Prospects for GBS prevention - current candidates & removing barriers to licensure of a GBS vaccine for pregnant women globally
https://www.meningitis.org/mrf-conference-2017
What next for prevention of pneumococcal disease in light of serotype replacement? Is there a pathway to licensure for novel pneumococcal vaccines?
https://www.meningitis.org/mrf-conference-2017
Preparedness for and response to meningococcal outbreaks: preliminary results of a Canadian Immunization Research Network (CIRN) randomized controlled trial of two schedules of 4CMenB vaccine in adolescents and young adults.
https://www.meningitis.org/mrf-conference-2017
Efficacy differences between PCV10 and PCV13 - Slideset by Professors Esposit...WAidid
Ā
This slideset edited by Professors Esposito, Palmu, De Wals and Sanders for the Second WAidid Congress present some studies that compare in different countries (including Finland, Sweden, Quebec and the Netherlands) efficacy differences between PCV10 and PCV13.
To learn more please visit www.waidid.org
Prospects for GBS prevention - current candidates & removing barriers to licensure of a GBS vaccine for pregnant women globally
https://www.meningitis.org/mrf-conference-2017
What next for prevention of pneumococcal disease in light of serotype replacement? Is there a pathway to licensure for novel pneumococcal vaccines?
https://www.meningitis.org/mrf-conference-2017
Preparedness for and response to meningococcal outbreaks: preliminary results of a Canadian Immunization Research Network (CIRN) randomized controlled trial of two schedules of 4CMenB vaccine in adolescents and young adults.
https://www.meningitis.org/mrf-conference-2017
Efficacy differences between PCV10 and PCV13 - Slideset by Professors Esposit...WAidid
Ā
This slideset edited by Professors Esposito, Palmu, De Wals and Sanders for the Second WAidid Congress present some studies that compare in different countries (including Finland, Sweden, Quebec and the Netherlands) efficacy differences between PCV10 and PCV13.
To learn more please visit www.waidid.org
Presentation by Camelia Savulescu during the ESCAIDE 2016 parallel session on Vaccine-preventable diseases (2) on 29 November 2016 in Stockholm, Sweden
Richard Garfein, PhD, MPH
Professor
Herbert Wertheim School of Public Health and Human Longevity Science
Adjunct Professor
Division of Infectious Disease and Global Public Health
Department of Medicine
University of California, San Diego
TB and Bangladesh - Threats and Way Forward.pptxMdNadimReza1
Ā
TB and Bangladesh - Threats and Way Forward. Describes the overall TB situation in Bangladesh in 2023 based on evidence. It also describes the challenges, diagnostic options, and also way forwards in the management of TB in Bangladesh.
EXAMPLETask NAME BUILDINGSTART DATE APRIL 2022FIBetseyCalderon89
Ā
EXAMPLE
Task NAME: BUILDING
START DATE: APRIL 2022
FINISH DATE JULY 2022
BUILDING MATERIALS
Total Workers Involved: 26 to 32 The 3 -4 months of construction on an average home requires this
many people. On average, it takes seven months to build a house from start to finish.
PREP
External Materials
Internal Materials
Prepare Construction Site and Pour Foundation, Complete Rough Framing, Complete Rough Plumbing, Electrical HVAC, Install Insulation, Complete Drywall and Interior Fixtures
house Mud and, Clay bricks and Blocks, Sand, Stone, Thatch, Wood Floor System, Walls, Roof Systems are Completed, and sheathing Applied to Exterior Walls, Covered with Protective Wrap
Light fixtures, outlets and switches are installed, and the electrical panel is completed. HVAC equipment is installed, and registers completed.
Sinks, toilets, and faucets are put in place.
Finish, Finish Interior Trim, Install Exterior Walkways and Driveway,
Install Hard Surface Flooring,
Timber, Cement, Fabric, Foam, Glass, Gypcrete Metal, Plastics.
Ceramic tile, vinyl and wood
Interior doors, baseboards, door casings, windowsills,
moldings, stair balusters and
Countertops; Complete Exterior Grading, Finish Mechanical Trims;
flooring is installed as well as countertop.
other decorative trim is installed, along with cabinets, vanities, and fireplace mantels
and surrounds
TASK NAME: IMSPECTION
START DATE: JULY 30TH 2022
FINISH DATE: JULY 30TH 2022
Phase Inspection Process
During the building process, there are three windows of opportunity in which you should take advantage of the recommendation to have a third-party inspector review and report on the quality of the craftsmanship and construction of your new home. In order to guarantee that major building flaws within your property are not hidden from view, the traditional 3-phase inspection technique is performed.
