Local outbreak of Streptococcus pneumoniae serotype 12F caused high morbidity and mortality among children and adults

Abstract

Pneumococcal serotype replacement is an important issue after the introduction of pneumococcal conjugate vaccine (PCV) in children. After the introduction of 13-valent PCV, the incidence of invasive pneumococcal diseases (IPD) caused by Streptococcus pneumoniae serotype 12F (Sp12F) have increased in some countries; however, an outbreak of Sp12F has not reported in the post-13-valent PCV era. We experienced a local outbreak of Sp12F during March through May 2016 in Tsuruoka city, Japan after the introduction of 13-valent PCV in 2013. The IPD patients were two children and seven adults, three of whom died with a rapid disease progress. Although the clear transmission route was not determined, eight of the nine patients (89%) had close contact with children, which suggests that transmitted colonisation of Sp12F among children and adults might be the source of transmission. Continuous monitoring of IPDs, along with the determination of pneumococcal serotypes, is warranted in the post-13-valent PCV era. New IPD control strategies may be needed if this fatal outbreak continues to occur.

Epidemiological and clinical features of invasive pneumococcal disease caused by serotype 12F in adults, Japan

“…MLST analysis of a total of 120 isolates of serotype 12F demonstrated that they belonged to four STs: ST4846 (n = 71), ST6945 (n = 46), ST14306 (n = 2), and ST13063 (n = 1). A local outbreak of 12F IPD was transiently observed among children and adults in Tsuruoka city, Yamagata Prefecture, from March to May, 2016 [16]. No cluster of 12F IPD cases was identified in any institution in these areas, suggesting that disease transmission occurred in the community setting.…”

“…pneumoniae serotype 12F is rarely found among colonizing isolates, but causes invasive disease in children and adults [6, 8]. Furthermore, serotype 12F is known to cause outbreaks in some institutions [9, 10] and community settings [11–16]. A high attack rate and a short duration of carriage, which were characteristics for serogroups of highly invasive disease potential, were confirmed in serotype 12F among children [5].…”

Current situation and need for prevention of invasive pneumococcal disease and pneumococcal pneumonia in 6- to 64-year-olds in Japan

“…According to our systematic literature review, major IPD serotypes were 3 and 19A (PCV13 serotypes); 10A, 12F, and 22F (PPSV23-PCV13 serotypes); and 6C, 15A, 23A, 24F, and 35B (non-PCV13/PPSV23 serotypes) and major PP serotypes were 3 and 19A (PCV13 serotypes); 10A and 15B (PPSV23-PCV13 serotypes); and 15A and 35B (non-PCV13/PPSV23 serotypes) after the PCV13 introduction era in Japan. Among them, serotype 12F was reported as the outbreak serotype [39,40,59], and 15A and 35B were reported as the drug-resistant serotypes [58].…”

“…Another study reported a total of 122/506 (24.1%) deaths within 28 days (<50 years, 5; 50e64 years, 18; 65e79 years, 51; 80 years, 48 deaths), including 40/92 deaths in patients on mechanical ventilation [28]. Among patients with IPD caused by serotype 12F, 3/9 (33.3%) deaths were reported in the age range of 1 year 4 monthse89 years [39]. On the other hand, according to the nationwide surveillance, the mortality rate of 12F IPD (17/120; 14.2%) was significantly lower than that of non-12F IPD (205/1157; 17.7%) [40].…”

Complete Genome Sequence of a Sequence Type 4846 Streptococcus pneumoniae Serotype 12F Strain Isolated from a Meningitis Case in Japan

“…In 2016, we experienced a community cluster IPD episode caused by serotype 12F S. pneumoniae—9 episodes occurred from March to May 2016 in Tsuruoka City, Japan (7). The isolates were confirmed to be S.…”