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Li J, Liu L, Zhang H, Guo J, Wei X, Xue M, Ma X. Severe problem of macrolides resistance to common pathogens in China. Front Cell Infect Microbiol 2023; 13:1181633. [PMID: 37637457 PMCID: PMC10448830 DOI: 10.3389/fcimb.2023.1181633] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/18/2023] [Indexed: 08/29/2023] Open
Abstract
With the widespread use of macrolide antibiotics in China, common pathogens causing children's infections, such as Streptococcus pneumoniae, Streptococcus (including Group A streptococcus, Group B streptococcus), Staphylococcus aureus, Bordetella pertussis, and Mycoplasma pneumoniae, have shown varying degrees of drug resistance. In order to provide such problem and related evidence for rational use of antibiotics in clinic, we reviewed the drug resistance of common bacteria to macrolides in children recent 20 years.
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Affiliation(s)
- Jialin Li
- Department of Respiratory Disease, Children's Hospital Affiliated to Shandong University, Jinan, Shandong, China
- Jinan Key Laboratory of Pediatric Respiratory Diseases, Jinan Children’s Hospital, Jinan, China
| | - Lesen Liu
- Surgical Department, Huaiyin People’s Hospital, Jinan, China
| | - Hua Zhang
- Department of Respiratory Disease, Children's Hospital Affiliated to Shandong University, Jinan, Shandong, China
- Jinan Key Laboratory of Pediatric Respiratory Diseases, Jinan Children’s Hospital, Jinan, China
| | - Jing Guo
- Department of Respiratory Disease, Children's Hospital Affiliated to Shandong University, Jinan, Shandong, China
- Jinan Key Laboratory of Pediatric Respiratory Diseases, Jinan Children’s Hospital, Jinan, China
| | - Xiaoling Wei
- Department of Respiratory Disease, Children's Hospital Affiliated to Shandong University, Jinan, Shandong, China
- Jinan Key Laboratory of Pediatric Respiratory Diseases, Jinan Children’s Hospital, Jinan, China
| | - Min Xue
- Department of Respiratory Disease, Children's Hospital Affiliated to Shandong University, Jinan, Shandong, China
- Jinan Key Laboratory of Pediatric Respiratory Diseases, Jinan Children’s Hospital, Jinan, China
| | - Xiang Ma
- Department of Respiratory Disease, Children's Hospital Affiliated to Shandong University, Jinan, Shandong, China
- Jinan Key Laboratory of Pediatric Respiratory Diseases, Jinan Children’s Hospital, Jinan, China
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Zeng Y, Song Y, Cui L, Wu Q, Wang C, Coelho AC, Zhang G, Wei D, Li C, Zhang J, Corbeil J, Li Y, Feng J. Phylogenomic insights into evolutionary trajectories of multidrug resistant S. pneumoniae CC271 over a period of 14 years in China. Genome Med 2023; 15:46. [PMID: 37403170 DOI: 10.1186/s13073-023-01200-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 05/31/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Streptococcus pneumoniae is a gram-positive opportunistic pathogen, and infection risks of S. pneumoniae can be profoundly augmented by its acquired multidrug-resistance (MDR). The rapid development of MDR in S. pneumoniae was attributed to the international dissemination of a small number of multidrug-resistant "clones." Clonal complex (CC) 271 is a prevalent MDR CC in the world and the most prevalent CC in China. However, the evolutionary trajectories of multidrug-resistant S. pneumoniae CC271 in China still are largely unknown. METHODS We investigated a collection of 1312 S. pneumoniae isolates collected from 28 tertiary hospitals in China from 2007 to 2020. Recombination prediction and recombination-masked phylogenetic analysis were combined to determine the population structure and mode of evolution of CC271. Data from the Global Pneumococcal Sequencing program (GPS) were combined to understand the global distribution of clones identified in this study. Bayesian analysis were recruited to analysis the evolutionary dynamics of dominant clones within CC271 in China. RESULTS The phylogenomic analysis resulted in the discovery of two globally distributed clones, ST271-A and ST271-B. ST271-A was a derivative of ST236 and an ancestor of ST271-B and ST320, refining the internal phylogenetic relationship of CC271. ST271-B was the most dominant clone in China, with higher β-lactam resistance especially for cephalosporins comparing to other MDR clones. Bayesian skyline plot showed a rapid expansion of 19F ST271-B from 1995 to 2000, which correlates with the widespread use of cephalosporins in the 1990s in China. 19A ST320, a vaccine-escape clone, is the second largest population in China. The Bayesian skyline plot showed that the 19A ST320 began to expand rapidly around 2001, which appeared to coincide with the prevalence of 19A after application of PCV7 in 2000 in the USA. We also observed frequent transmission of 19A ST320 between countries. It suggests that mass vaccination in some countries could affect the prevalence of clones in unvaccinated countries in the context of high-frequency international transmission. CONCLUSIONS Our results refined the internal phylogenetic relationship of CC271, showing that the 19F ST271-B and 19A ST320 evolved independently from ST271-A, with different histories and driving forces for their evolution and dissemination in China.