Pre-pour Foundation Inspection
Two days before the day that the actual pour would take place. Because of this, the foundation will be much more likely to be ready for inspection. This provides the contractor with sufficient time to make any and all necessary modifications, or to postpone the day that the pour is scheduled to take place.
Framing Inspection
Walk-through with a framework. During this stage of the construction process, the builder will attempt to guarantee that all of the previously discussed and agreed upon design criteria have been appropriately incorporated into the house.
Final Inspection
The final inspection should be scheduled a few days before your scheduled walk-through with your builder. The final inspection is conducted as part of a real estate transaction. it is regulated by the local Real Estate Commission. The final inspection incorporates all the major systems in
the home.
COMMUNICATION PLAN & PROJECT SCHEDULE- HOME BUILD:
DESCRIPTI ON
FREQUEN CY
COMMUNICATI ON METHOD
AUDIENCE
Kick off Meeting
DAILY- 1ST OF THE SHIFT
Team huddle, allocate tasks needed to be completed that ...
Kathleen Brady - HIV in Philadelphia (Annual Epidemiological Presentation)Office of HIV Planning
Ā
On April 27, 2016, Kathleen Brady of the Philadelphia AIDS Activities Coordinating Office (AACO) presented her annual review of the HIV Epidemic in Philadelphia and the surrounding areas.
Role of vaccines and child health - Professor Shabir MadhiWAidid
Ā
"Role of vaccines in making the world a better place for children" - Slideset by professor Madhi (WAidid Board Member) presented at the 2015 World Congress of Nephrology, held in Cape Town from March 13-17 2015.
Find more on www.waidid.org
Big Data Analysis Suggests COVID Vaccination Increases Excess Mortality Of ...sdateam0
Ā
Explaination of Paper
Sakura, Ken. 2024. āBig Data Analysis Suggests COVID Vaccination Increases Excess Mortality of Highly Vaccinated North Temperate Zone and North Frigid Zone Countries.ā OSF Preprints. April 8. doi:10.31219/osf.io/zv6j8.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Ā
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Health Education on prevention of hypertensionRadhika kulvi
Ā
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
Ā
The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patientās body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Global launch of the Healthy Ageing and Prevention Index 2nd wave ā alongside...ILC- UK
Ā
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Explore our infographic on 'Essential Metrics for Palliative Care Management' which highlights key performance indicators crucial for enhancing the quality and efficiency of palliative care services.
This visual guide breaks down important metrics across four categories: Patient-Centered Metrics, Care Efficiency Metrics, Quality of Life Metrics, and Staff Metrics. Each section is designed to help healthcare professionals monitor and improve care delivery for patients facing serious illnesses. Understand how to implement these metrics in your palliative care practices for better outcomes and higher satisfaction levels.
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Ā
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
The Importance of Community Nursing Care.pdfAD Healthcare
Ā
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
1. Presented by Maria Deloria Knoll, PhD
on behalf of the PSERENADE Team
Meningitis Research Foundation
November 2021
November 2021
1
Conclusions from the PSERENADE Project:
Implications for Pneumococcal Vaccine Policy
and What is Happening Next
2. Conflicts of Interest
Dr. Maria Knoll reports grants from Merck, personal fees from Merck, and grants from Pfizer, outside the
submitted work.
This work was conducted as part of a grant from the WHO funded by Bill and Melinda Gates Foundation
The funders had no role in the design of the study or in the collection, analyses, or interpretation of data.
DATE, 2021
2
3. Background
ā¢ Pneumococcal conjugate vaccines (PCVs) have been widely introduced into infant
immunization programs over the last 20 years
ā¢ 10 years of PCV10 (GSK) and PCV13 (Pfizer) use
ā¢ Invasive pneumococcal disease (IPD) caused by serotypes targeted by the
vaccines has been reduced
ā¢ But questions remain regarding the net overall impact after long term use on
pneumococcal disease, in both children and adults
ā¢ Countries want to understand differences between PCV10 and PCV13 in the
overall impact on all pneumococcal disease
ā¢ The amount of disease prevented in older children and adults through indirect
herd protection has varied by country
DATE, 2021
3
4. November 2021
The PSERENADE Project was conducted to use all available data globally to answer these questions.
Aim: to assess the impact of PCVs introduced into infant immunization programs on invasive
pneumococcal disease (IPD), including meningitis.
