impact of the pneumococcal conjugate vaccine in south africa
TRANSCRIPT
Impact of the pneumococcal conjugate vaccine in South Africa
Anne von Gottberg
Centre for Respiratory Diseases and Meningitis (CRDM)
Mortality due to pneumonia
• South Africa first African country to introduce pneumococcal vaccine into routine immunisation programmes
• National Strategic Plan: <5 mortality, infant mortality reductions
• Millennium Development Goals (MDG) 4: To reduce child mortality
• Sustainable Development Goal (SDG) 3: Ensure healthy lives and promote well-being for all at all ages
Pneumococcus (Streptococcus
pneumoniae)
• Gram-positive cocci • Carriage in nasopharynx (>50%
of children <3 years of age) Bogaert et al, Lancet ID 2004
• Commonest bacterial cause of pneumonia
• Causes pneumonia, meningitis, sinusitis, otitis media
• Clinically significant bacteraemia in Kenya: 436/100,000 children <5 years Brent et al, Lancet 2006
• Associated with HIV • High morbidity and mortality
Pneumococcal capsule
• Polysaccharide capsule
• >90 serotypes
• 23-valent polysaccharide vaccine
• Conjugate vaccine: effective in children – 7 serotypes in the 7-valent
vaccine (PCV7): common paediatric serotypes, also most resistant
– PCV10, PCV13
Description of the licensed PCV
vaccines
4, 6B, 9V, 14, 18C, 19F, 23F
NTHi protein D
4, 6B, 9V, 14, 18C, 19F, 23F
1, 5, 7F
PCV13
4, 6B, 9V, 14, 18C, 19F, 23F
1, 5, 7F 3, 6A, 19A
NTHi protein D
CRM197 Diphtheria carrier protein
CRM197 Diphtheria carrier protein
T D
6A, 19A
6A PCV7
PHiD-CV
POET formulation: included serotype 3 + all polysaccharides conjugated to protein D
Cross-protection
Cross-reactivity
Serotypes
Serotypes
Serotypes
POET, Pneumococcal Otitis Efficacy Trial Slide courtesy of gsk
O’Brien and Levin, Lancet, 2006
Randomised trials of efficacy of pneumococcal conjugate vaccine against vaccine-serotype specific disease
6
Laboratory-based surveillance for IPD in South Africa
GERMS-SA (Group for Enteric, Respiratory and Meningeal Disease Surveillance in South Africa) surveillance for laboratory-confirmed cases invasive disease >270 clinical microbiology laboratories enhanced surveillance at 25 hospital sites
Definitions and methods
• Active, national laboratory-based surveillance
• Case: identification of Streptococcus pneumoniae, from normally sterile site specimens
• Repeat isolates from the same patient are excluded; recurrent episodes were defined as repeated isolation >21 days
• Serotyping by Quellung
Number of cases of IPD reported by age and HIV, South Africa, 2005-2008 (enhanced sites only [7382/19233, 38% of all IPD], with known age and HIV status
[5302/7382, 72%])
0
200
400
600
800
1000
1200
1400
1600
1800
2000
0–4
5–9
10–14
15–19
20–24
25–29
30–34
35–39
40–44
45–49
50–54
55–59
60–64
>64
Age group (years)
Nu
mb
er
of ca
se
s
HIV infected
HIV uninfected
Percentage of invasive pneumococcal disease due to vaccine serotypes by age group in 2005-2008, South Africa (n=13723/19200 [71%]
cases with serotyping results)
2611
430131
64 169 343 431 419 281202 151 86 60 132
238
527
77
21
1029
7097
8058
37 2614 10
23
41
282
235
112
55
115 171223 186
13991
5735
2751
85
398 6318
17
71 149200 171 155
94
74 5738 55
49
0%
20%
40%
60%
80%
100%
0–4
5–9
10–14
15–19
20–24
25–29
30–34
35–39
40–44
45–49
50–54
55–59
60–64
>64
Age
unk
nown
Age group (in years)
Pe
rce
nta
ge
other
pcv13
pcv10
