Background
Methods
Study population
Study design
Pneumococcal isolates
Pneumococcal serogrouping/serotyping
Antimicrobial susceptibility
Statistical and data analysis
Results
Isolate information and incidence rate of IPD
Pre-vaccine period 2007–2010 no. of cases/100,000 populationsa | Post-implementation no. of cases/100.000 populationsb | Baseline (2007–2010) vs early post-vaccine period (2011–2014) | Baseline (2007–2010) vs mature post-vaccine period (2015–2019) | ||||||
---|---|---|---|---|---|---|---|---|---|
Early post-vaccine period 2011–2014 | Mature post-vaccine period 2015–2019 | Absolute risk reduction cases/100,000 populations (95% CI) | Relative Risk Reduction % (95% CI) | p-value | Absolute risk reduction cases/100,000 populations (95% CI) | Relative risk reduction % (95% CI) | p-value | ||
15–59 years | |||||||||
CSF | 0.18 | 0.09 | 0.26 | − 0.09 (− 0.20 to + 0.02) | − 47.53 (− 110.37 to + 9.88) | 0.09 | − 0.09 (− 0.20 to + 0.02) | 0.73 (0.45 to 1.20) | 0.19 |
Blood | 0.35 | 0.37 | 0.16 | + 0.02 (− 0.15 to + 0.19) | + 5.23 (− 42.98 to + 52.99) | 0.82 | + 0.02 (− 0.15 to + 0.19) | 0.86 (0.44 to 1.71) | 0.65 |
Pleural fluid | 0.07 | 0.04 | 0.03 | − 0.03 (− 0.11 to 0.04) | − 46.03 (− 157.46 to + 53.22) | 0.48 | − 0.03 (− 0.11 to 0.04) | 0.48 (0.12 to 1.77) | 0.21 |
cOthers | 0.11 | 0.04 | 0.02 | − 0.07 (− 0.16 to 0.00) | − 65.65 (− 147.48 to + 4.07) | 0.09 | − 0.07 (− 0.16 to 0.00) | 0.18 (0.03 to 0.70) | 0.0037 |
Total | 0.71 | 0.54 | 0.47 | − 0.17 (− 0.39 to + 0.04) | − 24.18 (− 55.51 to + 6.33) | 0.02 | − 0.17 (− 0.39 to + 0.04) | 0.66 (0.46 to 0.93) | 0.0137 |
≥ 60 years | |||||||||
CSF | 0.77 | 0.56 | 0.23 | − 0.20 (− 0.95 to + 0.50) | − 26.55 (− 124.25 to + 64.88) | 0.53 | − 0.20 (− 0.95 to + 0.50) | 0.68 (0.12 to 3.65) | 0.58 |
Blood | 0.34 | 1.12 | 0.17 | + 0.78 (+ 0.08 to + 1.58) | + 230.55 (+ 24.26 to + 463.05) | 0.04 | + 0.78 (+ 0.08 to + 1.58) | 0.22 (0.03 to 0.90) | 0.0149 |
Pleural fluid | 0.09 | 0.24 | 0.23 | + 0.16 (− 0.27 to + 0.63) | + 183.32 (− 319.24 to + 739.21) | 0.62 | + 0.16 (− 0.27 to + 0.63) | 2.72 (0.26 to 134.03) | 0.35 |
Other | 0.09 | 0.16 | 0.06 | + 0.08 (− 0.34 to + 0.51) | + 88.88 (− 397.33 to + 595.49) | 1 | + 0.08 (− 0.34 to + 0.51) | 0.68 (0.008 to 53.41) | 0.78 |
Total | 1.28 | 2.09 | 0.69 | + 0.81 (− 0.25 to + 1.91) | + 63.70 (− 19.53 to 149.45) | 0.12 | + 0.81 (− 0.25 to + 1.91) | 0.54 (0.23 to 1.24) | 0.11 |
Serotype distribution of pneumococcal isolates
