Browsing by Author "Ramirez, M"
Now showing 1 - 5 of 5
Results Per Page
Sort Options
- Decreasing Incidence and Changes in Serotype Distribution of Invasive Pneumococcal Disease in Persons Aged Under 18 Years Since Introduction of 10-Valent and 13-Valent Conjugate Vaccines in Portugal, July 2008 to June 2012Publication . Aguiar, SI; Brito, MJ; Horacio, AN; Lopes, JP; Ramirez, M; Melo-Cristino, JThe 10-valent pneumococcal conjugate vaccine (PCV10) became available in Portugal in mid-2009 and the 13-valent vaccine (PCV13) in early 2010. The incidence of invasive pneumococcal disease (IPD) in patients aged under 18 years decreased from 8.19 cases per 100,000 in 2008–09 to 4.52/100,000 in 2011–12. However, IPD incidence due to the serotypes included in the 7-valent conjugate vaccine (PCV7) in children aged under two years remained constant. This fall resulted from significant decreases in the number of cases due to: (i) the additional serotypes included in PCV10 and PCV13 (1, 5, 7F; from 37.6% to 20.6%), particularly serotype 1 in older children; and (ii) the additional serotypes included in PCV13 (3, 6A, 19A; from 31.6% to 16.2%), particularly serotype 19A in younger children. The decrease in serotype 19A before vaccination indicates that it was not triggered by PCV13 administration. The decrease of serotype 1 in all groups, concomitant with the introduction of PCV10, is also unlikely to have been triggered by vaccination, although PCVs may have intensified and supported these trends. PCV13 serotypes remain major causes of IPD, accounting for 63.2% of isolates recovered in Portugal in 2011–12, highlighting the potential role of enhanced vaccination in reducing paediatric IPD in Portugal.
- Dominance of Vaccine Serotypes in Pediatric Invasive Pneumococcal Infections in Portugal (2012-2015)Publication . Silva-Costa, C; Brito, MJ; Aguiar, SI; Lopes, JP; Ramirez, M; Melo-Cristino, JWe evaluated the impact of continued 13-valent pneumococcal conjugate vaccine (PCV13) use in the private market (uptake of 61%) in pediatric invasive pneumococcal disease (pIPD) in Portugal (2012-2015). The most frequently detected serotypes were: 3 (n = 32, 13.8%), 14 (n = 23, 9.9%), 1 (n = 23, 9.9%), 7F (n = 15, 6.4%), 19A (n = 13, 5.6%), 6B and 15B/C (both n = 12, 5.2%), and 24F, 10A and 12B (all with n = 10, 4.3%). Taken together, non-PCV13 serotypes were responsible for 42.2% of pIPD with a known serotype. The use of PCR to detect and serotype pneumococci in both pleural and cerebrospinal fluid samples contributed to 18.1% (n = 47) of all pIPD. Serotype 3 was mostly detected by PCR (n = 21/32, 65.6%) and resulted from a relevant number of vaccine failures. The incidence of pIPD varied in the different age groups but without a clear trend. There were no obvious declines of the incidence of pIPD due to serotypes included in any of the PCVs, and PCV13 serotypes still accounted for the majority of pIPD (57.8%). Our study indicates that a higher vaccination uptake may be necessary to realize the full benefits of PCVs, even after 15 years of moderate use, and highlights the importance of using molecular methods in pIPD surveillance, since these can lead to substantially increased case ascertainment and identification of particular serotypes as causes of pIPD.
