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Antimicrobial susceptibility and clonality of Streptococcus pneumoniae isolates recovered from invasive disease cases during a period with changes in pneumococcal childhood vaccination, Norway, 2004-2016.
Vaccine. 2020 Jul 22; 38(34):5454-5463.V

Abstract

Changes in pneumococcal antimicrobial resistance (AMR) have been reported following use of pneumococcal conjugate vaccines (PCVs) in childhood vaccination programmes. We describe AMR trends and clonality in Norway during 2004-2016; we studied 10,239 invasive pneumococcal disease (IPD) isolates in terms of serotypes, antimicrobial susceptibility, and for a systematically collected subset of 2473 isolates, multilocus sequence types (ST). The IPD cases were notified to the Norwegian Surveillance System for Communicable Diseases and pneumococcal isolates were collected through the National Reference Laboratory for Pneumococci. The cases are sourced from the entire Norwegian population. We supplemented the IPD isolates with isolates from carriage studies in children attending day-care, performed in 2006 (before mass childhood vaccination with PCV7), 2008 (2 years after PCV7 introduction), 2013 (2 years after the transition to PCV13), and 2015. IPD cases were 0-102 years old; median 64 years. Carriage study participants were typically aged 1-5 years. Overall, AMR was low; a maximum of 7% of IPD isolates were resistant, depending on the antimicrobial. Erythromycin and trimethoprim/sulfamethoxazole resistant IPD (ERY-R and SXT-R, respectively) decreased in the PCV7 period (2006-2010). In the PCV13 period (2011-2016) however, we saw an indication of increased non-susceptibility among IPD isolates. This increase was mainly due to non-vaccine serotypes 15A-ST63 (multidrug resistant), 24F-ST162 (SXT-R), 23B-ST2372 (penicillin non-susceptible and SXT-R) and 33F (ERY-R and clindamycin resistant). Resistant or non-susceptible IPD isolates were often clones introduced into Norway during the study period. The exception was ERY-R isolates; initially, these largely consisted of an established serotype 14-ST9 clone, which disappeared after introducing PCV7. The carriage study results mostly resembled the changes seen in IPD with a maximum of 9% of the participants per study carrying resistant pneumococci. As actual PCVs are not fully limiting AMR, higher-valency vaccines and prudent use of antimicrobials are still needed to temper pneumococcal AMR.

Authors+Show Affiliations

Department of Infection Control and Vaccines, Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway; European Program for Public Health Microbiology Training (EUPHEM), European Centre for Disease Prevention and Control, (ECDC), Stockholm, Sweden.Department of Infection Control and Vaccines, Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.Department of Infection Control and Vaccines, Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway; Department of Community Medicine and Global Health, Faculty of Medicine, University of Oslo, Oslo, Norway.Department of Infection Control and Vaccines, Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway. Electronic address: anneke.steens@fhi.no.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32616324

Citation

Siira, Lotta, et al. "Antimicrobial Susceptibility and Clonality of Streptococcus Pneumoniae Isolates Recovered From Invasive Disease Cases During a Period With Changes in Pneumococcal Childhood Vaccination, Norway, 2004-2016." Vaccine, vol. 38, no. 34, 2020, pp. 5454-5463.
Siira L, Vestrheim DF, Winje BA, et al. Antimicrobial susceptibility and clonality of Streptococcus pneumoniae isolates recovered from invasive disease cases during a period with changes in pneumococcal childhood vaccination, Norway, 2004-2016. Vaccine. 2020;38(34):5454-5463.
Siira, L., Vestrheim, D. F., Winje, B. A., Caugant, D. A., & Steens, A. (2020). Antimicrobial susceptibility and clonality of Streptococcus pneumoniae isolates recovered from invasive disease cases during a period with changes in pneumococcal childhood vaccination, Norway, 2004-2016. Vaccine, 38(34), 5454-5463. https://doi.org/10.1016/j.vaccine.2020.06.040
Siira L, et al. Antimicrobial Susceptibility and Clonality of Streptococcus Pneumoniae Isolates Recovered From Invasive Disease Cases During a Period With Changes in Pneumococcal Childhood Vaccination, Norway, 2004-2016. Vaccine. 2020 Jul 22;38(34):5454-5463. PubMed PMID: 32616324.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Antimicrobial susceptibility and clonality of Streptococcus pneumoniae isolates recovered from invasive disease cases during a period with changes in pneumococcal childhood vaccination, Norway, 2004-2016. AU - Siira,Lotta, AU - Vestrheim,Didrik F, AU - Winje,Brita A, AU - Caugant,Dominique A, AU - Steens,Anneke, Y1 - 2020/06/30/ PY - 2020/01/16/received PY - 2020/05/25/revised PY - 2020/06/15/accepted PY - 2020/7/4/pubmed PY - 2020/7/4/medline PY - 2020/7/4/entrez KW - Antimicrobial resistance KW - Invasive pneumococcal disease KW - Pneumococcal conjugate vaccine KW - Streptococcus pneumoniae KW - Surveillance SP - 5454 EP - 5463 JF - Vaccine JO - Vaccine VL - 38 IS - 34 N2 - Changes in pneumococcal antimicrobial resistance (AMR) have been reported following use of pneumococcal conjugate vaccines (PCVs) in childhood vaccination programmes. We describe AMR trends and clonality in Norway during 2004-2016; we studied 10,239 invasive pneumococcal disease (IPD) isolates in terms of serotypes, antimicrobial susceptibility, and for a systematically collected subset of 2473 isolates, multilocus sequence types (ST). The IPD cases were notified to the Norwegian Surveillance System for Communicable Diseases and pneumococcal isolates were collected through the National Reference Laboratory for Pneumococci. The cases are sourced from the entire Norwegian population. We supplemented the IPD isolates with isolates from carriage studies in children attending day-care, performed in 2006 (before mass childhood vaccination with PCV7), 2008 (2 years after PCV7 introduction), 2013 (2 years after the transition to PCV13), and 2015. IPD cases were 0-102 years old; median 64 years. Carriage study participants were typically aged 1-5 years. Overall, AMR was low; a maximum of 7% of IPD isolates were resistant, depending on the antimicrobial. Erythromycin and trimethoprim/sulfamethoxazole resistant IPD (ERY-R and SXT-R, respectively) decreased in the PCV7 period (2006-2010). In the PCV13 period (2011-2016) however, we saw an indication of increased non-susceptibility among IPD isolates. This increase was mainly due to non-vaccine serotypes 15A-ST63 (multidrug resistant), 24F-ST162 (SXT-R), 23B-ST2372 (penicillin non-susceptible and SXT-R) and 33F (ERY-R and clindamycin resistant). Resistant or non-susceptible IPD isolates were often clones introduced into Norway during the study period. The exception was ERY-R isolates; initially, these largely consisted of an established serotype 14-ST9 clone, which disappeared after introducing PCV7. The carriage study results mostly resembled the changes seen in IPD with a maximum of 9% of the participants per study carrying resistant pneumococci. As actual PCVs are not fully limiting AMR, higher-valency vaccines and prudent use of antimicrobials are still needed to temper pneumococcal AMR. SN - 1873-2518 UR - https://www.unboundmedicine.com/medline/citation/32616324/Antimicrobial_susceptibility_and_clonality_of_Streptococcus_pneumoniae_isolates_recovered_from_invasive_disease_cases_during_a_period_with_changes_in_pneumococcal_childhood_vaccination,_Norway,_2004-2016 L2 - https://linkinghub.elsevier.com/retrieve/pii/S0264-410X(20)30826-4 DB - PRIME DP - Unbound Medicine ER -
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