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Increasing incidence of invasive pneumococcal disease and pneumonia despite improved vaccination uptake: surveillance in Hull and East Yorkshire, UK, 2002–2009

  • J. W. T. ELSTON (a1), A. SANTANIELLO-NEWTON (a2), J. A. MEIGH (a3), D. HARMER (a2), V. ALLGAR (a4), T. ALLISON (a5), G. RICHARDSON (a6), R. MEIGH (a3), S. R. PALMER (a7) and G. BARLOW (a1)...
Summary
SUMMARY

Introduction of pneumococcal polysaccharide (PPV23) and conjugate vaccine (PCV7) programmes were expected to change the epidemiology of invasive pneumococcal disease (IPD) and pneumonia in the UK. We describe the epidemiology of IPD and hospitalization with pneumonia using high-quality surveillance data over an 8-year period, 2002–2009. Although PPV23 uptake increased from 49% to 70% and PCV7 uptake reached 98% by 2009, the overall incidence of IPD increased from 11·8/100 000 to 16·4/100 000 (P=0·13), and the incidence of hospitalization with pneumonia increased from 143/100 000 to 207/100 000 (P<0·001). Although a reduction in the proportion of IPD caused by PCV7 serotypes was observed, concurrent increases in PPV23 and non-vaccine serotype IPD contributed to an increased IPD burden overall. Marked inequalities in the geographical distribution of disease were observed. Existing vaccination programmes have, so far, not been sufficient to address an increasing burden of pneumococcal disease in our locality.

