Susceptibility of pneumococci causing meningitis in Spain and prevalence among such isolates of serotypes contained in the 7-valent pneumococcal conjugate vaccine

Fenoll, Asunción; Giménez, María-José; Vicioso, María-Dolores; Granizo, Juan-José; Robledo, Olga; Aguilar, Lorenzo

doi:10.1093/jac/dkp376

Cited by 8 publications

(7 citation statements)

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“…In the post-PCV-7 period, significant decreasing trends for the incidence of PCV-7 serotypes were found in the total population (R 2 ϭ 0.492; ␤ ϭ Ϫ0.751; P ϭ 0.032) and in children (R 2 ϭ 0.576; ␤ ϭ Ϫ0.798; P ϭ 0.018), without significant trends for oral penicillin nonsusceptibility in the three populations. In previous studies, the association of decreases in PCV-7 serotype incidence with decreases in penicillin nonsusceptibility rates in the current decade was shown by analyzing all invasive isolates (8) and the subset of cerebrospinal fluid isolates (10). In the present study, the significant decreasing trend for PCV-7 serotype incidence found in the total population and in children in the post-PCV-7 period was not accompanied by a decrease in the rate of nonsusceptibility to oral penicillin.…”

supporting

confidence: 59%

Serotype Distribution and Susceptibility of Streptococcus pneumoniae Isolates from Pleural Fluid in Spain from 1997 to 2008

Fenoll

Aguilar

Vicioso

et al. 2010

Antimicrob Agents Chemother

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Trends in serotype incidence and susceptibility (1997 to 2008) of Spanish Streptococcus pneumoniae pleural isolates (n ‫؍‬ 831) were explored. Penicillin (oral) nonsusceptibility rates and the incidence of 7-valent pneumococcal conjugate vaccine (PCV-7) serotypes showed decreasing trends (R 2 > 0.600; P < 0.002). In a recent report, years after licensure of the 7-valent pneumococcal conjugate vaccine (PCV-7), more than one-third of pediatric hospitalizations for pneumonia were complicated by empyema, with pediatric parapneumonic empyema a common cause of invasive pneumococcal disease (2). The use of PCV-7 has reduced the incidence of invasive disease in children (19), but annual empyema-associated hospitalization rates have increased (15).PCV-7 has been available in Spain since October 2001, only in the private market for healthy children, with a small impact on the incidence of pediatric parapneumonic empyema in Spain (16,17) given that vaccine coverage in 2006 was below 50% (13), and the disease detection has improved over time.Since rates of parapneumonic empyema have been increasing worldwide in the current decade (2-4, 7, 16, 17) despite PCV-7 introduction, it is essential to estimate the serotype epidemiology and resistance of Streptococcus pneumoniae isolates from pleural fluid. This study focuses on all isolates from pleural fluid received by the Spanish Reference Laboratory of Pneumococci (SRLP) from January 1997 to December 2008 through a passive, laboratory-based surveillance system. Isolates were serotyped by Quellung reaction and/or dot blot assay (11). Susceptibility was determined by agar dilution (12) according to CLSI (5) using Mueller-Hinton agar (Difco Laboratories, Detroit, MI) supplemented with 5% sheep blood (Biomedics, Madrid, Spain) and incubation under 5% CO 2 atmosphere. S. pneumoniae ATCC 6303 and S. pneumoniae ATCC 49619 plus five clinical isolates were used as quality controls (9). Current CLSI nonsusceptibility breakpoints for parenteral penicillin (Ն4 g/ml; nonmeningitis), oral penicillin (Ն0.12 g/ml), amoxicillin (Ն4 g/ml), cefotaxime (Ն2 g/ml; nonmeningitis), erythromycin (Ն0.5 g/ml), and levofloxacin (Ն4 g/ml) (6) were considered. Trends over time were explored by linear regression analysis. Tables 1 to 3 show yearly distribution of invasive and pleural isolates (with their susceptibilities) for the total population,

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supporting

confidence: 59%

Serotype Distribution and Susceptibility of Streptococcus pneumoniae Isolates from Pleural Fluid in Spain from 1997 to 2008

Fenoll

Aguilar

Vicioso

et al. 2010

Antimicrob Agents Chemother

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“…In a post-introduction surveillance study the percentage of reduction in invasive disease caused by PCV7 serotypes was 78%, with 50% reduction in invasive disease caused by vaccine-related serotypes [22]. However, serotype replacement has been reported in surveillances (laboratory-based surveillance system) analyzing invasive isolates along the current decade in Spain [11-13], USA [23] and several European countries [24]. In addition, several studies have shown that PCV7 vaccination also reduces the nasopharyngeal carriage of vaccine serotypes and increases carriage of non-vaccine types, with an overall rate of pneumococcal colonization unchanged in most cases [25-28].…”

Section: Discussionmentioning

confidence: 99%

“…Despite the irregular regional PCV7 uptake in Spain, vaccination has resulted in a decrease in PCV7 serotypes among invasive isolates from children and adults (due to herd effect). This reduction has been associated with a decrease in the proportion of isolates non-susceptible to penicillin [11-13]. However, as in other countries, these changes were associated with an increase in the prevalence of non-PCV7 serotypes causing invasive disease [11].…”

