Program Schedule

Prevention of Antimicrobial Resistant Infection Among Children Aged <5 Years with the 13-valent Pneumococcal Conjugate Vaccine — Selected U.S. Areas, 2005–2013

Session: Oral Abstract Session: Defining and Reducing the Impact of Pediatric Infections
Thursday, October 9, 2014: 9:00 AM
Room: The Pennsylvania Convention Center: 111-AB

Prevention of Antimicrobial-Resistant Infections Among Children Aged <5 Years with the 13-valent Pneumococcal Conjugate Vaccine — Selected U.S. Areas, 2005–2013

S. Tomczyk, J. Jorgensen, R. Lynfield, W. Schaffner, D. Aragon, L. Harrison, M. Nichols, S. Petit, A. Thomas, A. Reingold, MM. Farley, S. Zansky, B. Beall, L. McGee, L. Kim

Background:  Following introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) in 2000, antimicrobial-resistant (AR) invasive pneumococcal disease (IPD) decreased in the U.S.  In 2010, a 13-valent PCV (PCV13) replaced PCV7.  We evaluated the impact of PCV13 on AR IPD and progress towards the Healthy People (HP) 2020 goal to reduce AR IPD to 6.0 cases per 100,000 among children <5 years in the U.S.

Methods: IPD cases (isolation of pneumococcus from sterile sites) were identified from 10 Active Bacterial Core surveillance (ABCs) sites during 2005–2013 in children <5 years.  Isolates were serotyped, and antimicrobial susceptibility testing was performed at reference laboratories.  AR was defined as a bacterial isolate exhibiting intermediate or resistant patterns to ≥1 antimicrobial class (i.e. penicillins, macrolides, cephalosporins, and tetracyclines) according to the Clinical and Laboratory Standards Institute's minimum inhibitory concentration breakpoints.  Multidrug resistance (MR) was defined as resistance to ≥3 antimicrobial classes. We calculated overall incidence rates during 2005–2013 of AR and MR IPD.  We also stratified overall AR by PCV5-type (i.e. the 5 serotypes not protected by PCV7) and non-vaccine type IPD (i.e. not included in PCV7 or PCV13).

Results: We identified 745 resistant cases pre-PCV13 (2005–2009) and 378 resistant cases post-PCV13 (2010–2013).  Overall incidence of AR IPD decreased from 9.3 to 3.5 per 100,000 in 2009 and 2013, respectively (percent change, -62) (Figure 1). Similarly, PCV5-type AR and MR IPD decreased by 93% and 86% from 2009 to 2013, respectively. Non-vaccine type AR IPD increased from 2.5 to 3.1 per 100,000 (Figure). 

Conclusion: Substantial decreases in overall, PCV5-type, and MR IPD occurred after PCV13 introduction in children <5 years.  The HP 2020 goal was met in 2011, 9 years earlier than the target year. The use of appropriate antimicrobials remains important in addition to sustained high use of PCV13.



Sara Tomczyk1, James Jorgensen, PhD2, Ruth Lynfield, MD3, William Schaffner, MD4, Deborah Aragon, MSPH5, Lee Harrison, MD6, Megin Nichols, DVM, MPH, DACVPM7, Susan Petit, MPH8, Ann Thomas, MD, MPH9, Arthur Reingold, MD10, Monica M. Farley, MD11,12, Shelley M. Zansky, PhD13, Bernard Beall, PhD1, Lesley Mcgee, PhD1 and Lindsay Kim, MD, MPH1, (1)Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, (2)University of Texas Health Sciences Center, San Antonio, TX, (3)Minnesota Department of Health, St. Paul, MN, (4)Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, (5)Colorado Department of Public Health & Environment, Denver, CO, (6)John Hopkins Bloomberg School of Public Health, Pittsburgh, MD, (7)New Mexico Department of Public Health, Santa Fe, NM, (8)Connecticut Department of Public Health, Hartford, CT, (9)Oregon Public Health Division, Portland, OR, (10)University of California - Berkeley, Berkeley, CA, (11)Emory University School of Medicine, Atlanta, GA, (12)Atlanta Veterans Affairs Medical Center, Decatur, GA, (13)New York State Department of Health, Albany, NY


S. Tomczyk, None

J. Jorgensen, Merck: Grant Investigaor for a different study regarding gram-negative, Research support
Accelerate Diagnostics: Scientific Advisor, Consulting fee

R. Lynfield, None

W. Schaffner, Pfizer, GlaxoSmithKline, Dynavax: Limited consulting fee, Consulting fee
Merck & Sanofi-Pasteur: Data safety monitoring board, Board membership benefits

D. Aragon, None

L. Harrison, Pfizer & Merck: Limited consulting fee terminated in 2012, Consulting fee

M. Nichols, None

S. Petit, None

A. Thomas, None

A. Reingold, None

M. M. Farley, None

S. M. Zansky, None

B. Beall, None

L. Mcgee, None

L. Kim, None

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