6A
pcv7
Pneumococcal Vaccine Introduction in South Africa
• PCV7 introduced in 2009, replaced by PCV13 in 2011
• Three-dose schedule – 6 weeks, 14 weeks and 9 months
• Estimated PCV7 coverage 2009 and 2010 (Expanded Programme on Immunisation administrative data)
Year PCV7 1st dose PCV7 3rd dose
2009 41% 11%
2010 87% 63%
PCV7: 7-valent pneumococcal conjugate vaccine; PCV13: 13-valent pneumococcal conjugate vaccine
Changes in overall invasive pneumococcal disease (IPD) incidence rates by age group, 1998–2007*Seven-valent pneumococcal conjugate vaccine
(PCV7) was introduced in the United States for routine use among young children and infants in the second half of 2000
Pilishvili et al. JID 2010
Incidence of IPD by vaccine and non-
vaccine serotypes, Soweto, 2003-2008
2003-2004 2003-2004 2005-2006 2005-2006 2007-2008 2007-2008
Nunes M et al, AIDS, 2011
Incidence of IPD Among All Ages South Africa, 2005‒2012
0
2
4
6
8
10
12
2005 2006 2007 2008 2009 2010 2011 2012
Incid
en
ce
(ca
se
s p
er
10
0,0
00
pe
rso
n-y
ea
rs)
Time (years)
PCV7 PCV13
Post-vaccine year (2012)
% change in IPD incidence: -40% (95% CI: -42% to -37%)
Pre-vaccine average 2005‒2008
• 35,192 IPD cases identified • Isolates available for 70% (24,552) • Age unknown for 5% (1648)
Incidence of IPD Among Those <15 Years of Age by Year and Age Group—South Africa, 2005‒2012
0
10
20
30
40
50
60
70
2005 2006 2007 2008 2009 2010 2011 2012
Incid
en
ce
(case
s p
er
10
0,0
00
pe
rson
-ye
ars
)
Time (years)
<2
2–4
5–9
10–14
*Percentage change in IPD incidence: post-vaccine (2012) vs. pre-vaccine (2005-2008) years.
Age group, years:
<2 years old: -69% (-72% to -65%)*
2-4 years old: -59% (-67% to -50%)*
5-9 years old: -44% (-54% to -33%)*
10-14 years old: -6% (-28% to +23%)*
PCV13
PCV7
Incidence of IPD Among HIV-Uninfected Children <2 Years of Age by Year and Serotype, South Africa, 2005-2012
0
2
4
6
8
10
12
14
16
18
2005 2006 2007 2008 2009 2010 2011 2012
Incid
en
ce
(case
s p
er
10
0,0
00
pe
rson
-ye
ars
)
Time (years)
Vaccine serotypes (VT)
Serotype 6A
Serotypes 1, 3, 5, 7F, 19A (PCV13)
Non-vaccine serotypes (NVT)
Serotype 6A: -77% (-88% to -59%)*
PCV13: -34% (-53% to -7%)*
NVT: +33% (+15% to +48%)*
VT: -85% (-89% to -79%)*
*% change in IPD incidence: post-vaccine (2012) vs. pre-vaccine (2005-2008) years
Incidence of IPD Among HIV-Infected Children <2 Years of Age by Year and Serotype, South Africa, 2005-2012
0
50
100
150
200
250
300
350
400
450
2005 2006 2007 2008 2009 2010 2011 2012
Incid
en
ce
(case
s p
er
10
0,0
00
pe
rson
-ye
ars
)
Time (years)
Vaccine serotypes (VT)
Serotype 6A
Serotypes 1, 3, 5, 7F, 19A (PCV13)
Non-vaccine serotypes (NVT)
Serotype 6A: -85% (-95% to -62%)*
NVT: -31% (-59% to +11)* PCV13: -72% (-88% to -44%)*
Relative reduction=55%
VT: -86% (-91% to -78%)*
*% change in IPD incidence: post-vaccine (2012) vs. pre-vaccine (2005-2008) years
Incidence of IPD Among Those ≥15 Years of Age by Year and Age Group—South Africa, 2005‒2012
0
2
4
6
8
10
12
14
2005 2006 2007 2008 2009 2010 2011 2012
Incid
en
ce
(case
s p
er
10
0,0
00
pe
rson
-ye
ars
)
Time (years)
15–24
25–44
45–64
>64
15-24 years of age: -29% (-42% to -16%)*
25-44 years of age: -34% (-39% to -29%)*
45-64 years of age: -14% (-23% to -3%)*
>64 years of age : +1% (-26% to +22%)*
*Percentage change in IPD incidence: post-vaccine (2012) vs. pre-vaccine (2005-2008) years.
