Streptococcus pneumoniae outbreaks and implications for transmission and control: a systematic review

Abstract

BackgroundStreptococcus pneumoniae is capable of causing multiple infectious syndromes and occasionally causes outbreaks. The objective of this review is to update prior outbreak reviews, identify control measures, and comment on transmission.MethodsWe conducted a review of published S. pneumoniae outbreaks, defined as at least two linked cases of S. pneumoniae.ResultsA total of 98 articles (86 respiratory; 8 conjunctivitis; 2 otitis media; 1 surgical site; 1 multiple), detailing 94 unique outbreaks occurring between 1916 to 2017 were identified. Reported serotypes included 1, 2, 3, 4, 5, 7F, 8, 12F, 14, 20, and 23F, and serogroups 6, 9, 15, 19, 22. The median attack rate for pneumococcal outbreaks was 7.0% (Interquartile range: 2.4%, 13%). The median case-fatality ratio was 12.9% (interquartile range: 0%, 29.2%). Age groups most affected by outbreaks were older adults (60.3%) and young adults (34.2%). Outbreaks occurred in crowded settings, such as universities/schools/daycares, military barracks, hospital wards, and long-term care facilities. Of outbreaks that assessed vaccination coverage, low initial vaccination or revaccination coverage was common. Most (73.1%) of reported outbreaks reported non-susceptibility to at least one antibiotic, with non-susceptibility to penicillin (56.0%) and erythromycin (52.6%) being common. Evidence suggests transmission in outbreaks can occur through multiple modes, including carriers, infected individuals, or medical devices. Several cases developed disease shortly after exposure (< 72 h). Respiratory outbreaks used infection prevention (55.6%), prophylactic vaccination (63.5%), and prophylactic antibiotics (50.5%) to prevent future cases. PPSV23 covered all reported outbreak serotypes. PCV13 covered 10 of 16 serotypes. For conjunctival outbreaks, only infection prevention strategies were used.ConclusionsTo prevent the initial occurrence of respiratory outbreaks, vaccination and revaccination is likely the best preventive measure. Once an outbreak occurs, vaccination and infection-prevention strategies should be utilized. Antibiotic prophylaxis may be considered for high-risk exposed individuals, but development of antibiotic resistance during outbreaks has been reported. The short period between initial exposure and development of disease indicates that pneumococcal colonization is not a prerequisite for pneumococcal respiratory infection.Electronic supplementary materialThe online version of this article (10.1186/s41479-018-0055-4) contains supplementary material, which is available to authorized users.

Super-dominant pathobiontic bacteria in the nasopharyngeal microbiota as causative agents of secondary bacterial infection in influenza patients

“…The bacterial genera most frequently detected in the nasopharyngeal microbiota of healthy adults were Corynebacterium, Dolosigranulum, Staphylococcus, and Streptococcus [25], which include the well-recognized respiratory pathogens S. aureus [26], S. pneumoniae [27], Dolosigranulum pigrum [28], and Corynebacterium propinquum/pseudodiphtheriticum [29]. Notably, the human nasopharyngeal microbiota is composed of both true commensal bacteria and pathobiontic species, which can act as harmless colonizing microbes or as highly invasive pathogens depending on environmental circumstances [30,31].…”

Co-infections of SARS-CoV-2 with multiple common respiratory pathogens in infected patients

“…A total of 76 (40.86%) cases were negative for all pathogens in our test. We speculate that this is probably due to the presence of other pathogen infections like the mycoplasma pneumonia or other bacteria, which were generally rampant during the current season (Waites and Talkington, 2004;Zivich et al, 2018). Additionally, the intrinsic limitation of the sensitivity of this method for the different respiratory viruses and low load of virus in upper respiratory specimens may also partially contribute to the negative results.…”

Resistance of Gram-Positive Bacteria to Current Antibacterial Agents and Overcoming Approaches

“…Pneumococcal infections are increasing rapidly due to the development of antimicrobial resistance which started to appear in 1912 [40,41]. However, it was not until 1965 that penicillin resistance S. pneumoniae (PRSP) was reported.…”