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Corresponding author
*Author for correspondence: Dr J. W. T. Elston, Department of Infection and Tropical Medicine, Main Administration block, Castle Hill Hospital, Cottingham, East Yorkshire, HU16 5JQ, UK. (Email: jameselston2003@yahoo.co.uk)
References
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1.World Health Organization. Pneumococcal conjugate vaccine for childhood immunisation-WHO position paper. Weekly Epidemiological Record 2007; 82: 93–104.
2.Melegaro A, et al. The current burden of pneumococcal disease in England and Wales. Journal of Infection 2006; 52: 3748.
3.Fine MJ, et al. Efficacy of pneumococcal vaccination in adults. A meta-analysis of randomized controlled trials. Archives of Internal Medicine 1994; 154: 26662677.
4.Melegaro A, Edmunds WJ. The 23-valent pneumococcal polysaccharide vaccine. Part I. Efficacy of PPV in the elderly: a comparison of meta-analyses. European Journal of Epidemiology 2004; 19: 353363.
5.Moberley SA, et al. Vaccines for preventing pneumococcal infection in adults. Cochrane Database of Systematic Reviews 2008; Issue 1, Art. No. CD000422.
6.Huss A, et al. Efficacy of pneumococcal vaccination in adults: a meta-analysis. Canadian Medical Association Journal 2009;180: 4858.
7.Maruyama T, et al. Efficacy of 23-valent pneumococcal vaccine in preventing pneumonia and improving survival in nursing home residents: double blind, randomised and placebo controlled trial. British Medical Journal 2010; 340: c1004.
8.Jackson LA, et al. Effectiveness of pneumococcal polysaccharide vaccine in older adults. New England Journal of Medicine 2003; 348: 17471755.
9.Shapiro ED, et al. The protective efficacy of polyvalent pneumococcal polysaccharide vaccine. New England Journal of Medicine 1991; 325: 14531460.
10.Foster D, et al. Invasive pneumococcal disease: epidemiology in children and adults prior to implementation of the conjugate vaccine in the Oxfordshire region, England. Journal of Medical Microbiology 2008; 57: 480487.
11.Centers for Disease Control and Prevention. Invasive pneumococcal disease in children 5 years after conjugate vaccine introduction-eight states, 1998–2005. Morbidity and Mortality Weekly Report 2008; 57: 144148.
12.Lexau CA, et al. Changing epidemiology of invasive pneumococcal disease among older adults in the era of pediatric pneumococcal conjugate vaccine. Journal of the American Medical Association 2005; 294: 20432051.
13.Whitney CG, et al. Decline in invasive pneumococcal disease after the introduction of protein-polysaccharide conjugate vaccine. New England Journal Medicine 2003; 348: 17371746.
14.Rodenburg GD, et al. Effects of pneumococcal conjugate vaccine 2 years after its introduction, the Netherlands. Emerging Infectious Diseases 2010; 16: 816823.
15.Health Protection Agency. Cumulative weekly number of reports of invasive pneumococcal disease due to any of the seven serotypes in Prevenar™: children aged <2 years in England and Wales by epidemiological year: July–June (2003–to date) (http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1207821645727). Accessed December 2010.
16.Health Protection Agency. Cumulative weekly number of reports of invasive pneumococcal disease due to any of the serotypes NOT in Prevenar™: children aged <2 years in England and Wales by epidemiological year: July–June (2003–to date) (http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1207821646480). Accessed December 2010.
17.Foster D, et al. Reduction in invasive pneumococcal disease following implementation of the conjugate vaccine in the Oxfordshire region, England. Journal of Medical Microbiology 2011; 60: 9197.
18.Hausdorff WP, et al. Which pneumococcal serogroups cause the most invasive disease: implications for conjugate vaccine formulation and use, part 1. Clinical Infectious Diseases 2000; 30: 100121.
19.Office for National Statistics. 2006-based sub national population projections (http://www.statistics.gov.uk/downloads/theme_population/SNPP-2006/Table2.xls). Accessed August 2010.
20.APHO and Department of Health. Health profile 2010, Kingston upon Hull. (© Crown Copyright 2010.)
21.APHO and Department of Health. Health profile 2010, East Riding of Yorkshire. (© Crown Copyright 2010.)
22.Health Protection Agency. Pneumococcal vaccination uptake monitoring on behalf of Department of Health (http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/Pneumococcal/PPVUptake/#03/04). Accessed October 2010.
23.Orenstein WA, et al. Field evaluation of vaccine efficacy. Bulletin of the World Health Organisation 1985; 63: 10551068.
24.Association of Public Health Observatories. Commonly used public health statistics and their confidence intervals (http://www.apho.org.uk/resource/item.aspx?RID=48457). Accessed 29 June 2011.
25.Department for Communities and Local Government. The English Indices of Deprivation 2007, Summary. (© Crown Copyright 2007.)
26.Perneger TV. What's wrong with Bonferroni adjustments. British Medical Journal 1998; 316: 12361238.
27.Trotter CL, et al. Epidemiology of invasive pneumococcal disease in the pre-conjugate vaccine era: England and Wales, 1996–2006. Journal of Infection 2009; 60: 200208.
28.Ihekweazu CA, et al. Trends in incidence of pneumococcal disease before introduction of conjugate vaccine: South West England, 1996–2005. Epidemiology and Infection 2008; 136: 10961102.
29.Trotter CL, et al. Increasing hospital admissions for pneumonia, England. Emerging Infectious Diseases 2005; 14; 727733.
30.Department of Health. JCVI statement on discontinuation of the routine pneumococcal vaccination programme for adults aged 65 years and older, 16 March 2011 (http://www.dh.gov.uk/ab/JCVI/DH_094744). Accessed 16 March 2011.
31.Dr Foster Health. Hull and East Yorkshire Hospitals NHS Trust – quality report 2009/10 (http://www.drfosterhealth.co.uk/quality-reports/trust.aspx?otype=2&id=271). Accessed 13 March 2011.
32.Grant CC, et al. Invasive pneumococcal disease in Oxford, 1985–2001: a retrospective case series. Archives of Disease in Childhood 2003; 88: 712714.
33.The Health and Social Care Information Centre. NHS Immunisation Statistics, England (http://www.ic.nhs.uk/statistics-and-data-collections/health-and-lifestyles/immunisation/nhs-immunisation-statistics-england-2009–10). Accessed 7 July 2011.
34.Harboe ZB, et al. Pneumococcal serotypes and mortality following invasive pneumococcal disease: a population-based cohort study. PLoS Medicine 2009; 6: e1000081.
35.Hausdorff WP, Feikin DR, Klugman KP. Epidemiological differences among pneumococcal serotypes. Lancet Infectious Diseases 2005; 5: 8393.
36.Dransfield MT, et al. Superior immune response to protein-conjugate versus free pneumococcal polysaccharide vaccine in chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine 2009; 180: 499505.
37.Goldblatt D, et al. The immunogenicity of 7-valent pneumococcal conjugate vaccine versus 23-valent polysaccharide vaccine in adults aged 50–80 years. Clinical Infectious Diseases 2009; 49: 13181325.
38.The Health and Social Care Information Centre. GP registered populations (http://www.ic.nhs.uk/statistics-and-data-collections/population-and-geography/gp-registered-populations). Accessed 12 July 2011.
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Epidemiology & Infection
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Supplementary Tables

Elston Supplementary Table S2
Supplementary Table S2: Data and information sources

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Supplementary Tables

Elston Supplementary Table S1
Supplementary Table S1: Hospital Trusts and hospital sources

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