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| 26. |
- Backhaus, Erik
(författare)
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Invasive Pneumococcal Infections
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Streptococcus pneumoniae is a major cause of disease, ranging from uncomplicated respiratory infections to severe invasive pneumococcal disease (IPD), including bacteraemic pneumonia, septicaemia with unknown focus and meningitis. Case fatality rate (CFR) remains high and antibiotic resistance is increasing globally. S. pneumoniae is surrounded by a polysaccharide capsule that can be divided into more than 90 immunologically different serotypes. Vaccination may reduce morbidity and mortality due to IPD. Two vaccine types exist: pneumococcal polysaccharide vaccine (PPV-23) and pneumococcal conjugate vaccines (PCV-7, 10, 13). The former contains 23 serotypes, but does not work in small children, whereas the latter also protects children below two years of age, but includes only 7, 10 and 13 serotypes, respectively. The aim was to explore the epidemiology of IPD before the introduction of PCV-7 in the Swedish childhood vaccination programme, in January 2009: serotype distribution, antimicrobial susceptibility and potential vaccine coverage among isolates causing IPD; mortality, case fatality rate and incidence of different IPD manifestations related to age and risk groups; the impact of serotype and genotype on manifestations and outcome; and finally, long-term changes in the epidemiology during 45 years. Consecutive isolates and clinical data from 836 adults and children with IPD were collected in the Västra Götaland region (VGR) and Halland during 1998-2001. Serotype and antibiotic susceptibility were tested. Clonal complex (CC) was determined for these isolates together with 424 IPD isolates from adults and children in Stockholm using pulsed field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST). Clinical data for all 2977 IPD episodes in VGR during 1996-2008 were retrieved from hospital notes. Prevalence data for predisposing factors were included from patient registries and recent publications. Of 836 strains, 42%, 70%, 75% and 94% belonged to serotypes included in PCV-7, -10, -13 and PPV- 23, respectively. Decreased susceptibility was uncommon, and largely confined to certain clones and serotypes, especially those included in PCV-7. Serotypes 1 and 7F were most common; they infected younger patients with less underlying disease and caused lower CFR than other serotypes, whereas 19A caused higher CFR. Clonal distribution differed between adults and children. CC306 (all serotype 1), caused lower CFR among adults than six other CCs. The relation between serotype and CC was complicated; clinical characteristics differed between some CCs within the same serotype and between some serotypes within the same CC; it was often difficult to determine whether these differences were related to serotype, CC or both. The annual incidence of IPD was 15/100,000 and varied largely with age and underlying disease. It was highest at extremes of age and in patients with myeloma (2238/100,000), followed by chronic lymphatic leukemia, haemodialysis, lung cancer, HIV, rheumatic diseases, chronic obstructive pulmonary disease and diabetes mellitus. In contrast, it was not elevated among asthma patients. When compared with data from previous studies during 45 years, the incidence increased threefold and the CFR dropped from 20 to 10% for all IPD, whereas the incidence remained stable (1.1/100,000/year) and the CFR dropped from 33 to 13% for meningitis. In conclusion, incidence and CFR have changed considerably over time and vary widely between different age and risk groups. CFR is also influenced by serotype and genotype. These factors have to be considered during planning and evaluation of vaccination against pneumococci.
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| 27. |
- Browall, Sarah, et al.
(författare)
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Clinical manifestations of invasive pneumococcal disease by vaccine and non-vaccine types
- 2014
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Ingår i: European Respiratory Journal. - : European Respiratory Society. - 0903-1936 .- 1399-3003. ; 44:6, s. 1646-1657
-
Tidskriftsartikel (refereegranskat)abstract
- Pneumococcal conjugated vaccines (PCVs) have shown protection against invasive pneumococcal disease by vaccine serotypes, but an increase in non-vaccine serotype disease has been observed. Type-specific effects on clinical manifestation need to be explored.Clinical data from 2096 adults and 192 children with invasive pneumococcal disease were correlated to pneumococcal molecular serotypes. Invasive disease potential for pneumococcal serotypes were calculated using 165 invasive and 550 carriage isolates from children.The invasive disease potential was lower for non-PCV13 compared to vaccine-type strains. Patients infected with non-PCV13 strains had more underlying diseases, were less likely to have pneumonia and, in adults, tended to have a higher mortality. Furthermore, patients infected with pneumococci belonging to clonal serotypes only expressing non-PCV13 capsules had a higher risk for septicaemia and mortality.PCV vaccination will probably lead to a decrease in invasive pneumococcal disease but an alteration in the clinical manifestation of invasive pneumococcal disease. Genetic lineages causing invasive pneumococcal disease in adults often express non-vaccine serotypes, which can expand after vaccination with an increased risk of infection in patients with underlying diseases.
