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Decline in Pneumococcal Nasopharyngeal Carriage of Vaccine Serotypes After the Introduction of the 13-Valent Pneumococcal Conjugate Vaccine in Children in Atlanta, Georgia.
Pediatr Infect Dis J. 2015 Nov; 34(11):1168-74.PI

Abstract

BACKGROUND

Streptococcus pneumoniae (SP) serotype distribution among nasopharyngeal (NP) carriage isolates changed significantly after the introduction of the 7-valent pneumococcal conjugate vaccine (PCV7). We evaluated the impact on NP carriage and invasive disease of SP after the introduction of the 13-valent PCV (PCV13) in March 2010.

METHODS

NP swabs were collected from children 6-59 months of age in an emergency department from July 2010 to June 2013. After broth enrichment, samples were cultured for SP and isolates were serotyped. Clinical and immunization records were reviewed. Findings during 6 sequential 6-month study periods were compared. Surveillance isolates of invasive disease isolates were reviewed.

RESULTS

A total of 2048 children were enrolled, and 656 (32%) were SP carriers. Mean age of carriers was 27 months, 54% were males. Carriage was higher among day-care attendees (P < 0.01) and children with respiratory tract illnesses (P < 0.5) and otitis media (P < 0.01). Commonly carried serotypes included 35B (15.2%), 15B/C (14.2%), 19A (9.6%), 11A (8%), 23B (5.6%), 6C (5.3%), 21 (5%), and 15A (5%); 13.9% were PCV13 serotypes. The proportion of children with SP carriage remained stable but the serotype distribution changed during the study period. Among carriers, PCV13 serotypes declined from 29% (36/124) to 3% (3/99; P < 0.0001), predominantly because of decline of serotype 19A from 25.8% (32/124) to 3% (3/99; P < 0.0001); non-PCV13 serotypes (excluding 6C) increased from 68.4% (78/114) to 97% (95/98; P < 0.0001); serotype 35B significantly increased from 8.9% (11/124) to 25.3% (25/99; P < 0.05). Nonsusceptibility to ceftriaxone declined from 22.6% (28/124) to 0% (0/99; P < 0.0001), with a similar decline in penicillin nonsusceptibility.

CONCLUSIONS

Introduction of PCV13 for universal infant use was associated with significant reductions in nasopharyngeal carriage of PCV13 serotypes and resistant strains. Carriage of non-PCV13 serotypes increased modestly, particularly serotype 35B. Further investigation is warranted to determine whether nonvaccine pneumococcal serotypes carried in the nasopharynx are associated with significant replacement disease.

Authors+Show Affiliations

From the *Emory University School of Medicine, Atlanta, Georgia; †Children's Healthcare of Atlanta, Atlanta, Georgia; ‡Women and Children's Hospital of Buffalo, University at Buffalo, The State University of New York, Buffalo, New York; §Georgia Emerging Infections Program, Atlanta, Georgia; ¶Veterans Affairs Medical Center, Atlanta, Georgia; and ‖Division of Bacterial Diseases, Respiratory Diseases Branch, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia. Ankita P. Desai, MD is currently at the Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26226445

