Respiratory infections in the elderly: epidemiology and prevention strategies. Mike Jackson Kaiser Permanente Washington 22 March 2017

Transcription

1 Respiratory infections in the elderly: epidemiology and prevention strategies Mike Jackson Kaiser Permanente Washington 22 March 2017

2 Conflicts of interest I have received a research grant from Sanofi Pasteur to estimate the incidence of disease due to respiratory syncytial virus in Washington State 2

3 Pathogens covered in this talk Haemophilus influenzae type b (Hib) Influenza Respiratory syncytial virus (RSV) Streptococcus pneumoniae 3

4 Haemophilus influenzae type b (Hib) Trends in incidence of invasive Haemophilus influenzae disease, by age group United States, Source: Modified from MacNeil; Clin Infect Dis 2011; 53(12):

5 Haemophilus influenzae type b (Hib) Source: Modified from Georges et al; Epidem Infect 2013; 141:

6 Influenza: surveillance challenges 1. Influenza infection causes non-specific clinical signs and symptoms 2. Influenza infection causes a variety of secondary complications 6

7 Influenza: surveillance challenges Reported and estimated pediatric deaths due to laboratory-confirmed influenza United States, 2010/11 through 2012/13 seasons 1,400 Pediatric deaths 1,200 1, Reported Estimated / / /13 Influenza season Sources: Observed from US Centers for Disease Control FluView 2012/13 season summary ( Estimated from Reed; PLoS One 2015; 10(3):e

8 Incidence of severe influenza Hospitalizations for pneumonia due to laboratory-confirmed influenza Thailand Source: Modified from Simmerman; PloS One 2009; 4(11):e7776 8

9 Incidence of severe influenza 450 Incidence of acute respiratory illness hospitalization due to influenza northern India, Hospitalizations per 100, <1 year 1-4 years 5-14 years years 60+ years Age group Source: Data from Hirve; J Infect 2015; 70:

10 Incidence of severe influenza Incidence of severe acute respiratory illness (SARI) due to influenza Ghana, SARI hospitalizations per 100, <5 years 5-14 years years years years 65+ years Age group Source: Data from Ntiri; BMC Infect Dis 2016; 16:757 10

11 Incidence of severe influenza Incidence of presumptive influenza hospitalizations in adults aged 65 years Five Central American Countries, Hospitalizations per 100, Costa Rica El Salvador Guatemala Honduras Nicaragua Country Source: Data from Descalzo; Influenza Other Resp Virus 2016; 10(4):

12 Influenza vaccine effectiveness Forest plot of studies included in meta-analysis: influenza vaccine effectiveness in elderly adults Weighted mean: Favors vaccination Odds ratio Source: Data from Darvishian; Lancet Infect Dis 2014; 14: Does not favor vaccination 12

13 Adjuvanted influenza vaccine Odds ratio for laboratory-confirmed influenza MF59-adjuvanted vs unadjuvanted vaccine Puig-Barbera, Vaccine 2013 Van Buynder, Vaccine Favors MF59 Favors unadjuvanted Odds ratio Source: Domnich; Vaccine 2017; 35:

14 Intradermal vaccination in the elderly Forest plots of the risk ratio of seroprotection for intradermal compared with intramuscular influenza vaccine administration Source: Pileggi; Drugs Aging 2015; 32:

15 Vaccinate schoolchildren to protect the elderly Start school vaccination program School vaccination obligatory School vaccination discontinued Source: Modified from Reichert; NEJM 2001; 344(12):

16 RSV incidence Incidence of hospitalization for pneumonia due to laboratory-confirmed RSV infection by age group Thailand, Source: Fry; PLoS One 2010; 5(11):e

17 RSV incidence Mortality attributed to influenza and RSV in seniors in various countries 250 Rate per 100,000 person-years Influenza RSV 0 USA, ages USA, ages 75+ Netherlands South Africa, 1997 South Africa, 1998 South Africa, 1999 Sources: (USA:) Matias; Influenza Other Resp Viruses 2014; 8(5): (Netherlands:) Jansen; Eur Resp J 2007; 30: (South Africa:) Karstaedt; South Africa Med J 2009;99(10):

18 RSV vaccine pipeline: vaccines aimed at adults aged 55 years Platform Sponsor Most advanced trial phase Registration number Bavarian Nordic Phase 2 NCT Recombinant viral vector Janssen Vaccine Phase 1 NCT Reithera Phase 1 NCT Vaxart Phase 1a NCT Recombinant subunit Dalhousie University Phase 1a NCT Novavax Phase 3 NCT MedImmune Phases 2b NCT Source: 18

19 Invasive pneumococcal disease Source: Motlova; Epidem Infect 2009; 137:

20 Invasive pneumococcal disease Incidence of hospitalized pneumococcal bacteremia rural Thailand, Source: Rhodes; PLoS One 2013; 8(6):e

21 Invasive pneumococcal disease role of HIV infection Incidence of invasive pneumococcal disease Blantyre, Malawi, Source: Bar-Zeev;. PLoS One 10(6): e

22 Pneumococcal pneumonia Incidence of pneumococcal pneumonia hospitalizations by age group rural Thailand, Source: Piralam; Am J Trop Med Hyg 2015; 93(6):

23 Pneumococcal pneumonia Incidence of hospitalized pneumococcal pneumonia incidence by age Guatemala, Source: Contreras; PLoS One 2015; 10(10):e

24 Pneumococcal polysaccharide vaccine effectiveness Forest plots of meta-analyses of randomized controlled trials of PPV23 against invasive pneumococcal disease (IPD) and pneumococcal pneumonia in seniors Source: Falkenhorst; PLoS One 2017; 12(1): e

25 Pneumococcal conjugate vaccine effectiveness Efficacy of PCV13 against vaccine-type pneumococcal disease in seniors Community-acquired pneumonia (CAP) Non-bacteremic CAP Invasive pneumococcal disease 0% 20% 40% 60% 80% 100% Vaccine efficacy Source: Bonten; NEJM 2015; 372:

26 Impact of childhood PCV vaccination on IPD in seniors incidence of invasive pneumococcal disease among adults aged 65 years United States, All IPD PCV13 type PPV23 type Childhood PCV13 introduced Incidence per 100, Childhood PCV7 introduced PCV13 recommended for seniors Year 26 Source: Active Bacterial Core surveillance;

27 Phase-out of PCV for seniors? Source: Tomczyk; Morb Mort Wkly Rep 2014; 63(37):

28 A potential complication: Reduced dose schedules for childhood PCV 3+1 (N=26) 3+0 (N=58) 2+1 (N=49) Source:VIEW-hub Report: Global Vaccine Introduction and Implementation, May

29 Thank you! Questions? 29