Advertisement

Recent trends in epidemiology of invasive pneumococcal disease in Poland

  • A. Skoczyńska
  • A. Kuch
  • E. Sadowy
  • I. Waśko
  • M. Markowska
  • P. Ronkiewicz
  • B. Matynia
  • A. Bojarska
  • K. Wasiak
  • A. Gołębiewska
  • M. van der Linden
  • W. Hryniewicz
  • Participants of a laboratory-based surveillance of community acquired invasive bacterial infections (BINet)
Article

Abstract

The objectives of this study were to assess the current incidence of invasive pneumococcal disease (IPD) in Poland (2011–2013), where mass vaccination has not been implemented, and to characterize the Streptococcus pneumoniae isolates responsible for invasive infections by determining their serotype distribution and antimicrobial resistance patterns. For all isolates identification, serotyping and antimicrobial minimal inhibitory concentrations determination were performed based on routine techniques. The highest incidence rates were observed among adults older than 85 years old (4.62/100,000) and children under 1 year of age (4.28/100,000). The general case fatality ratio (CFR) was 25.4 %, with the highest CFR in the age group ≥85 years old (59.7 %). The most common serotypes were 3, 14, 19A, 4, 9V, 19F, 1, and 23 F (61.3 % of all isolates). The 10- and 13-valent pneumococcal conjugated vaccines (PCV) covered 46.0 and 71.8 % of all IPD cases, 61.4 and 79.5 % of cases in children under two years, and 60.4 and 78.6 % of cases involving children under five years of age, respectively. The PCV13 and 23-valent polysaccharide vaccine covered 68.7 and 86.0 % of cases in adults >65 years old, respectively. Decreased susceptibility was noted for penicillin (24.8 %), cefotaxime (10.0 %), meropenem (5.0 %), rifampicin (0.8 %), chloramphenicol (4.3 %), erythromycin (29.7 %) and clindamycin (25.6 %). Multi-drug resistance characterized 21.6 % of the pneumococci tested. Despite deficiencies in the Polish surveillance system and strong underestimation of IPD cases, results of the study showed good theoretical coverage of PCV, which should encourage inclusion of anti-pneumococcal conjugate vaccine into the national immunization program.

Keywords

Meningitis Cefotaxime Meropenem Invasive Pneumococcal Disease Vaccine Coverage 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

We thank all BINet participants and all other physicians and microbiologists who participated by contributing isolates and data to the national surveillance program of invasive pneumococcal diseases in Poland. The authors would like to thank Kenneth van Horn for English language editing.

Financial support

The study was partially supported by the Ministry of Health within the framework of the National Programme of Antibiotic Protection (MODUL I NPOA), by the Ministry of Science and Higher Education (Mikrobank 2 Programme), and by an unrestricted grant from Pfizer Poland.

Conflict of interest

Assistance to attend scientific meetings and honoraria for lecturing was funded from Pfizer (AS, ES, AK, WH, ML) and from GlaxoSmithKline (AS, WH). Some authors are members of the Advisory Boards of GlaxoSmithKline (AS) and Pfizer (AS, ML). Other authors: no conflicts of interest.