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Affiliation(s)
- Yuan Zeng
- State Key Laboratory of Microbial Resources, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
- College of Life Science, University of Chinese Academy of Sciences, Beijing, China
| | - Yuqin Song
- State Key Laboratory of Microbial Resources, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Lanqing Cui
- Institute of Clinical Pharmacology, Peking University First Hospital, Beijing, China
| | - Qi Wu
- State Key Laboratory of Mycology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Chao Wang
- State Key Laboratory of Microbial Resources, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Adriano Cappellazzo Coelho
- Departamento de Biologia Animal, Instituto de Biologia, Universidade Estadual de Campinas (UNICAMP), Campinas, Brazil
| | - Gang Zhang
- State Key Laboratory of Microbial Resources, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Dawei Wei
- State Key Laboratory of Microbial Resources, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Chao Li
- State Key Laboratory of Microbial Resources, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Jingren Zhang
- Center for Infectious Disease Research, Department of Basic Medical Science, School of Medicine, Tsinghua University, Beijing, China
| | - Jacques Corbeil
- Department of Molecular Medicine, Big Data Research Centre, Nutrition Health and Society Centre (NUTRISS), INAF Institute Intelligence and Data, Laval University, Québec, Canada
| | - Yun Li
- Institute of Clinical Pharmacology, Peking University First Hospital, Beijing, China.
| | - Jie Feng
- State Key Laboratory of Microbial Resources, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China.
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The Cost-Effectiveness of 13-Valent Pneumococcal Conjugate Vaccine in Seven Chinese Cities. Vaccines (Basel) 2021; 9:vaccines9111368. [PMID: 34835299 PMCID: PMC8624982 DOI: 10.3390/vaccines9111368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/11/2021] [Accepted: 11/13/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: This study estimates the cost-effectiveness of vaccination with the 13-valent pneumococcal conjugate vaccine (PCV13) among infants in Beijing, Shanghai, Shenzhen, Chengdu, Karamay, Qingdao, and Suzhou. Methods: A previously published cost-effectiveness model comparing vaccination with PCV13 to no vaccination was localized to the included Chinese cities. A systematic literature review was undertaken to identify age-specific incidence rates for pneumococcal bacteremia, pneumococcal meningitis, pneumonia, and otitis media (AOM). Age-specific direct medical costs of treating the included pneumococcal diseases were taken from the Chinese Health Insurance Association database. The base case analysis evaluated vaccine efficacy using direct effect and indirect effects (DE+ IDE). A subsequent scenario analysis evaluated the model outcomes if only DE was considered. A vaccination rate of 70% was used. The model reported outcomes over a one-year period after it was assumed the vaccine effects had reached a steady state (5–7 years after vaccine introduction) to include the direct and indirect effects of vaccination. Health outcomes were discounted at 5% during the steady-state period. Results: Vaccination with PCV13 was cost-effective in the base case analysis for all included cities with the incremental cost-effectiveness ratio (ICER) ranging from 1145 CNY(Shenzhen) to 15,422 CNY (Qingdao) per quality-adjusted life-year (QALY) gained. PCV13 was the dominant strategy in Shanghai with lower incremental costs and higher incremental QALYs. PCV13 remained cost-effective in the DE-only analysis with all ICERs falling below a cost-effectiveness threshold of three times GDP per capita in each city. Conclusions: Vaccination with PCV13 was a cost-effective strategy in the analyzed cities for both the DE-only and DE + IDE analyses. PCV13 became very cost-effective when a vaccination rate was reached where IDE is observed.
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Antibacterial Activity of a Modified Choline Binding Peptide Against Streptococcus pneumoniae with Corresponding Antibody. Int J Pept Res Ther 2021. [DOI: 10.1007/s10989-021-10300-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Liang Z, Fu J, Li L, Yi R, Xu S, Chen J, Ye X, McGrath E. Molecular epidemiology of Streptococcus pneumoniae isolated from pediatric community-acquired pneumonia in pre-conjugate vaccine era in Western China. Ann Clin Microbiol Antimicrob 2021; 20:4. [PMID: 33407509 PMCID: PMC7788854 DOI: 10.1186/s12941-020-00410-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 12/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Streptococcus pneumoniae (S. pneumoniae) is one of the most common pathogens which can cause morbidity and mortality in pediatric infections worldwide. This study aimed to describe the phenotypic and molecular characteristics of community-acquired pneumonia (CAP)-causing S. pneumoniae recovered from children in Western China. METHODS We retrospectively enrolled pediatric patients younger than 5 years diagnosed with CAP. All 419 S. pneumoniae isolates were tested for antibiotic susceptibility, serotypes, virulence genes, resistance genes, and sequence types. The potential relationships between molecular characteristics were tested by correspondence analysis. RESULTS Most of S. pneumoniae isolates were resistant to erythromycin, tetracycline, clindamycin and trimethoprim-sulfamethoxazole, with 93.8% isolates classified as multidrug resistant. The dominant STs were ST271 (30.8%) and ST320 (12.2%), while the prevailing serotypes were 19F (46.8%), 6B (11.5%), 23F (9.5%) and 19A (9.3%). The coverage rates of PCV-7 and PCV-13 were 73.03% and 86.16%, while the coverage rates of PCV13 among children aged < 1 year and 1-2 years were high in 93.18% and 93.62%. We also observed that CC271 expressed more of mef (A/E), lytA, rlrA and sipA than non-CC271 isolates. Moreover, there were strong corresponding relationships between molecular characteristics. CONCLUSIONS The high coverage rate of PCV13 suggests the necessity of introducing the PCV13 vaccine in Western China. Our findings underscore the value of monitoring multiple molecular characteristics to provide new guidance for developing future pneumococcal vaccines.
