Indirect Effects of Pneumococcal Childhood Vaccination in Individuals Treated With Immunosuppressive Drugs in Ambulatory Care: A Case-cohort Study
| Autor: | Richard A. White, Anneke Steens, Arne Broch Brantsæter, Brita Askeland Winje, Didrik F. Vestrheim, Ingvild Odsbu |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male 0301 basic medicine Microbiology (medical) medicine.medical_specialty 030106 microbiology Pneumococcal Infections Cohort Studies Pneumococcal Vaccines Immunocompromised Host 03 medical and health sciences 0302 clinical medicine Ambulatory care Internal medicine Epidemiology Ambulatory Care Humans Medicine 030212 general & internal medicine Aged Norway business.industry Incidence (epidemiology) Pneumococcal 7-Valent Conjugate Vaccine Middle Aged medicine.disease Chemotherapy regimen Pneumococcal infections Infectious Diseases Relative risk Female business Immunosuppressive Agents Cohort study |
| Zdroj: | Clinical Infectious Diseases |
| ISSN: | 1537-6591 1058-4838 2005-2014 |
| DOI: | 10.1093/cid/ciy714 |
| Popis: | Background The extent to which iatrogenically-immunosuppressed individuals benefit from indirect effects of childhood vaccination with pneumococcal conjugate vaccines (PCVs) is unknown. We determined how the sequential introduction of PCV7 (2006) and PCV13 (2011) in the Norwegian childhood vaccination program has affected the epidemiology of invasive pneumococcal disease (IPD) in individuals treated with immunosuppressants in ambulatory care. Methods We conducted a case-cohort study comprising 7926 IPD cases reported to the Norwegian Surveillance System for Communicable Diseases in 2005-2014 and 249998 individuals randomly selected from the National Registry in 2012. We defined immunosuppressive treatment groups based on dispensed prescriptions retrieved from the Norwegian Prescription Database. Incidences and age-adjusted relative risks (RR) were estimated. Results IPD incidences decreased in all groups. The PCV13 incidence decreased by 5-12% across groups. The non-PCV13 incidence increased by 4-10%, mostly in individuals on chemotherapy (overlapping 95% confidence intervals). In the PCV13 era, the RR for IPD was highest (significant) and the percentage of cases caused by the polysaccharide vaccine PPV23 serotypes lowest (numerical) in individuals on chemotherapy (RR = 20.4, PPV23 = 52%), followed by individuals on corticosteroids (RR = 6.2, PPV23 = 64%), other immunosuppressants (RR = 5.6, PPV23 = 68%), and no immunosuppressants (RR = 1 [reference], PPV23 = 74%). Conclusions IPD incidences declined after PCV introduction in both immunocompetent and iatrogenically-immunosuppressed individuals, underscoring the benefit of childhood vaccination for the entire population. Still, individuals treated with immunosuppressants in ambulatory care are at increased risk of IPD caused by a more diverse group of serotypes. |
| Databáze: | OpenAIRE |
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