The following questions will be addressed in this presentation:
1. What were the direct effects of PCV10/13 vaccination in children <5 years old on all IPD?
2. Were there differences between countries that used PCV10 vs PCV13?
3. Was impact the same for meningitis?
4. What were the indirect effects on older children and adults?
5. What were the effects on Serotype 1 outbreaks?
6. Did vaccine schedule affect vaccine impact? Is a booster dose needed?
7. What pneumococcal serotypes remain?
8. What proportion of remaining disease is caused by serotypes covered by higher valency products?
Pneumococcal Serotype Replacement and Distribution
Estimation (PSERENADE) Project
5. 5
November 2021
Overview of Sites with invasive pneumococcal disease (IPD) data
Reference: Deloria Knoll et al. Microorganisms. 2021
Children <18
years of age
Eligibility Criteria
ā¢ PCV universally
recommended in the infant
immunization schedule
ā¢ At least 50% uptake of PCV
ā¢ ā„1 complete post PCV year
of invasive pneumococcal
disease (IPD)*
ā¢ At least 50% of cases
serotyped
ā¢ Stable surveillance system
Number of eligible sites included in analyses:
Incidence: 47 sites in 33 countries
Serotype Distribution: 54 sites in 41 countries
*IPD = predominantly pneumonia, meningitis and sepsis cases with
pneumococcus detected in blood or cerebral spinal fluid (CSF)
6. Methods: estimating change in incidence over time relative to
pre-PCV period (incidence rate ratios)
July 2020
6
*Time 0 = year of PCV7 introduction
and year +4 = 5th year of PCV use
Observed IR (data from site)
Site-specific modeled IR & surrounding 95% CIs
Step 1: estimate IPD Incidence over time for each site
PCV7
Intro
PCV13
Intro
-10 -8 -6 -4 -2 0 2 4 6 8 10
Time relative to PCV10/13 introduction
Incidence
rate
per
100,000
Pre-PCV
period
Post-PCV
period
Pre-PCV rate
7. Methods: estimating change in incidence over time relative to
pre-PCV period (incidence rate ratios)
July 2020
7
IRR and surrounding 95% CIs
*Time 0 = year of PCV7 introduction
and year +4 = 5th year of PCV use
Observed IR (data from site)
Site-specific modeled IR & surrounding 95% CIs
Step 2: Calculate Incidence Rate Ratio relative to pre-PCV
period
PCV7
Intro
PCV13
Intro
PCV7
Intro
PCV13
Intro
-10 -8 -6 -4 -2 0 2 4 6 8 10 -2 0 2 4 6 8 10
Time relative to PCV10/13 introduction
Incidence
rate
per
100,000
Time relative to PCV10/13 introduction
Incidence
rate
ratio
Step 1: estimate IPD Incidence over time for each site
Pre-PCV
period
Post-PCV
period
8. Methods: estimating change in incidence over time relative to
pre-PCV period (incidence rate ratios)
