title: Initial effects of the National PCV7 Childhood Immunization Program on adult invasive pneumococcal disease in Israel.
abstract: BACKGROUND
  PCV7 was introduced as universal childhood vaccination in Israel in July 2009 and PCV13 in November 2010. Here we report data on adult invasive pneumococcal disease (IPD), two years post PCV7 implementation and before an expected effect of PCV13.
  
  
  METHODS
  An ongoing nationwide active-surveillance (all 27 laboratories performing blood cultures in Israel), providing all blood & CSF S. pneumoniae isolates from persons >18 y was initiated in July 2009. Capture-recapture method assured reporting of >95% cases. All isolates were serotyped in one central laboratory. IPD outcome and medical history were recorded in 90%. Second year post PCV implementation is compared to the first year.
  
  
  RESULTS
  During July 2009 to June 2011, 970 IPD cases were reported (annual incidence [/100,000] of 9.17 and 10.16 in the two consecutive years, respectively). Respective case fatality rates (CFRs) were 20% and 19.1%. Incidence of IPD and CFR increased with age and number of comorbidities. Incidence rate was significantly greater during the second winter, 7.79/100,000 vs. 6.14/100,000 in first winter, p = 0.004, with a non-significant decrease during summer months (3.02 to 2.48/100,000). The proportion of IPD cases due to PCV7-serotypes decreased from 27.5% to 13.1% (first to second year) (p<0.001). Yet, non-PCV13-strains increased from 32.7% to 40.2% (p = 0.017). The increase in non-PCV13-strains was highly significant in immunocompromised patients and to a lesser degree in non-immunocompromised at risk or in older patients (>64 y). Among younger/healthier patients serotype 5 was the major increasing serotype. Penicillin and ceftriaxone resistance decreased significantly in the second year.
  
  
  CONCLUSIONS
  While overall annual incidence of IPD did not change, the indirect effect of PCV7 vaccination was evident by the significant decrease in PCV7 serotypes across all age groups. Increase in non-VT13 strains was significant in immunocompromised patients. A longer follow-up is required to appreciate the full effect of infant vaccination on annual IPD.
authors: Infectious Disease Unit, Sheba Medical Center, Ramat-Gan, Israel.
authors: Gili
authors: G
authors: Regev-Yochay
authors: Infectious Disease Unit, Sheba Medical Center, Ramat-Gan, Israel.
authors: Galia
authors: G
authors: Rahav
authors: Infectious Disease Soroka University Medical Center, Beer-Sheva, Israel.
authors: Klaris
authors: K
authors: Riesenberg
authors: Infectious Disease Unit, Shaare Zedek Medical Center, Jerusalem, Israel.
authors: Yonit
authors: Y
authors: Wiener-Well
authors: Department of Clinical Microbiology & Infectious Disease, Hadassah-Hebrew University, Jerusalem, Israel.
authors: Jacob
authors: J
authors: Strahilevitz
authors: Pediatric Infectious Disease Unit, Wolfson Medical Center, Holon, Israel.
authors: Michal
authors: M
authors: Stein
authors: Pediatric Infectious Disease Service, Western Galilee Hospital, Nahariya, Israel.
authors: Daniel
authors: D
authors: Glikman
authors: Infectious Disease Unit, Carmel Medical Center, Haifa, Israel.
authors: Gabriel
authors: G
authors: Weber
authors: Infectious Disease Unit, Bnei-Zion Medical Center, Haifa, Israel.
authors: Israel
authors: I
authors: Potasman
authors: Pediatric Infectious Diseases Unit, Soroka University Medical Center & Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors: Ron
authors: R
authors: Dagan
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D017589:Immunization Programs; D015994:Incidence; D007557:Israel / Q000453:epidemiology; D008297:Male; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000517:prevention & control*; D022242:Pneumococcal Vaccines; D011159:Population Surveillance; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification / Q000302:isolation & purification*
chemical_list: D022242:Pneumococcal Vaccines