Section: Introductionmentioning

confidence: 99%

Increase in serotype 19A prevalence and amoxicillin non-susceptibility among paediatric Streptococcus pneumoniae isolates from middle ear fluid in a passive laboratory-based surveillance in Spain, 1997-2009

et al. 2011

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BackgroundConjugate vaccines, such as the 7-valent conjugate vaccine (PCV7), alter serotype nasopharyngeal carriage, potentially increasing cases of otitis media by non-vaccine serotypes.MethodsAll paediatric middle ear fluid (MEF) isolates received in the Spanish Reference Laboratory for Pneumococci through a passive, laboratory-based surveillance system from January 1997 to June 2009 were analysed. Data from 1997 to 2000 were pooled as pre-vaccination period. Trends over time were explored by linear regression analysis.ResultsA total of 2,077 isolates were analysed: 855 belonging to PCV7 serotypes, 466 to serotype 19A, 215 to serotype 3, 89 to serotype 6A and 452 to other serotypes (< 40 isolates each). Over time, there has been a decreasing trend for PCV7 serotypes (R2 = 0.944; p < 0.001, with significant decreasing trends for serotypes 19F, 14, 23F and 9V), and increasing trends for serotype 19A (R2 = 0.901; p < 0.001), serotype 3 (R2 = 0.463; p = 0.030) and other non-PCV7 serotypes (R2 = 0.877; p < 0.001), but not for serotype 6A (R2 = 0.311; p = 0.094). Considering all isolates, amoxicillin non-susceptibility showed an increasing trend (R2 = 0.528; p = 0.017). Regarding serotype 19A, increasing trends in non-susceptibility to penicillin (R2 = 0.726; p = 0.001), amoxicillin (R2 = 0.804; p < 0.001), cefotaxime (R2 = 0.546; p = 0.005) and erythromycin (R2 = 0.546; p = 0.009) were found, with amoxicillin non-susceptibility firstly detected in 2003 (7.4%) and increasing up to 38.0% in 2009. In PCV7 serotypes (which prevalence decreased from 70.7% during 1997-2000 to 10.6% in 2009) amoxicillin non-susceptibility rates showed an increasing trend (R2 = 0.702; p = 0.002). However, overall, amoxicillin non-susceptibility (≈25% in 2008-9) could be mainly attributed to serotype 19A (> 35% isolates) since PCV7 strains represented < 11% of total clinical isolates.ConclusionsIn contrast to reports on invasive pneumococcal strains, in MEF isolates the reduction in the prevalence of PCV7 serotypes was not associated with decreases in penicillin/erythromycin non-susceptibility. The high prevalence of serotype 19A among paediatric MEF isolates and the amoxicillin non-susceptibility found in this serotype are worrisome since amoxicillin is the most common antibiotic used in the treatment of acute otitis media. These data suggest that non-PCV7 serotypes (mainly serotype 19A followed by serotypes 3 and 6A) are important etiological agents of acute otitis media and support the added value of the broader coverage of the new 13-valent conjugate vaccine.

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“…Several studies from Spain have examined the issue, with some areas reporting complete serotype replacement with no net effect of the vaccine on IPD incidence [5, 54–55] while another reported no increase in NVTs [56]. The Spanish data are further complicated by regional differences in blood culturing practices and by increases in blood culturing and reporting rates since the introduction of PCV7 [43–44, 57]. In France, the vaccine had no overall effect in the most recent national study of pediatric meningitis in children under 5, though it showed a benefit in those under 2 [58].…”

Section: Introductionmentioning

confidence: 99%

Serotype replacement in disease after pneumococcal vaccination

Weinberger

Malley

Lipsitch³

2011

The Lancet

855

654

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Vaccination with the protein-polysaccharide conjugate vaccine, PCV7, has significantly reduced the burden of pneumococcal disease in populations where it is in widespread use and has had an important public health benefit. This vaccine targets only 7 of the more than 92 pneumococcal serotypes, and there have been concerns that the non-vaccine serotypes (NVTs) could increase in prevalence and reduce the benefits of vaccination. Indeed, among asymptomatic carriers, the prevalence of NVTs has increased substantially, and as a result, there has been little or no net change in the carriage prevalence of the bacteria. In many populations, there has been an increase in pneumococcal disease caused by NVT, but in most cases this increase in NVT disease has been less than the increase in NVT carriage. In this article, we review the evidence for serotype replacement in carriage and disease and address the surveillance biases that might affect these findings. We then discuss possible reasons for the discrepancy between near-complete replacement in carriage and partial replacement for disease, and address the possibility that differences in invasiveness between vaccine serotypes and those causing replacement could contribute to this difference. We contend that the magnitude of serotype replacement in disease can be attributed, in part, to a combination of lower invasiveness of the replacing serotypes, biases in the pre-vaccine carriage data (unmasking), and biases in the disease surveillance systems that could underestimate the true amount of replacement. We conclude by discussing the potential for serotype replacement in disease in the future and the need for ongoing surveillance.

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Susceptibility of pneumococci causing meningitis in Spain and prevalence among such isolates of serotypes contained in the 7-valent pneumococcal conjugate vaccine

Cited by 8 publications

References 5 publications

Serotype Distribution and Susceptibility of Streptococcus pneumoniae Isolates from Pleural Fluid in Spain from 1997 to 2008

Serotype Distribution and Susceptibility of Streptococcus pneumoniae Isolates from Pleural Fluid in Spain from 1997 to 2008

Increase in serotype 19A prevalence and amoxicillin non-susceptibility among paediatric Streptococcus pneumoniae isolates from middle ear fluid in a passive laboratory-based surveillance in Spain, 1997-2009

Serotype replacement in disease after pneumococcal vaccination

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