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Affiliation(s)
- Zhuoxin Liang
- Department of Pediatric Intensive Care Unit, Department of Prevention and Health Care, Department of Pediatric, Department of Laboratory, Department of Neonatology, Liuzhou Maternity and Child Health Care Hospital, Liuzhou, China
| | - Jinjian Fu
- Department of Pediatric Intensive Care Unit, Department of Prevention and Health Care, Department of Pediatric, Department of Laboratory, Department of Neonatology, Liuzhou Maternity and Child Health Care Hospital, Liuzhou, China
| | - Ling Li
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Rongsong Yi
- Department of Pediatric Intensive Care Unit, Department of Prevention and Health Care, Department of Pediatric, Department of Laboratory, Department of Neonatology, Liuzhou Maternity and Child Health Care Hospital, Liuzhou, China
| | - Shaolin Xu
- Department of Pediatric Intensive Care Unit, Department of Prevention and Health Care, Department of Pediatric, Department of Laboratory, Department of Neonatology, Liuzhou Maternity and Child Health Care Hospital, Liuzhou, China
| | - Jichang Chen
- Department of Pediatric Intensive Care Unit, Department of Prevention and Health Care, Department of Pediatric, Department of Laboratory, Department of Neonatology, Liuzhou Maternity and Child Health Care Hospital, Liuzhou, China
| | - Xiaohua Ye
- Laboratory of Molecular Epidemiology, School of Public Health, Guangdong Pharmaceutical University, 283# Jianghai Dadao, Haizhu District, 510310, Guangzhou, China.
| | - Eric McGrath
- Children's Hospital of Michigan, Detroit, MI, USA.,Wayne State University School of Medicine, Detroit, MI, USA
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Li MC, Wang Y, Zhang H, Liu Y, Chen XJ, Yang HW, Ma P, Wang DC, Zhang BC, Dong AY, Wang CX, Li Y, Bai P, Tang WM, Wang J, Shao ZJ, Xu YC. Serotype distribution and clinical characteristics associated with streptococcus pneumoniae among Chinese children and adults with invasive pneumococcal disease: a multicenter observational study. Hum Vaccin Immunother 2021; 17:146-156. [PMID: 32530720 PMCID: PMC7872053 DOI: 10.1080/21645515.2020.1757996] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 04/14/2020] [Indexed: 11/30/2022] Open
Abstract
Few studies in China focused on serotypes of Streptococcus pneumoniae in patients with invasive pneumococcal disease (IPD). We aimed at investigating the serotype distribution for IPD-causing S. pneumoniae and vaccine coverage among Chinese children and adults. This was a multicenter, observational study to collect S. pneumoniae isolates from normal sterile sites and IPD-related clinical information among children and adults. Serotyping was performed by a Capsule-Quellung reaction test using type-specific antisera. The study collected a total of 300 eligible isolates (pediatric = 148, adult = 152) were serotyped in a central laboratory. The most prevalent serotypes were 19A (20.9%) and 23 F (20.3%) in the pediatric group; 3 (21.7%) and 19 F (11.8%) in the adult group. PCV10 had low-to-moderate serotype coverage rates for children (60.8%) and adults (34.2%). PCV13 and PPV23 had high coverage rates for children (89.9%, 93.2%) and adults (70.4%, 82.9%), respectively, Investigational PCVs including PCV15 and PCV20 had high estimated coverage rates in children (89.9%, 93.9%). The study identified 269 subjects with IPD reported as the primary diagnosis in the medical records. Sepsis (48/136, 35.3%) and pneumonia (48/133, 36.1%) had the highest occurrence in the pediatric and adult groups, respectively. Study findings showed that non-PCV7 S. pneumoniae 19A and 3 were the most prevalent serotypes in Chinese children and adults, respectively. High-valent vaccines had similar coverage rates and may have a greater potential in preventing IPD.
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Affiliation(s)
- Ma-Chao Li
- State Key Laboratory for Infectious Diseases Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yao Wang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
- Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Beijing, China
| | - Hong Zhang
- Department of Laboratory Medicine, Children’s Hospital of Shanghai, Shanghai, China
| | - Yong Liu
- Department of Laboratory Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xue-Jun Chen
- Department of Clinical Laboratory, The Children’s Hospital, Zhenjiang University School of Medicine, Hangzhou, China
| | - Hong-Wei Yang
- Department of Laboratory Medicine, Taihe Hospital, Hubei University of Medicine Shiyan, Shiyan, China
| | - Ping Ma
- Department of Laboratory Medicine, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Ding-Cheng Wang
- Department of Laboratory Medicine, Tangdu Hospital, Fourth Military Medical University, Xian, China
| | - Bing-Chang Zhang
- Department of Clinical Laboratory, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Ai-Ying Dong
- Department of Laboratory Medicine, North China University of Science and Technology Affiliated Hospital, Tangshan, China
| | - Chun-Xin Wang
- Department of Medical Laboratory, Wuxi People’s Hospital, Wuxi, China
| | - Yan Li
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
| | - Peng Bai
- Global Medical Affairs, Merck Sharp & Dohme China, Shanghai, China
| | - Wen-Min Tang
- Global Medical Affairs, Merck Sharp & Dohme China, Shanghai, China
| | - Jue Wang
- Global Medical Affairs, Merck Sharp & Dohme China, Shanghai, China
| | - Zhu-Jun Shao
- State Key Laboratory for Infectious Diseases Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ying-Chun Xu
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Serotype distribution and antimicrobial resistance patterns of invasive pneumococcal disease isolates from children in mainland China-a systematic review. Braz J Microbiol 2019; 51:665-672. [PMID: 31797324 DOI: 10.1007/s42770-019-00198-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 11/22/2019] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES This study aimed to review and report the serotype distribution and antimicrobial resistance patterns of invasive pneumococcal disease (IPD) isolates, as this information is important for policy making since China has not adopted any pneumococcal vaccines in the national immunization schedule. METHODS A systematic review of the published literature from January 2000 to December 2018 was performed to identify articles that describe the serotype and/or antimicrobial resistance patterns of IPD cases in children in mainland China. Analysis of the extracted data was performed with the Microsoft Excel spreadsheet program. The percentage of the serotypes was calculated by dividing the number of isolates for each serotype with the total number of isolates included in all the studies. The theoretical impact of the vaccine was estimated by calculating the percentage of isolates that exhibited the serotypes included in the vaccines. The prevalence of antimicrobial resistance was defined as the number of isolates that were resistant divided by the total number of isolates tested for resistance to the specific antimicrobial agent. RESULTS Forty-two articles were screened in the preliminary search, of which sixteen fulfilled inclusion criteria and were included in the final analysis. The predominant serotypes were 19A, 19F, 14, 23F, and 6B, and the estimated impact of PCV13 was 90.4%. The isolates exhibited a high frequency of resistance to cefuroxime, cefaclor, and erythromycin. CONCLUSIONS It is necessary for Chinese children to receive PCV13. Clinical workers should pay attention to the high frequency of resistance to antimicrobial agents.
