[News article] Vaccination leads to decline in pneumococcal disease and antibiotic resistance | Daily Science News

Vaccination leads to decline in pneumococcal disease and antibiotic resistance | Daily Science News.

Wits University and the National Institute for Communicable Diseases (NICD) released a new study, led by Wits academics, showing rates of invasive pneumococcal disease (IPD) – including cases caused by antibiotic resistant bacteria – have fallen substantially in South Africa following the introduction of a pneumococcal conjugate vaccine (PCV) in 2009.

The release of the results of the study coincides with World Pneumonia Day, commemorated annually on 12 November.

The study, titled: Effects of Vaccination on Invasive Pneumococcal Disease in South Africa, published in the latest edition of the New England Journal of Medicine (NEJM), compares IPD incidence after the introduction of PCV (post-introduction: 2011 and 2012) to incidence prior to its introduction (2005-2008), focusing on high-risk groups.

Although the majority of childhood pneumococcal deaths occur in Africa, evidence of the potential impact of pneumococcal vaccines in routine use has largely been drawn from high-income countries. However, two recent publications from South Africa have demonstrated PCVs to be effective in preventing pneumococcal disease among South African children, in conditions of routine vaccine use.

“The results show that the vaccine works as rolled out in our immunization program and this supports the hard work of our national and provincial Departments of Health. However, much still remains to be done in South Africa, other countries in Africa and elsewhere to prevent children from developing and dying from pneumonia,”said Dr Anne von Gottberg, lead author of the paper, Clinical Microbiologist, Head of the Centre for Respiratory Diseases and Meningitis at the NICD and Associate Professor in the School of Pathology at Wits.

This study demonstrates significant declines in pneumococcal disease cases caused by bacteria resistant to one or more antibiotics, a phenomenon of growing concern among health professionals. In fact, the rate of infections resistant to two different antibiotics declined nearly twice as much as infections that could be treated with antibiotics. This proportionately greater effect of vaccination on antibiotic-resistant strains points to a very valuable added benefit of immunization.

“These are very compelling results,” said Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance, a Geneva-based global health organization that part-funded the research. “Not only does it add significant weight to the growing body of evidence that PCV prevents disease, but it suggests that vaccines may have a role to play in the fight against antibiotic resistance.”

“Vaccination is one of the most effective and underappreciated tools available to reduce antibiotic resistance. The majority of resistant strains of pneumococcus are of types which are included in the vaccine, for this reason, vaccine introduction in South Africa, has led to a substantial decline in antibiotic resistant invasive pneumococcal disease,” said Dr Cheryl Cohen, co-author of the paper, Clinical Epidemiologist at the NICD and senior lecturer in the School of Public Health at Wits.

In 2009, South Africa became the first African country – and the first nation in the world with a high HIV prevalence – to introduce PCV7 into its routine immunization program. The current study shows a significant decline in IPD in children and in unvaccinated adults, which demonstrates the indirect protection conferred by herd immunity. Among children under two years of age, overall incidence of IPD declined nearly 70% after PCV introduction, and rates of IPD caused by bacteria specifically targeted by the vaccine plummeted nearly 90%.

A recent study published by the researchers in the Pediatric Infectious Disease Journal found that the risk of IPD in South African children increased with HIV exposure, as well as with underlying medical conditions, malnutrition, tuberculosis, upper-respiratory tract infections and exposure to other children.

“We have shown that HIV-infected and HIV-exposed children experience a disproportionate burden of pneumococcal disease. The vaccine has also been shown to be highly effective in HIV-exposed children and disease reductions have been observed in both HIV-infected and uninfected children,” said Dr Claire von Mollendorf, a medical epidemiologist from the NICD. “This study reinforces what the scientific community has known – that the pneumococcal vaccine saves lives.”

Although incidence of HIV among infants is decreasing in South Africa due to improved prevention of the mother-to-child HIV transmission and the use of anti-retrovirals, a large number of HIV-exposed yet uninfected children remain, for whom vaccination against pneumococcal disease may be of particular importance to ensuring reduced risk of life-threatening infections in childhood.

Source: University of the Witwatersrand

by Taboola

Patient Safety Materials at Healthy Roads Media

HealthyRoads Media contains free patient and consumer health information in a variety of formats and languages.

It has recently added a set of patient safety materials adapted from guides created by SHEA (Society for Healthcare Epidemiology of America)
and partners and the development support was provided by Inova Fairfax Hospital.

The materials are in English (Spanish coming soon) and  are available as handouts, web-videos and downloadable mobile videos.

