Decline in Pneumococcal Nasopharyngeal Carriage of Vaccine Serotypes After the Introduction of the 13-Valent Pneumococcal Conjugate Vaccine in Children in Atlanta, Georgia

Desai, Ankita P; Sharma, Dolly; Crispell, Emily K.; Baughman, Wendy; Thomas, Stepy; Tunali, Amy; Sherwood, Logan K.; Zmitrovich, April; Jerris, Robert; Satola, Sarah W.; Beall, Bernard; Moore, Matthew R.; Jain, Shabnam; Farley, Monica M.

doi:10.1097/inf.0000000000000849

Cited by 108 publications

(107 citation statements)

References 19 publications

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“…The high sensitivity of this UAD assay allows for the possibility that it will also detect small amounts of polysaccharide antigen in urine as a result of carriage as well as disease. Pneumococcal carriage rates in children range from 30% to 86%, with higher rates in lower-income countries (65)(66)(67)(68)(69)(70)(71)(72), and studies have found positive BinaxNOW results in healthy children carrying pneumococci in their nasal pharynges (24)(25)(26)(27). Adult carriage rates are much lower than those of children; carriage in the United Kingdom is predicted to be approximately 3.4% (66).…”

Section: Discussionmentioning

confidence: 99%

Development of an Extended-Specificity Multiplex Immunoassay for Detection of Streptococcus pneumoniae Serotype-Specific Antigen in Urine by Use of Human Monoclonal Antibodies

Eletu

Sheppard

Thomas

et al. 2017

Clin Vaccine Immunol

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Current pneumococcal vaccines cover the 10 to 23 most common serotypes of the 92 presently described. However, with the increased usage of pneumococcal-serotype-based vaccines, the risk of serotype replacement and an increase in disease caused by nonvaccine serotypes remains. Serotype surveillance of pneumococcal infections relies heavily on culture techniques, which are known to be insensitive, particularly in cases of noninvasive disease. Pneumococcal-serotypespecific urine assays offer an alternative method of serotyping for both invasive and noninvasive disease. However, the assays described previously cover mainly conjugate vaccine serotypes, give little information about circulating nonvaccine serotypes, and are currently available only in one or two specialist laboratories. Our laboratory has developed a Luminex-based extended-range antigen capture assay to detect pneumococcal-serotype-specific antigens in urine samples. The assay targets 24 distinct serotypes/serogroups plus the cell wall polysaccharide (CWP) and some cross-reactive serotypes. We report that the assay is capable of detecting all the targeted serotypes and the CWP at 0.1 ng/ml, while some serotypes are detected at concentrations as low as 0.3 pg/ml. The analytical serotype specificity was determined to be 98.4% using a panel of polysaccharide-negative urine specimens spiked with nonpneumococcal bacterial antigens. We also report clinical sensitivities of 96.2% and specificities of 89.9% established using a panel of urine specimens from patients diagnosed with community-acquired pneumonia or pneumococcal disease. This assay can be extended for testing other clinical samples and has the potential to greatly improve serotype-specific surveillance in the many cases of pneumococcal disease in which a culture is never obtained.KEYWORDS diagnostics, immunization, monoclonal antibodies, pneumococcus, surveillance studies D espite being vaccine preventable, Streptococcus pneumoniae (pneumococcus) remains a major cause of morbidity and mortality worldwide. Pneumococcal disease (PD) includes both invasive and noninvasive disease. The former includes bacteremia and meningitis; the latter, nonbacteremic pneumonia, sinusitis, and acute otitis media. To date, 97 "serotypes" of pneumococcus have been reported (1); however, some of these show only genotypic differences and produce the same polysaccharide structures (2). Ninety-two serotypes are currently described by the Danish system using commercial typing sera from SSI Diagnostica AG (Hillerød, Denmark). These serotypes differ in

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Section: Discussionmentioning

confidence: 99%

Development of an Extended-Specificity Multiplex Immunoassay for Detection of Streptococcus pneumoniae Serotype-Specific Antigen in Urine by Use of Human Monoclonal Antibodies

Eletu

Sheppard

Thomas

et al. 2017

Clin Vaccine Immunol

View full text Add to dashboard Cite

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“…23 A recent US study showed 15% and 14% of pneumococcal isolates from the nasopharynx of 656 children in Atlanta were 35B and 15B/C, respectively. 35 Serotypes 35B and 15B/C have also been identified as increasing causes of IPD. Adult pneumococcal surveillance data are limited, however, between 2009 and 2012, Mendes observed an increase in prevalence of pneumococcal infections in hospitalized adults in the US due to serotypes 15B/C from 2.7% to 6.3% and 35B from 3.6% to 8.2%.…”

Section: Discussionmentioning

confidence: 99%

“…40 Similarly, Desai found that 9% and 11% of IPD in studied children in Atlanta were caused by serotypes 35B and 15B/C, respectively. 35 By 2015, the CDC's Active Bacterial Core Surveillance program showed that serotypes 15B/ C and 35B have emerged as 2 of the top 4 most frequent causes of IPD in children less than 5 years of age. 41 Furthermore, as serotypes 15B/C and 35B emerged, it became clear that many isolates are b-lactam resistant.…”