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Fu J, Yi R, Jiang Y, Xu S, Qin P, Liang Z, Chen J. Serotype distribution and antimicrobial resistance of Streptococcus pneumoniae causing invasive diseases in China: a meta-analysis. BMC Pediatr 2019; 19:424. [PMID: 31711442 PMCID: PMC6844036 DOI: 10.1186/s12887-019-1722-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 09/12/2019] [Indexed: 12/13/2022] Open
Abstract
Background To summarize information about invasive pneumococcal disease (IPD) among children in mainland China. Methods Sixteen eligible studies were included in this systematic review and the random effect model was used to estimate the pool prevalence of IPD. Results The most predominant serotypes circulating in children were 19F (27.7, 95% confidence interval (95% CI): 17.7–37.6%), 19A (21.2%, 16.4–26.1%), 14 (16.5%, 12.8–20.1%), 6B (8.6%, 5.2–10.8%) and 23F (7.3%, 5.2–9.5%). The serotype coverage of the available pneumococcal conjugate vaccines PCV7, PCV10, and PCV13 was 60.8% (52.5–69.4%), 65.1% (57.7–72.4%), and 90.0% (87.1–92.8%), respectively. The pooled antibiotic resistance rates of Streptococcus pneumoniae revealed a resistance to penicillin prevalence rate of 32.0% (12.1–51.9%). Approximately 94.4% (90.7–98.1%) and 92.3% (87.4–97.3%) of isolates were resistant to erythromycin and clindamycin. eBURST analysis revealed great diversity among isolates, with 102 sequence types (STs) for 365 isolates. The major predominant clonal complexes (CCs) were CC271 (43.6%, 159/365), CC876 (13.4%, 49/365), CC81 (5.2%, 19/365), and CC90 (4.1%, 15/365). Long-term and regional surveillance of S. pneumoniae is necessary. Conclusions Based on our pooled results showing that PCV13 coverage of the reported serotypes was 90% and that most serotypes contributed to the distribution of antibiotic-resistant isolates, implementation of PCV13 into the Chinese Expanded Program on Immunizations (EPI) would achieve health benefits in Chinese children.
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Affiliation(s)
- Jinjian Fu
- Department of Laboratory Medicine, Liuzhou Maternity and Child Health Care Hospital, Liuzhou, 545001, Guangxi, China.,Department of Laboratory Medicine, Affiliated Rong'an of Liuzhou Maternity and Child Health Care Hospital, Liuzhou, 545001, Guangxi, China
| | - Rongsong Yi
- Department of Pediatric, Liuzhou Maternity and Child Health Care Hospital, Liuzhou, 545001, Guangxi, China
| | - Yongjiang Jiang
- Department of Neonatology, Liuzhou Maternity and Child Health Care Hospital, Liuzhou, 545001, Guangxi, China
| | - Shaolin Xu
- Department of Laboratory Medicine, Liuzhou Maternity and Child Health Care Hospital, Liuzhou, 545001, Guangxi, China
| | - Peixu Qin
- Department of Laboratory Medicine, Liuzhou Maternity and Child Health Care Hospital, Liuzhou, 545001, Guangxi, China
| | - Zhuoxin Liang
- Department of Pediatric Intensive Care Unit, Liuzhou Maternity and Child Health Care Hospital, Liuzhou, 545001, Guangxi, China. .,Department of Pediatric, Affiliated Rong'an of Liuzhou Maternity and Child Health Care Hospital, Liuzhou, 545001, Guangxi, China.
| | - Jichang Chen
- Department of Neonatology, Liuzhou Maternity and Child Health Care Hospital, Liuzhou, 545001, Guangxi, China.