Serotype | Pre-vaccine period (2007–2010): N = 71 | Early post-vaccine period (2011–2014): N = 57 | Mature post-vaccine period (2015–2019): N = 58 | ||||||
---|---|---|---|---|---|---|---|---|---|
n | % | Cumulative % | n | % | Cumulative % | n | % | Cumulative % | |
4 | 0 | 0 | 0 | 1 | 1.75 | 1.75 | 0 | 0 | 0 |
6B | 1 | 1.41 | 1.41 | 5 | 8.77 | 10.52 | 1 | 1.72 | 1.72 |
9V | 1 | 1.41 | 2.82 | 1 | 1.75 | 12.28 | 1 | 1.72 | 3.45 |
14 | 1 | 1.41 | 4.23 | 1 | 1.75 | 14.03 | 0 | 0 | 3.45 |
18C | 6 | 8.45 | 12.68 | 0 | 0 | 14.03 | 0 | 0 | 3.45 |
19F | 2 | 2.82 | 15.49 | 1 | 1.75 | 15.79 | 0 | 0 | 3.45 |
23F | 3 | 4.23 | 19.72 | 4 | 7.02 | 22.8 | 0 | 0 | 3.45 |
1 | 3 | 4.23 | 23.94 | 4 | 7.02 | 29.82 | 1 | 1.72 | 5.17 |
5 | 1 | 1.41 | 25.35 | 0 | 0 | 29.82 | 1 | 1.72 | 6.9 |
7F | 2 | 2.82 | 28.17 | 3 | 5.26 | 35.08 | 0 | 0 | 6.9 |
Total PCV-10 | 20 | 28.17 | 20 | 35.09 | P = 0.4031 | 4 | 6.9 | P = 0.0021 | |
3 | 2 | 2.82 | 30.99 | 5 | 8.77 | 43.86 | 5 | 8.62 | 15.52 |
6A | 2 | 2.82 | 33.8 | 0 | 0 | 43.86 | 1 | 1.72 | 17.24 |
19A | 9 | 12.68 | 46.48 | 0 | 0 | 43.86 | 5 | 8.62 | 25.86 |
Total PCV-13 | 33 | 46.48 | 25 | 43.86 | P = 0.7682 | 15 | 25.86 | P = 0.0164 | |
2 | 1 | 1.41 | 47.89 | 0 | 0 | 43.86 | 0 | 0 | 25.86 |
7A | 1 | 1.41 | 49.3 | 2 | 3.51 | 47.36 | 0 | 0 | 25.86 |
7C | 1 | 1.41 | 50.7 | 0 | 0 | 47.36 | 0 | 0 | 25.86 |
8 | 7 | 9.86 | 60.56 | 4 | 7.02 | 54.38 | 4 | 6.9 | 32.76 |
10 | 2 | 2.82 | 63.38 | 1 | 1.75 | 56.14 | 0 | 0 | 32.76 |
11 | 0 | 0 | 63.38 | 2 | 3.51 | 59.64 | 1 | 1.72 | 34.48 |
12F | 3 | 4.23 | 67.61 | 2 | 3.51 | 63.15 | 0 | 0 | 34.48 |
17F | 0 | 0 | 67.61 | 2 | 3.51 | 66.66 | 3 | 5.17 | 39.66 |
22F | 0 | 0 | 67.61 | 1 | 1.75 | 68.42 | 1 | 1.72 | 41.38 |
23A | 2 | 2.82 | 70.42 | 0 | 0 | 68.42 | 1 | 1.72 | 43.1 |
33 | 0 | 0 | 70.42 | 1 | 1.75 | 70.17 | 3 | 5.17 | 48.27 |
34 | 3 | 4.23 | 74.65 | 1 | 1.75 | 71.93 | 1 | 1.72 | 49.99 |
9N | 0 | 0 | 74.65 | 0 | 0 | 71.93 | 1 | 1.72 | 51.71 |
35F | 0 | 0 | 74.65 | 1 | 1.75 | 73.68 | 0 | 0 | 51.71 |
NVT | 18 | 25.35 | 100 | 15 | 26.32 | 100 | 28 | 48.28 | 100 |
Total non PCV-13 | 38 | 54 | 32 | 56.14 | P = 0.8096 | 43 | 74.14 | P = 0.0189 |
Serotype | Pre-vaccine period (2007–2010) N = 15 | Early post-vaccine period (2011–2014) N = 26 | Mature post-vaccine period (2015–2019) N = 12 | ||||||
---|---|---|---|---|---|---|---|---|---|
N | % | Cumulative % | N | % | Cumulative % | N | % | Cumulative % | |
4 | 2 | 13.33 | 13.33 | 0 | 0 | 0 | 0 | 0 | 0 |
6B | 0 | 0 | 13.33 | 1 | 3.85 | 3.85 | 1 | 8.33 | 8.33 |
9V | 0 | 0 | 13.33 | 0 | 0 | 3.85 | 0 | 0 | 8.33 |