Age group, years:
PCV7 introduced in April 2009 and replaced with PCV13 in June/July 2011.
INDIRECT EFFECT
VACCINES REDUCE ANTIBIOTIC RESISTANCE
#vaccineswork
– Incidence of antibiotic-resistant invasive pneumococcal disease in children < 2 years, South Africa (cases per 100,000 person-years)
Source: A von Gottberg et al, for GERMS-SA. NEJM 2014;371:1889-99.
GERMS-SA IPD surveillance featured in the journal Nature for the work being done on the impact of the pneumococcal vaccine in South Africa. Nature; Vol. 312, Aug., 2014; News in Focus, Vaccines column; Article entitled: “Hidden bonus from vaccination – Immunization against pneumococcus in Africa also reduces levels of antibiotic resistance”
Cumulative weekly number of IPD cases due to any of the seven serotypes (4, 6B, 9V, 14, 18C, 19F and 23F) in PCV7: children <5
years of age, South Africa, from 2005 to date
PCV7 introduced in April 2009 and replaced with PCV13 in June/July 2011
0
100
200
300
400
500
600
700
800
1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52
Nu
mb
er
of
Cas
es
Epidemiological Week
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Cumulative weekly numbers of IPD cases due to any of the serotypes not in PCV13: children <5 years of age, South Africa,
from 2005 to date
PCV7 introduced in April 2009 and replaced with PCV13 in June/July 2011
0
50
100
150
200
250
1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52
Nu
mb
er
of
Cas
es
Epidemiological Week
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Summary
• Using a novel, infant schedule aligned with developing country Expanded Programme on Immunization – Substantial reductions in IPD in HIV-infected and –
uninfected children
– Indirect effects (adults and infants)
– Some reductions due to HIV interventions, but bulk of impact due to PCV
• Antimicrobial resistance decreasing in all ages
• Non-vaccine serotype replacement
Thank you to all participating patients, laboratory, clinical and administrative staff for submitting case reports and
isolates
NICD
CED: Bolele Disenyeng, Elias KhomaneFlorah Mnyameni, Husna Ismail, Jack
Kekana, Mimmy Ngomane, Mzikazi Dickmolo, Nomsa Tau, Rosah Mabokachaba,
Tshegofatso Ntshabele, Kingdom Mncube,
COTHI: Andriena Saif, Ashika Singh-Moodley, Boniwe Makwakwa, Crystal
Viljoen, Florah Motsai, Gloria Molaba, Gloria Zulu, Mabatho Moerani, Nondumiso
Sithole, Notsikelelo Matiwane, Peggy Wilson, Refilwe Letsoela, Rubeina Badat,
Samantha Iyaloo, Serisha Naicker, Tsidiso Maphanga, Verushka Chetty.
CRDM: Dineo Mogale, Fahima Moosa, Happy Skosana, Karistha Ganesh, Kedibone
Ndlangisa, Lifuo Makhele, Maimuna Carrim, Malefu Moleleke, Mignon du Plessis,
Nicole Wolter, Noluthando Duma, Olga Hattingh, Prabha Naidoo, Thabo Mohale.
CTB: Duduzile Kandawili
DPHSR: Bulelwa Zigana, Emily Dloboyi, Judith Tshabalala, Mbali Dube, Portia
Mogale, Sydney Mogokotleng, Thembi Mthembu, Tsakane Nkuna.