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Bao Y, Wang Q, Yao K, Xie G, Gao W, Huang L, Liu X, Zhu C, Chen H, Wang H, Shen K, Zheng Y, Yang Y. The changing phenotypes and genotypes of invasive pneumococcal isolates from children in Shenzhen during 2013–2017. Vaccine 2019; 37:7248-7255. [DOI: 10.1016/j.vaccine.2019.09.069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 09/03/2019] [Accepted: 09/20/2019] [Indexed: 01/29/2023]
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Shi W, Li J, Dong F, Qian S, Liu G, Xu B, Zhou L, Xu W, Meng Q, Wang Q, Shen K, Ma L, Yao K. Serotype distribution, antibiotic resistance pattern, and multilocus sequence types of invasive Streptococcus pneumoniae isolates in two tertiary pediatric hospitals in Beijing prior to PCV13 availability. Expert Rev Vaccines 2018; 18:89-94. [PMID: 30526145 DOI: 10.1080/14760584.2019.1557523] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Invasive pneumococcal disease (IPD) is a serious threat to children worldwide. This study reported the serotype distribution, antibiotic resistance pattern, and multilocus sequence types of 111 IPD strains isolated from children less than 14 years old in two tertiary pediatric centers in Beijing during the years 2012-2017. METHODS Serotypes were determined using Quellung reaction. Antibiotic resistance was tested using the E-test or disc diffusion method. Sequence types (STs) were assigned via multilocus sequence typing. RESULTS The most common serotypes of the IPD isolates were 19F, 19A, 14, 23F, and 6B, and the PCV13 coverage rate was 90.1%. For the meningitis isolates, the resistance rate to penicillin was 95.7%, and the non-susceptibility rate to ceftriaxone was 65.2%. All of the non-meningitis isolates were susceptible to penicillin, and the susceptibility rate to ceftriaxone was 89.8%. All but one of the isolates were highly resistant to erythromycin. The multidrug resistance rate of all isolates was 89.2%. The most common STs were ST320, ST271, ST876, and ST81, which belonged to serotype 19A, 19F, 14, and 23F, respectively. CONCLUSION Given the high coverage rate of PCV13 and the worrisome non-susceptibility rate of IPD isolates to antibiotics, PCV13 use would be beneficial for Chinese children.
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Affiliation(s)
- Wei Shi
- a Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases , National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health , Beijing , China
| | - Jing Li
- b Department of Clinical Laboratory , Capital Institute of Pediatrics , Beijing , China
| | - Fang Dong
- c Clinical Laboratory, Beijing Children's Hospital , Capital Medical University, National Center for Children's Health , Beijing , China
| | - Suyun Qian
- d Pediatric Intensive Care Unit, Beijing Children's Hospital , Capital Medical University, National Center for Children's Health , Beijing , China
| | - Gang Liu
- e Department of Infectious Diseases, Beijing Children's Hospital , Capital Medical University, National Center for Children's Health , Beijing , China
| | - Baoping Xu
- f Department of Respiratory, Beijing Children's Hospital , Capital Medical University, National Center for Children's Health , Beijing , China
| | - Lin Zhou
- b Department of Clinical Laboratory , Capital Institute of Pediatrics , Beijing , China
| | - Wenjian Xu
- b Department of Clinical Laboratory , Capital Institute of Pediatrics , Beijing , China
| | - Qinghong Meng
- a Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases , National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health , Beijing , China
| | - Qing Wang
- a Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases , National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health , Beijing , China
| | - Kunling Shen
- f Department of Respiratory, Beijing Children's Hospital , Capital Medical University, National Center for Children's Health , Beijing , China
| | - Lijuan Ma
- b Department of Clinical Laboratory , Capital Institute of Pediatrics , Beijing , China
| | - Kaihu Yao
- a Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases , National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health , Beijing , China
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Cai K, Wang Y, Guo Z, Xu X, Li H, Zhang Q. Clinical characteristics and antimicrobial resistance of pneumococcal isolates of pediatric invasive pneumococcal disease in China. Infect Drug Resist 2018; 11:2461-2469. [PMID: 30538512 PMCID: PMC6263219 DOI: 10.2147/idr.s183916] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose Streptococcus pneumoniae causes serious infections globally, including invasive pneumococcal disease (IPD). We analyze clinical features of pediatric IPD cases identified in China and antibiotic susceptibility of isolated pneumococcal strains. Methods Confirmed pediatric IPD patients were prospectively recruited to the study. Symptoms at the time of hospitalization, laboratory tests, antimicrobial susceptibility of pneumococcal isolates, treatments, hospital stay, and residual findings at discharge were analyzed systematically. Results From January 2008 to December 2017, a total of 123 hospitalized children diagnosed with IPD were enrolled: 68 from pediatric departments of Xinhua Hospital, and 55 from Lanzhou University Second Hospital. Of these pediatric IPD patients, 81 (65.86%) were male, and 98 (79.67%) <5 years old. Most cases (96, 78.05%) were diagnosed during the cold season between September and February. Sepsis was observed in 82 (66.67%) patients, 48 (39.02%) children were diagnosed with meningitis, 41 (33.33%) with pneumonia, 30 (24.39%) with pleurisy, and 4 (3.25%) with osteomyelitis. Underlying diseases were noted in 35 (28.45%) patients and concurrent infections in 45 (36.58%). The overall mortality rate was 2.44%. IPD children who developed sepsis and necrotizing pneumonia showed higher proportions of intensive care-unit admission, intravenous γ-globulin, glucocorticoid use, hemofiltration and ventilator, and longer duration of fever, hospital stay, and antibiotic use than nonsepsis and pneumonia subjects. Antimicrobial resistance of S. pneumoniae showed a highly unsusceptible rate for erythromycin (96.75%), trimethoprim-sulfamethoxazole (79.67%), and tetracycline (77.23%). All isolates were sensitive to vancomycin, linezolid, and levofloxacin. Conclusion Clinical symptoms were severe in the majority of pediatric IPD patients. More intensive treatments were demanded for IPD children with sepsis and necrotizing pneumonia. High resistance rates for erythromycin, trimethoprim–sulfamethoxazole, and tetracycline were found.