July 2020
8
IRR and surrounding 95% CIs
*Time 0 = year of PCV7 introduction
and year +4 = 5th year of PCV use
Step 2: Calculate Incidence Rate Ratio relative to pre-PCV
period
PCV7
Intro
PCV13
Intro
-2 0 2 4 6 8 10
Time relative to PCV10/13 introduction
Incidence
rate
ratio
9. Methods: meta-averaged change in incidence across sites
9
PCV10/13
introducti
on
IRRs from example site
1 2 3 4 5 6 7 8 9
0
Year Relative to PCV10/13 Introduction
0
0.5
1.0
1.5
Incidence
Rate
Ratio
Step 2: Calculate Incidence Rate Ratio relative to pre-PCV
period
PCV7
Intro
PCV13
Intro
-2 0 2 4 6 8 10
Time relative to PCV10/13 introduction
Incidence
rate
ratio
10. Methods: meta-averaged change in incidence across sites
10
1 2 3 4 5 6 7 8 9
0
Year Relative to PCV10/13 Introduction
Annual IRRs calculated for each site
PCV10/13
introducti
on
IRRs from all sites
0
0.5
1.0
1.5
Incidence
Rate
Ratio
11. Methods: meta-averaged change in incidence across sites
11
PCV10/
13
introdu
ction
Meta-average across sites
1 2 3 4 5 6 7 8 9
0
Year Relative to PCV10/13 Introduction
Annual IRRs calculated for each site
0
0.5
1.0
1.5
Incidence
Rate
Ratio
12. Why do IRRs at year 0 vary across the sites?
12
1 2 3 4 5 6 7 8 9
0
Year Relative to PCV10/13 Introduction
Annual IRRs calculated for each site
PCV10/
13
introdu
ction
IRRs from all sites
PCV7
Intro
PCV10/13
Intro
Year Relative to PCV10/13 intro
-2 0 2 4 6 8 10
Change in IRR due to prior
PCV7 use
0
0.5
1.0
1.5
Incidence
Rate
Ratio
13. Why do IRRs at year 0 vary across the sites?
13
1 2 3 4 5 6 7 8 9
0
Year Relative to PCV10/13 Introduction
PCV10/
13
introdu
ction
0
0.5
1.0
1.5
Incidence
Rate
Ratio
Stratification by prior PCV7 use
No PCV7 use
Moderate PCV7
impact
Substantial PCV7
impact
14. Methods: meta-averaged change in incidence across sites
14
PCV10/
13
introdu
ction
1 2 3 4 5 6 7 8 9
0
Year Relative to PCV10/13 Introduction
0
0.5
1.0
1.5
Incidence
Rate
Ratio
Stratification by prior PCV7 use
No PCV7 use
Moderate PCV7
impact
Substantial PCV7
impact
16. Number of cases of pneumococcal meningitis and IPD
DATE, 2021
16
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
450,000
500,000
<5 years ā„18 years ā„65 years
Number
of
Cases
CSF+ Pneumococcal
Meningitis
Invasive pneumococcal
disease (IPD)
13,391 7,277
33 countries with eligible data
Over 500,000 IPD cases
<5 years: ~76,000 cases
18+ years ~450,000 cases
65+ years ~210,000 cases
Proportion of IPD that was
meningitis:
<5 years: ~15%
18+ years: ~7%
Larger IPD sample size enables
more sub-analyses
36,322
76,010
451,338
209,730
17. 1. What were the direct effects of PCV10/13 vaccination in
children <5 years old on all IPD?
2. Were there differences between countries that used
PCV10 vs PCV13?
November, 2021
18
18. Change in IPD in children <5 years: PCV10 Types
DATE, 2021
Key messages
ā¢ Prior PCV7 use greatly impacted
PCV7 type IPD
ā¢ The new serotypes covered by
PCV10/13 declined substantially and
are expected to continue declining
Incidence
Rate
Ratio
86-99%
declines
Year since PCV10/13 introduction
70-94%
PCV10/13
Intro
PCV10/13
Intro
Serotypes 1, 5, and 7F IPD
PCV7 Serotype IPD
PCV7 Impact
Substantial
Moderate
No use
19. Change in IPD in children <5 years: PCV13 (non-PCV10) Types
DATE, 2021
Key messages
ā¢ Evidence of cross
protection against
6A for PCV10
ā¢ 19A was reduced at
PCV13 sites, butnot
eliminated; it
increased at PCV10
sites
ā¢ No clear trends in
Serotype 3 for either
product
PCV10/13
Intro
PCV10/13
Intro
PCV10/13
Intro
Incidence
Rate
Ratio
67-87%
decrease
1.5-2.2 fold
increase
Year since PCV10/13 introduction
76-99%
Serotype 6A Serotype 19A Serotype 3
PCV7 Impact
Substantial
Moderate
No use
20. Change in IPD in children <5 years: Non-PCV13 Types
DATE, 2021
21
2-2.8 fold
increase
Key messages
Non-vaccine serotypes increased
2-2.8 fold by year 5
Has not stabilized
Similar for both PCV10 & PCV13
PCV10/13
Intro
Incidence
Rate
Ratio
Year since PCV10/13 introduction
Non-PCV13 Serotypes
*High HIV prevalence site that had other concurrent interventions besides PCV13, including ART therapy
* PCV7 Impact
Substantial
Moderate
No use
21. Change in all IPD in children <5 years
DATE, 2021
22
Incidence
Rate
Ratio
Pre-PCV Rate
60-79%
decline
Year since PCV10/13 introduction
Key messages
ā¢ Overall, all IPD declined 60-79%
(IRRs 0.21-0.40) by 5 years after
PCV10/13 introduction across
strata
ā¢ No meaningful differences
between PCV10 and PCV13
PCV10/13
Intro
PCV7 Impact
Substantial
Moderate
No use
22. 3. Was impact the same for meningitis?
November, 2021
23
23. Impact of PCV on Pneumococcal Meningitis vs All IPD: Children <5y
November 2021
24
PCV10
PCV13
Meningitis
All IPD
Incidence
Rate
Ratio
Key messages: children <5y
ā¢ Reduction in pneumococcal meningitis was >50% in all strata for both products
ā¢ PCV impact on pneumococcal meningitis was ~5% less than for all IPD
by PCV10/13 product and years of prior PCV7 impact
No PCV7 Use Moderate PCV7 Use Substantial PCV7 Use
PCV10/13
Intro
Pneumococcal
Meningitis
PCV10/13
Intro
PCV10/13
Intro
All IPD
Years Relative to PCV10/13 Introduction
See poster: Changes in Pneumococcal Meningitis Incidence Following Introduction of PCV10
and PCV13: Results from the Global PSERENADE Project (J. Yang)
24. 4. What were the indirect effects in adults?
