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Purpose: Common respiratory infections were significantly reduced during the COVID-19 pandemic due to general protective and hygiene measures. The gradual withdrawal of these non-pharmaceutical interventions (NPI) was associated with a notable increase in these infections, particularly in pediatric and adult otorhinolaryngology. The aim of this retrospective monocentric study was to evaluate the impact of NPI during the COVID-19 pandemic on the incidence and severity of acute mastoiditis (AM). Methods: Pre-pandemic clinical data of AM cases from 2011 to 2019 were compared with infection counts from January 2020 to June 2023 for seasonal periodicity, age-specific differences, pathogens, and complication rates in a German third-level hospital. Results: Out of 196 patients with AM 133 were children, the majority between 1 and 5 years of age. Complications of AM, such as meningitis, brain abscess, and sinus vein thrombosis, were more common in adults (87%) than in children (17%). Morbidity and mortality rates were similar before, during and after the pandemic. Pneumococci were the most common pathogen in both age groups, with a post-pandemic cumulation of Streptococcus pyogenes infections in children. While pre-pandemic cases clustered in spring, seasonality was absent in all age groups during the main phase of the pandemic. The cessation of NPI caused a steep rise in AM cases in both age groups starting from December 2022. Conclusion: NPI during the COVID-19 pandemic reduced the incidence of AM. Their reversal led to a substantial increase in the incidence of AM during the post-pandemic period, which may be due to a general increase in viral respiratory infections and an insufficiently trained immune system. [ABSTRACT FROM AUTHOR]

Introduction: Invasive pneumococcal disease is a major cause of morbidity and mortality in infectious diseases. Selective reporting of antibiotic susceptibility test results might lead to a tailored antibiotic therapy and could therefore be an important antibiotic stewardship program intervention. The aim of this study was to analyse whether a switch to selective reporting of antibiotic test results leads to a more focused antibiotic therapy in patients with a bloodstream infection with Streptococcus pneumoniae. Methods: This study was performed as a retrospective cohort study at the University Hospital Regensburg, Germany. All blood cultures positive for Streptococcus pneumoniae between 2006 and 2021 were analysed. In 2014, a switch to selective reporting of antibiotic susceptibility test results omitting sensitivity results for agents not recommended was introduced. Results: Twenty-four hours after final antibiotic susceptibility test results were available, 20.9% before (BI) versus 15.4% after implementation (AI) of selective reporting of antibiotic test results received a narrow-spectrum penicillin, while only 2.3% BI versus 5.8% AI received a narrow-spectrum penicillin from the beginning. Conclusion: Selective reporting of antibiotic susceptibility test results without further antimicrobial stewardship interventions did not lead to a higher use of a narrow-spectrum penicillin in this study.

Currently, methotrexate (MT) remains one of the immunosuppressive drugs most commonly used in rheumatology. However, its effect on the immunogenicity of vaccines has until recently been studied only to a limited extent, which has led to the lack of clear recommendations for the use of MT during vaccination. Significant progress was made during the COVID-19 pandemic due to the dynamic development of vaccine research, including in patients with immuno-inflammatory rheumatic diseases. The review presents data on the effect of MT on the immunogenicity of vaccines against influenza, pneumococcus, herpes zoster, tetanus/diphtheria/pertussis, yellow fever and COVID-19 (including humoral and cellular responses) in rheumatological patients. The necessity of observing certain time intervals during vaccination in the case of MT use has been demonstrated. The potential mechanisms by which MT influences the immunogenicity of vaccines are presented. The importance of further clinical studies is emphasized in order to assess the effect of MT therapy on the vaccine response and to develop methods for its optimization.

In modern conditions, patients with immuno-inflammatory rheumatic diseases (IIRD) are at significant risk of influenza, pneumococcal and herpes viral infections, as well as COVID-19, in some cases fatal. The most effective way to prevent infectious diseases and reduce mortality from them is vaccination, which is recommended in the inactive phase of IIRD. However, a number of patients with IIRD have a refractory course of the disease, and achieving remission in them turns out to be a difficult task, and therefore the problem of vaccination of such patients against the background of an active inflammatory process is very relevant. The review analyzes data on the use of vaccine prophylaxis for the above infections in the active phase of IIRD. In the vast majority of cases, vaccination was safe and did not lead to an exacerbation of IIRD or the development of new autoimmune phenomena.

Vaccines prevent a significant number of deaths annually. However, certain populations do not respond adequately to vaccination due to impaired immune systems. Cirrhosis, a condition marked by a profound disruption of immunity, impairs the normal immunization process. Critical vaccines for cirrhotic patients, such as the hepatitis A virus (HAV), hepatitis B virus (HBV), influenza, pneumococcal, and coronavirus disease 19 (COVID-19), often elicit suboptimal responses in these individuals. The humoral response, essential for immunization, is less effective in cirrhosis due to a decline in B memory cells and an increase in plasma blasts, which interfere with the creation of a long-lasting response to antigen vaccination. Additionally, some T cell subtypes exhibit reduced activation in cirrhosis. Nonetheless, the persistence of memory T cell activity, while not preventing infections, may help to attenuate the severity of diseases in these patients. Alongside that, the impairment of innate immunity, particularly in dendritic cells (DCs), prevents the normal priming of adaptive immunity, interrupting the immunization process at its onset. Furthermore, cirrhosis disrupts the gut–liver axis balance, causing dysbiosis, reduced production of short-chain fatty acids (SCFAs), increased intestinal permeability, and bacterial translocation. Undermining the physiological activity of the immune system, these alterations could impact the vaccine response. Enhancing the understanding of the molecular and cellular factors contributing to impaired vaccination responses in cirrhotic patients is crucial for improving vaccine efficacy in this population and developing better prevention strategies. [ABSTRACT FROM AUTHOR]

Urticarial vasculitis (UV) is a type III hypersensitivity reaction, characterized by immune complex deposition in small vessels leading to complement activation. Hypocomplementemic urticarial vasculitis syndrome (HUVS) represents the most severe form of UV, manifesting as chronic and recurrent urticarial skin lesions with leukocytoclastic vasculitis on histology, hypocomplementemia, anti-C1q antibodies, and systemic organ involvement. This case study focuses on an adolescent who initially presented with invasive pneumococcal infection and was later diagnosed with two rare disorders: HUVS and coexisting complement factor 1 (CF1) deficiency by genotyping. The role of CF1 deficiency in the development of HUVS in this patient is uncertain but has not previously been described.

The review presents the recommendations of the American College of Rheumatology on vaccination of patients with rheumatic diseases. The indications for vaccination against major infections and the tactics of immunization with inactivated vaccines are highlighted. The possibility of safe vaccination with any disease activity and simultaneous administration of several vaccines is emphasized. The conditions of immunization with live attenuated vaccines are considered. The principles of vaccination of children born to mothers treated with biological drugs, as well as recommendations for the contacts of rheumatological patients with vaccinated population are reflected. Emphasis is placed on the need for joint decision-making by the rheumatologist and the patient.

Pneumococcal infection remains a significant global health problem, and vaccination is the main measure for its prevention. To date, the period of use of pneumococcal conjugated polysaccharide vaccines in Russia exceeds 14 years, and 13-valent conjugated polysaccharide pneumococcal vaccine (PCV13) - more than 10 years. During this time, extensive experience has been accumulated in the use of this type of vaccines, and many studies have been carried out to evaluate their effectiveness and safety.The purpose of this review is to summarize the experience of using PCV13 in Russian Federation with an assessment of its epidemiological and clinical effectiveness. A search was made for scientific publications devoted to the study of the epidemiological efficacy, the safety as well as cost-effectiveness of PCV13 use in Russian Federation. The review included original studies published in Russian journals. The results of the studies carried out indicate the efficacy and safety of PCV13 for both adults and children. The effectiveness of immunization of children at risk (premature, suffering from congenital pathology, having chronic diseases and often ill) was demonstrated, the need and safety of the timely start of vaccination (from 2 months of age) of newborns was shown, the possibility of its combination with immunization against other infections within the framework of the national vaccination schedule, the importance of following the recommended vaccination schedule in accordance with the age of the child. The effectiveness of vaccination of adults suffering from chronic diseases has been shown both in terms of preventing the aggravation of the course of the underlying pathology and reducing the risk of pneumonia. Positive experience has been gained in immunizing adults from occupational risk groups - medical workers, conscripts and persons exposed to a harmful production factor and having occupational lung diseases. The conducted studies have shown a high cost-effectiveness of PCV13 vaccination, however, with any changes in price and epidemiological parameters, it is necessary to clarify the economic feasibility of vaccination under the changed conditions. Taking into account the positive experience gained in immunization, it seems appropriate to further maintain a high level of vaccination coverage of the child population, expanding risk groups among the adult population subject to vaccination against pneumococcal infection within the framework of the National Immunization Schedule, taking into account its epidemiological, clinical and economic efficiency.

