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Streptococcus pneumoniae colonization after introduction of 13-valent pneumococcal conjugate vaccine for US adults 65 years of age and older, 2015-2016.
Vaccine. 2019 02 14; 37(8):1094-1100.V

Abstract

BACKGROUND

Vaccination of children with 13-valent pneumococcal conjugate vaccine (PCV13) led to declines in vaccine-type pneumococcal nasopharyngeal carriage among adults through indirect effects. In August 2014, PCV13 immunization of all U.S. adults ≥65 years of age was recommended. This study sought to define prevalence and serotype distribution of pneumococcal carriage among adults ≥65 years of age and to describe risk factors for colonization soon after introduction of PCV13 in adults.

METHODS

A cross-sectional survey of non-institutionalized U.S. adults ≥65 years of age was conducted in four states in 2015-2016. Demographic information, risk factors for disease, PCV13 vaccination history, and nasopharyngeal (NP) and oropharyngeal (OP) swabs were collected. NP and OP swabs were processed separately and pneumococcal isolates were serotyped by Quellung reaction. Antimicrobial susceptibility of pneumococcal isolates was performed. NP swabs also underwent real-time PCR for pneumococcal detection and serotyping.

RESULTS

Of 2989 participants, 45.3% (1354/2989) had been vaccinated with PCV13. Fifty-five (1.8%) carried pneumococcus (45 identified by culture and 10 by real-time PCR only) and PCV13 serotypes were found in eight (0.3%) participants. Almost half (22/45) of pneumococcal isolates were not susceptible to at least one of the antibiotics tested. Vaccine-type carriage among vaccinated and unvaccinated individuals was similar (0.2% vs. 0.1%, respectively). Respiratory symptoms were associated with higher odds of pneumococcal colonization (adjusted OR: 2.1; 95% CI = 1.1-3.8).

CONCLUSIONS

Pneumococcal carriage among non-institutionalized adults ≥65 years of age was very low. Less than 0.5% of both vaccinated and unvaccinated individuals in our study carried vaccine-type serotypes. Over a decade of PCV vaccination of children likely led to indirect effects in adults. However, given the low vaccine-type carriage rates we observed in an already high PCV13 adult coverage setting, it is difficult to attribute our findings to the direct versus indirect effects of PCV13 on adult carriage.

Authors+Show Affiliations

Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Atlanta, Georgia. Electronic address: wii7@cdc.gov.Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Atlanta, Georgia.Emory University School of Medicine, Department of Medicine, Atlanta, Georgia; Hope Clinic of the Emory Vaccine Center, Emory University, Decatur, Georgia.University of Rochester School of Medicine and Dentistry, Department of Medicine, Rochester, New York.Vanderbilt University Medical Center, Nashville, Tennessee.Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.Emory University School of Medicine, Department of Medicine, Atlanta, Georgia; Atlanta Veterans Affairs Medical Center, Atlanta, Georgia.Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine.Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Atlanta, Georgia.Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Atlanta, Georgia. Electronic address: flessa@cdc.gov.No affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

