden of disease Synthesis of available data shows that pneumococcal disease is an important cause of childhood morbidity and mortality worldwide, as well as in South Asia. No reason to suspect that the epidemiology of pneumococcal disease in South Asia is different from that in other countries with similar socio-economic & mortality profile. 24

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26 EXTRA SLIDES

27 IPD serotypes, India (5-213) (n=349) % Vaccine Types % C u m m l a t i v e 2 1 6A/B/C/D 14 19F 4 18A/B/C/F 23F 9A/V 5 1 7A/F 19A 15B/C 27 11A/D 22A/F 33C 33F A 1F 16 F 17F 19B 19F 23A 24B 24F 47F 9N/L PCV7 PCV1 PCV13 NVT Vaccine Type Cummlative Data for the period of

28 IPD serotypes, Nepal (5-13) (n=21) % Vaccine Types % C u m m l a t i v e A/V 18A/B/C/F 23F 19F 6A/B/C/D A/F 3 19A A 25F B 23A 23B 47F A 15A 1A PCV7 PCV1 PCV13 NVT Vaccine Type Cummlative Data for the period of

29 IPD serotypes, Sri Lanka (5-13) ( n=176) % Vaccine Types % C u m m l a t i v e F 6A/B/C/D 23F 9A/V 18A/B/C/F A 15B/C 23A 47F A/D 15A 22A/F C 16A 17F 19C 33B 35,42 35C 9N/L PCV7 PCV1 PCV13 NVT Vaccine Type Cummlative Data for the period of

30 India by Year 3

31 Nepal by Year % Vaccine Type A/V 18A/B/C/F 23F 19F 6A/B/C/D A/F 3 19A 23.5 PCV7 PCV1 PCV13 NVT Data for the period of

32 Sri Lanka by Year % Vaccine Type F 6A/B/C/D 23F 9A/V 18A/B/C/F A PCV7 PCV1 PCV13 NVT Data for the period of