The  topics covered are

• Catheter-Associated Bloodstream Infections
• Catheter-Associated Urinary Tract Infections
• Clostridium Difficile
• MRSA
• Surgical Site Infections
• Vancomycin Resistant Enterococcus
• Ventilator Associated Pneumonia

Related link

Healthy Roads Media – A source of quality health information in many languages and multiple formats

 

 

Blacks Readmitted to Hospital More Than Whites: Study

Blacks Readmitted to Hospital More Than Whites: Study
Return rates even higher for hospitals serving mostly minority patients, research shows

From the February 15, 2011 Health Day news item

TUESDAY, Feb. 15 (HealthDay News) — After leaving the hospital for treatment of three common conditions, older black people are more likely to be readmitted within 30 days than older white people, a new study finds.

Overall, older blacks have 13 percent greater odds of being readmitted to the hospital, recent research suggests, while patients treated at hospitals that primarily serve minority populations have 23 percent greater odds of readmission within 30 days.

“There are significant racial disparities in readmission rates in this country,” said the study’s lead author, Dr. Karen Joynt, a health policy fellow at the Harvard School of Public Health in Boston.

“We found that both race and site of care mattered. The next step is to find out why this disparity exists,” she said.

And, she noted, no matter what the race, about 20 percent of people discharged from the hospital are readmitted within 30 days, which suggests that there are gaps in care that need to be identified and addressed.

“Hospital discharge is a really vulnerable time. Going home from the hospital often requires medication changes, diet changes and lifestyle changes. Even in the best case scenario, one in five is being readmitted,” she said.

Because readmissions are so common, reducing the rate of readmission is a focus in health-care policy. Previous studies have suggested that racial disparities may play a role in readmission rates, but the evidence was inconclusive, according to background information in Joynt’s study.

Using national Medicare data that included more than 3 million hospital discharges for heart attack, congestive heart failure and pneumonia, the researchers compared the rate of readmissions for blacks and for whites. To conform with other research, the researchers considered any non-black patients as white, which means that Hispanics, Asians and Native Americans were placed in the white category for this study.

The researchers also looked at the data by hospital, and whether or not a hospital was primarily a minority-serving hospital.

Of the 3 million plus discharges, 276,681 (8.7 percent) were for black patients, and 2,886,330 (91.3 percent) were for white patients. About 40 percent of the black patients and 6 percent of white patients received care at hospitals that primarily served minorities.

The average age of the patients was mid-70s to early 80s, depending on the condition. There were slightly more women included in this study than men.

Overall, readmission rates were 24.8 percent for blacks and 22.6 percent for whites, which means black patients have 13 percent greater odds of readmission within 30 days after discharge, according to the study.

Among those who had been admitted for heart attack, black patients from minority-serving hospitals had the highest readmission rates — 26.4 percent, according to the study. That translated to 35 percent greater odds of readmission for this group.

The results of the study are published in the Feb. 16 issue of the Journal of the American Medical Association.***

Joynt said this study wasn’t able to tease out the reasons that these disparities exist, but said that less access to transitional care may play a role. She said that other research has shown that good follow-up care after a hospital discharge can make a difference in readmission rates.

“The biggest take-away from this study is that currently, hospital readmission is a major problem in the U.S., and we need better solutions to help prevent readmission,” said the co-author of an editorial in the same issue of the journal, Dr. Adrian Hernandez, an associate professor of medicine at Duke University School of Medicine in Durham, N.C.

“This was an excellent study that raises important questions. How can we get a process in place that strengthens the support received after discharge? How do we get resources that will enable hospitals to reach beyond their doors to provide services and support to vulnerable populations?” he said.

SOURCES: Karen Joynt, M.D., M.P.H., health policy fellow, Harvard School of Public Health, and cardiology fellow, Brigham and Women’s Hospital, Boston; Adrian Hernandez, M.D., M.H.S., associate professor, medicine, Duke University School of Medicine, Durham, N.C.; Feb. 16, 2011, Journal of the American Medical Association***

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Prevent Pneumonia

Excerpts from the American Lung Association Web page

Can Pneumonia be Prevented?

Yes.

Get a flu shot every year to prevent seasonal influenza. The flu is a common cause of pneumonia, so preventing the flu is a good way to prevent pneumonia!
Get vaccinated against pneumococcal pneumonia if you are at high risk of getting this type of pneumonia.
——————
Be aware of your general health!

Since pneumonia often follows respiratory infections, be aware of any symptoms that linger more than a few days.
Good health habits—a healthy diet, rest, regular exercise, etc.—help you from getting viruses and respiratory illnesses. They also help promote fast recovery when you do get a cold, the flu or other respiratory illness.