November, 2021
25
25. Herd Effects of Infant PCV program on IPD in Adults >65 years
DATE, 2021
26
Years Relative to PCV10/13 Introduction
Key messages:
Vaccine type IPD decreased
substantially (>75%) in
adults >65y
ā¢ Took 2-3 years longer for
the full effect than for
children <5y
Non-vaccine type increased
~>2 fold
1.7 to 2.5
fold
increase
Non-PCV13 serotypes
Incidence
Rate
Ratio
PCV10 serotypes
PCV10 &
PCV13
combined
PCV7 Impact
Substantial
Moderate
No use
>75%
declines
26. Herd Effects of Infant PCV program on all IPD in Adults ā„65 years
DATE, 2021
27
Incidence
Rate
Ratio
Year since PCV10/13 introduction
49% decline
Pre-PCV Rate
Key messages:
Net effect of VT declines and non-VT increases:
Heterogenous
Total IPD incidence had sustained declines in
some sites but others returned to baseline
No change
All IPD
Heterogenous
PCV7 Impact
Substantial
Moderate
No use
27. 3. Was impact the same for meningitis?
(Adults)
November, 2021
28
28. Impact of PCV on Pneumococcal Meningitis vs all IPD: Adults ā„18y
November 2021
29
Years Relative to PCV10/13 Introduction
PCV10
PCV13
Meningitis
All IPD
Incidence
Rate
Ratio
Key messages: Adults ā„18y
ā¢ Results for meningitis were generally similar to all IPD
ā¢ Heterogeneous by site, ranging from no net change to ~50% decline
PCV10/13
Intro
PCV10/13
Intro
PCV10/13
Intro
by PCV10/13 product and years of prior PCV7 impact
No PCV7 Use Moderate PCV7 Use Substantial PCV7 Use
See poster: Changes in Pneumococcal Meningitis Incidence Following Introduction of PCV10
and PCV13: Results from the Global PSERENADE Project (J. Yang)
29. 5. What were effects of PCV10/13 on
Serotype 1 outbreaks?
November, 2021
30
30. ST1 IPD IRRs, by region and age group
November, 2021
31
Key messages:
ST1 IPD substantially declined in all sites
among all ages & in all regions
ā¢ Including Sub-Saharan Africa, butā¦
ā¢ Did not have data from countries with
largest outbreaks (e.g., Burkina Faso,
Niger)
Incidence
Rate
Ratio
<5
years
5-17
y
18-49
y
50-64
y
65+
y
Europe North America Oceania Sub-Saharan
Africa
North Africa &
Western Asia
Asia Latin America
& Caribbean
Ref: Bennett JC et al. Microorganisms. 2021
31. ST1 IPD IRRs, by region and age group
November, 2021
32
Ref: Bennett JC et al. Microorganisms. 2021
Incidence
Rate
Ratio
<5
years
5-17
y
18-49
y
50-64
y
65+
y
Little to no data in adults in
Northern Africa, Asia or Latin
America & Caribbean
Also do not
have adult data
in all regions
Europe North America Oceania Sub-Saharan
Africa
North Africa &
Western Asia
Asia Latin America
& Caribbean
32. ST1 IPD IRRs, by region and age group
November, 2021
33
Key messages:
ā¢ ST 1 outbreaks occurred
in all age groups
ā¢ Outbreaks continued
for 3-4 years after
PCV10 and 13
introduction, but
eventually stopped
Incidence
Rate
Ratio
<5
years
5-17
y
18-49
y
50-64
y
65+
y
Europe North America Oceania Sub-Saharan
Africa
North Africa &
Western Asia
Asia Latin America
& Caribbean
Ref: Bennett JC et al. Microorganisms. 2021
ST1 outbreaks
post-PCV that
had larger
incidence than
average pre-PCV
annual incidence
33. Global weighted average IRRs for serotype 1 IPD: All age groups
November 2020
34
Bennett JC et al. Microorganisms. 2021
1.0 = Pre-PCV Rate
Year Relative to PCV10/13 Introduction
Incidence
Rate
Ratio
0 1 2 3 4 5 6 7 8 9
Key messages:
ā¢ST1 nearly eliminated in all
ages after 6 years
ā¢Older children and adults
similar to children <5y (small
lag)
1.0
1.25
0.75
0.50
0.25
0.0
98-99%
decline
34. 6. Did dosing schedule affect vaccine impact?
Is a booster dose needed?
November, 2021
35
35. Impact of Vaccine Schedule on Serotype 1 IRR
November, 2021
36
Reference: Bennett JC et al.