Abstract Background The morbidity and mortality of adult diseases caused by S. pneumoniae increase with age and presence of underlying chronic diseases. Currently, two vaccine technologies against S. pneumoniae are used: the 23-valent pneumococcal polysaccharide vaccine (PPV23) and the pneumococcal conjugate vaccines, one of which is the 20-valent pneumococcal conjugate vaccine (PCV20) that has recently been approved for adults. Objective This study was conducted to investigate the cost-effectiveness of implementing PCV20 in a reimbursement scheme for Norwegian adults aged 18–99 years at risk of pneumococcal diseases and those aged 65 years and older at low risk compared to PPV23. Methods An established Markov model was adapted to a Norwegian setting to estimate the economic and clinical consequences of vaccinating the Norwegian population in specific age and risk groups against pneumococcal diseases. Inputs for the model were found in Norwegian or Danish real-world evidence or retrieved from available studies. The costs and clinical outcomes were assessed using a health sector perspective and a lifetime time horizon. Results The results showed that PCV20 was associated with better health outcomes including fewer disease cases, fewer disease-attributable fatalities, a higher gain of life years and quality-adjusted life years compared to PPV23. In addition, PCV20 had a lower total cost compared to PPV23. Therefore, PCV20 was the dominant vaccination strategy. The base case result was investigated in multiple sensitivity analyses, which showed that the results were robust to changes in input parameters and methodological assumptions, as PCV20 remained the dominant vaccination strategy in almost all scenarios. Conclusion Results showed that vaccinating the Norwegian adults with PCV20 was cost-effective compared to PPV23. Changes in the hospital cost of pneumonia, the price of PCV 20, the effectiveness of PCV20 against pneumonia, and the pneumonia disease incidence had the highest impact on the ICER, i.e., were the main drivers of the results.

Relevance. Vaccination of the child population against pneumococcal infection (PI) has been carried out in the Republic of Tatarstan according to the national calendar of preventive vaccinations since 2014. The vaccination scheme includes vaccination with PCV-13 conjugated pneumococcal vaccine.Aim. Study of the the frequency of bacterial transmission and the serotype landscape of S. pneumoniae isolated from healthy children- bacterial carriers of preschool age in the Republic of Tatarstan (RT).Materials and methods. During the period from 2016 to 2022, 1,426 children from Kazan and the districts of the Republic of Tatarstan were examined. Examination of nasopharyngeal smears was carried out by the classical bacteriological method. Serotyping was performed using molecular genetic methods (PCR).Results. The detection rate of S. pneumoniae among healthy preschool children varied in different years from 29.5 to 63%, averaging 38.5%. In urban children, the incidence of pneumococcal transmission was significantly higher than in rural children (p

Background and Aims: Pneumococcal infection prophylaxis (PIP) is necessary for children with sickle cell disease (SCD) due to the enhanced risk of pneumococcal infections and associated mortalities. PIP measures include periodic administration of pneumococcal conjugate vaccine (PCV), twice‐daily administration of phenoxymethylpenicillin tablets, and nonpharmacological measures. This work assessed the attitude, knowledge, and perception of parents of SCD children on PIP, how parents obtain phenoxymethylpenicillin, and their preference for PIP. Methods: This prospective cross‐sectional study involved 200 parents of SCD children between 2 and 12 years old seeking medical care at the SCD clinic of the Komfo Anokye Teaching Hospital, Ghana. Infants involved had hemoglobin SS, SC, or S‐βthal. A survey questionnaire (written) was administered to gather and interpret the data using Statistical Package for Social Sciences version 25 software. Results: Out of 200 respondents in this study, 12% knew vaccination could prevent pneumococcal disease, but only 4% had heard about PCV, 96% had heard about phenoxymethylpenicillin tablets, and 40% knew it could prevent it. Although phenoxymethylpenicillin is reimbursed on national insurance, 87% obtained the tablets from outside the hospital with cash, whereas 12% obtained the tablets from the hospital either on insurance or with cash. About 38% mentioned that they had discontinued treatment with tablets due to intentional withdrawal, lack of funds, noncompliant children, and running out of medicine. All but 2% of respondents said they would prefer vaccines to tablets. Conclusion: There is a significant shortfall in knowledge, attitude, and perception of parents of SCD children concerning PIP, which warrants education and awareness creation on PIP in sickle cell clinics to ensure optimum clinical and health outcomes and reduce morbidity and mortality related to such infections. Key points: Agents often used are oral phenoxymethylpenicillin and pneumococcal vaccines.There is a significant deficit in parents' knowledge, attitude, and perception of pneumococcal infection prophylaxis (PIP).Education on PIP in sickle cell clinics is necessary to improve children's clinical and health outcomes with sickle cell disease. [ABSTRACT FROM AUTHOR]

Abstract Background and Aims Pneumococcal infection prophylaxis (PIP) is necessary for children with sickle cell disease (SCD) due to the enhanced risk of pneumococcal infections and associated mortalities. PIP measures include periodic administration of pneumococcal conjugate vaccine (PCV), twice‐daily administration of phenoxymethylpenicillin tablets, and nonpharmacological measures. This work assessed the attitude, knowledge, and perception of parents of SCD children on PIP, how parents obtain phenoxymethylpenicillin, and their preference for PIP. Methods This prospective cross‐sectional study involved 200 parents of SCD children between 2 and 12 years old seeking medical care at the SCD clinic of the Komfo Anokye Teaching Hospital, Ghana. Infants involved had hemoglobin SS, SC, or S‐βthal. A survey questionnaire (written) was administered to gather and interpret the data using Statistical Package for Social Sciences version 25 software. Results Out of 200 respondents in this study, 12% knew vaccination could prevent pneumococcal disease, but only 4% had heard about PCV, 96% had heard about phenoxymethylpenicillin tablets, and 40% knew it could prevent it. Although phenoxymethylpenicillin is reimbursed on national insurance, 87% obtained the tablets from outside the hospital with cash, whereas 12% obtained the tablets from the hospital either on insurance or with cash. About 38% mentioned that they had discontinued treatment with tablets due to intentional withdrawal, lack of funds, noncompliant children, and running out of medicine. All but 2% of respondents said they would prefer vaccines to tablets. Conclusion There is a significant shortfall in knowledge, attitude, and perception of parents of SCD children concerning PIP, which warrants education and awareness creation on PIP in sickle cell clinics to ensure optimum clinical and health outcomes and reduce morbidity and mortality related to such infections.

Background: The morbidity and mortality of adult diseases caused by S. pneumoniae increase with age and presence of underlying chronic diseases. Currently, two vaccine technologies against S. pneumoniae are used: the 23-valent pneumococcal polysaccharide vaccine (PPV23) and the pneumococcal conjugate vaccines, one of which is the 20-valent pneumococcal conjugate vaccine (PCV20) that has recently been approved for adults. Objective: This study was conducted to investigate the cost-effectiveness of implementing PCV20 in a reimbursement scheme for Norwegian adults aged 18–99 years at risk of pneumococcal diseases and those aged 65 years and older at low risk compared to PPV23. Methods: An established Markov model was adapted to a Norwegian setting to estimate the economic and clinical consequences of vaccinating the Norwegian population in specific age and risk groups against pneumococcal diseases. Inputs for the model were found in Norwegian or Danish real-world evidence or retrieved from available studies. The costs and clinical outcomes were assessed using a health sector perspective and a lifetime time horizon. Results: The results showed that PCV20 was associated with better health outcomes including fewer disease cases, fewer disease-attributable fatalities, a higher gain of life years and quality-adjusted life years compared to PPV23. In addition, PCV20 had a lower total cost compared to PPV23. Therefore, PCV20 was the dominant vaccination strategy. The base case result was investigated in multiple sensitivity analyses, which showed that the results were robust to changes in input parameters and methodological assumptions, as PCV20 remained the dominant vaccination strategy in almost all scenarios. Conclusion: Results showed that vaccinating the Norwegian adults with PCV20 was cost-effective compared to PPV23. Changes in the hospital cost of pneumonia, the price of PCV 20, the effectiveness of PCV20 against pneumonia, and the pneumonia disease incidence had the highest impact on the ICER, i.e., were the main drivers of the results. [ABSTRACT FROM AUTHOR]

