Elsevier

Vaccine

Volume 32, Issue 29, 17 June 2014, Pages 3644-3650
Vaccine

European enhanced surveillance of invasive pneumococcal disease in 2010: Data from 26 European countries in the post-heptavalent conjugate vaccine era

https://doi.org/10.1016/j.vaccine.2014.04.066Get rights and content

Highlights

  • We analyse data from the first European IPD enhanced surveillance in the post-PCV7 era.

  • In 2010 IPD notification rates were highest among children <1 and adults ≥65 years.

  • The most common serotypes were 19A, 1, 7F, 3, 14, 22F, 8, 4, 12F and 19F.

  • Non-susceptibility to erythromycin was highest at 17.6% followed by penicillin at 8.9%.

  • In children <5 years PCV7 serotype coverage was 19.2%, PCV10 46.1% and PCV13 73.1%.

Abstract

Streptococcus pneumoniae is a leading cause of severe infectious diseases worldwide. This paper presents the results from the first European invasive pneumococcal disease (IPD) enhanced surveillance where additional and valuable data were reported and analysed. Following its authorisation in Europe in 2001 for use in children aged between two months and five years, the heptavalent pneumococcal conjugate vaccine (PCV7) was progressively introduced in the European Union (EU)/European Economic Area (EEA) countries, albeit with different schemes and policies. In mid-2010 European countries started to switch to a higher valency vaccine (PCV10/PCV13), still without a significant impact by the time of this surveillance. Therefore, this surveillance provides an overview of baseline data from the transition period between the introduction of PCV7 and the implementation of PCV10/PCV13.

In 2010, 26 EU/EEA countries reported 21 565 cases of IPD to The European Surveillance System (TESSy) applying the EU 2008 case definition. Serotype was determined in 9 946/21 565 (46.1%) cases. The most common serotypes were 19A, 1, 7F, 3, 14, 22F, 8, 4, 12F and 19F, accounting for 5 949/9 946 (59.8%) of the serotyped isolates. Data on antimicrobial susceptibility testing (AST) in the form of minimum inhibitory concentrations (MIC) were submitted for penicillin 5 384/21 565 (25.0%), erythromycin 4 031/21 565 (18.7%) and cefotaxime 5 252/21 565 (24.4%). Non-susceptibility to erythromycin was highest at 17.6% followed by penicillin at 8.9%.

PCV7 serotype coverage among children <5 years in Europe, was 19.2%; for the same age group, the serotype coverage for PCV10 and PCV13 were 46.1% and 73.1%, respectively.

In the era of pneumococcal conjugate vaccines, the monitoring of changing trends in antimicrobial resistance and serotype distribution are essential in assessing the impact of vaccines and antibiotic use control programmes across European countries.

Introduction

Streptococcus pneumoniae infections are a major public health threat and cause high morbidity and mortality worldwide especially among children under 5 years and amongst the elderly [1], [2]. It is the leading cause of bloodstream infection (BSI), meningitis, upper respiratory tract infections and otitis media [2]. It is the most frequent causative agent of community acquired pneumonia (CAP), resulting in high case-fatality ratios (CFR) [3].

S. pneumoniae is surrounded by a polysaccharide capsule that protects the bacterium from phagocitosis and intracellular killing and therefore is an important virulence factor [4]. Based on differences in the capsule and recognition by different specific antibodies, 93 serotypes with different invasiveness and mortality potential have been identified [5], [6].

Different medical practices [7] and country differences in reporting and surveillance systems of IPD may well explain the large variation of IPD notification rates from 0.4 to 20 cases per 100 000 population per year [8] between European countries that have been reported previously [9].

The introduction of PCV7 targeting children less than 5 years of age has proven highly successful in reducing invasive and mucosal disease caused by the vaccine serotypes and in decreasing antibiotic resistance associated with vaccine serotypes [10]. An additional benefit of the PCV is the decrease in nasopharyngeal carriage of vaccine serotypes that confers a degree of herd immunity in the population [11]. Nevertheless, this success may be partially offset by an increase in non-vaccine serotypes [12], [13]. Furthermore, antimicrobial resistance has emerged and spreads in these non-vaccine serotypes [14].

In response, new pneumococcal conjugate vaccines (PCV10, PCV13) that include additional serotypes have been licensed and EU/EEA countries started introducing them gradually since 2010. The impact of pneumococcal conjugated vaccines and the burden of pneumococcal infections should be closely monitored and better quality data should be analysed in order to assess vaccine strategies throughout Europe. Moreover, it may prove useful to indicate where new expanded valency vaccines should be developed in response to serotype replacement observed after the implementation of PCV7 and as expected for PCV13 [15]. Here we report on the results from an analysis of data from the first enhanced surveillance programme for IPD set up by the European Centre for Disease Prevention and Control (ECDC) in collaboration with the EU/EEA Member States in order to assess the burden of IPD and the prevalence of the different serotypes across Europe.

Section snippets

Scope

Twenty-six European countries participated in the surveillance for IPD from 1st January to 31st December 2010 inclusive, namely Austria, Belgium, Bulgaria, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Lithuania, Malta, The Netherlands, Norway, Poland, Romania, Slovakia, Slovenia, Spain, Sweden, and the United Kingdom. This corresponded to approximately 82% of the total population of EU/EEA countries in 2010. A case of IPD was

Epidemiology

In 2010, 21 565 cases of IPD were reported by 26 EU/EEA countries. Notification rates ranged from 0.3 in Lithuania to 17.4 per 100 000 in Denmark (Table 2). The Nordic countries (Denmark, Norway, Finland and Sweden) and Belgium had the highest notification rates.

Of the 21 473 reported cases for which age information was provided, 45.3% were 65 years of age or older, 42.1% 15–64 years of age and 12.6% 0–14 years of age. The highest notification rates were reported among children below 1 year (18.5

Discussion

The 21 565 confirmed cases of IPD reported in the EU/EEA in 2010 showed a wide variation in notification rates. The variation in the notification rate of IPD in Europe may well be due to differences in case definitions of IPD, surveillance methods, medical practices (mainly blood culturing) and clinical presentation of IPD cases [17]. Therefore, a certain degree of under-diagnosis and under-reporting is suspected. Geographic variations in the distribution have been described elsewhere [19] and

Conclusions

European IPD pooled-data analysis is relevant to assess differences across the world and to help formulate policies at a European level. However, differing national surveillance systems and differing vaccination schedules make it difficult to compare data throughout Europe.

Despite these caveats, the establishment of the IPD enhanced surveillance at a European level has provided baseline information on the epidemiology of IPD and has allowed an estimate of the burden of the disease across Europe

Authors’ contributions

Adoración Navarro Torné coordinated the collection of data, performed the data analysis and wrote the manuscript.

Joana Gomes Dias, Chantal Quinten, and Marta Cecilia Busana contributed to the data analysis.

Frantiska Hruba, Pier Luigi Lopalco, Andrew J. Amato Gauci and Lucia Pastore-Celentano reviewed the manuscript.

The ECDC country experts for pneumococcal disease contributed to the data collection and reviewed the manuscript.

Conflict of interest

Authors declare no conflict of interest.

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