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Burden of Disease

Burden of Disease

Description of the DiseaseGlobal EpidemiologyIndian EpidemiologyPneumococcal Disease and InfluenzaChallenges

Risk Factors
 

Risk Factors

Secondary Infections
​​​​​​​

Secondary Infections

Mechanism of Action
​​​​​​​

Mechanism of Action

Prevention of Pneumococcal Disease
 

Polysaccharide VaccineConjugate VaccineDifference

Need for Pneumococcal Vaccination

In ElderlyIn India

Cost-effectiveness of PCV13
 

NeedIndian StudiesGlobal Studies

Legacy of Prevenar
 

ManufacturingCRM197Activation and ConjugationPneumococcal Disease and InfluenzaDistributionVideos

Safety
 

Safety

Conclusion
 

Conclusion
Dosing

Dosing
 

Adults ≥18 Years of AgeAdults ≥50 Years of AgeCOVID VaccinationFlu Vaccination
Efficacy

Prevenar 13® Clinical Experience
 

IntroductionClinical Trials

Efficacy of Prevenar 13®
 

IntroductionStudyObjectiveMethodologyCriteriaResultsConclusion

Effectiveness of Prevenar 13® 
 

IntroductionObjectiveMethodologyAnalysisResultsLimitationsLearningsConclusion

Indian Clinical Trials
 

IntroductionStudy DesignResultsLimitationsConclusion
Recommendations for Use

Recommendations for Use
 

ACIP 2019NCCN 2020RSSDI 2020IMA GuidelinesIAOH Guidelines for Working AdultsClinical Practice Guidelines 2019 (ICS/NCCP)The Geriatric Society of India, 2015Indian Society of Nephrology
FAQs

PCV13 in Pulmonology
 

RoleComplicationsClinical DataRecommendations

PCV13 in Nephrology
 

RoleClinical DataRecommendations

PCV13 in Oncology
 

RoleClinical DataRecommendations

PCV13 in Rheumatology
 

RoleComplicationsDataRecommendationsConsensus

PCV13 in Diabetes
 

RoleComplicationsDataRecommendations

PCV13 in HIV Infection
 

RoleBurdenPulmonary InfectionDataEfficacyRecommendations

PCV13 in Cardiology
 

RoleBurdenComplicationsDataRecommendations
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Indian Epidemiology

Indian Epidemiology

Across various studies that have identified the aetiology of CAP in adults in India, S. pneumoniae has been identified as the most common causative pathogen accounting for about 30% to 55% of cases (where diagnosis was possible).1-6 
​​​​​A systematic review and meta-analysis evaluated the contribution of S. pneumoniae in the causation of CAP infection in the Indian population. This study revealed that approximately one-fifth of the Indian adult population with CAP had S. pneumoniae infection. Therefore, this study further validated the notion that S. pneumoniae is the leading causative organism of CAP in the Indian adult population and is responsible for a significant burden of CAP in India.

Age Association and Percentage of S. pneumoniae in CAP in the Indian Adult Population1-6 


In a 10-year retrospective study of community-acquired acute bacterial meningitis in India, S. pneumoniae accounted for >60% of cases in adults.8 According to the IBIS study, the CFR in IPD has been found to be the highest in adults aged above 50 years (28%) in India.9 A prospective 15-year  hospital surveillance in adults also documented similar CFR (30.2% in patients aged 50-60 years and 26.1% in patients aged >60 years).10 A single-centre study from India including 72 consecutive CAP patients, evaluated the prognostic factors and clinical profile of CAP, with emphasis on the elderly patients. This study reported that the mortality from CAP in the elderly patients aged ≥50 years (35%) was significantly higher (P = 0.04) than in adults aged <50 years (14%).1

Increasing Mortality Due to CAP With Advancing Age: India1

​​​​​​​Adapted from Dey AB, et al. 1997.
​​​​​​​

As observed by Dey AB, et al in a study on 72 adult patients hospitalised for CAP in India, adults aged ≥50 years had a 2.5-fold higher rate of mortality due to CAP than compared to adults aged <50 years.1

In a surveillance study between 2007 and 2011 conducted at the Christian Medical College, Vellore, PCV13 and PPSV23 provided serotype coverage of 77% and 83%, respectively, in adults aged ≥60 years.11

IPDs continue to be a major global concern of illness and death. The at-risk patients for pneumococcal diseases are adults aged over 50 years and younger adults with specific chronic health conditions.12

A previous prospective surveillance study of IPD in individuals aged >18 years across 7 centres in India between 1993 and 2008 assessed the seroepidemiology among older adults who were admitted to hospitals. A total of 1037 subjects with suspected invasive bacterial infection were enrolled in the study. S. pneumoniae was identified in 43.3% of patients recruited in the study. The most common clinical conditions associated with IPD were pneumonia (33.9%) and meningitis (34.3%). Across all the age groups, 25% to 30% CFR was observed.10