Surveillance Officers: Sandisiwe Joyi, Siyabonga Mboxwana (EC); Khasiane Mawasha, Thandeka Kosana (FS); Anna Motsi, Dikeledi Leshaba, Fiona Timber, Hazel Mzolo,
Lerato Mthombeni, Molly Morapeli, Nthabiseng Motati, Ophtia Kaoho, Phindile Ngema, Rachel Nare, Thandi Mdima Venesa Kok, Vusi Ndlovu, Zodwa Kgaphola (GA);
Indran Naidoo, Nkosinathi Mbhele, Nokuthula Nzuza, Thobeka Simelani (KZN); Maria Mokwena (LP); Sunnieboy Njikho (MP); Matsheko Siyaka (NC); Bekiwe Ncwana,
Joice Tsotsotso, Louisa Phalatse; (NW); Cheryl Mentor, Elizabeth Jerome, Nazila Shalabi, Priscilla Mouton (WC).
GERMS-SA: Carel Haummann, Patricia Hanise, Pieter Ekermans; Sandeep Vasaikar (EC); Anwar Hoosen, Dominique Goedhals, Madeleine Pieters (FS); Alan Karstaedt,
Caroline Maluleka, Charl Verwey, Charles Feldman, Chris Lippincott, David Spencer, Gary Reubenson, Jeannette Wadula, Jeremy Nel, Kathy Lindeque, Maphoshane
Nchabeleng, Mokotsi Molapisi, Norma Bosman, Ranmini Kularatne, Ruth Lekalakala, Sharona Seetharam, Theunis Avenant, Trusha Nana, Vindana Chibabhai (GA); Adhil
Maharj, Asmeeta Burra, Fathima Naby, Halima Dawood, Koleka Mlisana, Lisha Sookan, Praksha Ramjathan, Prasha Mahabeer, Sumayya Haffejee, Yacoob Coovadia (KZN);
Ken Hamese, Ngoaka Sibiya (LP); Greta Hoyland, Jacob Lebudi (MP); Eunice Weenink; Riezaah Abrahams, Sindiswa Makate (NC); Ebrahim Variava,(NW); Andrew
Whitelaw, Preneshni Naicker, Shareef Abrahams (WC); Adrian Brink, Charlotte Sriruttan, Inge Zietsman, Maria Botha, Peter Smith, Suzy Budavari, Xoliswa Poswa
(AMPATH); Chetna Govind, Keshree Pillay (LANCET); Catherine Samuel, Marthinus Senekal (PathCare); Anne Schuchat, Stephanie Schrag (CDC); Keith Klugman
(Emory); Anne von Gottberg, Anthony Smith, Arvinda Sooka, Cecilia Miller, Charlotte Sriruttan, Cheryl Cohen, Chikwe Ihekweazu, Claire von Mollendorf, Genevie Ntshoe,
Jack Manamela, Karen Keddy, Linda de Gouveia, Linda Erasmus, Marshagne Smith, Mmakgomo Rakhudu, Mokupi Manaka, Nazir Ismail, Nelesh Govender, Nevashan
Govender, Nishi Sing, Olga Perovic, Oliver Murangandi, Penny Crowther-Gibson, Portia Mutevedzi, Riyadh Manesen, Ruth Mpembe, Sarona Lingana, Sibongile Walaza,
Simbarashe Takuva, Sonwabo Lindani, Susan Meiring, Thejane Motladiile, Vanessa Quan, Verushka Chetty (NICD).
This work has been supported by NICD/NHLS and the President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) under the terms of [5U2GPS001328]. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of NICD/NHLS or CDC.
The contents of this presentation are solely the responsibility of the authors and do not necessarily represent the official views of the CDC.
