Reunião Regional de Vigilância das Meningites e Pneumonias Bacterianas (SIREVA) e Rotavirus 09 - 11 de December, CanCun, Mexico

Maria Cristina de Cunto Brandileone

Núcleo de Meningites e Infecções Pneumocócicas Centro de Bacteriologia

Instituto Adolfo Lutz (IAL), São Paulo, Brasil

Prevalence of pneumococcal serotypes in Latin America countries: SIREVA II data

IAL

No. Spn invasive isolates by country

19-year period : 44,933

All age groups (SIREVA/SIREVA II)

Country 1994-1999 2000-2005 2006-2012 total

Argentina 1,006 1,277 2,226 4,509

Bolivia 151 249 400

Brasil 1,203 4,169 6,108 11,480

CAREC 178 142 320

Chile 495 4,182 5,765 10,442

Colombia 623 1,396 2,382 4,401

Costa Rica 222 361 583

Cuba 1,283 354 1,637

Ecuador 60 332 392

El Salvador 88 260 348

Guatemala 247 129 376

Honduras 65 70 135

Mexico 426 1,039 1,327 2,792

Nicaragua 55 66 121

Panama 189 311 500

Paraguay 667 1,091 1,758

Peru 172 218 390

Dominican R. 487 441 928

Uruguay 352 884 1,329 2,565

Venezuela 492 364 856

Total 4,105 17,303 23,525 44,933 by Brandileone, MCC

Country PCV7 PCV10 PCV13

Uruguay 2008 (PNI) ---- 2010

Mexico 2008 --- 2013

Costa Rica 2009 (PNI) --- 2011

Peru 2009 2011 ---

Brazil --- 2010 (PNI) ---

Argentina --- --- 2012 (PNI)

Colombia --- 2010 (PNI) ---

Panama 2010 --- 2011

El Salvador 2010 --- 2011

Ecuador 2010 --- 2011

Chile --- 2011 (PNI) ---

Nicaragua --- --- 2011

Paraguay --- 2012 (PNI) ---

Honduras --- --- 2013 (PNI)

Dominican R --- --- 2013 (PNI)

Bolivia --- --- ---

Cuba --- --- ---

Venezuela --- --- ---

Introduction of Universal Pneumococcal Conjugate Vaccine in Latin American countries

Data : SIREVA II group

2012 versus 2007 Overall Reduction: 65%

2012 versus 2007 Overall Increases of others: 250%

4 to 14 isolates (serotypes 12F, 24F, 24A, 22F and 33)

Distribution of PCV10 serotypes in Chile Pre- (2007-2010) and Pos-PCV10 (2012) periods

PCV10 in 2011 (3 + 1), <2y old

67

174

265

55

36

91

0

50

100

150

200

250

3002007-2010 (annual average n=264,7)

2011 (n=168)

2012 (n=91)

Data: Instituto de Salud Publica de Chile by Brandileone, MCC

No. IPD cases

2012 versus 2007-2010 Reduction PCV10 types: 80%

Overall reduction: 65%

2012 versus 2007-2011 Reduction PCV13 types: 33%

Overall reduction : 25%

2006-2007: PCV7 for children <2 years in high-risk groups

2009: PCV7 10 departments including Bogota and Indigenous populations

to all <3 months (2+1 doses)

2010: PCV10 in those departments, and in 8 additional and 3 districts for all <3

months (2+1 doses)

December 2010: PCV10 all country (2+1 doses)

PCV10 coverage in 2011: 69.9%

in 2012: 84.1%

Introduction of PCV in Colombia

Data: Instituto Nacional de Salud, Colombia by Brandileone, MCC

2012 versus 2007-2008 Reduction PCV10 types: 81%

Overall reduction: 68%

2001: PCV7 is introduced in private offices

2006-2007: PCV7 is introduced in low economic income population (3+0 doses)

2008-2009: PCV7 in routine immunization (2+0 doses)

2010: PCV7 in routine immunization (2+1 doses)

2010: PCV10 is introduced in Instituto Mexicano del Seguro Social (2+1 doses)

2011: PCV13 in routine immunization (2+1 doses)

Introduction of PCV in Mexico

Data: Instituto Nacional de Salud Pública, Mexico by Brandileone, MCC

0

10

20

30

40

50

60

70

80

90

2007 2008 2009 2010 2011 2012

19A Total PCV13 PCV7 Others

Introducion of PCV in Mexico: No. DPI cases from < 2 years old by year

No

. IP

D c

ases

PCV7/PCV10 2+1

PCV13 2+1

PCV7 2+0

Data: Instituto Nacional de Salud Pública, Mexico

PCV7 2+1

by Brandileone, MCC

Improvement of surveillance

Introduction of RT-PCR for diagnosis of meningitis: increase of molecular diagnosis and decrease in forwarding strains to IAL.

Privatization of hospital labs over the last years: decrease in forwarding strains to IAL.

In 2010, Minister of Health requests private labs for forwarding strains to IAL: strengthening of surveillance.

In 2010, PCV10 was introduced in Brazil: case-control study with improvement of pneumococcal surveillance in 10 States with increased blood cultures and increased forwarding strains to IAL.

Variation of serotypes over the years: "secular trend“

Brazil: Interference Factors in the Laboratory-Based Surveillance of Pneumococcal before and after introduction of PCV10

by Brandileone, MCC

Pos- versus Pre-PCV10 Reduction PCV10 types: 77% Total reduction: 50%

4

7 8

1 2 1

1 1 1 0 1 0

17

11

8 7

5 4

3 3 3

2 2 2 2

18

0

2

4

6

8

10

12

14

16

18

20

3 19A 6A 12F 6C 20 22F 11A 13 15A 15B 16F 9others

2001-2009 (37 other types)

2010 (16 other types)

2011-2012 (21 other types)

No. DPI cases by non-PCV10 types, Pre- (2001-2009) and Pos-PCV10 introduction (2011-2012)

Brazil, <2y old

No. DPI cases

Serotypes

by Brandileone, MCC

Data: IAL

Others: 3, 12F, 6C, 20, 22F, 11A , 13, 15A , 16F, others

Pos- versus Pre-PCV10 Increase of other types: 49%

The SIREVA II laboratory-based surveillance of pneumococcal serotypes shows

a decrease of IPD cases caused by PCV serotypes after PCV introduction.

up to now, except in Mexico, an non increase of 19A isolates in pos-PCV period.

It is essential

to monitor the pneumococcal serotypes in the post-PCV period to evaluate the effect of vaccination and trends of serotypes in all age groups.

to observe the sustainable increase of nonvaccine serotypes observed in the early years after the vaccine introduction, confirming the phenomenon of replacement serotypes, or whether this finding was due to the secular variation of serotype or other factors.

We emphasize

it is very important to point that each country should review its data taking into account the possible factors affecting the laboratory-based surveillance of serotypes.

Summary

by Brandileone, MCC

Obrigada

Thank you, Muchas Gracias, Obrigada

SIREVA II study group

Reconocimientos: Maria da Gloria de Carvalho – CDC, Atlanta Mary Agocs – WHO, Geneve Fatima Serhan Lucia de Oliveira – PAHO, WDC Gloria Rey Jean Marc Gabastou