Relevance. To date, there is ample evidence that diabetes mellitus (DM) and obesity are predictors of a severe course and adverse outcome of COVID-19. The SARS-CoV-2 virus is known to have deleterious effects on the pancreas, exacerbating insulin resistance The SARS-CoV-2 virus is known to have deleterious effects on the pancreas, exacerbating insulin resistance. Long-term data have been accumulated regarding pneumococcal infection and influenza, both of which are severe in patients with diabetes and obesity. The aim is to analyze scientific publications on the problems of vaccinating patients with diabetes and obesity against SARS-CoV-2, pneumococcal infection, and influenza. Conclusions. Vaccination against COVID-19 in patients with DM and obesity is an effective preventive measure. Experience with vaccination against COVID-19 using the following vaccines: Moderna mRNA-1273, Pfizer BioNTech, BNT162b2, AstraZeneca COVID-19 vaccine AZD1222, SII Covishield, SK Bioscience, Sputnik V showed similar safety and efficacy profiles among obese and DM patients and those at risk. Researchers in numerous publications have emphasized the importance of routine vaccination for people living with diabetes amid a pandemic of a new coronavirus infection. Researchers in numerous publications have emphasized the importance of routine vaccination for people living with diabetes in the face of a new coronavirus pandemic. Analysis of the literature reviewed in this review suggests that vaccination against SARS-CoV-2, especially for those at risk, will be an intensive area of research in the coming years and that vaccination against coronavirus infection is likely to be routine for people with diabetes and obesity.

Diseases caused by Streptococcus pneumoniae, as well as antibiotic resistance of its serotypes, are the leading cause of death amongst children worldwide. To prevent pneumococcal infection, the population is immunised with conjugate vaccines containing different amounts of polysaccharides of certain serotypes. Development of a full-cycle Russian vaccine is vital because the active pharmaceutical ingredients for the vaccines registered in the Russian Federation are produced abroad, and only the final stages of production of vaccines of this group are performed in the territory of the Russian Federation. Considering the phenomenon of serotype replacement associated with the long-term widespread use of pneumococcal conjugate vaccines, it is necessary to carefully select the serotype composition for the new vaccine. The aim of this work was to analyse the serotype distribution of pneumococci in the Russian Federation and other countries in order to select optimal serotypes for the Russian vaccine for human use, taking into account vaccination schedules for each age group. This review presents an analysis of the pneumococcal serotype distribution in the Russian Federation in the pre-vaccination era, as well as after the introduction of routine vaccination. In addition, the review includes data on the serotype distribution in the Eurasian Economic Union countries. The authors described a model composition containing at least sixteen serotypes. It will increase effectiveness of immune protection of the population, providing a more complete coverage of serotypes, considering their prevalence in the Russian Federation. Based on the analysis, the serotype composition for the sixteen-valent pneumococcal conjugate vaccine is proposed for further production and preclinical and clinical trials. A new Russian pneumococcal conjugate vaccine will ensure vaccination of all population groups within the National Immunisation Schedule of the Russian Federation.

Background: Age and certain medical/social conditions are risk factors for invasive pneumococcal disease (IPD). For prevention of IPD, the National Advisory Committee on Immunization (NACI) has recommended the 23-valent polysaccharide pneumococcal vaccine, PNEU-P-23, for adults 65 years of age and older and adults over 18 years of age living with certain underlying conditions. NACI has also recommended 13-valent conjugate pneumococcal vaccine, PNEU-C-13, for adults; however, in publicly funded programs, this recommendation is limited to individuals with risk factors for IPD. Two new conjugate vaccines, PNEU-C-15 and PNEU-C-20, have been authorized by Health Canada for prevention of IPD in adults. This article summarizes NACI public health recommendations for pneumococcal vaccines in adults given these new conjugate vaccines that provide additional serotype coverage over PNEU-C-13. Methods: Key studies evaluating the immunogenicity and safety of PNEU-C-15 and PNEU-C-20 were reviewed. The Grading of Recommendations, Assessment, Development and Evaluations framework methodology was used to assess the certainty of evidence. Results: The PNEU-C-15 and PNEU-C-20 vaccines showed comparable immune responses, and safety profiles for all mild, moderate, and severe adverse events, to the currently used vaccines. No data were available on the efficacy or effectiveness of PNEU-C-15 or PNEU-C-20. Economic evidence and feasibility assessments supported the use of the PNEU-C-20 vaccine. Conclusion: NACI recommends PNEU-C-20 for adults 65 years of age and older, 50-64 years of age and living with factors placing them at higher risk of pneumococcal disease, and 18-49 years of age with immunocompromising conditions, with PNEU-C-15+PNEU-P-23 an alternative. [ABSTRACT FROM AUTHOR]

To examine rates of serious pneumococcal infections up to 10 years after vaccination with 7-valent conjugated pneumococcal vaccine (PCV7) in patients with arthritis compared to non-vaccinated arthritis patients. In total, 595 adult arthritis patients (rheumatoid arthritis; RA = 342, 80 % women and spondylarthropathy; SpA = 253, 45 % women) received one dose of PCV7. Mean age/disease duration were 62/16 and 51/14 years, respectively. For each patient, 4 matched reference subjects were identified. At vaccination, 420 patients received bDMARDs (anti-TNF = 330, tocilizumab = 15, abatacept = 18, anakinra = 1, rituximab = 56). Methotrexate was given as monotherapy (n = 86) or in combination with bDMARD (n = 220). 89 SpA patients received NSAIDs without DMARD. The Skåne Healthcare Register was searched for ICD-10 diagnostic codes for pneumococcal infections (pneumonia, lower respiratory tract infection, septicemia, meningitis, septic arthritis) between January 2000 and December 2018. Frequency of infections after vs before vaccination were calculated (relative risks). Relative risk ratio (RRR) and relative risk reduction (1-RRR) were calculated comparing patients vs non-vaccinated references. Kaplan-Meier and Cox regression were used to investigate time to first event and predictors of infections. Among vaccinated RA and SpA patients, there was a significant relative risk reduction of pneumonia and all serious infections; 53% and 46%, respectively. There was no significant difference in time to first pneumonia or all serious infections after vaccination between patients and references. Higher age, RA diagnosis and concomitant prednisolone were associated with infections. One dose of pneumococcal conjugate vaccine may decrease risk of serious pneumococcal infection up to 10 years in patients with arthritis receiving immunomodulating treatment. [ABSTRACT FROM AUTHOR]

Pneumococcal infection strongly contributes to morbidity and mortality in Spain. A total of 253,899 hospitalizations related to pneumococcal infection occurred from 2016 to 2020. Fifty-eight percent were men, the mean age was 67 years old, and the average length of hospitalization was 12.72 days. The annual hospitalization rate was 10.84 hospitalizations per 10,000 population, increasing significantly with age, reaching 65.75 per 10,000 population in those aged >85 years. The hospitalization rates for pneumococcal pneumonia, sepsis, and meningitis were 2.91, 0.12, and 0.08 hospitalizations per 10,000, respectively, and reached the highest value in those aged >85 for pneumococcal pneumonia and sepsis, with 22.29 and 0.71 hospitalizations per 10,000, respectively, and in children up to 1 year old for pneumococcal meningitis, with 0.33 hospitalizations per 10,000. The total number of deaths during the study period was 35,716, with a case-fatality rate of 14.07%. For pneumococcal pneumonia, sepsis, and meningitis, the case-fatality rates were 8.47%, 23.71%, and 9.99%, respectively. The case-fatality rate increased with age and did not vary by sex. The annual cost of these hospitalizations was more than EUR 359 million. There is therefore a high burden of disease and mortality caused by pneumococcal infection in our country, especially in elderly individuals. [ABSTRACT FROM AUTHOR]

Vaccination plays an important role in the prevention of infectious diseases in patients with immunoinflammatory diseases. When vaccinating patients with systemic lupus erythematosus (SLE), as with other immunoinflammatory rheumatic diseases, its safety is of great importance, including mitigating the risks of the primary disease or the development of new autoimmune phenomena. Many practitioners continue to consider autoimmune diseases as a contraindication for vaccination due to the perceived possibility of their exacerbation and reduced vaccine effectiveness during active immunosuppressive therapy.The lecture presents current data on the immunogenicity, efficacy and safety of vaccines against a number of infections caused by influenza viruses, hepatitis B, Herpes zoster, human papilloma viruses, COVID-19 and pneumococcus in patients with SLE. It has been shown that the benefits of vaccination in patients with SLE significantly outweigh the risk of adverse events or exacerbations of the disease. At the same time, it was noted that the problem of vaccination of such patients requires further study.