Cumulative weekly numbers of IPD cases due to any of the six additional (1, 3, 5, 6A, 7F, 19A) serotypes in PCV 13 but not in
PCV7: children <5 years of age, South Africa, from 2005 to date
PCV7 introduced in April 2009 and replaced with PCV13 in June/July 2011
0
50
100
150
200
250
300
350
400
1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52
Nu
mb
er
of
Cas
es
Epidemiological Week
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Changes in invasive pneumococcal disease (IPD) incidence by
serotype group among children aged <5 years (A) and adults aged ≥65 years (B), 1998–2007 *Seven-valent
pneumococcal conjugate vaccine (PCV7) was introduced in the United States for routine use among young children and infants in the second
half of 2000
Pilishvili et al. JID 2010
(A)
(B)
Percentage of invasive pneumococcal disease due to vaccine serotypes by HIV infection in children ≤5 years, South Africa, 2003-2007 (2864/5865 [49%]
from enhanced sites, 66% with HIV results)
863239
181
55
60
48
15542
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
HIV-positive HIV-negative
Pe
rce
nta
ge
of ca
se
s
Other
13-valent serotypes
10-valent serotypes
6A
7-valent vaccine serotypes
Annual Incidence of Pneumococcal Bacteraemia by Age and HIV Status, Soweto, 1996
1844
197
50 24
64
0
200
400
600
800
1000
1200
1400
1600
1800
2000
0–2 18–40 65+
Case
s p
er
10
0,0
00
po
pu
lation
Age group (years)
HIV-infected
HIV-uninfected
• Rate of pneumococcal bacteraemia is 37-fold increased in HIV-infected children and 8-fold increased in HIV-infected adults1
• Rate of IPD is 42-fold increased in HIV-infected children2
1. Jones N, Huebner R, Khoosal M, et al. AIDS. 1998;12(16):2177-2184; 2. Madhi SA, Petersen K, Madhi A, et al. Pediatr Infect Dis. 2000;19(12):1141-1147
Incidence of IPD Among Those 25-44 Years of Age by Year and Serotype, South Africa, 2005-2012
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
2005 2006 2007 2008 2009 2010 2011 2012
Incid
en
ce
(case
s p
er
10
0,0
00
po
pu
lation
-ye
ars
Time (years)
Vaccine serotypes (VT)
Serotype 6A
Serotypes 1, 3, 5, 7F, 19A (PCV13)
Non-vaccine serotypes (NVT)
VT: -57% (-63% to -50%)*
PCV13: -32% (-40% to -22%)*
NVT: -11% (-21% to +4%)*
Serotype 6A: -46% (-61% to -26%)*
*% change in IPD incidence: post-vaccine (2012) vs. pre-vaccine (2005-2008) years
Incidence of IPD Among HIV-Uninfected Adults 25-44 Years of Age by Year and Serotype, South Africa, 2005-2012
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
2005 2006 2007 2008 2009 2010 2011 2012
Incid
en
ce
(case
s p
er
10
0,0
00
pe
rson
ye
ars
)
Time (years)
Vaccine serotypes (VT)
Serotype 6A
Serotypes 1, 3, 5, 7F, 19A (PCV13)
Non-vaccine serotypes
VT: -52% (-72% to -19%)*
NVT: +28% (-7% to +51%)*
PCV13: -11% (-42% to +36%)*
Serotype 6A: -55% (-88% to +46%)*
*% change in IPD incidence: post-vaccine (2012) vs. pre-vaccine (2005-2008) years
0
2
4
6
8
10
12
14
16
18
20
2005 2006 2007 2008 2009 2010 2011 2012
Incid
en
ce
(case
s p
er
10
0,0
00
pe
rson
ye
ars
)
Time (years)
Vaccine serotypes (VT)
Serotype 6A
Serotypes 1, 3, 5, 7F, 19A (PCV13)
Non-vaccine serotypes (NVT)
VT: -59% (-65% to -52%)*
NVT: -19% (-28% to -8%)*
PCV13: -36% (-45% to -27%)*
Serotype 6A: -47% (-62% to -27%)*
Incidence of IPD Among HIV-Infected Adults 25-44 Years of Age by Year and Serotype, South Africa, 2005-2012
*% change in IPD incidence: post-vaccine (2012) vs. pre-vaccine (2005-2008) years
Relative reduction=40%
Incidence of Disease Caused by Non-Susceptible Pneumococcal Isolates, All Serotypes, Among All Ages by Year
and Antimicrobial Agent, South Africa, 2005-2012
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0
2005 2006 2007 2008 2009 2010 2011 2012
Incid
en
ce
(case
s p
er
10
0,0
00
pe
rson
-ye
ars
)
