EPIDEMIOLOGY OF INVASIVE PNEUMOCOCCAL DISEASE: SYSTEMATIC REVIEW OF - - PowerPoint PPT Presentation

Pneumo Epi of IPD All Results as of October 10, 2017

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EPIDEMIOLOGY OF INVASIVE PNEUMOCOCCAL DISEASE: SYSTEMATIC REVIEW OF SEROTYPES IDENTIFIED BETWEEN 2010-2017

Dylan Green, Lola Arakaki, Jennifer Slyker

10/10/2017

Pneumo Epi of IPD All Results as of October 10, 2017

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 Objective  To conduct a systematic review of pneumococcal serotypes identified in cases of

invasive pneumococcal disease (IPD) among persons of all age since 2010, to inform the potential next generation of Pneumococcal vaccines

 Sources  Published primary literature  Utilized search terms from previously published systematic reviews  Expanded age ranges to include individuals >5 years old  International Symposium on Pneumococci & Pneumococcal Diseases (2014, 2016)  BMGF Collaborators [unpublished data]  Publicly available surveillance data  Inclusion Criteria  Serotype counts or incidence, published after 2010, and isolates from sterile sites

Objectives and Methods

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Systematic Review of IPD Serotypes

Pneumo Epi of IPD All Results as of October 10, 2017

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Abstracts Screened (n – 1,151) Full Length Articles Reviewed (n – 268)

Screened out by abstract (n – 883)

• Pre-2010 (n – 402)
• No serotype data (n – 226)
• Not IPD (n – 111)
• Non-sterile sites (n – 100)
• Other (n – 44)

Screened out (n – 173)

• Pre-2010 (n – 65)
• No serotype data (n – 29)
• Non-sterile sites (n – 28)
• Duplicates (n – 37)
• Other (n – 14)

Included and Abstracted Data (n – 95) Public Surveillance (n – 6) BMGF Collaborators (n – 5) ISPPD (n – 3) Total Sources Included in Analysis (n – 109) 172,564 Isolates

Data Sources for IPD Systematic Review

Systematic Review of IPD Serotypes

Pneumo Epi of IPD All Results as of October 10, 2017

|  The following data elements were collected from each data source:

 Serotype case counts  Age range for cases  Year/year range of isolates  Country  GAVI Alliance Status  Per Capita Income Group  PCV use and coverage  Region  Study duration less than one year  Study/sampling design  Whether study also reported 1) incidence and 2) antimicrobial resistance data

Data Elements Collected

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Systematic Review of IPD Serotypes

Pneumo Epi of IPD All Results as of October 10, 2017

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Available serotype data from 2010+ are primarily sourced from wealthy, non-GAVI countries that have implemented PCV13

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Percent of Isolates

GAVI Status Income Group PCV Use Region

GAVI Middle Income Low Income

Systematic Review of IPD Serotypes

Pneumo Epi of IPD All Results as of October 10, 2017

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41 Non-GAVI countries and 168,000 serotype isolates included

Five Countries Account for ~40% of Global IPD Isolates in Surveillance Reports and Published Primary Research

19,000 isolates 15,000 isolates 15,000 isolates 12,000 isolates 10,000 isolates Systematic Review of IPD Serotypes

Pneumo Epi of IPD All Results as of October 10, 2017

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13 GAVI countries and 4,000 serotype isolates included

Few IPD Isolates are Available from Only a Small Number of GAVI Countries

300 isolates 525 isolates 150 isolates 900 isolates Systematic Review of IPD Serotypes

Pneumo Epi of IPD All Results as of October 10, 2017

|  Highly skewed distribution of serotypes

 40 least common serotypes account for 1% of isolates  11 Serotypes had no data reported - 6E, 6F, 6G, 6H, 11E, 20A, 20B, 33E, 43,

44, 47A

 Lack of serotype detail in many surveillance reports and publications

 Uncommon isolates often grouped together as “Other” – 12.5%

 European Surveillance accounts for 65% of this

 Untypeable isolates reported as “Not Known” – 0.70%  Serogroup data with no serotype detail – 1.5% of isolates

 Lack of age disaggregation in many surveillance reports and publications

 Age not specified: >50% of isolates

 European Surveillance accounts for 50% of isolates categorized as “other”

Data Considerations

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Systematic Review of IPD Serotypes

Pneumo Epi of IPD All Results as of October 10, 2017

|  Data are stratified in the following ways:

 All data (includes all ages, countries, and time periods)  GAVI vs Non-GAVI countries  Highly developed countries  Pre-2013 vs Post-2013 data

 Key questions within these strata:

 What proportion of isolates are PCV types?  What are the most common non-PCV types?  How many serotypes account for 80% of isolates?

Key Questions and Comparisons

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Only children <5 years, excluding “Other” & “Not Known” isolates

Systematic Review of IPD Serotypes