- Falência Vacinal na Doença Invasiva Pneumocócica DIP). Reportar e Investigar. Que Devemos Fazer a Seguir?Publication . Marujo, F; Costa, C; Ramirez, M; Melo Cristino, J; Brito, MJIntrodução: A vacina conjugada pneumococica 13-valente (VCP13V) foi comercializada em Portugal em 2010 e introduzida no PNV em Junho de 2015. As falências vacinais não põem em causa a eficácia global da vacina, mas devem ser reportadas e investigadas. Objetivos: Avaliar atitudes clínicas face a falências vacinais da VCP13V. Métodos: Estudo retrospetivo, observacional e descritivo, de 2016 a 2018, de doentes com falência vacinal internados num hospital terciário. Identificaram-se serotipos e estado vacinal de acordo com o grupo etário e procedimentos realizados. Resultados: Total de 8 casos, com mediana de 24 meses (máx 5A; mín 12M) sendo 7/8 crianças com menos de 5 anos de idade. Os serotipos implicados foram: 3 (7) e 19A (1). Em 4/8 casos ocorreu co-infecção viral. Os diagnósticos foram pneumonia (7) e meningite (1). Ocorreram complicações em 7/8 doentes: empiema (4), derrame pleural (2), pneumotórax (2), fístula pleural (1) e cerebrite (1). Necessitaram de cuidados intensivos 7/8, drenagem torácica 6/8e ventilação mecânica 4/8 crianças. A duração do internamento foi 22 dias. Foram notificadas no Sistema Nacional de Vigilância Epidemiológica (SINAVE) 5/8 casos e reportados à Autoridade Nacional do Medicamento e Produtos de Saúde, no portal de RAM (Reação Adversa Medicamentosa) do Infarmed e fabricante 4/8 casos. O seguimento hospitalar foi realizado (média 13 meses) para exclusão de deficit de imunidade em 7/8 doentes, identificando-se diminuição de anticorpos vacinais em dois e diminuição das células B de memória em um caso. Conclusão: A investigação e a notificação das falências vacinais DIP não é realizada de forma sistemática e devidamente notificada, pelo que importa sensibilizar para os procedimentos face a este evento.
- Serotype 3 Remains the Leading Cause of Invasive Pneumococcal Disease in Adults in Portugal (2012-2014) Despite Continued Reductions in Other 13-Valent Conjugate Vaccine SerotypesPublication . Horácio, A; Silva-Costa, C; Lopes, J; Ramirez, M; Melo-Cristino, J; Portuguese Group for the Study of Streptococcal InfectionsSince 2010 the 13-valent pneumococcal conjugate vaccine (PCV13) replaced the 7-valent vaccine (PCV7) as the leading pneumococcal vaccine used in children through the private sector. Although, neither of the PCVs were used significantly in adults, changes in adult invasive pneumococcal disease (IPD) were expected due to herd protection. We characterized n = 1163 isolates recovered from IPD in adults in 2012-2014 with the goal of documenting possible changes in serotype prevalence and antimicrobial resistance. Among the 54 different serotypes detected, the most frequent, accounting for half of all IPD, were serotypes: 3 (14%), 8 (11%), 19A (7%), 22F (7%), 14 (6%), and 7F (5%). The proportion of IPD caused by PCV7 serotypes remained stable during the study period (14%), but was smaller than in the previous period (19% in 2009-2011, p = 0.003). The proportion of IPD caused by PCV13 serotypes decreased from 51% in 2012 to 38% in 2014 (p < 0.001), mainly due to decreases in serotypes 7F and 19A. However, PCV13 serotype 3 remained relatively stable and the most frequent cause of adult IPD. Non-PCV13 serotypes continued the increase initiated in the late post-PCV7 period, with serotypes 8 and 22F being the most important emerging serotypes. Serotype 15A increased in 2012-2014 (0.7% to 3.5%, p = 0.011) and was strongly associated with antimicrobial resistance. However, the decreases in resistant isolates among serotypes 14 and 19A led to an overall decrease in penicillin non-susceptibility (from 17 to 13%, p = 0.174) and erythromycin resistance (from 19 to 13%, p = 0.034). Introduction of PCV13 in the NIP for children, as well as its availability for adults may further alter the serotypes causing IPD in adults in Portugal and lead to changes in the proportion of resistant isolates.
- Sustained Increase of Paediatric Invasive Streptococcus Pyogenes Infections Dominated by M1UK and Diverse Emm12 isolates, Portugal, September 2022 to May 2023Publication . Gouveia, C; Bajanca-Lavado, MP; Mamede, R; Araújo Carvalho, A; Rodrigues, F; Melo-Cristino, J; Ramirez, M; Friães, Aince autumn 2022, observed numbers of paediatric invasive group A Streptococcus infections in Portugal (n = 89) were higher than in pre-COVID-19 seasons. Between September 2022 and May 2023, the dominant diagnoses were pneumonia (25/79), mostly with empyema (20/25), and sepsis (22/79). A number of cases required admission to intensive care (27/79) and surgery (35/79), and the case fatality rate was 5.1% (4/79). Genomic sequencing (n = 55) revealed multiple genetic lineages, dominated by the M1UK sublineage (26/55) and more diverse emm12 isolates (12/55).