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Affiliation(s)
- Kang Cai
- Department of Pediatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China,
| | - Yizhong Wang
- Department of Infectious Diseases, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China,
| | - Zhongqin Guo
- School of Public Health and Management, Ningxia Medical University, Yinchuan, China
| | - Xiaonan Xu
- Department of Pediatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China,
| | - Huajun Li
- Department of Pediatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China,
| | - Qingli Zhang
- Department of Pediatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China, .,Department of Pediatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Chongming Branch, Shanghai, China,
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12
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Shen M, Yao R, Yue H, Zhang J, Chen M, Zhang W, Liu D, Wu K. Serotype prevalence and antibiotic susceptibility patterns of pneumococcal isolates in Zunyi city, China. Saudi Med J 2018; 38:1243-1249. [PMID: 29209675 PMCID: PMC5787637 DOI: 10.15537/smj.2017.12.21090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To assess the serotype distribution and antimicrobial susceptibility of pneumococci isolated from inpatients of all ages suspected of having bacterial infections. METHODS In this retrospective study, pneumococcal isolates were consecutively collected from the Third Affiliated Hospital of Zunyi Medical University, in Zunyi city, China, between January 2014 and December 2016. Pneumococci were identified using routine microbiological assays. We performed antimicrobial susceptibility analyses using the bacteria identification/susceptibility system VITEK2 and E-tests. Capsular types of all isolates were determined by multiplex polymerase chain reaction. RESULTS We identified 778 pneumococcal isolates. Serotypes 19F, 6A/6B, 19A, 23F, and 15B/15C were the most prevalent strains, accounting for 71.5% (556/778) of all isolates. Data show that 409 (70.4%) isolates could be covered by the PCV13 vaccine in children less than 2 years old. Irrespective of serotypes, 747 (96%) isolates were sensitive to penicillin, while 720 to 778 (90% to 100%) isolates were not susceptible to erythromycin, tetracycline, and trimethoprim/sulfamethoxazole. For isolates resistant to penicillin, ceftriaxone, cefotaxime, and meropenem, 22 to 39 (70% to 81.25%) strains belonged to PCV13 serotypes. CONCLUSION We found a substantial increase in the annual number of pneumococcal isolates since 2014. The theoretical impact of PCV13 was high in children less than 2 years old, and penicillin might be effective against pneumococcal infections in this region.
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Affiliation(s)
- Meijing Shen
- Department of Laboratory Medicine, The Third Affiliated Hospital of Zunyi Medical University, Zunyi, China. E-mail.
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13
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Shen K, Wasserman M, Liu D, Yang YH, Yang J, Guzauskas GF, Wang BCM, Hilton B, Farkouh R. Estimating the cost-effectiveness of an infant 13-valent pneumococcal conjugate vaccine national immunization program in China. PLoS One 2018; 13:e0201245. [PMID: 30044865 PMCID: PMC6059448 DOI: 10.1371/journal.pone.0201245] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 07/11/2018] [Indexed: 01/29/2023] Open
Abstract
Background The burden of pneumococcal disease in China is high, and a 13-valent pneumococcal conjugate vaccine (PCV13) recently received regulatory approval and is available to Chinese infants. PCV13 protects against the most prevalent serotypes causing invasive pneumococcal disease (IPD) in China, but will not provide full societal benefits until made broadly available through a national immunization program (NIP). Objective To estimate clinical and economic benefits of introducing PCV13 into a NIP in China using local cost estimates and accounting for variability in vaccine uptake and indirect (herd protection) effects. Methods We developed a population model to estimate the effect of PCV13 introduction in China. Modeled health states included meningitis, bacteremia, pneumonia (PNE), acute otitis media, death and sequelae, and no disease. Direct healthcare costs and disease incidence data for IPD and PNE were derived from the China Health Insurance and Research Association database; all other parameters were derived from published literature. We estimated total disease cases and associated costs, quality-adjusted life years (QALYs), and deaths for three scenarios from a Chinese Payer Perspective: (1) direct effects only, (2) direct+indirect effects for IPD only, and (3) direct+indirect effects for IPD and inpatient PNE. Results Scenario (1) resulted in 370.3 thousand QALYs gained and 12.8 thousand deaths avoided versus no vaccination. In scenarios (2) and (3), the PCV13 NIP gained 383.2 thousand and 3,580 thousand QALYs, and avoided 13.1 thousand and 147.5 thousand deaths versus no vaccination, respectively. In all three scenarios, the vaccination cost was offset by cost reductions from prevented disease yielding net costs of ¥29,362.32 million, ¥29,334.29 million, and ¥13,524.72 million, respectively. All resulting incremental cost-effectiveness ratios fell below a 2x China GDP cost-effectiveness threshold across a range of potential vaccine prices. Discussion Initiation of a PCV13 NIP in China incurs large upfront costs but is good value for money, and is likely to prevent substantial cases of disease among children and non-vaccinated individuals.