14 | 0 | 0 | 13.33 | 1 | 3.85 | 7.69 | 1 | 8.33 | 16.67 |
18C | 0 | 0 | 13.33 | 0 | 0 | 7.69 | 0 | 0 | 16.67 |
19F | 0 | 0 | 13.33 | 3 | 11.54 | 19.23 | 0 | 0 | 16.67 |
23F | 1 | 6.67 | 20 | 0 | 0 | 19.23 | 0 | 0 | 16.67 |
1 | 0 | 0 | 20 | 2 | 7.69 | 26.92 | 0 | 0 | 16.67 |
5 | 2 | 13.33 | 33.33 | 0 | 0 | 26.92 | 0 | 0 | 16.67 |
7F | 0 | 0 | 33.33 | 0 | 0 | 26.92 | 0 | 0 | 16.67 |
Total PCV-10 | 5 | 33.33 | 7 | 26.92 | P = 0.6692 | 2 | 16.67 | P = 0.33 | |
3 | 4 | 26.67 | 60 | 6 | 23.08 | 50 | 0 | 0 | 16.67 |
6A | 0 | 0 | 60 | 0 | 0 | 50 | 0 | 0 | 16.67 |
19A | 0 | 0 | 60 | 1 | 3.85 | 53.85 | 0 | 0 | 16.67 |
Total PCV-13 | 9 | 60 | 14 | 53.85 | P = 0.7058 | 2 | 16.67 | P = 0.0255 | |
8 | 1 | 6.67 | 66.66 | 4 | 15.38 | 69.23 | 1 | 8.33 | 25 |
9N | 1 | 6.67 | 73.33 | 0 | 0 | 69.23 | 1 | 8.33 | 33.33 |
12F | 1 | 6.67 | 80 | 1 | 3.85 | 73.08 | 0 | 0 | 33.33 |
17F | 0 | 0 | 80 | 1 | 3.85 | 76.92 | 0 | 0 | 33.33 |
20 | 1 | 6.67 | 86.66 | 0 | 0 | 76.92 | 0 | 0 | 33.33 |
23A | 0 | 0 | 86.66 | 0 | 0 | 0 | 1 | 8.33 | 41.67 |
22F | 1 | 6.67 | 93.33 | 0 | 0 | 76.92 | 0 | 0 | 41.67 |
NVT | 1 | 6.67 | 100 | 6 | 23.08 | 100 | 7 | 58.33 | 100 |
Total no PCV-13 | 6 | 40 | 12 | 46.15 | P = 0.7058 | 10 | 83.33 | P = 0.026 |
Antimicrobial resistance
Antibiotic | Adult (15–59 years old) | Elderly (≥ 60 years old) | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
Pre-vaccine period 2007–2010a | Post-vaccine period (2011–2019) | p-value | Pre-vaccine period | Post-vaccine period (2011–2019)b | p-value | |||||
2007–2010 (N = 71) | Early post period:2011–2014 (N = 57) | Mature post period: 2015–2019 (N = 69) | (2011–2014) | (2015–2019) | 2007–2010 (N = 15) | Early post-vaccine period: 2011–2014 (N = 26) | Mature post-vaccine period: 2015–2019 (N = 12) | (2011–2014) | (2015–2019) | |
Penicillin G n (%) | 17 (23.94) | 5 (8.77) | 11 (15.94) | 0.02 | 0.23 | 2 (13.33) | 2 (7.69) | 2 (16.66) | 0.61 | 0.81 |
Erythromycin n (%) | 5 (7.04) | 6 (10.52) | 11 (15.94) | 0.48 | 0.09 | 1 (6.66) | 2 (7.69) | 1 (8.33) | 1 | 0.87 |
Cotrimoxazole n (%) | 21 (29.58) | 5 (8.77) | 5 (7.24) | 0.003 | 0.0007 | 2 (13.33) | 2 (7.69) | 0 (0.00) | 0.61 | 0.19 |
Tetracycline n (%) | 22 (30.98) | 11 (19.30) | 23 (33.33) | 0.13 | 0.76 | 4 (26.27) | 6 (23.08) | 3 (25.00) | 0.9 | 0.94 |
Chloramphenicol n (%) | 3 (4.22) | 6 (10.53) | 3 (4.34) | 0.29 | 0.96 | 3 (20.00) | 1 (3.85) | 1 (8.33) | 0.13 | 0.4 |
Ceftriaxone n (%) | 1 (1.41) | 1 (1.75) | 2 (2.89) | 1 | 0.54 | 0 (0.00) | 0 (0.00) | 0 (0.00) | NS | NS |