Prevention of Antimicrobial Resistant Infection Among Children Aged <5 Years with the 13-valent Pneumococcal Conjugate Vaccine Selected U.S. Areas, 20052013
Prevention of Antimicrobial-Resistant Infections Among Children Aged <5 Years with the 13-valent Pneumococcal Conjugate Vaccine Selected U.S. Areas, 20052013
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 20052013 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 20052013 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 (20052009) and 378 resistant cases post-PCV13 (20102013). 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.
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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