Predictors of pneumococcal carriage and the effect of the 13-valent pneumococcal conjugate vaccination in the Western Australian Aboriginal population

Abstract

BackgroundThe 7-valent pneumococcal conjugate vaccine (PCV7) was introduced to prevent invasive pneumococcal disease (IPD) in Western Australian (WA) Aboriginal people in 2001. PCV13 replaced PCV7 in July 2011, covering six additional pneumococcal serotypes; however, IPD rates remained high in Aboriginal people in WA. Upper respiratory tract pneumococcal carriage can precede IPD, and PCVs alter serotype distribution.MethodsTo assess the impact of PCV13 introduction, identify emerging serotypes, and assess risk factors for carriage, nasopharyngeal swabs and information on demographic characteristics, health, medication and living conditions from Aboriginal children and adults across WA from August 2008 to November 2014 were collected. Bacteria were cultured using selective media and pneumococcal isolates were serotyped by Quellung reaction. Risk factors were analysed by multivariable logistic regression.ResultsOne thousand five hundred swabs pre- and 1385 swabs post-PCV13 introduction were collected. Pneumococcal carriage was detected in 66.8% of children <5 years old and 53.2% of 5–14 year-olds post-PCV13, compared with pre-PCV13 prevalence of 72.2% and 49.4%, respectively. The prevalence of PCV13-non-PCV7 serotypes decreased in children <5 years old from 13.5% pre-PCV13 to 5.8% post-PCV13 (p < 0.01), and from 8.4% to 6.1% in children 5–14 years old (p > 0.05). The most common serotypes post-PCV13 were 11A (prevalence 4.0%), 15B (3.5%), 16F (3.5%), and 19F (3.2%).Risk of detection of pneumococcal carriage increased until age 12 months (odds ratio [OR] 4.19, 95% confidence interval [CI] 2.39–7.33), with nasal discharge (OR 2.49 [95% CI 2.00–3.09]), residence in a remote community (OR 2.21 [95% CI 1.67–2.92]) and household crowding (OR 1.36 [95% CI 1.11–1.67]). Recent antibiotic use was negatively associated with pneumococcal carriage (OR 0.48 [95% CI 0.33–0.69]). Complete resistance to penicillin was present among isolates of serotypes 19A (6.0%), 19F (2.3%) and non-serotypeable isolates (1.9%). Serotype 23F and newly emerged serotype 7B isolates showed high rates of resistance to cotrimoxazole, erythromycin and tetracycline (86.9%, 86.9%, 82.0%, respectively for 23F, 100.0%, 100.0% and 93.3% for 7B).ConclusionSince PCV13 replaced PCV7, carriage of PCV13-non-PCV7 serotypes decreased significantly among children <5 years old, those most likely to have received PCV13, and to a lesser extent in older people. Known risk factors for carriage including crowding and young age remain in the Aboriginal population.

Changes in pneumococcal carriage prevalence and factors associated with carriage in Norwegian children, four years after introduction of PCV13

“…Furthermore, we found that recent antimicrobial use, vaccine history and older age were negatively associated with carriage. A reduction in overall carriage prevalence after the introduction of PCV7 and/or PCV13 has been observed before [12,15,16,21,26], though in several other settings the overall carriage prevalence remained the same [17,[27][28][29]. The decrease in carriage has mainly been driven by the reduction in VT carriage [12,15,16,21,26].…”

“…A reduction in overall carriage prevalence after the introduction of PCV7 and/or PCV13 has been observed before [12,15,16,21,26], though in several other settings the overall carriage prevalence remained the same [17,[27][28][29]. The decrease in carriage has mainly been driven by the reduction in VT carriage [12,15,16,21,26]. While many studies showed only some concurrent increase in NVT prevalence, in several studies the decrease in VT and increase in NVT carriage was of similar size leading to near-complete replacement [17,[27][28][29].…”

“…However, the incidence of IPD caused by non-vaccine serotypes (NVT) increased [6], particularly for serotype 19A [1,6,[11][12][13]. The overall prevalence of carriage among children remained stable, due to a decrease in PCV7type carriage and an increase in non-PCV7 type carriage (called serotype replacement) [6,12,[14][15][16][17].…”

Impact of PCV7 vaccination on nasopharyngeal carriage and antimicrobial resistance among children in Turkey

“…The changes in the prevalence percentages of the all types of serotypes (PCV7 and non-PCV7) before and after vaccination. study, Colins et al showed that household crowding was associated with pneumococcal carriage [16].…”

Epidemiological consequences of enduring strain-specific immunity requiring repeated episodes of infection

“…502 S. pneumoniae has over 90 different serotypes, and the multivalent pneumococcal 503 conjugate vaccines (PCVs) targeted the most prevalent S. pneumoniae serotypes 504 responsible for severe disease in different populations. The response to the PCVs varied 505 across subgroups within these populations [48,49]. However, generally there was a 506 decrease in detection of vaccine strains and an increase in detection of non-vaccine 507 strains following the implementation of PCV programs [50].…”