30685247

Citation

Milucky, Jennifer, et al. "Streptococcus Pneumoniae Colonization After Introduction of 13-valent Pneumococcal Conjugate Vaccine for US Adults 65 Years of Age and Older, 2015-2016." Vaccine, vol. 37, no. 8, 2019, pp. 1094-1100.
Milucky J, Carvalho MG, Rouphael N, et al. Streptococcus pneumoniae colonization after introduction of 13-valent pneumococcal conjugate vaccine for US adults 65 years of age and older, 2015-2016. Vaccine. 2019;37(8):1094-1100.
Milucky, J., Carvalho, M. G., Rouphael, N., Bennett, N. M., Talbot, H. K., Harrison, L. H., Farley, M. M., Walston, J., Pimenta, F., & Lessa, F. C. (2019). Streptococcus pneumoniae colonization after introduction of 13-valent pneumococcal conjugate vaccine for US adults 65 years of age and older, 2015-2016. Vaccine, 37(8), 1094-1100. https://doi.org/10.1016/j.vaccine.2018.12.075
Milucky J, et al. Streptococcus Pneumoniae Colonization After Introduction of 13-valent Pneumococcal Conjugate Vaccine for US Adults 65 Years of Age and Older, 2015-2016. Vaccine. 2019 02 14;37(8):1094-1100. PubMed PMID: 30685247.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Streptococcus pneumoniae colonization after introduction of 13-valent pneumococcal conjugate vaccine for US adults 65 years of age and older, 2015-2016. AU - Milucky,Jennifer, AU - Carvalho,Maria de Gloria, AU - Rouphael,Nadine, AU - Bennett,Nancy M, AU - Talbot,H Keipp, AU - Harrison,Lee H, AU - Farley,Monica M, AU - Walston,Jeremy, AU - Pimenta,Fabiana, AU - Lessa,Fernanda C, AU - ,, Y1 - 2019/01/23/ PY - 2018/11/19/received PY - 2018/12/20/revised PY - 2018/12/24/accepted PY - 2019/1/28/pubmed PY - 2020/7/2/medline PY - 2019/1/28/entrez KW - Older adults KW - PCV13 KW - Pneumococcal carriage KW - Pneumococcal conjugate vaccine KW - Streptococcus pneumoniae SP - 1094 EP - 1100 JF - Vaccine JO - Vaccine VL - 37 IS - 8 N2 - BACKGROUND: Vaccination of children with 13-valent pneumococcal conjugate vaccine (PCV13) led to declines in vaccine-type pneumococcal nasopharyngeal carriage among adults through indirect effects. In August 2014, PCV13 immunization of all U.S. adults ≥65 years of age was recommended. This study sought to define prevalence and serotype distribution of pneumococcal carriage among adults ≥65 years of age and to describe risk factors for colonization soon after introduction of PCV13 in adults. METHODS: A cross-sectional survey of non-institutionalized U.S. adults ≥65 years of age was conducted in four states in 2015-2016. Demographic information, risk factors for disease, PCV13 vaccination history, and nasopharyngeal (NP) and oropharyngeal (OP) swabs were collected. NP and OP swabs were processed separately and pneumococcal isolates were serotyped by Quellung reaction. Antimicrobial susceptibility of pneumococcal isolates was performed. NP swabs also underwent real-time PCR for pneumococcal detection and serotyping. RESULTS: Of 2989 participants, 45.3% (1354/2989) had been vaccinated with PCV13. Fifty-five (1.8%) carried pneumococcus (45 identified by culture and 10 by real-time PCR only) and PCV13 serotypes were found in eight (0.3%) participants. Almost half (22/45) of pneumococcal isolates were not susceptible to at least one of the antibiotics tested. Vaccine-type carriage among vaccinated and unvaccinated individuals was similar (0.2% vs. 0.1%, respectively). Respiratory symptoms were associated with higher odds of pneumococcal colonization (adjusted OR: 2.1; 95% CI = 1.1-3.8). CONCLUSIONS: Pneumococcal carriage among non-institutionalized adults ≥65 years of age was very low. Less than 0.5% of both vaccinated and unvaccinated individuals in our study carried vaccine-type serotypes. Over a decade of PCV vaccination of children likely led to indirect effects in adults. However, given the low vaccine-type carriage rates we observed in an already high PCV13 adult coverage setting, it is difficult to attribute our findings to the direct versus indirect effects of PCV13 on adult carriage. SN - 1873-2518 UR - https://www.unboundmedicine.com/medline/citation/30685247/Streptococcus_pneumoniae_colonization_after_introduction_of_13_valent_pneumococcal_conjugate_vaccine_for_US_adults_65_years_of_age_and_older_2015_2016_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0264-410X(19)30070-2 DB - PRIME DP - Unbound Medicine ER -