The impact of vaccination on the burden of invasive pneumococcal disease from a nationwide surveillance program in Lebanon: an unexpected increase in mortality driven by non-vaccine serotypes
Lina Reslan, Nour Youssef, Celina F. Boutros, Aia Assaf‐Casals, Danielle Fayad, Sarah Khafaja, Fata Akl, Marc Finianos, Amena A. Rizk, Rouba Shaker, Alissar Zaghlout, Mireille Lteif, Bassam El Hafi, Mohammad Bahij Moumneh, Rita El Feghali, Soha Ghanem, Tamima Jisr, Gilbert Karayakoupoglou, Malak Naboulsi, Monzer Hamzé, Salam Samad, Elie Khoury, Ricardo Sarraf, Marwan Osman, Elie Bou Raad, Hadi El Amin, Ibrahim Abadi, Hicham Abdo, Marwan Chedid, Fatima Chamseddine, Angélique Barakat, Mohammad Houmani, Antoine Haddad, Georges Abdel Nour, Jacques Mokhbat, Ziad Daoud, Mohamad El‐Zaatari, Elie Salem Sokhn, Nada Ghosn, Walid Ammar, Randa Hamadeh, Ghassan M. Matar, George F. Araj, Ghassan Dbaibo
Abstract
BACKGROUND: The impact of pneumococcal conjugate vaccines (PCVs) on the burden of invasive pneumococcal disease (IPD) and serotype distribution was examined across age groups from data collected by the Lebanese Inter-Hospital Pneumococcal Surveillance Program. METHODS: isolates were collected from 79 hospitals throughout Lebanon. Serotypes and antimicrobial resistance (AMR) profiles were identified, and trends compared over 3 eras: PCV7, post-PCV7/ pre-PCV13, and PCV13 eras. RESULTS: <0.001). PCV13-only serotypes remained stable in the PCV13 compared to the post-PCV7 eras, especially serotypes 1 and 3, whereas non-vaccine types (NVT) increased throughout the study period, especially 24 and 16F. The mortality rate increased substantially from 12.5% (PCV7 era) to 24.8% (PCV13 era). A significant decrease in AMR was observed across the three study eras. CONCLUSION: PCVs substantially impacted IPD and AMR in vaccinated and unvaccinated populations despite an increase in mortality driven by NVT. Broadening the recommendation of vaccination to include older age-groups, using higher valency vaccines, and implementing stringent antimicrobial stewardship are likely to further impact the burden of IPD.