Time (years)
Penicillin
Ceftriaxone
Multidrug resistance (MDR)
Ceftriaxone: -58% (-65% to -50%)*
MDR: -52% (-57% to -46%)*
Penicillin: -57% (-60% to -53%)*
*% change in IPD incidence: post-vaccine (2012) vs. pre-vaccine (2005-2008) years
Incidence of Disease Caused by Non-Susceptible Pneumococcal Isolates, All Serotypes, Among Children <2
Years of Age by Year and Antimicrobial Agent, South Africa, 2005-2012
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
2005 2006 2007 2008 2009 2010 2011 2012
Inci
den
ce (
case
s p
er 1
00
,00
0 p
erso
n-y
ears
)
Time (years)
Penicillin
Ceftriaxone
MDR: -84% (-88% to -79%)*
Ceftriaxone: -85% (-91% to -77%)*
Penicillin: -82% (-85% to -78%)*
*% change in IPD incidence: post-vaccine (2012) vs. pre-vaccine (2005-2008) years
Age-specific incidence rates* for laboratory-confirmed, invasive pneumococcal disease, reported to GERMS-SA, South Africa, 2009
through 2013
0
10
20
30
40
50
60
70
80
<1 1–4 5–9 10–14 15–24 25–44 45–64 >64
Inci
den
ce (
case
s p
er 1
00
,00
0 p
op
ula
tio
n)
Age category (years)
2009 (N=4602)
2010 (N=4057)
2011 (N=3585)
2012 (N=2969)
2013 (N=2724)
(2009: N=4765; age unknown for n=163; 2010: N=4199; age unknown for n=142); 2011: N=3804; age unknown for n=219; 2012: N=3222, age unknown for n=253; 2013: N=2865, age unknown for n=141.)
Pneumoccocal serotypes, in descending order, causing laboratory-confirmed, invasive pneumococcal disease, reported to GERMS-SA, in
children <5 years, South Africa, 2009-2013
0
20
40
60
80
100
120
140
160
14 6B 6A 23F 19F 19A 1 4 18C 8 9V 5 15B 12F 3 9N 16F 7F Other
Nu
mb
er o
f is
ola
tes
Serotype
2009 (N=1009)
2010 (N=649)
2011 (N=465)
2012 (N=353)
2013 (N=322)
(2009: N=1337, n=1009 with viable isolates; 2010: N=909; n=649 with viable isolates; 2011: N=696, n=465 with viable isolates; 2012; N=509, n=353 with viable isolates; N=498, n=322 with viable isolates)
Cumulative weekly number of IPD cases due to any of the seven serotypes (4, 6B, 9V, 14, 18C, 19F and 23F) in PCV7: individuals
≥5 years of age, South Africa, from 2005 to date
0
100
200
300
400
500
600
700
800
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Nu
mb
er
of
case
s
Epidemiological week
2005 2006
2007 2008
2009 2010
2011 2012
2013 2014
PCV7 introduced in April 2009 and replaced with PCV13 in June/July 2011
Cumulative weekly numbers of IPD cases due to any of the six additional (1, 3, 5, 6A, 7F, 19A) serotypes in PCV 13 but not in
PCV7: individuals ≥5 years of age, South Africa, from 2005 to date
0
100
200
300
400
500
600
700
800
900
1000
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Nu
mb
er
of
case
s
Epidemiological week
2005 2006
2007 2008
2009 2010
2011 2012
2013 2014
PCV7 introduced in April 2009 and replaced with PCV13 in June/July 2011
Cumulative weekly numbers of IPD cases due to any of the serotypes not in PCV13: individuals ≥5 years of age, South Africa,
from 2005 to date
0
100
200
300
400
500
600
700
800
900
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Nu
mb
er
of
case
s
Epidemiological week
2005 2006
2007 2008
2009 2010
2011 2012
2013 2014
PCV7 introduced in April 2009 and replaced with PCV13 in June/July 2011
Number of laboratory-confirmed, invasive pneumococcal disease cases, reported to GERMS-SA, by age group and penicillin
susceptibility, South Africa, 2013, n=2865 (n=1933 with viable isolates)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
<1(n=190)
1–4 (n=132)
5–9 (n=56)
10–14 (n=50)
15–24 (n=108)
25–44 (n=833)
45–64 (n=375)
>64(n=127)
Unknownage (n=62)
Perc
enta
ge o
f is
ola
tes
Age category (years)
Resistant Intermediate Susceptible
2013 CLSI breakpoints for penicillin (oral penicillin V) were used: susceptible, ≤0.06mg/L; intermediately resistant, 0.12-1mg/L; resistant, ≥2mg/L.