Background. Immunosuppressive drugs are widely used for the treatment of patients with spondyloarthritis (SpA) to effectively control the activity of the disease. At the same time, the use of these drugs is associated with an increased risk of developing infections of the upper and lower respiratory tract, which can be prevented by vaccination. The aim of the study was to evaluate the immunogenicity, safety, and clinical efficacy of the 23-valent pneumococcal polysaccharide vaccine (PPV-23) in patients with SpA. Material and methods. The study included 54 patients with SpA: 39 with ankylosing spondylitis, and 15 with psoriatic arthritis. Most patients had a history of two or more cases of lower respiratory tract infections, 2 patients reported a monthly exacerbation of chronic sinusitis, one patient reported the development of otitis every 2–3 months. 72% of patients received immunosuppressive therapy at the time of inclusion in the study. PPV-23 was administered in the amount of 1 dose (0.5 ml) against the background of ongoing antirheumatic therapy. The level of antibodies to pneumococcal capsular polysaccharide was determined using the EIA PCP IgG kit (TestLine Clinical Diagnostics s.r.o., Czech Republic) at baseline, after 1, 3, and 12 months after vaccination. The tolerability of PPV-23, the effect of vaccination on SpA activity (according to the dynamics of the BASDAI index), and the incidence of upper and lower respiratory tract infections were assessed. Results. The concentration of antibodies to pneumococcal capsular polysaccharide was significantly higher 1, 3, and 12 months after vaccination compared to baseline. There was no negative effect of vaccination on the activity of SpA and the emergence of «new» autoimmune disorders. The vaccine was well tolerated by 76% of patients., Only one patient developed pneumonia during the observation period. Patients suffering from frequent sinusitis and otitis reported the absence of these infections after vaccination. Conclusions. Preliminary results of the study indicate sufficient immunogenicity, safety, and clinical efficacy of PPV-23 in patients with SpA.

The article for the first time provides a relatively comprehensive overview of the main aspects of the epidemiology and clinical features of infectious pathology, i.e., community-acquired pneumonia, as comorbid and aggravating conditions in patients with type 1 and type 2 diabetes mellitus. Risk factors and pathogenetic patterns of infectious processes development, as well as the special etiological role of pneumococcal infection in this group of patients, are considered. Particular attention is paid to the possibilities of and approaches to the primary prevention of vaccine-preventable infections as the causes of the development of community-acquired pneumonia and invasive diseases in patients with diabetes mellitus with a review of international studies, guidelines, and local experience data in pneumococcal infection immunization.

Relevance. Pneumococcal disease is a common cause of morbidity and mortality in adults and children worldwide. Vaccination against pneumococcal infection was included in the National Immunization Schedule in the Russian Federation in 2014. But despite the progress made, the proportion of children who received a completed course of vaccination remains insufficient. Coverage of the adult population remains low. A significant role in this is played by confidence of the population to vaccination against pneumococcal infection. In this regard, we conducted a study to assess the effectiveness of the educational programs in the improving of confidence in vaccination against pneumococcal infection among various target groups of population. Materials and methods. The results of the developed and conducted educational campaigns, consisting of two stages, were used as material: a series of face-to-face events for young people (students of non-medical universities in Moscow) and a series of webinars for medical professionals of various specialties. In the first stage of the educational component, the total coverage of the target audience («future parents») amounted to 650 people. Face-to-face events were held with the participation of students from Sechenov University using the peer-to-peer approach. The total audience of the second phase of the educational component (a series of 5 webinars for health professionals) was more than 3,000 people (2,902 connections, some of them group). Online events for medical workers were held by leading experts in the field of epidemiology and vaccine prevention, psychology. Evaluation of the effectiveness of the campaign was carried out through measurements (surveys before and after the event). To assess the statistical significance of differences, Pearson's Chi2 test was used at the accepted level of statistical significance p < 0.05. Qualitative variables are presented as proportion and 95% confidence interval of the proportion. Statistical processing was performed using IBM SPSS Statistics v.20.0, data visualization – Microsoft Excel 2016. Results. The proportion of students who have a positive attitude towards vaccination increased by 16% – from 41.0±5.6% to 57.0±6.0%, p

Thrombotic microangiopathy (TMA) is a disease that causes organ damage due to microvascular hemolytic anemia, thrombocytopenia, and microvascular platelet thrombosis. Streptococcus pneumoniae-associated TMA (spTMA) is a rare complication of invasive pneumococcal infection. In addition, atypical hemolytic uremic syndrome (aHUS) is TMA associated with congenital or acquired dysregulation of complement activation. We report the case of a nine-month-old boy with refractory nephrotic syndrome complicated by spTMA in the setting of heterozygous complement factor-I (CFI) gene mutation and CFHR3-CFHR1 deletion. He repeatedly developed thrombocytopenia, anemia with schistocytes, hypocomplementemia, and abnormal coagulation triggered by infection, which manifested clinically with convulsions and an intraperitoneal hematoma. Eculizumab (a monoclonal humanized anti-C5 antibody) provided transient symptomatic benefit including improvement in thrombocytopenia; however, he developed unexplained cardiac arrest and was declared brain dead a few days later. In this report, we highlight the diagnostic challenges of this case and the causal relationship between spTMA and complement abnormalities and consider the contribution of heterozygous mutation of CFI and CFHR3-CFHR1 deletion. [ABSTRACT FROM AUTHOR]

Introduction: Invasive pneumococcal disease (IPD) remains a pediatric health challenge despite national vaccination efforts in Colombia. We described the socio-demographic, epidemiological, and clinical characteristics of children (<18 years of age) with IPD at a pediatric reference center in Bolívar, Colombia., Methods: Descriptive cross-sectional study of all pediatric patients (under 18 years of age) diagnosed with IPD between 2016 and 2023. Data was collected retrospectively from medical records. IPD was defined as identifying Streptococcus pneumoniae (Spn) in blood, cerebrospinal, pleural, synovial, peritoneal, or pericardial fluid. Spn serotyping data was provided by the Colombian National Institute of Health. Descriptive statistics were performed to describe all variables., Results: Between 2016-2023, we identified fifty-four pediatric IPD cases. Most cases were reported among children in the 2-9 age group (44.4%), male sex (57.4%), low socio-economic strata (100%), and previous medical conditions (61.1%). Half of the patients were vaccinated. Serotyping data were available from 35 (64.8%) isolates. Fifteen Spn serotypes were identified, Spn19A being the most frequent (20.4%). All Spn isolates were vancomycin sensitive, while 34% had meropenem-decreased sensitivity. Three-quarters of the patients (76.0%) were diagnosed with bacteremia (bacteremic pneumonia/meningitis and bacteremia without known focus). The 79.6% of children were admitted to the pediatric intensive care unit (PICU). The median hospitalization days were 13.5 (IQR 5.5-23.5) while the median PICU length of stay was 9.5 (IQR 4-18) days. Nineteen patients died (35.2%)., Conclusion: IPD disproportionately affects vulnerable children, resulting in high PICU admission and mortality rates and prolonged hospital stay in Bolívar, Colombia. In addition, the emergence of resistance to carbapenems is of concern., Competing Interests: Conflict of interest: To carry out this study, the authors declare having received funding from Pfizer through a grant.

[Display omitted] • 4.5% out of 4.0 million adults at risk were vaccinated against pneumococcus. • 92% of adults at risk visited a GP and 36% visited an outpatient specialist. • From 10.3% in 2014 up to 18.8% in 2018 of immunocompromised patients were vaccinated against pneumococcus. • From 12.9% in 2014 down to 2.9% in 2018 of people with a chronic medical condition were vaccinated. • 43.6% of adults at risk of pneumococcal disease were vaccinated against influenza. The risk of developing pneumococcal infections increases with certain chronic conditions and in immunocompromised patients. We aimed to monitor pneumococcal vaccination coverage in at-risk patients and to examine factors associated with pneumococcal vaccination in France. In this annual cross-sectional study, at-risk patients were extracted between 2014 and 2018 from the National Health Insurance's (NHI) General scheme's claims database with their vaccine reimbursements. Descriptive analyses and a logistic model were performed to assess the influence of healthcare use and medical and demographic factors on pneumococcal vaccination. In 2018, 4.5% of 4,045,021 at-risk adults were up to date with their pneumococcal vaccination. During the study period, the number of patients with chronic medical conditions (86% of 4,045,021) increased by 10.1%, but vaccination coverage decreased from 12.9% to 2.9%. The population with immunocompromised status (14% of 4,045,021) increased by 16.2% and vaccination coverage from 10.3% to 18.8%. Influenza vaccination coverage was much higher and stable (around 45.0%). Factors associated with pneumococcal vaccination were: immunocompromised status vs. having a chronic medical condition (odds ratio [OR] 4.72), influenza vaccination (OR 2.36–3.42), hepatitis B vaccination (OR 2.82), DTPolio vaccination (OR 1.52), ≥5 specialist physicians' visits (OR 1.17), and age above 74 (OR 1.12). Pneumococcal vaccine dispensing was extremely low (median of 9 per GP,1 per specialist over 9 years) despite frequent healthcare visits. Pneumococcal and influenza vaccination coverage of adults at risk of pneumococcal disease fell well below public health expectations. Invitations for pneumococcal vaccination should be sent by the NHI to high-risk patients. Patient management protocols should include pneumococcal vaccination. Patients with multiple comorbidities are a high-priority population given the large potential health gains offered by pneumococcal vaccination. Commitment of both scientific societies and health authorities is urgently needed to increase vaccination coverage in at-risk populations. [ABSTRACT FROM AUTHOR]