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| 28. |
- Molander, Viktor, 1985, et al.
(författare)
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Invasive pneumococcal infections in Vellore, India: clinical characteristics and distribution of serotypes.
- 2013
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Ingår i: BMC infectious diseases. - : Springer Science and Business Media LLC. - 1471-2334. ; 13:532
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Tidskriftsartikel (refereegranskat)abstract
- Streptococcus pneumoniae infection is a serious problem worldwide and the case fatality rate remains high. The aim of this study was to analyze the distribution of pneumococcal serotypes causing invasive pneumococcal disease (IPD), to survey the potential coverage of present and future vaccines, and to investigate differences between serotypes and groups of serotypes with regard to manifestation, case fatality rate, age, and other risk factors.
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| 29. |
- Aad, G., et al.
(författare)
-
- 2014
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Ingår i: Physical Review C (Nuclear Physics). - 0556-2813 .- 1089-490X. ; 90:4
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Tidskriftsartikel (refereegranskat)
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| 30. |
- Aad, G., et al.
(författare)
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- 2013
-
Tidskriftsartikel (refereegranskat)
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| 31. |
- Aad, G., et al.
(författare)
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- 2013
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Ingår i: New Journal of Physics. - : IOP Publishing. - 1367-2630. ; 15
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Tidskriftsartikel (refereegranskat)
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| 32. |
- Aad, G., et al.
(författare)
-
- 2014
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Ingår i: The European Physical Journal C. - : Springer Science and Business Media LLC. - 1434-6052. ; 74:8
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Tidskriftsartikel (refereegranskat)
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| 33. |
- Aad, G., et al.
(författare)
-
- 2012
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Ingår i: The European Physical Journal C. - : Springer Science and Business Media LLC. - 1434-6052. ; 72:7
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Tidskriftsartikel (refereegranskat)
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| 34. |
- Aad, G., et al.
(författare)
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- 2013
-
Tidskriftsartikel (refereegranskat)
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| 35. |
- Aad, G., et al.
(författare)
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- 2013
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Ingår i: The European Physical Journal C. - : Springer Science and Business Media LLC. - 1434-6052. ; 73:1
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Tidskriftsartikel (refereegranskat)
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| 36. |
- Aad, G., et al.
(författare)
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- 2013
-
Tidskriftsartikel (refereegranskat)
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| 37. |
- Aad, G., et al.
(författare)
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- 2013
-
Tidskriftsartikel (refereegranskat)
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| 38. |
- Aad, G., et al.
(författare)
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- 2013
-
Tidskriftsartikel (refereegranskat)
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| 39. |
- Aad, G., et al.
(författare)
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- 2012
-
Tidskriftsartikel (refereegranskat)
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| 40. |
- Aad, G., et al.
(författare)
-
- 2013
-
Tidskriftsartikel (refereegranskat)
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| 41. |
- Aad, G., et al.
(författare)
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- 2012
-
Tidskriftsartikel (refereegranskat)
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| 42. |
- Aad, G., et al.
(författare)
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- 2012
-
Tidskriftsartikel (refereegranskat)
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| 43. |
- Aad, G., et al.
(författare)
-
- 2014
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Ingår i: The European Physical Journal C. - : Springer Science and Business Media LLC. - 1434-6052. ; 74:6
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Tidskriftsartikel (refereegranskat)
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| 44. |
- Aad, G., et al.
(författare)
-
- 2012
-
Tidskriftsartikel (refereegranskat)
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| 45. |
- Aad, G., et al.
(författare)
-
- 2014
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Ingår i: The European Physical Journal C. - : Springer Science and Business Media LLC. - 1434-6052. ; 74:10
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Tidskriftsartikel (refereegranskat)
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| 46. |
- Aad, G., et al.
(författare)
-
- 2013
-
Tidskriftsartikel (refereegranskat)
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| 47. |
- Aad, G., et al.
(författare)
-
- 2013
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Ingår i: The European Physical Journal C. - : Springer Science and Business Media LLC. - 1434-6052. ; 73:3
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Tidskriftsartikel (refereegranskat)
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| 48. |
- Aad, G., et al.
(författare)
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- 2014
-
Tidskriftsartikel (refereegranskat)
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| 49. |
- Aad, G., et al.
(författare)
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- 2013
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Ingår i: New Journal of Physics. - : IOP Publishing. - 1367-2630. ; 15
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Tidskriftsartikel (refereegranskat)
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| 50. |
- Aad, G., et al.
(författare)
-
- 2013
-
Ingår i: New Journal of Physics. - : IOP Publishing. - 1367-2630. ; 15
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Tidskriftsartikel (refereegranskat)
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