Clinical Infectious Diseases, 15 September 2014
•≥2 PCV-7 doses effective in: •HIV-uninfected – VE 74% (95% CI 25-91) •HIV-exposed-uninfected – VE 92% (47-99) •Effective against multidrug resistant IPD (VE 96%, 62-100)
•VE in HIV-infected -12% (-449-77)
Summary
• Using a novel, infant schedule aligned with developing country Expanded Programme on Immunization
– Indirect effects
– Some reductions due to HIV interventions, but bulk of impact due to PCV
• Non-vaccine serotype replacement
• Antimicrobial resistance decreasing in all ages
Thank you to all participating patients, laboratory, clinical and administrative staff for submitting case reports and
isolates
NICD
CED: Bolele Disenyeng, Elias KhomaneFlorah Mnyameni, Husna Ismail, Jack
Kekana, Mimmy Ngomane, Mzikazi Dickmolo, Nomsa Tau, Rosah Mabokachaba,
Tshegofatso Ntshabele, Kingdom Mncube,
COTHI: Andriena Saif, Ashika Singh-Moodley, Boniwe Makwakwa, Crystal
Viljoen, Florah Motsai, Gloria Molaba, Gloria Zulu, Mabatho Moerani, Nondumiso
Sithole, Notsikelelo Matiwane, Peggy Wilson, Refilwe Letsoela, Rubeina Badat,
Samantha Iyaloo, Serisha Naicker, Tsidiso Maphanga, Verushka Chetty.
CRDM: Dineo Mogale, Fahima Moosa, Happy Skosana, Karistha Ganesh, Kedibone
Ndlangisa, Lifuo Makhele, Maimuna Carrim, Malefu Moleleke, Mignon du Plessis,
Nicole Wolter, Noluthando Duma, Olga Hattingh, Prabha Naidoo, Thabo Mohale.
CTB: Duduzile Kandawili
DPHSR: Bulelwa Zigana, Emily Dloboyi, Judith Tshabalala, Mbali Dube, Portia
Mogale, Sydney Mogokotleng, Thembi Mthembu, Tsakane Nkuna.
Surveillance Officers: Sandisiwe Joyi, Siyabonga Mboxwana (EC); Khasiane Mawasha, Thandeka Kosana (FS); Anna Motsi, Dikeledi Leshaba, Fiona Timber, Hazel Mzolo,
Lerato Mthombeni, Molly Morapeli, Nthabiseng Motati, Ophtia Kaoho, Phindile Ngema, Rachel Nare, Thandi Mdima Venesa Kok, Vusi Ndlovu, Zodwa Kgaphola (GA);
Indran Naidoo, Nkosinathi Mbhele, Nokuthula Nzuza, Thobeka Simelani (KZN); Maria Mokwena (LP); Sunnieboy Njikho (MP); Matsheko Siyaka (NC); Bekiwe Ncwana,
Joice Tsotsotso, Louisa Phalatse; (NW); Cheryl Mentor, Elizabeth Jerome, Nazila Shalabi, Priscilla Mouton (WC).
