Decreasing case fatality rate following invasive pneumococcal disease, North East England, 2006–2016

C. Houseman; K. E. Chapman; P. Manley; Russell Gorton; D. Wilson; G. J. Hughes

doi:10.1017/S0950268819000657

Decreasing case fatality rate following invasive pneumococcal disease, North East England, 2006–2016

C. Houseman, K. E. Chapman, P. Manley, Russell Gorton, D. Wilson, G. J. Hughes^*

^*Corresponding author for this work

Field Epidemiology (YH)

Research output: Contribution to journal › Article › peer-review

16 Citations (Scopus)

Abstract

Declining mortality following invasive pneumococcal disease (IPD) has been observed concurrent with a reduced incidence due to effective pneumococcal conjugate vaccines. However, with IPD now increasing due to serotype replacement, we undertook a statistical analysis to estimate the trend in all-cause 30-day case fatality rate (CFR) in the North East of England (NEE) following IPD. Clinical, microbiological and demographic data were obtained for all laboratory-confirmed IPD cases (April 2006–March 2016) and the adjusted association between CFR and epidemiological year estimated using logistic regression. Of the 2510 episodes of IPD included in the analysis, 486 died within 30 days of IPD (CFR 19%). Increasing age, male sex, a diagnosis of septicaemia, being in ≥1 clinical risk groups, alcohol abuse and individual serotypes were independently associated with increased CFR. A significant decline in CFR over time was observed following adjustment for these significant predictors (adjusted odds ratio 0.93, 95% confidence interval 0.89–0.98; P = 0.003). A small but significant decline in 30-day all-cause CFR following IPD has been observed in the NEE. Nonetheless, certain population groups remain at increased risk of dying following IPD. Despite the introduction of effective vaccines, further strategies to reduce the ongoing burden of mortality from IPD are needed.

Original language	English
Article number	e175
Journal	Epidemiology and Infection
Volume	147
DOIs	https://doi.org/10.1017/S0950268819000657
Publication status	Published - 2019

Bibliographical note

Funding Information:
We thank the Public Health England North East Health Protection Team for their participation in IPD enhanced surveillance, the Public Health England Respiratory and Vaccine Preventable Bacteria Reference Unit for providing serotype results, all North East National Health Service microbiology laboratories for reporting cases of IPD, teams from primary care and acute National Health Service trusts across NEE for providing enhanced surveillance and Nick Hinton for undertaking linkage to death data. This work was supported by a grant from the Health Protection Agency Strategic Research and Development Fund, April 2009?March 2012; an unrestricted educational grant from Sanofi Pasteur MSD (UK12C1036), April 2012?June 2014; and an unrestricted grant from Pfizer UK Ltd (WI194024), August 2015. The funders had no role in the study design, data collection and analysis or manuscript preparation.

Funding Information:
Financial support. This work was supported by a grant from the Health Protection Agency Strategic Research and Development Fund, April 2009– March 2012; an unrestricted educational grant from Sanofi Pasteur MSD (UK12C1036), April 2012–June 2014; and an unrestricted grant from Pfizer UK Ltd (WI194024), August 2015. The funders had no role in the study design, data collection and analysis or manuscript preparation.

Publisher Copyright:
© The Author(s) 2019.

Keywords

Case fatality rate
Invasive pneumococcal disease
Mortality
Pneumococcal infection
Pneumococcal vaccine
Streptococcus pneumoniae

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1017/S0950268819000657

Cite this

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title = "Decreasing case fatality rate following invasive pneumococcal disease, North East England, 2006–2016",

abstract = "Declining mortality following invasive pneumococcal disease (IPD) has been observed concurrent with a reduced incidence due to effective pneumococcal conjugate vaccines. However, with IPD now increasing due to serotype replacement, we undertook a statistical analysis to estimate the trend in all-cause 30-day case fatality rate (CFR) in the North East of England (NEE) following IPD. Clinical, microbiological and demographic data were obtained for all laboratory-confirmed IPD cases (April 2006–March 2016) and the adjusted association between CFR and epidemiological year estimated using logistic regression. Of the 2510 episodes of IPD included in the analysis, 486 died within 30 days of IPD (CFR 19%). Increasing age, male sex, a diagnosis of septicaemia, being in ≥1 clinical risk groups, alcohol abuse and individual serotypes were independently associated with increased CFR. A significant decline in CFR over time was observed following adjustment for these significant predictors (adjusted odds ratio 0.93, 95% confidence interval 0.89–0.98; P = 0.003). A small but significant decline in 30-day all-cause CFR following IPD has been observed in the NEE. Nonetheless, certain population groups remain at increased risk of dying following IPD. Despite the introduction of effective vaccines, further strategies to reduce the ongoing burden of mortality from IPD are needed.",

keywords = "Case fatality rate, Invasive pneumococcal disease, Mortality, Pneumococcal infection, Pneumococcal vaccine, Streptococcus pneumoniae",

author = "C. Houseman and Chapman, {K. E.} and P. Manley and Russell Gorton and D. Wilson and Hughes, {G. J.}",

