Impact of PCV10 on pediatric pneumococcal disease burden in Brazil: time for new recommendations?

Jarovsky, Daniel; Berezin, Eitan Naaman

doi:10.1016/j.jped.2022.11.003

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Sumário

REVIEW ARTICLE • J. Pediatr. (Rio J.) 99 (suppl 1) • Mar-Apr 2023 • https://doi.org/10.1016/j.jped.2022.11.003 copy

Impact of PCV10 on pediatric pneumococcal disease burden in Brazil: time for new recommendations?

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To describe the impact of the 10-valent pneumococcal conjugate vaccine on the pediatric burden of pneumococcal infections, carriage, serotype replacement, and antimicrobial resistance in Brazil since its introduction in 2010.

Data source:

A narrative review of English, Spanish, and Portuguese articles published in online databases and in Brazilian epidemiological surveillance databases was performed. The following keywords were used: Streptococcus pneumoniae, pneumococcal disease, conjugate vaccine, PCV10, antimicrobial resistance, and meningitis.

Summary of the findings:

Declines in hospitalization rates of all-cause pneumonia occurred in the target age groups and some age groups not targeted by vaccination early after the use of PCV10. Large descriptive studies of laboratory-confirmed pneumococcal meningitis and hospital-based historical series of hospitalized children with IPD have evidenced a significant impact on disease burden, in-hospital fatality rates, and admission to the intensive care unit before and after the inclusion of the vaccine. Impact data on otitis media is limited and inconsistent; the main benefit remains the prevention of complicated diseases. During the late post-vaccine years, a significant and progressive increase in high-level penicillin non-susceptibility pneumococci has been described. Since 2014 serotype 19A has been the leading serotype in all ages and was responsible for 28.2%-44.6% of all IPD in children under 5 yrs.

Conclusions:

PCV10 has performed a significant impact on IPD in Brazil since 2010, however, progress has been continuously hampered by replacement. Broader spectrum PCVs could provide expanded direct and indirect protection against ST19A and other additional serotypes of increasing importance if administered to children in the Brazilian National Immunization Program.

KEYWORDS
Streptococcus pneumoniae ; Pneumococcus; Pneumococcal disease; IPD; Serotypes; PCV10

Year	MENINGITIS STRAINS			NON-MENINGITIS STRAINS				ST19A
	Non-susceptible	Susceptible	n	Non-susceptible	Intermediate resistance	Susceptible	n	N (%)
2006	45.0%	55.0%	222	32.8%	32.8%	34.3%	64	11 (3.8%)
2007	48.6%	51.4%	220	0.0%	17.9%	82.1%	75	8 (2.5%)
2008	48.3%	51.7%	145	0.0%	14.9%	85.1%	154	15 (5.0%)
2009	46.5%	53.5%	129	0.0%	18.8%	81.2%	69	6 (3.0%)
2010	53.6%	46.4%	140	0.0%	17.3%	82.7%	75	13 (6.0%)
2011	35.7%	64.3%	126	0.0%	9.7%	90.3%	93	16 (7.3%)
2012	36.3%	63.7%	91	0.0%	7.5%	92.5%	106	19 (9.6%)
2013	32.3%	67.7%	62	0.0%	10.9%	89.1%	92	19 (12.3%)
2014	38.6%	61.4%	57	0.0%	18.6%	81.4%	87	37 (28.2%)
2015	40.0%	60.0%	55	0.0%	20.0%	80.0%	85	40 (28.6%)
2016	32.3%	67.7%	62	0.0%	16.1%	83.9%	88	47 (31.3%)
2017	48.0%	52.0%	58	0.0%	9.0%	91.0%	91	48 (32.2%)
2018	45.6%	54.4%	57	0.0%	23.1%	76.9%	117	70 (40.2%)
2019	65.0%	35.0%	80	1.1%	28.7%	70.2%	94	78 (44.6%)
2020	66.7%	33.3%	12	0.0%	28.9%	71.1%	47	20 (33.9%)
2021	66.7%	33.3%	29	0.0%	28.9%	71.1%	79	41 (38.0%)

Sociedade Brasileira de Pediatria Av. Carlos Gomes, 328 cj. 304, 90480-000 Porto Alegre RS Brazil, Tel.: +55 51 3328-9520 - Porto Alegre - RS - Brazil
E-mail: jped@jped.com.br

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[1] * Corresponding author at: Santa Casa de São Paulo School of Medical Sciences - Rua Dr. Cesário Mota Júnior 112 - Vila Buarque, São Paulo - SP, Brazil 01221-010. E-mail: daniel@jarovsky.com.br (D. Jarovsky).