Impact of Pneumococcal Conjugative Vaccine on Antibiotic Resistant Invasive Pneumococcal Disease in the United States

Background: Antibiotic-nonsusceptible invasive pneumococcal disease (NS-IPD) in the United States declined dramatically following the introduction of pneumococcal conjugative vaccines (7-valent, PCV7 in 2000, replaced by the 13-valent, PCV13 in 2010). We evaluated the long-term impact of PCV13 on NS-IPD.

Methods: IPD cases were identified through CDC’s Active Bacterial Core surveillance during 2005−2018. We applied 2012 Clinical and Laboratory Standards Institute breakpoints to minimum inhibitory concentrations determined by broth microdilution (2005−2014) or whole genome sequencing (2015−2018) and classified non-susceptible isolates as those intermediate or resistant to ≥1 antibiotic class. Isolates were serotyped and classified as PCV13 or non-vaccine type (NVT). Incidence rates (cases per 100,000) were calculated using United States Census Bureau population denominators.

Results: From 2005 to 2018, NS IPD incidence decreased from 8.5 to 3.2 among children < 5 years old and from 13.0 to 9.4 among adults ≥ 65 years old. Incidence of vaccine-type NS-IPD decreased in all age groups (Figure 1), while incidence of NVT NS-IPD increased in all age groups (Figure 2). The greatest absolute increase in NVT NS-IPD occurred among adults ≥ 65 years from 4.7 in 2005 to 7.2 in 2018. PCV13 serotypes contributed to 62% of NS-IPD (36% of NS-IPD caused by serotype 19A alone) in 2005−2009, and 27% of NS-IPD in 2014−18 (8% of NS-IPD caused by 19A). During 2014-18, NVTs 35B (11%), 33F (9%), 22F (9%), and 15A (9%) were the most common NS-IPD serotypes.Figure 1. Incidence of vaccine type antibiotic non-susceptible invasive pneumococcal disease by age group, 2005−2018.
Figure 2. Incidence of non-vaccine type antibiotic non-susceptible invasive pneumococcal disease by age group, 2005−2018.


Conclusion: NS-IPD incidence decreased following PCV13 use in the United States, driven by reductions in PCV13 serotypes. Recent increases in NVT NS-IPD, most pronounced among older adults, have started to erode PCV impact on NS-IPD. PCVs in development that contain serotypes 22F and 33F could help to further reduce NS-IPD.

Presenting Author(s)

• 

  Kristina Bajema, MD, MSc

  Epidemic Intelligence Service Officer
  Centers for Disease Control and Prevention
  Atlanta, GA

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

  Slides

Co-Author(s)

• 

  Ryan Gierke, MPH

  Epidemiologist
  Centers for Disease Control and Prevention
  Atlanta, Georgia

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• MF

  Monica M. Farley, MD

  Professor
  Emory University
  Atlanta, Georgia

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• WS

  William Schaffner, MD

  Professor of Preventive Medicine
  Vanderbilt University
  Nashville, Tennessee

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• AT

  Ann Thomas, MD, MPH

  Public Health Physician
  Oregon Public Health Division
  Portland, Oregon

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• AR

  Art Reingold, MD

  Professor
  University of California, Berkeley School of Public Health
  Berkeley, California

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• LH

  Lee Harrison, MD

  Head, Infectious Diseases Epidemiology Research Unit
  University of Pittsburgh
  Pittsburgh, Pennsylvania

  Disclosure: GSK: Consultant; Merck: Consultant; Pfizer: Consultant; Sanofi Pasteur: Consultant
• 

  Ruth Lynfield, MD

  State Epidemiologist
  Minnesota Department of Health
  St. Paul, Minnesota

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• KB

  Kari Burzlaff, MPH

  Emerging Infections Program Surveillance Officer
  New York State Department of Health
  Buffalo, New York

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• SP

  Susan Petit, MPH

  Epidemiologist
  Connecticut Department of Public Health
  Hartford, Connecticut

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• MB

  Meghan Barnes, MSPH

  Epidemiologist
  Colorado Department of Public Health and Environment
  Denver, Colorado

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• ST

  Salina Torres, PhD, MPH

  Active Bacterial Core Surveillance Project Coordinator
  New Mexico Department of Health
  Santa Fe, New Mexico

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• BB

  Bernard Beall, PhD

  Director, Streptococcus Laboratory
  Centers for Disease Control and Prevention
  Atlanta, Georgia

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• TP

  Tamara Pilishvili, PhD

  Epidemiologist
  Centers for Disease Control and Prevention, Atlanta, GA, USA
  Atlanta, Georgia

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.