Epidemiology and Infection
Volume 142 – Issue 12 – December 2014
http://journals.cambridge.org/action/displayIssue?jid=HYG&tab=currentissue

Review Articles
Pneumococcal and meningococcal infection
A review of the evidence to inform pneumococcal vaccine recommendations for risk groups aged 2 years and older
A. STEENSa1a2 c1, D. F. VESTRHEIMa1, I. S. AABERGEa1, B. S. WIKLUNDa1, J. STORSAETERa1, M. A. RIISE BERGSAKERa1, K. RØNNINGa1 and E. FURUSETHa1
a1 Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway
a2 European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
SUMMARY
For decades, vaccination with the 23-valent polysaccharide pneumococcal vaccine (PPV23) has been available for risk groups aged ≥2 years to prevent invasive pneumococcal disease (IPD). Recently, a 13-valent pneumococcal conjugated vaccine (PCV13) has been licensed for use in all age groups. PCV13 may induce better protection than PPV23 because of different immunogenic properties. This called for a revision of vaccine recommendations for risk groups. We therefore reviewed literature on risk groups for IPD, and effectiveness and safety of pneumococcal vaccines and supplemented that with information from public health institutes, expert consultations and data on IPD epidemiology. We included 187 articles. We discuss the implications of the heterogenic vulnerability for IPD within and between risk groups, large indirect effects of childhood immunization, and limited knowledge on additional clinical benefits of PCV13 in combination with PPV23 for the Norwegian recommendations. These are now step-wise and consider the need for vaccination, choice of pneumococcal vaccines, and re-vaccination interval by risk group.

Original Papers
Pneumococcal and meningococcal infection
The effect of distance on observed mortality, childhood pneumonia and vaccine efficacy in rural Gambia
S. M. A. ZAMANa1 c1, J. COXa2, G. C. ENWEREa1, C. BOTTOMLEYa3, B. M. GREENWOODa2 and F. T. CUTTSa1
a1 Medical Research Council Unit, Banjul, The Gambia
a2 Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
a3 Medical Research Council Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
SUMMARY
We investigated whether straight-line distance from residential compounds to healthcare facilities influenced mortality, the incidence of pneumonia and vaccine efficacy against pneumonia in rural Gambia. Clinical surveillance for pneumonia was conducted on 6938 children living in the catchment areas of the two largest healthcare facilities. Deaths were monitored by three-monthly home visits. Children living >5 km from the two largest healthcare facilities had a 2•78 [95% confidence interval (CI) 1•74–4•43] times higher risk of all-cause mortality compared to children living within 2 km of these facilities. The observed rate of clinical and radiological pneumonia was lower in children living >5 km from these facilities compared to those living within 2 km [rate ratios 0•65 (95% CI 0•57–0•73) and 0•74 (95% CI 0•55–0•98), respectively]. There was no association between distance and estimated pneumococcal vaccine efficacy. Geographical access to healthcare services is an important determinant of survival and pneumonia in children in rural Gambia.

Short Reports
Hepatitis
Hepatitis B vaccination for healthcare personnel in American Samoa: pre-implementation survey for policy decision
K. N. LYa1 c1, H. ROBERTSa1, R. E. WILLIAMSa1, Y. MASUNU-FALEAFAGAa2, J. DROBENIUCa1, S. KAMILIa1 and E. H. TESHALEa1
a1 Division of Viral Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA, USA
a2 American Samoa Immunization Program, American Samoa Department of Health, Pago Pago, American Samoa
SUMMARY
American Samoa does not have a hepatitis B vaccination policy for healthcare personnel (HCP). Consequently, hepatitis B has remained a health threat to HCP. In this study, we performed a cross-sectional study and examined demographic and risk information and hepatitis B vaccination, testing, and serostatus in hospital employees in American Samoa. Of 604 hospital employees, 231 (38•2%) participated, and of these, 158 (68•4%) were HCP. Of HCP participants, 1•9% had chronic hepatitis B infection, 36•1% were susceptible, and 60•8% were immune. Nearly half of HCP participants reported history of needlestick injury. Overall, participants’ knowledge of their hepatitis B infection and vaccination status was low. These data support the adoption of a hepatitis B vaccination policy for HCP by American Samoa, as currently recommended by the World Health Organization and the US Centers for Disease Control and Prevention. Adherence to the policy could be monitored as a way to measure protection.