While suboptimal pneumococcal vaccination rates have been reported in immunosuppressed patients with rheumatic diseases, data for patients with psoriasis (PsO) or atopic dermatitis (AD) are scarce. Pneumococcal vaccination in Germany is recommended in patients with certain comorbidities, immunosuppression, and/or aged 60 years or above. The aim of this multicenter cross-sectional study was to investigate the pneumococcal vaccination rate in patients with PsO compared to patients with AD and to evaluate patient perceptions. All patients completed a questionnaire on vaccination status and perceptions, patient and disease characteristics, as well as comorbidity. Medical records and vaccination certificates were reviewed. Over the whole cohort (n = 327 PsO (41.9% female), n = 98 AD (42.9% female)), 83.8% and 42.9% of PsO and AD patients, respectively, had an indication for pneumococcal vaccination due to immunosuppressive treatment. The pneumococcal vaccination rate was 14.4% and 10.2% in PsO and AD patients, respectively. The vaccination rate depended significantly on age, working status and presence of psoriatic arthritis. The most common reason for nonvaccination was lacking recommendation by physicians. Higher awareness, particularly for vaccination indication due to immunosuppression among dermatologists, general physicians, and patients, is warranted. [ABSTRACT FROM AUTHOR]

Relevance Antimicrobial resistance (AMR) is a growing acute global health issue. Uncontrolled combined use of antibiotics determines changes in the microbial agents' properties, leading to a decrease of susceptibility to antimicrobial substances and increasing the probability of severe invasive bacterial infections with limited possibilities to treat them. Vaccination against pneumococcal infection as well as improvement of the health care providers awareness can be considered as part of AMR management strategies. A number of epidemiological observations have been published indicating a change in antimicrobial resistance to Streptococcus pneumoniae following the implementation of the national infant immunization program against pneumococcal infection. Aim. To analyze the literature data on the pneumococcal vaccination contribution to the reduction of the number of pneumococcal diseases and the need for antibacterial therapy and to assess the burden of invasive pneumococcal diseases globally and in the Republic of Belarus (RB) and to identify gaps in the awareness of practicing physicians on pneumococcal infection immunoprophylaxis, its' effectiveness and impact on AMR. Conclusions. WHO considers and promote vaccination as an AMR containment measure. There are a lot of publications with the examples of countries with pneumococcal infection pediatric national immunization programs (NIP) and epidemiological data on changes in the S.pneumoniae sensitivity to antibacterial drugs after the start of the NIP. During the period of the mass PCV immunization and the subsequent drift of strains the sensitivity to antimicrobials may return. In Israel 88% and 93% reduction of otitis media cases caused by resistant to penicillin and macrolides vaccine types of S.pneumoniae after the phased introduction of PCV7 and PCV13 to the infant NIP, comparing to the period before vaccination introduction. A decrease in the frequency of bacteremia in combination with a sharp decrease in the proportion of penicillin-resistant pneumococcal isolates (from 50.9% to 5.3%) is also described. In France the proportion of S.pneumoniae strains with reduced susceptibility or resistance to penicillin declined from 47.1% to 39% after the start of PCV13 NIP; researchers also noted a decrease in antibiotic-resistant isolates of S.pneumoniae in children with otitis media: by 26, 31, 55, 29 and 57%, respectively, to penicillin, amoxicillin, cefotaxime, erythromycin and co-trimoxazole to in 2011. A study in Germany revealed a decrease in macrolide-resistant IPD strains after the start of PCV13 use of (in children 8.2%; in adults 8.8%) compared with the period after the introduction of PCV7 (17.3% and 13.0%) and especially in the cohort of children compared with the period before the use of PCV7 (24.8% and 13.3%). In Scotland, there was a decrease in the number of penicillin-resistant strains isolated from the blood of patients with IPD after the introduction of PCV13 into the NIP. The publication of the results of three parallel studies in Finland evaluated the effectiveness of PCV10 in reducing the number of IPD caused by vaccine-specific serotypes of PCV10 by 93%, 98% and 100%, respectively. At the same time, the effectiveness against «related» PCV10 serotypes was equal to 46%, 51% and 78%, respectively, and the estimated effectiveness against unrelated PCV10 serotypes was negative. Composition and resistance profile of the lower respiratory tract microflora isolated from sputum pneumococcal strains in children in 2016–2018, demonstrated up to 72.4% resistance to macrolides, 31.3% resistance to cefotaxime and 8.3% – to ceftriaxone. Spn serotypes structure in under 5 years of age children with meningitis was characterized by relatively high uniformity. Majority (92%) of multiresistant meningeal strains are covered by current PCVs. An anonymous questionnaire showed pediatricians' insufficient awareness about current approaches to pneumococcal infection prevention, underestimation of IPD risks and complications, and the impact of vaccination on reducing AMR. Additional education is required to increase the level of knowledge and understanding of the PCVs role in AMR reduction. PCV NIP introduction will provide additional opportunities to reduce AMR in the Republic of Belarus.

Background. Acute respiratory viral infections (ARVI) and pneumococcal infections (PI) annually cause great damage to the health and working capacity of the population, and lead to economic losses for employers and the state. Aim. To study the impact of influenza and PI vaccination coverage on morbidity of ARVI and community-acquired pneumonia (CAP) of the morbidity of population in Central administrative district (CAD) of Moscow. Material and methods. The analysis of official data on monitoring of morbidity from ARVI and CAP was carried out, and information on vaccination of the population against influenza and PI for 2012–2018 was used. Results. In 2018 ARVI accounted for 95.2% of infectious morbidity and the incidence rate was 29853.5 per 100 ths population. Over the period from 2012–2018, the incidence of ARVI and influenza gradually decreased by 2016, but in 2017 the incidence of ARVI was increased to the level of 2012 (+25.3%) however influenza was decreased (-40.9%). In 2018, the incidence of ARVI in adults remained at the level of 2017, and in children there was a decrease (-16.9%). The incidence of influenza in 2018 decreased in both adults (-65.4%) and children (-63.9%). During 2012–2018 the incidence of CAP had a persistent tendency to increase. The coverage of influenza vaccination in CAD population of Moscow has increased annually since 2012 and in 2018 reached 85.5% of children 0–17 years old and 65.5% of adults 18 years and older, and against PI – 46.3% of children and 2.6% of adults. Conclusion. The epidemic circulation of ARVI and influenza had a significant impact on the morbidity of CAD population of Moscow in 2012–2018. Annual vaccination of the population lead to decreasing of influenza incidence but the incidence of pneumonia tended to increase and need to improve prevention.