References

  1. 1.
    AlonsoDeVelasco E, Verheul A, Verhoef J, Snippe H (1995) Streptococcus pneumoniae: virulence factors, pathogenesis, and vaccines. Microbiol Rev 59:591–603PubMedCentralPubMedGoogle Scholar
  2. 2.
    World Health Organisation (2007) Pneumococcal conjugate vaccine for childhood immunization—WHO position paper. Wkly Epidemiol Rec 82:93–104Google Scholar
  3. 3.
    O'Brien KL, Wolfson LJ, Watt JP, Henkle E, Deloria-Knoll M, McCall N et al (2009) Burden of disease caused by Streptococcus pneumoniae in children younger than 5 years: global estimates. Lancet 374:893–902CrossRefPubMedGoogle Scholar
  4. 4.
    Hausdorff WP, Feikin DR, Klugman KP (2005) Epidemiological differences among pneumococcal serotypes. Lancet Infect Dis 5:83–93CrossRefPubMedGoogle Scholar
  5. 5.
    Dinleyici EC, Yargic ZA (2009) Current knowledge regarding the investigational 13-valent pneumococcal conjugate vaccine. Expert Rev Vaccines 8:977–986CrossRefPubMedGoogle Scholar
  6. 6.
    Komunikat Głównego Inspektora Sanitarnego z dnia 31.10.2013r (2013) Dziennik Urzędowy Ministra Zdrowia (poz. 43). http://www.gis.gov.pl/ckfinder/userfiles/files/EP/informacje%20dla%20podr%C3%B3%C5%BCuj%C4%85cych/PSO%202014.pdf. Accessed 30 September 2014
  7. 7.
    Patrzałek M, Albrecht P, Sobczyński M (2010) Significant decline in pneumonia admission rate after the introduction of routine 2 + 1 dose schedule heptavalent pneumococcal conjugate vaccine (PCV7) in children under 5 years of age in Kielce, Poland. Eur J Clin Micobiol Infect Dis 29:787–792CrossRefGoogle Scholar
  8. 8.
    National Institute of Public Health – National Institute of Hygiene and Chief Sanitary Inspectorate – Department for Communicable Disease and Infection Prevention and Control (2011) Vaccinations in Poland in 2010. http://www.pzh.gov.pl/oldpage/epimeld/2010/Sz_2010.pdf. Accessed 30 September 2014
  9. 9.
    National Institute of Public Health – National Institute of Hygiene and Chief Sanitary Inspectorate – Department for Communicable Disease and Infection Prevention and Control (2012) Vaccinations in Poland in 2011. http://www.pzh.gov.pl/oldpage/epimeld/2011/Sz_2011.pdf. Accessed 30 September 2014
  10. 10.
    National Institute of Public Health – National Institute of Hygiene and Chief Sanitary Inspectorate – Department for Communicable Disease and Infection Prevention and Control (2013) Vaccinations in Poland in 2012. http://www.pzh.gov.pl/oldpage/epimeld/2012/Sz_2012.pdf. Accessed 30 September 2014
  11. 11.
    Skoczyńska A, Sadowy E, Bojarska K, Strzelecki J, Kuch A, Gołębiewska A, Waśko I, Foryś M, van der Linden M, Hryniewicz W, Participants of a laboratory-based surveillance of community acquired invasive bacterial infections (BINet) (2011) The current status of invasive pneumococcal disease in Poland. Vaccine 29:2199–2205CrossRefPubMedGoogle Scholar
  12. 12.
    Skoczyńska A, Waśko I, Kuch A, Kadłubowski M, Gołębiewska A, Foryś M, Markowska M, Ronkiewicz P, Wasiak K, Kozińska A, Matynia B, Hryniewicz W, and participants of a laboratory-based surveillance of community acquired invasive bacterial infections (BINet) (2013) A decade of invasive meningococcal disease surveillance in Poland. PLoS One 8:e71943. doi: 10.1371/journal.pone.0071943 CrossRefPubMedCentralPubMedGoogle Scholar
  13. 13.
    Central Statistical Office (2012) Demographic yearbook of Poland 2012. http://stat.gov.pl/cps/rde/xbcr/gus/rs_rocznik_demograficzny_2012.pdf. Accessed 30 September 2014
  14. 14.
    Central Statistical Office (2013) Demographic yearbook of Poland 2013. http://stat.gov.pl/obszary-tematyczne/roczniki-statystyczne/roczniki-statystyczne/rocznik-demograficzny-2013,3,7.html. Accessed 30 September 2014
  15. 15.
    Toikka P, Nikkari S, Ruuskanen O, Leinonen M, Mertsola J (1999) Pneumolysin PCR-based diagnosis of invasive pneumococcal infection in children. J Clin Microbiol 37:633–637PubMedCentralPubMedGoogle Scholar
  16. 16.
    McAvin JC, Reilly PA, Roudabush RM, Barnes WJ, Salmen A, Jackson GW, Beninga KK, Astorga A, McCleskey FK, Huff WB, Niemeyer D, Lohman KL (2001) Sensitive and specific method for rapid identification of Streptococcus pneumoniae using real-time fluorescence PCR. J Clin Microbiol 39:3446–3451CrossRefPubMedCentralPubMedGoogle Scholar