Citation

Desai, Ankita P., et al. "Decline in Pneumococcal Nasopharyngeal Carriage of Vaccine Serotypes After the Introduction of the 13-Valent Pneumococcal Conjugate Vaccine in Children in Atlanta, Georgia." The Pediatric Infectious Disease Journal, vol. 34, no. 11, 2015, pp. 1168-74.
Desai AP, Sharma D, Crispell EK, et al. Decline in Pneumococcal Nasopharyngeal Carriage of Vaccine Serotypes After the Introduction of the 13-Valent Pneumococcal Conjugate Vaccine in Children in Atlanta, Georgia. Pediatr Infect Dis J. 2015;34(11):1168-74.
Desai, A. P., Sharma, D., Crispell, E. K., Baughman, W., Thomas, S., Tunali, A., Sherwood, L., Zmitrovich, A., Jerris, R., Satola, S. W., Beall, B., Moore, M. R., Jain, S., & Farley, M. M. (2015). Decline in Pneumococcal Nasopharyngeal Carriage of Vaccine Serotypes After the Introduction of the 13-Valent Pneumococcal Conjugate Vaccine in Children in Atlanta, Georgia. The Pediatric Infectious Disease Journal, 34(11), 1168-74. https://doi.org/10.1097/INF.0000000000000849
Desai AP, et al. Decline in Pneumococcal Nasopharyngeal Carriage of Vaccine Serotypes After the Introduction of the 13-Valent Pneumococcal Conjugate Vaccine in Children in Atlanta, Georgia. Pediatr Infect Dis J. 2015;34(11):1168-74. PubMed PMID: 26226445.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Decline in Pneumococcal Nasopharyngeal Carriage of Vaccine Serotypes After the Introduction of the 13-Valent Pneumococcal Conjugate Vaccine in Children in Atlanta, Georgia. AU - Desai,Ankita P, AU - Sharma,Dolly, AU - Crispell,Emily K, AU - Baughman,Wendy, AU - Thomas,Stepy, AU - Tunali,Amy, AU - Sherwood,Logan, AU - Zmitrovich,April, AU - Jerris,Robert, AU - Satola,Sarah W, AU - Beall,Bernard, AU - Moore,Matthew R, AU - Jain,Shabnam, AU - Farley,Monica M, PY - 2015/7/31/entrez PY - 2015/8/1/pubmed PY - 2016/7/15/medline SP - 1168 EP - 74 JF - The Pediatric infectious disease journal JO - Pediatr Infect Dis J VL - 34 IS - 11 N2 - BACKGROUND: Streptococcus pneumoniae (SP) serotype distribution among nasopharyngeal (NP) carriage isolates changed significantly after the introduction of the 7-valent pneumococcal conjugate vaccine (PCV7). We evaluated the impact on NP carriage and invasive disease of SP after the introduction of the 13-valent PCV (PCV13) in March 2010. METHODS: NP swabs were collected from children 6-59 months of age in an emergency department from July 2010 to June 2013. After broth enrichment, samples were cultured for SP and isolates were serotyped. Clinical and immunization records were reviewed. Findings during 6 sequential 6-month study periods were compared. Surveillance isolates of invasive disease isolates were reviewed. RESULTS: A total of 2048 children were enrolled, and 656 (32%) were SP carriers. Mean age of carriers was 27 months, 54% were males. Carriage was higher among day-care attendees (P < 0.01) and children with respiratory tract illnesses (P < 0.5) and otitis media (P < 0.01). Commonly carried serotypes included 35B (15.2%), 15B/C (14.2%), 19A (9.6%), 11A (8%), 23B (5.6%), 6C (5.3%), 21 (5%), and 15A (5%); 13.9% were PCV13 serotypes. The proportion of children with SP carriage remained stable but the serotype distribution changed during the study period. Among carriers, PCV13 serotypes declined from 29% (36/124) to 3% (3/99; P < 0.0001), predominantly because of decline of serotype 19A from 25.8% (32/124) to 3% (3/99; P < 0.0001); non-PCV13 serotypes (excluding 6C) increased from 68.4% (78/114) to 97% (95/98; P < 0.0001); serotype 35B significantly increased from 8.9% (11/124) to 25.3% (25/99; P < 0.05). Nonsusceptibility to ceftriaxone declined from 22.6% (28/124) to 0% (0/99; P < 0.0001), with a similar decline in penicillin nonsusceptibility. CONCLUSIONS: Introduction of PCV13 for universal infant use was associated with significant reductions in nasopharyngeal carriage of PCV13 serotypes and resistant strains. Carriage of non-PCV13 serotypes increased modestly, particularly serotype 35B. Further investigation is warranted to determine whether nonvaccine pneumococcal serotypes carried in the nasopharynx are associated with significant replacement disease. SN - 1532-0987 UR - https://www.unboundmedicine.com/medline/citation/26226445/Decline_in_Pneumococcal_Nasopharyngeal_Carriage_of_Vaccine_Serotypes_After_the_Introduction_of_the_13_Valent_Pneumococcal_Conjugate_Vaccine_in_Children_in_Atlanta_Georgia_ L2 - https://doi.org/10.1097/INF.0000000000000849 DB - PRIME DP - Unbound Medicine ER -