Mitochondrial functionality is crucial for the execution of physiologic functions of metabolically active cells in the respiratory tract including airway epithelial cells (AECs). Cigarette smoke is known to impair mitochondrial function in AECs. However, the potential contribution of mitochondrial dysfunction in AECs to airway infection and airway epithelial barrier dysfunction is unknown. In this study, we used an in vitro model based on AECs exposed to cigarette smoke extract (CSE) followed by an infection with Streptococcus pneumoniae (Sp). The levels of oxidative stress as an indicator of mitochondrial stress were quantified upon CSE and Sp treatment. In addition, expression of proteins associated with mitophagy, mitochondrial content, and biogenesis as well as mitochondrial fission and fusion was quantified. Transcriptional AEC profiling was performed to identify the potential changes in innate immune pathways and correlate them with indices of mitochondrial function. We observed that CSE exposure substantially altered mitochondrial function in AECs by suppressing mitochondrial complex protein levels, reducing mitochondrial membrane potential and increasing mitochondrial stress and mitophagy. Moreover, CSE-induced mitochondrial dysfunction correlated with reduced enrichment of genes involved in apical junctions and innate immune responses to Sp, particularly type I interferon responses. Together, our results demonstrated that CSE-induced mitochondrial dysfunction may contribute to impaired innate immune responses to Sp. [ABSTRACT FROM AUTHOR]

Relevance. Among the groups at high risk of developing invasive pneumococcal infections, patients with multiple myeloma (MM) stand out among the highest rates of morbidity and mortality due to the presence of profound immunosuppression. Aims: to outline the current state of the problem of vaccine prevention of pneumococcal infection in patients receiving treatment for multiple myeloma, to present the evidence base for vaccination with conjugated pneumococcal vaccine. A continuous data review method was used to evaluate the studies on vaccination approaches against pneumococcal infection in patients with multiple myeloma. Conclusions. The article presents modern epidemiological data, as well as the results of original studies of clinical and immunological aspects of pneumococcal vaccination in patients with MM receiving new targeted agents and immunotherapy. The effectiveness of the use of the conjugated pneumococcal vaccine in patients treated with MM with bortezomib, lenalidomide, and ixazomib was indicated. An independent protective effect of pneumococcal vaccination has been shown as a preventive measure in a cohort of patients with MM, against the background of treatment with new targeted drugs.

Summary: Background: Concentrations of particulate matter less than 10 microns (PM10) on underground railways are higher than those near urban roads. Traffic-related PM10 increases pneumococcal infection via increasing the expression of platelet-activating factor receptor (PAFR), a receptor co-opted by pneumococci to adhere to cells. To date, it is unknown whether underground railway PM10 increases pneumococcal infection. This study sought to determine the effect of London Underground (LU) PM10 on; i) pneumococcal adhesion to airway cells, and ii) susceptibility to pneumococcal disease. Methods: A549 cells and human primary airway epithelial cells were cultured with 20 µg/mL PM10 from the Bakerloo (B-PM10) and Jubilee (J-PM10) line platforms of Baker Street station. PAFR expression was assessed by flow cytometry, and pneumococcal adhesion by colony forming unit (CFU) counts. Traffic-related PM10 was collected next to a main road near the station's entrance. The PAFR blocker CV3988 and the antioxidant N-acetyl cysteine were used to assess the role of PAFR-mediated pneumococcal adhesion and oxidative stress respectively. Pneumococcal infection of mice was done after exposure to 3×80 μg doses of intranasal LU-PM10. Findings: In A549 cells, human primary nasal cells, and human primary bronchial epithelial cells, B-PM10 and J-PM10 increased PAFR expression and pneumococcal adhesion. Stimulated adhesion was abrogated by CV3988 and N-acetyl cysteine. Traffic-related PM10 stimulated increased adhesion compared with B-PM10. B-PM10 and J-PM10 increased lung and blood CFU and mortality in mice. Treatment of B-PM10-exposed mice with CV3988 reduced blood CFU. Interpretation: LU-PM10 increases pneumococcal adhesion to airway cells and susceptibility to invasive disease in mice. Funding: The Medical College of Saint Bartholomew's Hospital Trust, and the UK Medical Research Council Programme Grant (MR/P011284/1).

• We compared strategies of influenza and 23-valent polysaccharide vaccine (PPV23). • When compared with no vaccine, all vaccine strategies were cost-effective. • The earlier age of PPV23 was cost-effective in comparison with current programme. • Our findings could help inform design and implementation of vaccination strategies. Pneumococcal infection is a leading cause of morbidity and mortality. We aimed to evaluate the cost-effectiveness of 23-valent polysaccharide vaccine (PPV23) together with influenza vaccination or pneumococcal vaccination alone in adults starting from 50 years vs. 65 years in Hong Kong. A hypothetical population of 100,000 older adults was included in a Markov model with age ranging from 50 to 85 years to calculate the cost and quality-adjusted life-years (QALYs) gained for vaccination strategies, including: (1) annual influenza vaccine and PPV23 at 50 and 65 years; (2) annual influenza vaccine and PPV23 at 65 years (similar with the current vaccination programme); (3) PPV23 at 50 and 65 years; (4) PPV23 at 65 years; and (5) no vaccination. We evaluated the incremental cost-effectiveness ratio (ICER) and used Monte Carlo simulation for probabilistic sensitivity analysis. The cost-effectiveness threshold was extracted from previous literature. In comparison with no vaccination, all strategies were cost-effective with ICERs less than the threshold (US$24,302 per QALY gained). When compared with no vaccination, strategies 1–4 saved US$ 49.5, US$ 94.9, US$ 584.3, and US$ 1114.2 to gain one QALY respectively. In comparison with strategy 2, strategy 1 spent US$ 195.3 to gain one QALY, whilst strategies 3 and 4 showed less effectiveness with increased costs. All vaccination strategies were cost-effective, among which the strategy of PPV23 at 50/65 years with annual influenza vaccine was cost-effective even in comparison with current vaccination programme. These findings could help inform the design and implementation of vaccination strategies. [ABSTRACT FROM AUTHOR]

The review discusses national clinical practice guidelines for pneumococcal vaccination in different countries, existing approaches to adult immunization, and highlights key results of the most significant clinical studies and metaanalyses on the effectiveness of 23-valent polysaccharide pneumococcal vaccine and 13-valent conjugated pneumococcal vaccine in adults, including the elderly and patients with comorbidities.

The review discusses the current state of the use of vaccine prevention in the debarment of pneumococcal infection in patients with chronic kidney disease (CKD). Clinical and immunological features of various groups of patients with chronic kidney disease are considered, the specifics of their immunoreactivity, the features of their immune system, due to the underlying and concomitant diseases, as well as treatment. The review analyzes data on various approaches to preventive vaccination and discusses the results of various vaccination regimens and vaccines.Based on the materials reviewed, recommendations are given for organizing the most rational vaccine prevention of pneumococcal infection in patients with chronic kidney disease.

Two vaccines, 23-valent pneumococcal polysaccharide vaccine (PPSV23) and 13-valent pneumococcal conjugate vaccine (PCV13), are widely available for the prevention of pneumococcal disease in adults. However, it is unclear how cost-effective these pneumococcal vaccine choices are in the Hong Kong healthcare environment. We aimed to assess the cost-effectiveness of a sequential administration of PCV13 followed by PPSV23 compared to a single dose of PPSV23 vaccination for pneumococcal disease control in Hong Kong adults aged ≥65 years and individuals aged 20–64 years with immunocompromising and chronic conditions. A previously developed deterministic cohort sequential model was applied to compare the outcomes of two vaccination strategies from a societal perspective. Population-specific model input, including incidence, mortality, case-fatality, risk group distribution, vaccination costs, disease management, and productivity loss, was estimated from a Hong Kong-wide electronic medical database. Costs were valued in US$ in 2017. Vaccination strategies with an incremental cost-effectiveness ratio (ICER, defined as incremental cost per QALY saved) less than one local GDP per capita ($46,193 in 2017) were defined as highly cost-effective. Deterministic sensitivity analyses (SA) were conducted. Compared with single-dose PPSV23, sequential vaccination of PCV13 followed by PPSV23 was cost-saving for adults aged ≥20 years. In the deterministic SA, the base-case results were robust for tested parameter uncertainties. Future vaccination policies should consider the cost-effectiveness of a sequential vaccination strategy as a measure to reduce the vaccine-preventable pneumococcal disease burden in Hong Kong.

The purpose of the research: To investigate clinical and epidemiological features, clinical course and outcomes of pneumococcal meningoencephalitis in children, Streptococcus pneumoniae serotype distribution and their compliance with antigenic composition of existing pneumococcal vaccines, as well as antimicrobial resistance of the pathogen.Research tasks: 1. To characterize the clinical features of pneumococcal meningitis; 2. To study the serotypes and antimicrobial resistance of S. pneumoniae strains isolated from patients with pneumococcal meningitis; 3. To detect the genotypes (ST-types) of S. pneumoniae strains.Materials and Methods: There were 17 patients aged 2-15 years with pneumococcal meningitis under the supervision. DNA isolation of S. pneumoniae was done by «AmpliSens DNA-sorb B» kits (InterLabServise, Russia). Multiplex PCR was used for serotype deduction. S. pneumoniae antimicrobial resistance was investigated by Etest (bioMerieux, France). Statistical analysis was conducted by Microsoft Excel, and included the determination of percentages, averages, and mean deviations.Results: Pneumococci can cause not only meningeal lesions itself, but brain substance damage; it results to secondary severe meningoencephalitis with complicated course (cerebral edema, cerebral coma, and ventriculitis). S. pneumoniae serotypes identified (14, 19F, 3, 7F, 6AB) are common, most often causing meningitis in children and adults. All these serotypes are vaccine-preventable. More than half of isolates revealed penicillin-resistance.Conclusion: Due to complete accordance of S. pneumoniae serotypes detected to those included in widely used 13-valent pneumococcal conjugated vaccine (PCV13), the vaccination should be considered as effective preventive measure. The features of pneumococcal sensitivity to antimicrobials must be considered when prescribing antibiotics.

