Nasopharyngeal carriage of Streptococcus pneumoniae in Romanian children before the introduction of the pneumococcal conjugated vaccination into the national immunization programme: a national, multi-centre, cross-sectional observational study

Luminos, Monica; Dorobăţ, O; Jugulete, Gheorghiță; Popescu, Gabriel Adrian; Florea, Dragoș; Drăgănescu, Anca; Streinu-Cercel, Adrian; Rafilă, Alexandru

doi:10.1016/j.ijid.2014.08.020

Cited by 11 publications

(6 citation statements)

References 20 publications

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“…This specific broth enrichment combining STHB, yeast, and rabbit serum has been shown to improve pneumococcal isolation compared to conventional culture-based results by 16% [38]. Although the detected colonization prevalence was higher in our study, the proportion of PCV10-serotypes (37.3%) among children aged <5 years was similar to the results reported in other studies from Kenya, the Gambia and Nigeria [31, 46, 61, 62]. …”

Section: Discussionsupporting

confidence: 86%

Pneumococcal carriage and antibiotic susceptibility patterns from two cross-sectional colonization surveys among children aged <5 years prior to the introduction of 10-valent pneumococcal conjugate vaccine — Kenya, 2009–2010

et al. 2017

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BackgroundPneumococci are spread by persons with nasopharyngeal colonization, a necessary precursor to invasive disease. Pneumococcal conjugate vaccines can prevent colonization with vaccine serotype strains. In 2011, Kenya became one of the first African countries to introduce the 10-valent pneumococcal conjugate vaccine (PCV10) into its national immunization program. Serial cross-sectional colonization surveys were conducted to assess baseline pneumococcal colonization, antibiotic resistance patterns, and factors associated with resistance.MethodsAnnual surveys were conducted in one urban and one rural site during 2009 and 2010 among children aged <5 years. To reflect differences in vaccine target population, recruitment was age-stratified in Kibera, whereas a simple random sample of children was drawn in Lwak. Nasopharyngeal swabs were collected from eligible children. Pneumococci were isolated and serotyped. Antibiotic susceptibility testing was performed using the 2009 isolates. Antibiotic nonsusceptibility was defined as intermediate susceptibility or resistance to ≥1 antibiotics (i.e., penicillin, chloramphenicol, levofloxacin, erythromycin, tetracycline, cotrimoxazole, and clindamycin); multidrug resistance (MDR) was defined as nonsusceptibility to ≥3 antibiotics. Weighted analysis was conducted when appropriate. Modified Poisson regression was used to calculate factors associated with antibiotic nonsusceptibility.ResultsOf 1,087 enrolled (Kibera: 740, Lwak: 347), 90.0% of these were colonized with pneumococci, and 37.3% were colonized with PCV10 serotypes. There were no differences by survey site or year. Of 657 (of 730; 90%) isolates tested for antibiotic susceptibility, nonsusceptibility to cotrimoxazole and penicillin was found in 98.6 and 81.9% of isolates, respectively. MDR was found in 15.9% of isolates and most often involved nonsusceptibility to cotrimoxazole and penicillin; 40.4% of MDR isolates were PCV10 serotypes. In the multivariable model, PCV10 serotypes were independently associated with penicillin nonsusceptibility (Prevalence Ratio: 1.2, 95% CI 1.1–1.3), but not with MDR.ConclusionsBefore PCV10 introduction, nearly all Kenyan children aged <5 years were colonized with pneumococci, and PCV10 serotype colonization was common. PCV10 serotypes were associated with penicillin nonsusceptibility. Given that colonization with PCV10 serotypes is associated with greater risk for invasive disease than colonization with other serotypes, successful PCV10 introduction in Kenya is likely to have a substantial impact in reducing vaccine-type pneumococcal disease and drug-resistant pneumococcal infection.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-2103-0) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 86%