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Affiliation(s)
- Kunling Shen
- Department of Respiratory Diseases, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | | | | | - Yong-Hong Yang
- Key Laboratory of Major Diseases in Children and National Key Discipline of Pediatrics (Capital Medical University), Ministry of Education, National Clinical Research Centre for Respiratory Diseases, Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Laboratory of Microbiology, Beijing Children's Hospital, Beijing Pediatric Research Institute, Capital Medical University, Beijing, China
| | | | | | | | - Betsy Hilton
- Pfizer Inc. Collegeville, PA, United States of America
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Li C, Feng WY, Lin AW, Zheng G, Wang YC, Han YJ, Zhong JM, Bi J, Luo Q, Zhao FC, Jin P, Guo LY, Li N, Yu J, Yang XT, Liang J, Deng JK, Li YJ, Wang YJ, Yu XY, Wang DM, Ru L, Chen J, Yang YH, Yang QZ, Liu G. Clinical characteristics and etiology of bacterial meningitis in Chinese children >28 days of age, January 2014-December 2016: A multicenter retrospective study. Int J Infect Dis 2018; 74:47-53. [PMID: 30100536 DOI: 10.1016/j.ijid.2018.06.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/08/2018] [Accepted: 06/30/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To explore the clinical characteristics and etiology of bacterial meningitis (BM) in Chinese children. METHOD BM cases in children 28days to 18 years old were collected from January 2014-December 2016 and screened according to World Health Organization standards. Clinical features, pathogens, and resistance patterns were analyzed. RESULTS Overall, 837 cases were classified into five age groups: 28 days-2 months (17.0%), 3-11 months (27.8%), 12-35 months (24.0%), 3-6 years (13.9%), and >6years (17.3%). Major pathogens were Streptococcus pneumoniae (S. pneumoniae, n=136, 46.9%), group B Streptococcus (GBS, n=29, 10.0%), and Escherichia coli (E. coli, n=23, 7.9%). In infants <3 months old, GBS (46.5%) and E. coli (23.3%) were most common; in children >3 months old, S. pneumoniae (54.7%), which had a penicillin non-susceptibility rate of 55.4% (36/65), was most frequent. The resistance rates of S. pneumoniae and E. coli to cefotaxime and ceftriaxone were 14.0%/40.0% and 11.3%/68.4%, respectively. All GBS isolates were sensitive to penicillin. CONCLUSIONS The occurrence of BM peaked in the first year of life, while S. pneumoniae was the predominant pathogen in children >3months of old. The antibiotic resistance of S. pneumoniae was a concern.
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Affiliation(s)
- Chi Li
- Key Laboratory of Major Diseases in Children, Ministry of Education, Department of Infectious Diseases, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China, Beijing, China; Department of Infectious Diseases, Shenzhen Children's Hospital, Shenzhen, China
| | - Wen-Ya Feng
- Key Laboratory of Major Diseases in Children, Ministry of Education, Department of Infectious Diseases, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China, Beijing, China
| | - Ai-Wei Lin
- Department of Infectious Diseases, Qilu Children's Hospital of Shandong University, Jinan, China
| | - Guo Zheng
- Department of Neurology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Yan-Chun Wang
- Department of Infectious Diseases, Kunming Children's Hospital, Kunming Medical University, Kunming, China
| | - Yan-Jun Han
- Department of Pediatric, Affiliated Xingtai People's Hospital of Hebei Medical University, Xingtai, China
| | - Jian-Min Zhong
- Department of Pediatric Neurology, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Jing Bi
- Department of Infectious Diseases, Baoding Children's Hospital, Hebei Medical University, Baoding, China
| | - Qiong Luo
- Department of No. 3 Pediatric Internal, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Fang-Chao Zhao
- Department of Children's Diseases, Daming County People's Hospital, Handan, China
| | - Ping Jin
- Pediatric Intensive Care Unit, Bao'an Maternity and Child Health Hospital, Shenzhen, China
| | - Ling-Yun Guo
- Key Laboratory of Major Diseases in Children, Ministry of Education, Department of Infectious Diseases, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China, Beijing, China
| | - Na Li
- Department of Infectious Diseases, Qilu Children's Hospital of Shandong University, Jinan, China
| | - Jie Yu
- Department of Neurology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Xiao-Tao Yang
- Department of Infectious Diseases, Kunming Children's Hospital, Kunming Medical University, Kunming, China
| | - Jun Liang
- Department of Pediatric, Liaocheng People's Hospital, Liaocheng, China
| | - Ji-Kui Deng
- Department of Infectious Diseases, Shenzhen Children's Hospital, Shenzhen, China
| | | | - Yu-Jiao Wang
- Department of Pediatric, Affiliated Xingtai People's Hospital of Hebei Medical University, Xingtai, China
| | - Xiong-Ying Yu
- Department of Pediatric Neurology, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Dong-Meng Wang
- Department of Infectious Diseases, Baoding Children's Hospital, Hebei Medical University, Baoding, China
| | - Liang Ru
- Department of No. 3 Pediatric Internal, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Juan Chen
- Pediatric Intensive Care Unit, Bao'an Maternity and Child Health Hospital, Shenzhen, China
| | - Yong-Hong Yang
- Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China, Beijing, China
| | - Qiao-Zhi Yang
- Department of Pediatric, Liaocheng People's Hospital, Liaocheng, China.
| | - Gang Liu
- Key Laboratory of Major Diseases in Children, Ministry of Education, Department of Infectious Diseases, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China, Beijing, China.