  17. 17.
    Facklam RR, Washington JA (1991) Streptococcus and related catalase-negative gram-positive cocci. In: Balows A, Hausler WJ Jr, Herrmann KL, Isenberg HD, Shadomy HJ (eds) Manual of clinical microbiology, 5th edn. American Society for Microbiology, Washington, pp 238–257Google Scholar
  18. 18.
    Lawrence ER, Griffiths DB, Martin SA, George RC, Hall LMC (2003) Evaluation of semiautomated multiplex PCR assay for determination of Streptococcus pneumoniae serotypes and serogroups. J Clin Microbiol 41:601–607CrossRefPubMedCentralPubMedGoogle Scholar
  19. 19.
    Pai R, Gertz RE, Beall B (2006) Sequential multiplex PCR approach for determining capsular serotypes of Streptococcus pneumoniae isolates. J Clin Microbiol 44:124–131CrossRefPubMedCentralPubMedGoogle Scholar
  20. 20.
    Pai R, Limor J, Beall B (2005) Use of pyrosequencing to differentiate Streptococcus pneumoniae serotypes 6A and 6B. J Clin Microbiol 43:4820–4822CrossRefPubMedCentralPubMedGoogle Scholar
  21. 21.
    Neufeld F (1902) Über die agglutination der pneumokokken und über die theorie der agglutination. Z Hyg Infekt 40:54–72CrossRefGoogle Scholar
  22. 22.
    The European Committee on Antimicrobial Susceptibility Testing. Breakpoint tables for interpretation of MICs and zone diameters. Version 4.0, 2014. http://www.eucast.org. 30 September 2014
  23. 23.
    Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, Harbarth S, Hindler JF, Kahlmeter G, Olsson-Liljequist B, Paterson DL, Rice LB, Stelling J, Struelens MJ, Vatopoulos A, Weber JT, Monnet DL (2012) Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 18:268–281CrossRefPubMedGoogle Scholar
  24. 24.
    Torné AN, Dias JG, Quinten C, Hruba F, Busana MC, Lopalco PL, Gauci AJ, Pastore-Celentano L, the ECDC country experts for pneumococcal disease (2014) European enhanced surveillance of invasive pneumococcal disease in 2010: data from 26 European countries in the post-heptavalent conjugate vaccine era. Vaccine 32:3644–3650CrossRefGoogle Scholar
  25. 25.
    Whitney CG, Farley MM, Hadler J, Harrison LH, Bennett NM, Lynfield R, Reingold A, Cieslak PR, Pilishvili T, Jackson D, Facklam RR, Jorgensen JH, Schuchat A, Active Bacterial Core Surveillance of the Emerging Infections Program Network (2003) Decline in invasive pneumococcal disease after the introduction of protein-polysaccharide conjugate vaccine. N Eng J Med 348:1737–1746CrossRefGoogle Scholar
  26. 26.
    Hsu HE, Shutt KA, Moore MR, Beall BW, Bennett NM, Craig AS, Farley MM, Jorgensen JH, Lexau CA, Petit S, Reingold A, Schaffner W, Thomas A, Whitney CG, Harrison LH (2009) Effect of pneumococcal conjugate vaccine on pneumococcal meningitis. N Engl J Med 360:244–256CrossRefPubMedGoogle Scholar
  27. 27.
    Guzvinec M, Tesović G, Tambić-Andrasević A, Zidovec-Lepej S, Vukić BT, Begovac J (2008) The epidemiology of invasive Streptococcus pneumoniae disease in Croatian children. Med Sci Monit 14:PH59–64PubMedGoogle Scholar
  28. 28.
    Hsieh YC, Lin PY, Chiu CH, Huang YC, Chang KY, Liao CH, Chiu NC, Chuang YC, Chen PY, Chang SC, Liu JW, Yen MY, Wang JH, Liu CY, Lin TY (2009) National survey of invasive pneumococcal diseases in Taiwan under partial PCV7 vaccination in 2007: emergence of serotype 19A with high invasive potential. Vaccine 27:5513–5518CrossRefPubMedGoogle Scholar
  29. 29.
    Isaacman DJ, McIntosh ED, Reinert RR (2010) Burden of invasive pneumococcal disease and serotype distribution among Streptococcus pneumoniae isolates in young children in Europe: impact of the 7-valent pneumococcal conjugate vaccine and considerations for future conjugate vaccines. Int J Infect Dis 14:e197–209CrossRefPubMedGoogle Scholar
  30. 30.
    Choi EH, Kim SH, Eun BW, Kim SJ, Kim NH, Lee J, Lee HJ (2008) Streptococcus pneumoniae serotype 19A in children, South Korea. Emerg Infect Dis 14:275–281CrossRefPubMedCentralPubMedGoogle Scholar
  31. 31.