Pneumococcal carriage and antibiotic susceptibility patterns from two cross-sectional colonization surveys among children aged <5 years prior to the introduction of 10-valent pneumococcal conjugate vaccine — Kenya, 2009–2010

et al. 2017

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“…In contrast, from the 30 studies assessing carriage unrelated to IPD among children, only 5 studies reported PCV serotypes accounting for more than 50% of the total serotypes. 31,33,40,41,44 It would appear from the current snapshot that the introduction of PCV has had a greater impact in reducing nasopharyngeal carriage of PCV-specific serotypes among children without IPD than on IPD itself; further pneumococcal surveillance in coming years may show an additional impact on IPD cases caused by PCV serotypes in pediatric populations. PCV serotypes were responsible for >60% of total serotypes in IPD cases in few studies among adults aged 65 y and older 6,58 and 15-59 y.…”

Section: Discussionmentioning

confidence: 98%

“…25 In contrast, conjugate vaccine serotypes causing non-IPD conditions among children were more than 50% prevalent in only 5 of 30 studies (Table 1). 31,33,40,41,44 Prevalence of serotypes uniquely covered by PPV23 was reported in a total of 33 papers. Most often ranking in the top 3 among those serotypes in PPV23 but not in PCV13 for IPDrelated pneumococcal illness were serotypes 15B (or 15B/C) reported in 9 papers 6,[8][9][10]15,17,20,24,26 at up to 11.8% prevalent, 26 5 papers reporting serotype 22F ( 11.3%) 15 Prevalence of serotypes not covered by any pneumococcal vaccines (i.e., PCV13 or PPV23) was reported in a total of 34 papers.…”

Section: Pneumococcal Serotype Distribution Among Children Aged Undermentioning

confidence: 99%

Pneumococcal serotype distribution: A snapshot of recent data in pediatric and adult populations around the world

Cui

Patel²,

O’Neil³

et al. 2017

Human Vaccines & Immunotherapeutics

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“…IR13 was of ST81 and thus belongs to the clone Spain 23F -1; IR52 was of ST558, to which serotype 35B isolates from different continents also belong; and all others displayed new STs ( Table 1 ). The serogroup was determined for 11 Romanian isolates: 10 were serogroup 19, which is prevalent in Romania ( 30 , 31 ), and 1 was serogroup 6.…”

Section: Resultsmentioning

confidence: 99%

Diversity of Mosaic pbp2x Families in Penicillin-Resistant Streptococcus pneumoniae from Iran and Romania

Mousavi

Pană

Feizabadi

et al. 2017

Antimicrob Agents Chemother

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Penicillin-resistant Streptococcus pneumoniae strains are found at high rates in Romania and Iran. The mosaic structure of PBP2x was investigated in 9 strains from Iran and in 15 strains from Romania to understand their evolutionary history. Mutations potentially important for β-lactam resistance were identified by comparison of the PBP2x sequences with the sequence of the related PBP2x of reference penicillin-sensitive S. mitis strains. Two main PBP2x mosaic gene families were recognized. Eight Iranian strains expressed PBP2x variants in group 1, which had a mosaic block highly related to PBP2x of the Spain23F-1 clone, which is widespread among international penicillin-resistant S. pneumoniae clones. A second unique PBP2x group was observed in Romanian strains; furthermore, three PBP2x single mosaic variants were found. Sequence blocks of penicillin-sensitive strain S. mitis 658 were common among PBP2x variants from strains from both countries. Each PBP2x group contained specific signature mutations within the transpeptidase domain, documenting the existence of distinct mutational pathways for the development of penicillin resistance.

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Nasopharyngeal carriage of Streptococcus pneumoniae in Romanian children before the introduction of the pneumococcal conjugated vaccination into the national immunization programme: a national, multi-centre, cross-sectional observational study

Cited by 11 publications

References 20 publications

Pneumococcal carriage and antibiotic susceptibility patterns from two cross-sectional colonization surveys among children aged <5 years prior to the introduction of 10-valent pneumococcal conjugate vaccine — Kenya, 2009–2010

Pneumococcal carriage and antibiotic susceptibility patterns from two cross-sectional colonization surveys among children aged <5 years prior to the introduction of 10-valent pneumococcal conjugate vaccine — Kenya, 2009–2010

Pneumococcal serotype distribution: A snapshot of recent data in pediatric and adult populations around the world

Diversity of Mosaic pbp2x Families in Penicillin-Resistant Streptococcus pneumoniae from Iran and Romania

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