Microorganisms. 2021
Key messages:
ST1 IRR decreased in
all age groups
similarly by
vaccination schedule
2+1
3+1 3+0
Incidence
Rate
Ratio
<5
years
5-17
y
18-49
y
50-64
y
65+
y
36. 7. What pneumococcal serotypes remain?
8. What proportion of remaining disease is caused by serotypes
covered by future higher-valency PCV products?
November, 2021
37
37. Serotype distribution after extensive PCV10/13 use
November, 2021
38
Incidence
Rate
Ratio
Year since PCV10/13 introduction
PCV10/13
Intro
Change in all IPD
When did serotype distribution stabilize:
Children <5 years: after ~5 years of PCV10/13 use
Adults: after ~7 years of use
38. Serotype distribution after extensive PCV10/13 use
(after 5-7 years use)
DATE, 2021
39
Adults >50 years
PCV13
sites
PCV10
sites
Vaccine Type
Key messages:
ā¢ ST 3 was dominant and at both PCV10 and PCV13 sites, and in both children and adults
ā¢ STs 19A was the leading serotypes at PCV10 sites and still observed at PCV13 sites
Children <5 years
Percent
Percent
%
%
%
%
39. %
40
November 2021
Percent of remaining IPD due to serotypes included in future vaccines
Vaccine Serotypes
Percent
of
IPD
Children <5 years
Key messages:
Future PCVs (PCV20 & PCV24)
cover 50-60% of remaining cases
(after excluding ST3)
Polysaccharide 23-valent (PPV23)
covers ~60% of IPD in adults (after
excluding ST3)
Additional Serotypes Covered by:
PCV15: 22F, 33F
PCV20: 22F, 33F, 8, 10A, 11A, 12F, 15BC
PCV24: 22F, 33F, 2, 8, 9N, 10A, 11A, 12F, 15B, 17F, 20
Adults >50 years
Future Products
PCV13 Sites
Future Products
40. %
41
November 2021
Percent of remaining IPD due to serotypes included in future vaccines
Vaccine Serotypes
Percent
of
IPD
Children <5 years Key messages:
Results were similar for PCV10 sites
Additional Serotypes Covered by:
PCV15: 22F, 33F
PCV20: 22F, 33F, 8, 10A, 11A, 12F, 15BC
PCV24: 22F, 33F, 2, 8, 9N, 10A, 11A, 12F, 15B, 17F, 20
Adults >50 years
Future Products
PCV10 Sites
Future Products
41. Summary of PCV10 & PCV13 Impact
ā¢ All IPD in children <5 years declined 60-79%
ā¢ Similar for PCV10 & PCV13
ā¢ All IPD declined on average ~20% in adults but was heterogeneous among sites
ā¢ Vaccine serotypes declined substantially in all age groups
ā¢ Non-vaccine serotypes increased in all age groups
ā¢ Impact on meningitis generally similar to all IPD
ā¢ Serotype 1 outbreaks declined substantially ā across all age groups, vaccination schedules and regions
ā¢ Over half of remaining IPD in children is due to serotypes covered by possible future PCV20 & PCV24
ā¢ 75% of remaining adult IPD is due to serotypes covered by PPV23
DATE, 2021
42
42. What is Happening Next
Globally:
1. Results from Burkina Faso & Ghana
anticipated (impact on ST1 in adults)
2. Higher valency PCV products (PCV15,
PCV20, PCV24) anticipated
3. Policy/guidance about switching
products must be determined
4. Push for data support and well
characterized surveillance of older age
groups in LMICs (especially in
meningitis belt)
DATE, 2021
43
For PSERENADE:
1. Heterogeneity among sites in herd
effects in adults
2. Pneumonia cases
3. Determine if some non-VT serotypes
emerging faster than others
4. Does a booster schedule matter for
some serotypes?
Ex. Breakthrough 19F cases seen with
3+0 schedule
43. PSERENADE Team
PSERENADE Core Team:
IVAC / JHU:
Maria Deloria Knoll (PI)
Kyla Hayford (previously PI)
Julia Bennett
Maria Garcia Quesada
Scott Zeger
Yangyupei (Jade) Yang
Marissa Hetrich
Carly Herbert
WHO:
Daniel Feikin
Adam Cohen
Katherine OāBrien
November, 2021
44
Technical Advisory Group:
William Hausdorff
Thomas Cherian
Catherine Satzke
Cynthia Whitney
Elizabeth Miller
Shabir Madhi
Funded by: WHO and the Bill and
Melinda Gates Foundation
44. PSERENADE Site Investigators
45
Active Bacterial Core Surveillance (ABCs): R. Gierke, T. Pilishvili
Arctic Investigations Program (AIP): D. Bruden, M. G. Bruce
CASPER (CAlgary Streptococcus pneumoniae Epidemiology Research): J. D. Kellner, L. J. Ricketson
AdministraciĆ³n Nacional de Laboratorios e Institutos de Salud āDr. Carlos G. MalbrĆ”nā: C. S. Lara, D. Napoli, J.