The article presents an overview of the data of foreign and domestic literature, as well as the authors' own research on the problem of vaccination of the adult population against pneumococcal infection. The need to expand vaccination coverage against adult pneumococcal infection among atrisk populations was identified. The strategy and tactics of vaccination of the adult population against pneumococcal infection have been scientifically justified.

Introduction. Colonization of S.pneumoniae is considered as a factor in the spreading of pneumococcus in the population, and is a predictor of the development of pneumococcal infection. Vaccination against pneumococcal infection can significantly reduce the spread of S.pneumoniae and the number of carriers of invasive strains. The vaccination against pneumococcal infection in the Republic of Kazakhstan was carried out with a phased coverage throughout the country in the framework of the national program «Salamatty Kazakhstan» in 2011. Purpose. To characterize the nasopharyngeal carriage of S.pneumoniae in children under 2 years in two different regions of the country with different histories of immunization against pneumococcal infection. Methods. A prospective multicenter cross-sectional study was conducted in two cities - Almaty and Karaganda - for a two-year period. Nasopharyngeal samples were identified by microbiological and molecular/genetic methods, taking into account the vaccinal status of children. Results: During the study, 500 children from Almaty and 1000 children from Karaganda at the age of 2 years were examined. The prevalence of pneumococcal carriage in the first stage of the study was 15.6% in Almaty and 4.7% in Karaganda. In the second year of the study, the prevalence of pneumococcal carriage was 14.1% in Almaty and 17.6% in Karaganda. The most common serotypes in Almaty before the vaccination were: 13 - 12%, 6ABC - 8%, 15B/C - 8% and 17F - 8%, in Karaganda, where the vaccination was carried out for 2 years: 15V - 19%, 31 - 14, 3%, 38 - 14.3% and non-typed strains - 23.8%. At the second stage of the study, common serotypes in Almaty were: 15A - 11.1%, 39F - 11.1%, 22F - 8.3%, 31 - 8.3% and non-typed strains - 27.8%. The most frequently detected serotypes in Karaganda in 2016 were: 8 - 14.3%, 10F/10C/33C - 10.4%, 15B/C - 9.1% and non-typed strains - 23.4%. Discussion. The received data confirms the necessity of the monitoring measures within the framework of the current anti-pneumococcal vaccination.

Pneumococcal infection strongly contributes to morbidity and mortality in Spain. A total of 253,899 hospitalizations related to pneumococcal infection occurred from 2016 to 2020. Fifty-eight percent were men, the mean age was 67 years old, and the average length of hospitalization was 12.72 days. The annual hospitalization rate was 10.84 hospitalizations per 10,000 population, increasing significantly with age, reaching 65.75 per 10,000 population in those aged >85 years. The hospitalization rates for pneumococcal pneumonia, sepsis, and meningitis were 2.91, 0.12, and 0.08 hospitalizations per 10,000, respectively, and reached the highest value in those aged >85 for pneumococcal pneumonia and sepsis, with 22.29 and 0.71 hospitalizations per 10,000, respectively, and in children up to 1 year old for pneumococcal meningitis, with 0.33 hospitalizations per 10,000. The total number of deaths during the study period was 35,716, with a case-fatality rate of 14.07%. For pneumococcal pneumonia, sepsis, and meningitis, the case-fatality rates were 8.47%, 23.71%, and 9.99%, respectively. The case-fatality rate increased with age and did not vary by sex. The annual cost of these hospitalizations was more than EUR 359 million. There is therefore a high burden of disease and mortality caused by pneumococcal infection in our country, especially in elderly individuals.

Urticarial vasculitis (UV) is a type III hypersensitivity reaction, characterized by immune complex deposition in small vessels leading to complement activation. Hypocomplementemic urticarial vasculitis syndrome (HUVS) represents the most severe form of UV, manifesting as chronic and recurrent urticarial skin lesions with leukocytoclastic vasculitis on histology, hypocomplementemia, anti-C1q antibodies, and systemic organ involvement. This case study focuses on an adolescent who initially presented with invasive pneumococcal infection and was later diagnosed with two rare disorders: HUVS and coexisting complement factor 1 (CF1) deficiency by genotyping. The role of CF1 deficiency in the development of HUVS in this patient is uncertain but has not previously been described., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Lin, Kafisheh and Elder.)

Pneumococcal infection is a leading cause of disability and death globally. The Hong Kong Government has launched two programmes for pneumococcal vaccination - The Vaccination Subsidy Scheme (VSS) and the Government Vaccination Programme (GVP). This study aimed to examine the enabling factors, obstacles and perception of pneumococcal vaccination, and their association with its uptake in a general Chinese population. We performed a population-based, telephone survey in the general public aged 65 or above via simple random sampling. A validated survey based on the Health Belief Model (HBM) was used. Their socio-demographic information; history of previous participation in the GVP or VSS; and self-perceived health status were captured. Binary logistic regression models were constructed to examine the factors independently associated with vaccination. A total of 1,000 respondents were enrolled in the study, with 402 (40.2%) respondents having intention to join the GVP/VSS in 12 months. Respondents with long-term medical consultant and medication (adjusted odds ratios [aOR] = 1.541, 95% confidence interval (CI): 1.008–2.356, p = 0.046); high levels of perceived susceptibility of infections (aOR = 3.624, 95 %CI: 2.318–5.665, p < 0.001); high levels of perceived benefits of vaccine (aOR = 1.699, 95 %CI: 1.153–2.504, p < 0.001); recommendations from government (aOR = 8.025, 95 %CI: 4.771–13.497, p < 0.001) or physicians (aOR = 7.399, 95 %CI: 3.472–15.764, p = 0.008); and high levels of self-efficacy (aOR = 3.045, 95 %CI: 1.458–6.362, p = 0.003) were more likely to have intention to participate in the vaccination programme. The acceptance rate of pneumococcal vaccination programme remained suboptimal in the population. The government and physicians should be involved in the promotion of pneumococcal vaccination and GVP/VSS by increasing perceived benefits and self-efficacy, and reducing barriers towards vaccination among the target population. More studies are required to confirm our findings in other settings. [ABSTRACT FROM AUTHOR]

Objective: To improve pneumococcal vaccination (PV) rates among rheumatology clinic patients on immunosuppressive therapy in the outpatient settings.Methods: This quality improvement project was based on the pre-post intervention design. Phase I of the project targeted patients with rheumatoid arthritis from 13 rheumatology clinics (January 2013-July 2015) on immunosuppressive therapy to receive the pneumococcal polysaccharide vaccine (PPSV23). In the Phase II study (January 2016-October 2017), all patients on immunosuppressive medications regardless of diagnosis were targeted to receive PPSV23 and the pneumococcal conjugate vaccine (PCV13). The best practice alerts (BPAs) for both PVs were developed based on the Centers for Disease Control and Prevention guidelines, which appeared on electronic medical records for eligible patients at the time of assessment by the medical assistant. The BPA was designed to inform the vaccination status and enable the physician to order the PV, or to document refusal or deferral reasons. Education regarding vaccine guidelines, BPAs, vaccination process, and regular feedback of results were important project interventions. The vaccination rates during pre-post intervention for each study phase were compared using chi-square test.Results: During phase I, PPSV23 vaccination rates improved from a 28% preintervention rate to 61.5% (P < 0.0001). During phase II, 77.4% of patients had received either PPSV23, PCV13, or both, compared to 49.6% of patients in the preintervention period (P < 0.0001). The documentation rates (vaccine received, ordered, patient refusal and deferral reasons) increased significantly in both phases.Conclusion: Electronic identification of vaccine eligibility and implementation of BPAs with capabilities to order and document resulted in significantly improved PV rates. The process has potential for self-sustainability and generalizability. [ABSTRACT FROM AUTHOR]