    Chiang CS, Chen YY, Jiang SF, Liu DP, Kao PH, Teng HJ, Kuo TL, Yao SM, Tseng LR, Wang YL, Wu HS, Chang FY, Lin TY (2014) National surveillance of invasive pneumococcal diseases in Taiwan, 2008–2012: differential temporal emergence of serotype 19A. Vaccine 32:3345–3349CrossRefPubMedGoogle Scholar
  32. 32.
    Hicks LA, Harrison LH, Flannery B, Hadler JL, Schaffner W, Craig AS, Jackson D, Thomas A, Beall B, Lynfield R, Reingold A, Farley MM, Whitney CG (2007) Incidence of pneumococcal disease due to non-pneumococcal conjugate vaccine (PCV7) serotypes in the United States during the era of widespread PCV7 vaccination, 1998–2004. J Infect Dis 196:1346–1354CrossRefPubMedGoogle Scholar
  33. 33.
    Grabenstein JD, Weber DJ (2014) Pneumococcal serotype diversity among adults in various countries, influenced by pediatric pneumococcal vaccination uptake. Clin Infect Dis 58:854–564CrossRefPubMedGoogle Scholar
  34. 34.
    Helferty M, Rotondo JL, Martin I, Desai S (2013) The epidemiology of invasive pneumococcal disease in the Canadian North from 1999 to 2010. Int J Circumpolar Health 72:21606. doi: 10.3402/ijch.v72i0.21606 CrossRefGoogle Scholar
  35. 35.
    van Hoek AJ, Andrews N, Waight PA, George R, Miller E (2012) Effect of serotype on focus and mortality of invasive pneumococcal disease: coverage of different vaccines and insight into non-vaccine serotypes. PLoS One 7:e39150CrossRefPubMedCentralPubMedGoogle Scholar
  36. 36.
    Kyaw MH, Lynfield R, Schaffner W, Craig AS, Hadler J, Reingold A, Thomas AR, Harrison LH, Bennett NM, Farley MM, Facklam RR, Jorgensen JH, Besser J, Zell ER, Schuchat A, Whitney CG, Active Bacterial Core Surveillance of the Emerging Infections Program Network (2006) Effect of introduction of the pneumococcal conjugate vaccine on drug-resistant Streptococcus pneumoniae. N Engl J Med 354:1455–1463CrossRefPubMedGoogle Scholar
  37. 37.
    Appelbaum PC (2002) Resistance among Streptococcus pneumoniae: implications for drug selection. Clin Infect Dis 34:1613–1620CrossRefPubMedGoogle Scholar
  38. 38.
    Hackel M, Lascols C, Bouchillon S, Hilton B, Morgenstern D, Purdy J (2013) Serotype prevalence and antibiotic resistance in Streptococcus pneumoniae clinical isolates among global populations. Vaccine 31:4881–4887CrossRefPubMedGoogle Scholar
  39. 39.
    Dagan R, Klugman KP (2008) Impact of conjugate pneumococcal vaccines on antibiotic resistance. Lancet Infect Dis 8:785–795CrossRefPubMedGoogle Scholar
  40. 40.
    Miller E, Andrews NJ, Waight PA, Slack MP, George RC (2011) Herd immunity and serotype replacement 4 years after seven-valent pneumococcal conjugate vaccination in England and wales: an observational cohort study. Lancet Infect Dis 11:760–768CrossRefPubMedGoogle Scholar
  41. 41.
    Kaplan SL, Barson WJ, Lin PL, Stovall SH, Bradley JS, Tan TQ, Hoffman JA, Givner LB, Mason EO Jr (2010) Serotype 19A is the most common serotype causing invasive pneumococcal infections in children. Pediatrics 125:429–436CrossRefPubMedGoogle Scholar
  42. 42.
    Dortet L, Ploy M-C, Poyart C, Raymond J (2009) Emergence of Streptococcus pneumoniae of serotype 19A in France: molecular capsular serotyping, antimicrobial susceptibilities, and epidemiology. Diagn Microbiol Infect Dis 65:49–57CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • A. Skoczyńska
    • 1
  • A. Kuch
    • 1
  • E. Sadowy
    • 2
  • I. Waśko
    • 1
  • M. Markowska
    • 1
  • P. Ronkiewicz
    • 1
  • B. Matynia
    • 1
  • A. Bojarska
    • 2
  • K. Wasiak
    • 4
  • A. Gołębiewska
    • 1
  • M. van der Linden
    • 3
  • W. Hryniewicz
    • 1
  • Participants of a laboratory-based surveillance of community acquired invasive bacterial infections (BINet)
  1. 1.National Reference Centre for Bacterial Meningitis, Department of Epidemiology and Clinical MicrobiologyNational Medicines InstituteWarsawPoland
  2. 2.Department of Molecular MicrobiologyNational Medicines InstituteWarsawPoland
  3. 3.German National Reference Center for Streptococci, Department of Medical Microbiology University Hospital RWTH AachenAachenGermany
  4. 4.Department of MicrobiologyInstitute of Tuberculosis and Lung DiseasesWarsawPoland

Personalised recommendations