Every year in Poland there are about a thousand cases of invasive pneumococcal disease, which is the most severe form of pneumococcal infection. Due to its severe mileage, it can even be fatal. How to protect yourself from falling ill – explains Magdalena Mrożek-Gąsiorowska, an expert in the field of medical technology assessment from Pracownia HTA and an assistant from the Institute of Public Health of the Jagiellonian University Collegium Medicum.
Invasive pneumococcal disease (IPD) – that sounds scary. What is it about?
It is the most severe form of pneumococcal infection (Streptococcus pneumoniae, the most common and one of the most dangerous human bacterial pathogens). It includes pneumonia with bacteremia, meningitis, and sepsis. May be fatal. It is also associated with a high risk of complications such as hearing loss, deafness, changes in the lungs or heart, neurological symptoms, and profound impairment. Compared to other pneumococcal events, IPD is relatively rare. Diseases such as upper and lower respiratory tract inflammation, including otitis media, sinusitis and bronchitis, and pneumonia without bacteraemia are much more common.
What is the epidemiological situation in Poland regarding pneumococci?
The number of pneumococcal infections in Poland is still underestimated, both in terms of invasive and non-invasive forms. Monitoring of, among others invasive pneumococcal infections are dealt with by the National Reference Center for the Diagnostics of Bacterial Infections of the Central Nervous System (KOROUN) and the National Institute of Public Health – National Institute of Hygiene (NIZP-PZH). Based on the data of these centers, it can be concluded that currently over a thousand cases of invasive pneumococcal infections are detected annually.
As I mentioned, non-invasive infections are more common than invasive forms. Their number is also not known exactly. It is estimated that in Poland at least several thousand people suffer from pneumococcal pneumonia every year, and tens of thousands of people suffer from otitis media every year.
Pneumococcal infection is most dangerous for children under the age of two who still have an immature immune system, and for the elderly, who experience a decline in immunity with age.
What is our pneumococcal vaccination program?
In the current Protective Immunization Program (PSO), as well as the one for 2020, vaccination against invasive Streptococcus pneumoniae infections is included in the list of compulsory vaccinations in the general population of children born after December 31, 2016, as well as in the population of people with the so-called risk group, as well as on the list of recommended vaccinations (e.g. older children and adults over 50 years of age).
Compulsory vaccinations are financed from public funds and are carried out with vaccines purchased by the Minister of Health, intended for the implementation of PSO in a given group of children. The selection of a medicinal product for use under compulsory immunization is based on the results of public procurement conducted by the Public Procurement Department at the Minister of Health.
In 2017–2019, compulsory vaccinations in the general population of children were carried out and are currently the 10-valent conjugate vaccine. Based on the NIPH-NIH data, it is estimated that the vaccination rate is high, over 94%. for the year of children born in 2017. Data for 2018 also show that the program is implemented as planned and accepted by both parents and doctors.
The Polish PSO, as in most EU countries, does not indicate a specific vaccine to be administered to children as part of vaccination in the general population. Vaccines are selected on the basis of tendering procedures based on criteria prepared by local experts. We have countries that have opted for the 10-valent vaccine, the 13-valent vaccine, or both. There are countries that have decided to switch from the 13-valent vaccine to the 10-valent vaccine and vice versa …
Is the Polish childhood immunization program effective?
The effectiveness of vaccination against pneumococci has been proven in many countries. Numerous scientific reports have shown that the introduction of a general pneumococcal vaccination program reduces the incidence of IPD in children under the age of five, regardless of differences in programs (including differences in the type of vaccine or vaccination schedule) and the epidemiological situation in a given country (e.g. distribution of serotypes).
Universal vaccination against pneumococci in children was introduced in Poland only in 2017. The impact of vaccination in a given country is assessed within the framework of observational studies or the assessment of data from epidemiological surveillance, in our case data from KOROUN and / or NIPH-NIH. The KOROUN data, based on the voluntary shipment of biological material by hospitals, could indicate an increase in the number of IPD cases in the entire population in recent years. For example, these data show that in 2017 material was sent from 870 IPD cases, while in 2018 – from 1037 total IPD cases. Therefore, it might seem that the incidence of IPD is increasing. However, as KOROUN himself emphasizes, often after the introduction of vaccinations, “an apparent one is observed
It is worth noting that the KOROUN data present the overall number of IPD cases in the population and in particular age groups, but without being linked to the information on whether people who became infected were vaccinated and, if so, with which vaccine or not. Over 90 percent isolates flowing into KOROUN come from patients over 5 years of age, and mostly from older adults. IPC detection rates in Poland, based on the number of sent isolates, are much lower than in countries that have active epidemiological surveillance and have a vaccination program for many, often over 10 years.
What are the challenges we face in connection with WHO’s recommendations in this regard?
The 2019 WHO guidelines indicate that both available pneumococcal conjugate vaccines are effective and can be used in a childhood immunization program. There are no studies directly comparing the two medicinal products to show any possible differences in overall disease burden reduction.
WHO also indicates that when choosing a given medicinal product in a specific country, one should take into account, inter alia, epidemiological situation, as well as access to a given vaccine and its price, affecting cost effectiveness. For this reason, it is necessary to improve the epidemiological surveillance carried out in Poland. KOROUN data, presenting, inter alia, distribution of serotypes, only information from voluntarily reported cases of IPD is taken into account. Therefore, appropriate changes are necessary that will allow for active epidemiological surveillance and legal regulations that oblige microbiological testing and reporting all cases of IPC in our country.
Also read:
- Pneumonia – a disease from which thousands of Poles die
- Bacteria are becoming more and more dangerous. It wasn’t that bad yet
- NIK: pneumococcal vaccines for over half a million have been wasted
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