Background Streptococcus pneumoniae is an important pathogen responsible for severe pneumococcal diseases, including pneumonia, bacteraemia/sepsis, and meningitis. Inflammatory bowel disease [IBD] patients have an increased risk for infections due to an altered immune system and treatment with immunosuppressive medications. The aim of this study was to assess the prevalence of severe pneumococcal disease [SPD] and evaluate the impact of pneumococcal vaccination on the risk of SPD in Veterans with IBD. Methods Subjects with IBD and SPD were identified from the VA Health Administration database using ICD9/10 codes. Pneumococcal vaccination and use of immunosuppressant medications were collected. Risk of SPD was evaluated using an adjusted Cox proportional hazards model controlling for demographics, medications, vaccination, and comorbidities. Results A total of 1798 cases of SPD were identified [283 pneumonia, 1513 bacteraemia, and two meningitis]. SPD patients were older [60.9 years vs 59.4 years; p <0.001], had more comorbidities [Charlson Comorbidity Index of 2.11 vs 0.96; p <0.001], and had increased mortality [4.6% vs 1.5%, p <0.001]. The risk of SPD was increased in Crohn's disease (hazard ratio [HR] 1.15; 95% confidence interval [CI] 1.05–1.27) and with more comorbidities [HR 1.45; 95% CI 1.42–1.48]. Use of immunosuppressive medications increased the risk of SPD. Receipt of PCV13 either alone or in combination with PPSV23 predicted a 5-fold decreased risk of SPD compared with no vaccination. Conclusions Risk factors for severe pneumococcal disease include having Crohn's disease, more comorbidities, and exposure to combination immunosuppression. Vaccination with PCV13 alone or in combination with PPSV23 and revaccination with PPSV23, was protective against SPD. All IBD patients should be evaluated for pneumococcal vaccination, particularly those receiving or expected to receive immunosuppressive therapies. [ABSTRACT FROM AUTHOR]

Pneumococcal pneumonia is an important cause of morbidity and mortality among patients with lupus erythematosus. Therefore, a vaccination against pneumococcal infections prior to the immunosuppressive therapy is strongly recommended in these patients. Antimalarials are the standard first‐line systemic therapy for cutaneous lupus erythematosus (CLE). However, as many as 50% of CLE patients can be recalcitrant to this treatment and may require more intense immunosuppressive management such as for example, methotrexate, mycophenolate mofetil or azathioprine. The main aim of the current study was to assess the immunogenicity of the pneumococcal conjugate vaccine (PCV) in patients with CLE receiving hydroxychloroquine (HCQ) for at least 6 months prior to the study entry. Twenty patients with CLE but not systemic lupus erythematosus (SLE) who were receiving HCQ and five age‐ and sex‐matched healthy volunteers were included in this study. All individuals were vaccinated with 13‐valent PCV. Levels of anti‐pneumococcal capsular polysaccharide (anti‐PCP) IgM and IgG antibodies were measured before and 6 weeks after vaccination. Anti‐PCP IgM and IgG levels increased significantly in both CLE and controls upon vaccination (p < 0.0001 and p < 0.05, respectively). Ninety‐five percentage of CLE patients and 80% of healthy volunteers achieved at least 2‐fold increase in levels of anti‐PCP IgG upon vaccination. Vaccination was good tolerated in both groups. The CLE activity score before vaccination was not modified thereafter. Hydroxychloroquine does not impair immune response to PCV13. The time period when patients with CLE are receiving HCQ could be used for immunization before more intense immunosuppressive therapy would be initiated. [ABSTRACT FROM AUTHOR]

Objectives: To assess risk factors for mortality in invasive pneumococcal disease (IPD).Methods: We conducted a systemic literature search in January 2019. The main outcome measure included death within 30 days after diagnosis of IPD. The study protocol was registered in PROSPERO (CRD42019120189).Results: After reviewing 2514 potentially relevant records, remaining 190 articles were included in the analysis. A total of 228,782 IPD patients were identified and the mortality rate was 17.2% in the included articles. No significant evidence of publication bias was found according to the funnel plot and Egger's test (t = 1.464, p = 0.145). Male sex, older age, alcohol abuse, previous tuberculosis, meningitis, hospital acquired infections, multilobar infiltrate or effusion, Pitt bacteremia score≥4, Pneumonia Severity Index≥4, clinical conditions requiring intensive care, underlying clinical conditions, disease caused by serotypes 3, 6B, 9 N, 10A, 11A, 16 F, 17 F, 19, 19 F, 22 F, 23A, 23 F, 31 and 35 F, previous antibiotic use, inappropriate initial antibiotic therapy, penicillin resistance, and vancomycin use during the course of treatment were predicators of 30-day mortality.Conclusions: This meta-analysis highlights important risk factors for IPD-related mortality, many of which may be targeted through preventive measures. [ABSTRACT FROM AUTHOR]

This paper examined whether previously identified community-level factors (high proportion of crowded households and/or persons below the poverty level) remained associated with childhood pneumococcal carriage in the heptavalent pneumococcal conjugate vaccine (PCV7) era. Using logistic regression, individual factors were used to develop base models to which community-level factors were added to evaluate impact on pneumococcal carriage within two paediatric study cohorts from Massachusetts (urban Boston, outside Boston). Six years after introduction of universal childhood PCV7 vaccination, we found no consistent evidence that census tract characteristics (e.g. population size and density, age and race distribution, percent participating in group childcare, parental education, percent lacking in-unit plumbing, poverty, and community stability) affected odds of pneumococcal carriage when added to individual predictors (e.g. younger age, current respiratory tract infections, and attendance in group childcare). How community-level factors influence pneumococcal carriage continues to change in the era of increasing immunization coverage.

Abstract Background Pneumococcus is exposed to a variety of temperature and oxygen levels in the upper respiratory tract and as it invades the lung, tissues, and blood. We sought to determine the effect of environmental variability on growth in vitro and to assess variability between strains. We evaluated the effect of temperature and oxygen on the growth of 256 isolates representing 53 serotypes, recovered from healthy carriers and disease patients. Strains were grown at a range of temperatures, anaerobically or in ambient air with catalase, and were monitored by reading the optical density. Regression models evaluated variation in the characteristics of the growth curves. Results Most isolates grew to the maximal density at low temperatures (~33C) and under aerobic conditions. There was considerable variability between strains, and some of this variability was linked to serotype. However, capsule-switch experiments suggest that the production of different capsules might not be sufficient to explain this variation, suggesting there could be interactions between the capsule and genetic background. Conclusions Pneumococcal strains vary in how they respond to environmental variations, some of this variation can be explained by the capsule type being produced, but capsule production itself is not sufficient to explain the variability. This variability could help to explain why different lineages of pneumococcus are more common in carriage or disease.

The review presents data on the role of respiratory agents in the pathogenesis of exacerbations of bronchial asthma and the impact of vaccination on the clinical course of the disease. The features of the formation of protective immunity in various immunization schemes are analyzed. In patients with bronchial asthma, the substantiation of the vaccination scheme with the advantage of priority administration of conjugated polysaccharide vaccine followed by the introduction of polysaccharide pneumococcal vaccine after 8 weeks is given. It was shown that vaccination against pneumococcal infection resulted in elimination from sputum S. pneumoniae. Influenza vaccination in patients with bronchial asthma reduced the frequency and duration of exacerbations. Combined vaccination against influenza and pneumococcal infections did not reduce the clinical and immunological effect.

Relevance. Bronchial asthma is widespread in the world, according to WHO estimates, 235 million people suffer from it. In Russia, according to official figures, 1.3 million cases of bronchial asthma have been reported. Domestic experts reasonably believe that these data are underestimated at least 4 times. Considering that patients with bronchial asthma undergo significant changes in the immune system and are especially difficult to tolerate respiratory and other infectious diseases, determining the effect of vaccination on the clinical course of bronchial asthma is very important. The purpose of the review is to show how vaccinations against pneumococcal infection and influenza affect the condition of patients with bronchial asthma. Conclusion. Features of formation of protective immunity at various schemes of immunization against pneumococcal infection are analyzed. In patients with bronchial asthma, the justification of the vaccination scheme with the advantage of the priority administration of conjugated polysaccharide vaccine with the subsequent introduction of a polysaccharide pneumococcal vaccine after 8 weeks is given. Vaccination against pneumococcal infections has led to the elimination of sputum S. рneumoniae. In vaccination against pneumococcal infection, there was an improvement in the level of disease control, which was confirmed by the ACQ-5 test-a decrease in the indicator from 2 [1,5;1,8;3] points (lack of asthma control) to 0,6 [0;1] points (asthma control) during the year of observation, p < 0,001. Vaccination against influenza in patients with bronchial asthma leads to a decrease in the frequency and duration of exacerbations, there is a decrease in the level of markers of systemic inflammation. Combined vaccination against influenza and pneumococcal infection is not accompanied by a reliable difference in tolerability in comparison with monovaccination only against pneumococcal infection or influenza.