note = "Funding Information: We thank the Public Health England North East Health Protection Team for their participation in IPD enhanced surveillance, the Public Health England Respiratory and Vaccine Preventable Bacteria Reference Unit for providing serotype results, all North East National Health Service microbiology laboratories for reporting cases of IPD, teams from primary care and acute National Health Service trusts across NEE for providing enhanced surveillance and Nick Hinton for undertaking linkage to death data. This work was supported by a grant from the Health Protection Agency Strategic Research and Development Fund, April 2009?March 2012; an unrestricted educational grant from Sanofi Pasteur MSD (UK12C1036), April 2012?June 2014; and an unrestricted grant from Pfizer UK Ltd (WI194024), August 2015. The funders had no role in the study design, data collection and analysis or manuscript preparation. Funding Information: Financial support. This work was supported by a grant from the Health Protection Agency Strategic Research and Development Fund, April 2009– March 2012; an unrestricted educational grant from Sanofi Pasteur MSD (UK12C1036), April 2012–June 2014; and an unrestricted grant from Pfizer UK Ltd (WI194024), August 2015. The funders had no role in the study design, data collection and analysis or manuscript preparation. Publisher Copyright: {\textcopyright} The Author(s) 2019.",

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language = "English",

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journal = "Epidemiology and Infection",

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AU - Chapman, K. E.

AU - Manley, P.

AU - Gorton, Russell

AU - Wilson, D.

AU - Hughes, G. J.

N1 - Funding Information: We thank the Public Health England North East Health Protection Team for their participation in IPD enhanced surveillance, the Public Health England Respiratory and Vaccine Preventable Bacteria Reference Unit for providing serotype results, all North East National Health Service microbiology laboratories for reporting cases of IPD, teams from primary care and acute National Health Service trusts across NEE for providing enhanced surveillance and Nick Hinton for undertaking linkage to death data. This work was supported by a grant from the Health Protection Agency Strategic Research and Development Fund, April 2009?March 2012; an unrestricted educational grant from Sanofi Pasteur MSD (UK12C1036), April 2012?June 2014; and an unrestricted grant from Pfizer UK Ltd (WI194024), August 2015. The funders had no role in the study design, data collection and analysis or manuscript preparation. Funding Information: Financial support. This work was supported by a grant from the Health Protection Agency Strategic Research and Development Fund, April 2009– March 2012; an unrestricted educational grant from Sanofi Pasteur MSD (UK12C1036), April 2012–June 2014; and an unrestricted grant from Pfizer UK Ltd (WI194024), August 2015. The funders had no role in the study design, data collection and analysis or manuscript preparation. Publisher Copyright: © The Author(s) 2019.

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N2 - Declining mortality following invasive pneumococcal disease (IPD) has been observed concurrent with a reduced incidence due to effective pneumococcal conjugate vaccines. However, with IPD now increasing due to serotype replacement, we undertook a statistical analysis to estimate the trend in all-cause 30-day case fatality rate (CFR) in the North East of England (NEE) following IPD. Clinical, microbiological and demographic data were obtained for all laboratory-confirmed IPD cases (April 2006–March 2016) and the adjusted association between CFR and epidemiological year estimated using logistic regression. Of the 2510 episodes of IPD included in the analysis, 486 died within 30 days of IPD (CFR 19%). Increasing age, male sex, a diagnosis of septicaemia, being in ≥1 clinical risk groups, alcohol abuse and individual serotypes were independently associated with increased CFR. A significant decline in CFR over time was observed following adjustment for these significant predictors (adjusted odds ratio 0.93, 95% confidence interval 0.89–0.98; P = 0.003). A small but significant decline in 30-day all-cause CFR following IPD has been observed in the NEE. Nonetheless, certain population groups remain at increased risk of dying following IPD. Despite the introduction of effective vaccines, further strategies to reduce the ongoing burden of mortality from IPD are needed.

AB - Declining mortality following invasive pneumococcal disease (IPD) has been observed concurrent with a reduced incidence due to effective pneumococcal conjugate vaccines. However, with IPD now increasing due to serotype replacement, we undertook a statistical analysis to estimate the trend in all-cause 30-day case fatality rate (CFR) in the North East of England (NEE) following IPD. Clinical, microbiological and demographic data were obtained for all laboratory-confirmed IPD cases (April 2006–March 2016) and the adjusted association between CFR and epidemiological year estimated using logistic regression. Of the 2510 episodes of IPD included in the analysis, 486 died within 30 days of IPD (CFR 19%). Increasing age, male sex, a diagnosis of septicaemia, being in ≥1 clinical risk groups, alcohol abuse and individual serotypes were independently associated with increased CFR. A significant decline in CFR over time was observed following adjustment for these significant predictors (adjusted odds ratio 0.93, 95% confidence interval 0.89–0.98; P = 0.003). A small but significant decline in 30-day all-cause CFR following IPD has been observed in the NEE. Nonetheless, certain population groups remain at increased risk of dying following IPD. Despite the introduction of effective vaccines, further strategies to reduce the ongoing burden of mortality from IPD are needed.

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KW - Mortality

KW - Pneumococcal infection

KW - Pneumococcal vaccine

KW - Streptococcus pneumoniae

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JO - Epidemiology and Infection

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ER -

Decreasing case fatality rate following invasive pneumococcal disease, North East England, 2006–2016

Abstract

Bibliographical note

Keywords

UN SDGs

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