Zintgraff, N. M. SƔnchez Eluchans
CDC Global Disease Detection (GDD) Regional Center (collocated with the Kenya Medical Research Institute (KEMRI)
in Nairobi): G. M. Bigogo, J. R. Verani
Communicable Diseases Network Australia (CDNA) National Notifiable Disease Surveillance System (NNDSS): K.
Pennington, S. Jayasinghe, H. Cook, K. McMahon, V. Krause
Dhaka Shishu Hospital (DSH), Shishu Shasthya Foundation Hospital, & Kumudini Womenās Medical College Hospital
(WHO-IBD Sites) BGD-1: CMOSH; BGD-2: DSH; BGD-3: Kumuduni; BGD-4: SSF: H. Hasanuzzaman, H. Rahman, S. K.
Saha
National Reference Center of Streptococcus Pneumoniae - Belgium: S. Desmet
Brazilian National Reference Laboratory for Pneumococcal Infections: M. C. Brandileone, S. CG. Almeida
Department of Medical Microbiology, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria: L. P.
Setchanova
Navajo Nation and White Mountain Apache Tribal Lands: C. G. Sutcliffe, L. L. Hammitt
Public Health Department of Catalonia: C. Izquierdo, C. MuƱoz-Almagro, P. Ciruela, S. Broner
SIREVA Site/ ISP ā Chile: J. C. Hormazabal, J. DĆaz, M. T. Valenzuela, P. Alarcon, R. Puentes
SIREVA/ Centro Nacional de Referencia de BacteriologĆa (National Reference Lab); Instituto Costarricense de
InvestigaciĆ³n y EnseƱanza en NutriciĆ³n y Salud ā Costa Rica: G. Chanto ChacĆ³n
National Reference Lab for streptococcal infections, NIPH - Czech Republic: J. Kozakova, P. Krizova
IPD Surveillance Statens Serum Institut, SSI - Denmark: P. Valentiner-Branth, T. Dalby
ECDC: E. Colzani, L. P. Celentano, S. Bacci
Fiji IB-VPD- New Vaccine Evaluation Project: A. Sahu Khan, E. Rafai, F. M. Russell, R. Reyburn
National Institute for Health and Welfare (THL) - Finland: H. Rinta-Kokko, J. P. Nuorti, M. Toropainen
IPD surveillance /EPIBAC/CNRP, the French national public health agency: E. Varon, K. Danis, M. Ploy, D. Viriot
MRCG Basse - The Gambia: G. A. Mackenzie, I. Hossain
German National Reference Center for Streptococci (GNRCS): M. van der Linden
Department for Epidemiological Surveillance and Intervention of the National Public Health Organization; National
Reference Laboratory for Meningitis - Greece: G. Tzanakaki, I. Magaziotou, T. Georgakopoulou
Hong Kong IPD; Chinese University of Hong Kong: K-H. Chow, P-L. Ho
Landspitali University Hospital - Iceland: H. Erlendsdottir, K. G. Kristinsson
Health Services Executive- Health Protection Surveillance Centre - national surveillance centre in Ireland: J.
Mereckiene, M. Corcoran
IsraNIP: Pediatric Infectious Disease Unit, Soroka University medical Center, Israel: R. Dagan, N. Givon-Lavi
Italian surveillance of Invasive Pneumococcal Disease (IPD): F. Riccardo, M. Del Manso, R. Camilli
National Epidemiological Surveillance of Infectious Diseases: NESID (Adult IPD data) National Hospital Organization
Mie Hospital (pediatric IPD data) - Japan: K. Oishi, S. Suga
KEMRI-Wellcome Trust Research Programme (KWTRP); Kilifi Health and Demographic Surveillance System (KHDSS): E.
W. Kagucia, J. A. Scott
The Centre for Disease Prevention and Control (CDPC) - Latvia: E. Dimina, L. Savrasova
Notifiable Disease Surveillance System: EDO (SISPAL) - Madrid: J. C. Sanz, L. GarcĆa Comas, M. OrdobĆ”s GavĆn, S. de
Miguel
Malawi-Liverpool-Wellcome Trust Clinical Research Programme (MLW): J. E. Cornick, N. Bar-Zeev, N. French, S. Bilima, T.