A recent laboratory-based surveillance study from a tertiary care hospital in South India investigated the epidemiology of IPD and the prevalent serotypes in Indian adults aged >18 years between January 2007 and July 2017. Out of the total 408 IPD cases studied, the overall CFR was 17.8%. In individuals aged ≥66 years, the CFR was highest, that is, 34.9%. Although the CFR in the overall study population (17.8%) was lower than the previously reported Indian rates (25%-30%), the CFR in older individuals aged ≥66 years was higher than that reported between 1993 and 2008 (26%), thereby raising a concern. The most common clinical conditions associated with IPD were pneumonia (39%), meningitis (24.3%) and septicaemia (18.4%). The serotype data obtained from this study helped in the accurate estimation of PCV13 and PPSV23 protective coverage against IPD-causing serotypes in India. The coverage of PCV13 and PPSV23 was 58.7% and 67.4%, respectively. This study also evaluated the pattern of AMR in Indian adults.13 

Expected Coverage of PCV13 and PPSV23 for IPD Isolates From Indian Adults Aged >18 Years, Between January 2007 and July 201713

    

Adapted from Jayaraman R, et al. 2019.

Increasing Mortality Due to CAP With Advancing Age: India1

   

ACIP, Advisory Committee on Immunization Practices; AMR, antimicrobial resistance; CAP, community-acquired pneumonia; CFR, case fatality rate; IBIS, Intensive Blood Pressure Intervention in Stroke; IPD, invasive pneumococcal disease; PCV, pneumococcal conjugate vaccine; PCV13, 13-valent pneumococcal conjugate vaccine; PPSV23, 23-valent pneumococcal polysaccharide vaccine.

  

References:  

Dey AB, Nagarkar KM, Kumar V. Clinical presentation and predictors of outcome in adult patients with community-acquired pneumonia. Natl Med J India. 1997;10(4):169-172.Shah AN, Shah VV, Patel MN, et al. Cefepime as a monotherapy for empiric treatment of hospitalized patients with community-acquired pneumonia. J Assoc Physicians India. 2003;51:1286.Bansal S, Kashyap S, Pal LS, Goel A. Clinical and bacteriological profile of community acquired pneumonia in Shimla, Himachal Pradesh. Indian J Chest Dis Allied Sci. 2004;46(1):17-22.
Capoor MR, Nair D, Aggarwal P, Gupta B. Rapid diagnosis of community-acquired pneumonia using the BacT/Alert 3D system. Braz J Infect Dis. 2006;10(5):352-356.
Abdullah BB, Zoheb M, Ashraf SM, Ali S, Nausheen N. A study of community-acquired pneumonias in elderly individuals in Bijapur, India. ISRN Pulmonol. 2012; 2012: 10 pages. doi:10.5402/2012/936790.
Oberoi A, Aggarwal A. Bacteriological profile, serology and antibiotic sensitivity pattern of micro-organisms from community acquired pneumonia. JK Sci. 2006;8(2):79-82.
Ghia CJ, Dhar R, Koul PA, Rambhad G, Fletcher MA. Streptococcus pneumoniae as a cause of community-acquired pneumonia in Indian adolescents and adults: a systematic review and meta-analysis. Clin Med Insights Circ Respir Pulm Med. 2019;13:1179548419862790.
Mani R, Pradhan S, Nagarathna S, Chandramuki A. Bacteriological profile of community acquired acute bacterial meningitis: a ten-year retrospective study in a tertiary neurocare centre in South India. Indian J Med Microbiol. 2007;25(2):108-114.IBIS. Prospective multicentre hospital surveillance of Streptococcus pneumoniae disease in India. Invasive Bacterial Infection Surveillance (IBIS) Group, International Clinical Epidemiology Network (INCLEN). Lancet. 1999;353(9160):1216-1221.Thomas K, Kesavan LM, Veeraraghavan B, et al; IBIS Study Group IndiaCLEN Network. Invasive pneumococcal disease associated with high case fatality in India. J Clin Epidemiol. 2013;66(1):36-43.
Molander V, Elisson C, Balaji V, et al. Invasive pneumococcal infections in Vellore, India: clinical characteristics and distribution of serotypes. BMC Infect Dis. 2013;13:532.
Bonnave C, Mertens D, Peetermans W, et al. Adult vaccination for pneumococcal disease: a comparison of the national guidelines in Europe. Eur J Clin Microbiol Infect Dis. 2019;38(4):785-791.
Jayaraman R, Varghese R, Kumar JL, et al. Invasive pneumococcal disease in Indian adults: 11 years’ experience. J Microbiol Immunol Infect. 2019;52(5):736-742.​​​​​​​

   

Please click the Prescribing Information link to view the safety and adverse events information of Prevenar 13®.
For the use only of Registered Medical Practitioners or a Hospital or a Laboratory.

   

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Burden of Disease


Dosing

Help protect your adult patients against pneumococcal pneumonia with single-dose administration

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Efficacy

Efficacy proven by the CAPiTA study

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Recommendations for Use

The ACIP recommends routine use of PCV13 among adults

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