GERMS-SA: Carel Haummann, Patricia Hanise, Pieter Ekermans; Sandeep Vasaikar (EC); Anwar Hoosen, Dominique Goedhals, Madeleine Pieters (FS); Alan Karstaedt,
Caroline Maluleka, Charl Verwey, Charles Feldman, Chris Lippincott, David Spencer, Gary Reubenson, Jeannette Wadula, Jeremy Nel, Kathy Lindeque, Maphoshane
Nchabeleng, Mokotsi Molapisi, Norma Bosman, Ranmini Kularatne, Ruth Lekalakala, Sharona Seetharam, Theunis Avenant, Trusha Nana, Vindana Chibabhai (GA); Adhil
Maharj, Asmeeta Burra, Fathima Naby, Halima Dawood, Koleka Mlisana, Lisha Sookan, Praksha Ramjathan, Prasha Mahabeer, Sumayya Haffejee, Yacoob Coovadia (KZN);
Ken Hamese, Ngoaka Sibiya (LP); Greta Hoyland, Jacob Lebudi (MP); Eunice Weenink; Riezaah Abrahams, Sindiswa Makate (NC); Ebrahim Variava,(NW); Andrew
Whitelaw, Preneshni Naicker, Shareef Abrahams (WC); Adrian Brink, Charlotte Sriruttan, Inge Zietsman, Maria Botha, Peter Smith, Suzy Budavari, Xoliswa Poswa
(AMPATH); Chetna Govind, Keshree Pillay (LANCET); Catherine Samuel, Marthinus Senekal (PathCare); Anne Schuchat, Stephanie Schrag (CDC); Keith Klugman
(Emory); Anne von Gottberg, Anthony Smith, Arvinda Sooka, Cecilia Miller, Charlotte Sriruttan, Cheryl Cohen, Chikwe Ihekweazu, Claire von Mollendorf, Genevie Ntshoe,
Jack Manamela, Karen Keddy, Linda de Gouveia, Linda Erasmus, Marshagne Smith, Mmakgomo Rakhudu, Mokupi Manaka, Nazir Ismail, Nelesh Govender, Nevashan
Govender, Nishi Sing, Olga Perovic, Oliver Murangandi, Penny Crowther-Gibson, Portia Mutevedzi, Riyadh Manesen, Ruth Mpembe, Sarona Lingana, Sibongile Walaza,
Simbarashe Takuva, Sonwabo Lindani, Susan Meiring, Thejane Motladiile, Vanessa Quan, Verushka Chetty (NICD).
This work has been supported by NICD/NHLS and the President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) under the terms of [5U2GPS001328]. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of NICD/NHLS or CDC.
The contents of this presentation are solely the responsibility of the authors and do not necessarily represent the official views of the CDC.
Global Introduction Status of PCV
Source: International Vaccine Access Center (IVAC), Johns Hopkins Bloomberg School of Public Health. Vaccine Information Management System (VIMS)
Global Vaccine Introduction Report, March 2014.
Incidence of IPD Among Those <2 Years of Age by Year and Serotype, South Africa, 2005-2012
0
5
10
15
20
25
30
35
40
2005 2006 2007 2008 2009 2010 2011 2012
Incid
en
ce
(case
s p
er
10
0,0
00
po
pu
lation
-ye
ars
Time (years)
Vaccine serotypes (VT)
Serotype 6A
Serotypes 1, 3, 5, 7F, 19A (PCV13)
Non-vaccine serotypes (NVT)
PCV13: -57% (-68% to -42%)*
VT: -89% (-92% to -86%)*
NVT: +6% (-16% to +23%)*
Serotype 6A: -85% (-91% to -76%)*
*% change in IPD incidence: post-vaccine (2012) vs. pre-vaccine (2005-2008) years
Number of Penicillin Non-Susceptible Isolates Causing IPD in Children <2 Years of Age by Year and Serotype
South Africa, 2005-2012
0
100
200
300
400
500
600
2005-2008* 2009 2010 2011 2012
Nu
mb
er o
f is
ola
tes
Time (year of surveillance)
Vaccine serotypes
Serotype 6A
Serotypes 1, 3, 5, 7F and 19A (PCV13)
Non-vaccine serotypes
*Random retrospective sampling of ~500 isolates/year for 2005-2008 using same microbroth dilution methodology used on all viable isolates from 2009 onwards