D. Swarthout
Massachusetts pop. based surveillance/ Maxwell Finland Laboratory (Boston): I. Yildirim, S. I. Pelton
CHRC or NHCMCH; Sukhbaatar District Hospital; Combined site (6 Hospitals as 1 Site) (WHO-IBD Sites) - Mongolia: T.
Mungun, U. Chuluunbat
Surveillance of IPD in Casablanca - Morocco: I. Diawara, K. Zerouali, N. Nzoyikorera
Navarra Institute of Public Health: J. Castilla, M. Guevara
Netherlands Reference Laboratory for bacterial meningitis: A. Steens, M. J. Knol, N. M. van Sorge
Institute of Environmental Science and Research (ESR) - New Zealand: C. Gilkison, Y. M. Galloway
Kaiser Permanente Northern California (KPNC) Vaccine Study Center: L. Aukes, N. P. Klein
Norwegian surveillance system for communicable diseases: B. A. Winje, D. F. Vestrheim
Laboratorio Central de Salud Publica (LCSP) - Paraguay: A. Kawabata, G. Chamorro, M. E. LeĆ³n
Poland National Reference Centre for Bacterial Meningitis: A. Kuch, A. SkoczyÅska
Public Health England: S. N. Ladhani, Z. Amin-Chowdhury
Province of Quebec: B. Lefebvre, G. Deceuninck, P. De Wals
NHS Scotland: A. Smith, C. Cameron, K. Scott, L. Macdonald
MoH/ National Public Health Laboratory/ KK Women's and Children's Hospital - Singapore: G. Chan, KC. Thoon, M. Ang
Slovak National Surveillance - National Reference Center for Pneumococcal and Haemophilus Diseases: L. Mad'arovĆ”,
M. AvdiÄovĆ”
Nacionalni inŔtitut za javno zdravje (NIJZ) (National Institute of Public Health) Nacionalni laboratorij za zdravje, okolje
in hrano; National Laboratory for Health, Environment and Food - Slovenia: M. Grgic-Vitek, M. Paragi, N. Sinkovec
Zorko
Group for Enteric Respiratory and Meningeal Disease Surveillance sites (GERMS-SA) - South Africa: A. von Gottberg, C.
Cohen, J. Kleynhans, L. de Gouveia, M. du Plessis
SpIDNet/ Epiconcept: C. Savulescu, G. Hanquet
Public Health Agency - Sweden: E. Morfeldt, T. Lepp
Mandatory notification of invasive pneumococcal disease - Switzerland: M. Hilty, R. Born
Toronto Invasive Bacterial Diseases Network (TIBDN): A. McGeer
Primary Childrenās Medical Center (PCMC; Salt Lake City, UT; Intermountain Healthcare): C. L. Byington, K. Ampofo
WHO IB-VPD: F. Serhan, S. Antoni, T. Nakamura
WHO IB-VPD AFRO: J. M. Mwenda
WHO IB-VPD PAHO: G. Rey-Benito, H. O. Oliveira
Thank you!
45. November 2021 46
Publications & Presentations
Meningitis Research Foundation Oral Poster Presentation:
Changes in Pneumococcal Meningitis Incidence Following Introduction of PCV10 and PCV13: Results from the Global
PSERENADE Project (J. Yang)
Microorganisms 2021: Special Issue on Epidemiology and Vaccination of Bacterial Meningitis
Changes in Invasive Pneumococcal Disease Caused by Streptococcus pneumoniae Serotype 1 following Introduction of
PCV10 and PCV13: Findings from the PSERENADE Project (Bennett, et al.)
Serotype Distribution of Remaining Pneumococcal Meningitis in the Mature PCV10/13 Period: Findings from the
PSERENADE Project (Garcia Quesada, et al.)
Global Landscape Review of Serotype-Specific Invasive Pneumococcal Disease among Countries Using PCV10/13: The
Pneumococcal Serotype Replacement and Distribution Estimation (PSERENADE) Project (Deloria Knoll, et al.)
WHO SAGE yellow book 2020
Changes in serotype-specific incidence and serotype distribution in older adults following the use of PCV in childhood immunization
schedules, Session 9, page 13-16 (Hayford, et al.)
IDWeek 2021 Poster Presentations
Changes in Invasive Pneumococcal Disease Incidence Following Introduction of PCV10 and PCV13 Among Children <5 Years: The
PSERENADE Project (J. Bennett)
Serotype Distribution by Age of Remaining Invasive Pneumococcal Disease After Long-Term PCV10/13 Use: The PSERENADE Project
(M. Garcia Quesada)
Comparing Changes in Pneumococcal Meningitis Incidence to all Invasive Pneumococcal Disease Following Introduction of PCV10 and
PCV13: The PSERENADE Project (Y. Yang)