Section: Discussionmentioning

confidence: 99%

“…Published reports describe similar increases in these serotypes in children following PCV13 implementation. 17,22,31,[35][36][37][38] McElligot found serotype 35B to be among the leading source of penicillin non-susceptible pneumococci in both carriage and non-invasive pneumococcal infection in children in Ireland. 36 Cohen noted that serotypes 15B/C and 35B were among the non-PCV13 serotypes identified in carriage among children in France, with serotype 15B/C reaching the "emergent serotype" threshold of >5% in their study population.…”

Section: Discussionmentioning

confidence: 99%

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Nasopharyngeal pneumococcal carriage rates among HIV-infected adults following widespread pediatric use of conjugate pneumococcal vaccine-13

Feola

Bonville

Cibula

et al. 2016

Human Vaccines & Immunotherapeutics

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Background: Nasopharyngeal pneumococcal carriage rates among HIV-infected adults has not been described since conjugate pneumococcal vaccine-13 (PCV13) was added to the universal infant and childhood vaccination schedule in 2010. Methods: HIV-infected adults presenting for routine health care visits to the Designated AIDS Center in Syracuse, NY between December 2013 and June 2015 were eligible for enrollment. Demographic, medical, and social history were recorded after obtaining informed consent. Nasopharyngeal samples were collected and cultured for the presence of Streptococcus pneumoniae using standard microbiologic techniques. Antibiotic susceptibility testing was performed using E-test!. Results: 707 nasopharyngeal samples were collected from 414 HIV-infected adults. 18 samples were culture positive for S. pneumoniae; 1 (6%) isolate was of vaccine-type, 9 (50%) were non-vaccine types, and 8 (44%) were non-typeable. The 18 isolates were recovered from 15 different patients (4% of those enrolled). Three patients were culture positive for pneumococcus isolated from 2 consecutive samples, with non-typeable pneumococci identified consecutively from 2 patients and serotype 35B identified consecutively from 1 patient. The most commonly identified non-vaccine serotypes were 35B and 15B/C. Identified pneumococci were penicillin and cefotaxime susceptible. Conclusion: Four percent of HIVinfected adults in our study population were colonized with S. pneumoniae. The non-vaccine serotypes 35B and 15B/C predominated.

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“…Increasing proportions of clinical isolates within serotypes 35B and 6C in the United States with decreased susceptibility to ␤-lactams have been reported (295). Resistant serotype 35B (serotype 35B/ST558) IPD was virtually absent among children in the preconjugate vaccine era, but during the past decade, serotypes 35B, 6C, and additional serotypes have increased in both carriage (296,297) and IPD cases representing all ages (50,294,295), potentially as a consequence of the removal of competing conjugate vaccine serotypes from the pediatric carriage reservoir. The PMEN-24 serotype 35B clonal complex has emerged to become the predominant pediatric ␤-lactam-resistant IPD serotype (50).…”

Section: Current Moderately Successful Antibiotic-resistant Nonvaccinmentioning

confidence: 99%

Biological and Epidemiological Features of Antibiotic-Resistant Streptococcus pneumoniae in Pre- and Post-Conjugate Vaccine Eras: a United States Perspective

et al. 2016

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SUMMARYStreptococcus pneumoniaeinflicts a huge disease burden as the leading cause of community-acquired pneumonia and meningitis. Soon after mainstream antibiotic usage, multiresistant pneumococcal clones emerged and disseminated worldwide. Resistant clones are generated through adaptation to antibiotic pressures imposed while naturally residing within the human upper respiratory tract. Here, a huge array of related commensal streptococcal strains transfers core genomic and accessory resistance determinants to the highly transformable pneumococcus. β-Lactam resistance is the hallmark of pneumococcal adaptability, requiring multiple independent recombination events that are traceable to nonpneumococcal origins and stably perpetuated in multiresistant clonal complexes. Pneumococcal strains with elevated MICs of β-lactams are most often resistant to additional antibiotics. Basic underlying mechanisms of most pneumococcal resistances have been identified, although new insights that increase our understanding are continually provided. Although all pneumococcal infections can be successfully treated with antibiotics, the available choices are limited for some strains. Invasive pneumococcal disease data compiled during 1998 to 2013 through the population-based Active Bacterial Core surveillance program (U.S. population base of 30,600,000) demonstrate that targeting prevalent capsular serotypes with conjugate vaccines (7-valent and 13-valent vaccines implemented in 2000 and 2010, respectively) is extremely effective in reducing resistant infections. Nonetheless, resistant non-vaccine-serotype clones continue to emerge and expand.

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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

Cited by 108 publications

References 19 publications

Development of an Extended-Specificity Multiplex Immunoassay for Detection of Streptococcus pneumoniae Serotype-Specific Antigen in Urine by Use of Human Monoclonal Antibodies

Development of an Extended-Specificity Multiplex Immunoassay for Detection of Streptococcus pneumoniae Serotype-Specific Antigen in Urine by Use of Human Monoclonal Antibodies

Nasopharyngeal pneumococcal carriage rates among HIV-infected adults following widespread pediatric use of conjugate pneumococcal vaccine-13

Biological and Epidemiological Features of Antibiotic-Resistant Streptococcus pneumoniae in Pre- and Post-Conjugate Vaccine Eras: a United States Perspective

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