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Lyu S, Hu HL, Yang YH, Yao KH. A systematic review about Streptococcus Pneumoniae serotype distribution in children in mainland of China before the PCV13 was licensed. Expert Rev Vaccines 2017; 16:997-1006. [PMID: 28745918 DOI: 10.1080/14760584.2017.1360771] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Streptococcus pneumoniae (S. pneumoniae) is a major pathogen of infectious diseases in children. Surveillance of the distribution of pneumococcus serotypes is important for immunization strategies of pneumococcal polysaccharide conjugate vaccines (PCVs). Areas covered: This article is a systematic review of studies conducted from 2006 to 2016 that document serotypes of S. pneumoniae isolated from children less than 14 years old in the mainland of China. A total of 40 studies were included in this review. Serotypes 19F, 19A, 23F, 14 and 6B were the most common. Serotype prevalence and percentage varied by region and associated strains. The serotype coverage rate of PCV13 was higher than that of PCV10 due to the prevalence of serotype 19A, and there were no significant difference between the coverage rate of PCV13 and PPSV23. Expert commentary: To prevent Chinese children from S. pneumoniae infection, it is necessary for the universal immunization of PCV13 or develop new vaccines that include all the prevalent serotypes in China.
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Affiliation(s)
- Shuang Lyu
- a Paediatrics Department , Beijing Friendship Hospital, Capital Medical University , Beijing , China
| | - Hui-Li Hu
- b Infectious Diseases Department, Beijing Children's Hospital , Capital Medical University, National Center for Children's Health , Beijing , China
| | - Yong-Hong Yang
- c Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Key laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases , National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health , Beijing , China
| | - Kai-Hu Yao
- c Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Key laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases , National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health , Beijing , China
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Zhang X, Tian J, Shan W, Xue J, Tao Y, Geng Q, Ding Y, Zhao G, Zhang T. Characteristics of pediatric invasive pneumococcal diseases and the pneumococcal isolates in Suzhou, China before introduction of PCV13. Vaccine 2017; 35:4119-4125. [DOI: 10.1016/j.vaccine.2017.06.046] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 06/08/2017] [Accepted: 06/19/2017] [Indexed: 11/27/2022]
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17
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Zhang J, Cui YL, Jiang YM. [Immunoprotective effect of combined pneumococcal endopeptidase O and pneumococcal surface adhesin A vaccines against Streptococcus pneumoniae infection]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2017; 19:583-589. [PMID: 28506354 PMCID: PMC7389137 DOI: 10.7499/j.issn.1008-8830.2017.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 04/06/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate the prokaryotic expression of proteins pneumococcal endopeptidase O (PepO) and pneumococcal surface adhesin A (PsaA) in Streptococcus pneumoniae and their immunoprotective effect as vaccine candidate proteins. METHODS Specific primers of target gene fragments were designed, and then PCR amplification was performed to establish recombinant plasmids pET28a(+)-pepO and pET28a(+)-psaA, which were transformed into host cells, Escherichia coli BL21 and DE3, respectively, to induce expression. Highly purified target proteins PepO and PsaA were obtained after purification. Mucosal immunization was performed for BALB/c mice and specific antiserum was prepared. ELISA was used to measure the antibody titer, and Western blot was used to analyze the specificity of the antiserum of target proteins. The mice were randomly divided into negative control group, PepO group, PsaA group, and PepO+PsaA combined immunization group, with 18 mice in each group. The models of different serotypes of Streptococcus pneumoniae infection were established to evaluate the immunoprotective effect of target proteins used alone or in combination. RESULTS The target proteins PepO and PsaA were successfully obtained and Western blot demonstrated that the antiserum of these proteins had good specificity. There was no significant difference in the titers of IgA in saliva and IgG in serum between the PepO group and the combined immunization group (P>0.05); however, these two groups had significantly higher antibody titers than the PsaA group (P<0.05). The PepO, PsaA, and combined immunization groups had significantly higher protection rates for mice infected with Streptococcus pneumoniae D39 and CMCC31436 in the nasal cavity than the negative control group (P<0.05). The PepO and combined immunization groups had a significantly higher protection rate for mice infected with Streptococcus pneumoniae D39 than the PsaA group (P<0.05). The results of colonization experiment showed that compared with the control group, the PepO, PsaA, and combined immunization groups showed a significant reduction in the colonization of Streptococcus pneumoniae (CMCC31693 and CMCC31207) in the nasopharynx and lung (P<0.05). The combined immunization group showed a better effect on reducing the colonization of CMCC31207 in the lung than the PepO and PsaA alone groups. CONCLUSIONS Combined PepO/PsaA vaccines may produce a better protective effect by mucosal immunization compared with the vaccine used alone in mice. The combined vaccines can effectively reduce the colonization of Streptococcus pneumoniae in the nasopharynx and lung. Therefore, such protein vaccines may have a great potential for research and development.
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Affiliation(s)
- Jing Zhang
- Department of Clinical Laboratory, West China Second University Hospital, Sichuan University/Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Chengdu 610041, China.
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18
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Maurer KA, Chen HF, Wagner AL, Hegde ST, Patel T, Boulton ML, Hutton DW. Cost-effectiveness analysis of pneumococcal vaccination for infants in China. Vaccine 2016; 34:6343-6349. [PMID: 27810315 DOI: 10.1016/j.vaccine.2016.10.051] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 10/15/2016] [Accepted: 10/19/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Although China has a high burden of pneumococcal disease among young children, the government does not administer publicly-funded pneumococcal conjugate vaccines (PCV) through its Expanded Program on Immunization (EPI). We evaluated the cost-effectiveness of publicly-funded PCV-7, PCV-10, and PCV-13 vaccination programs for infants in China. METHODS Using a Markov model, we simulated a cohort of 16 million Chinese infants to estimate the impact of PCV-7, PCV-10, and PCV-13 vaccination programs from a societal perspective. We extrapolated health states to estimate the effects of the programs over the course of a lifetime of 75years. Parameters in the model were derived from a review of the literature. RESULTS We found that PCV-7, PCV-10, and PCV-13 vaccination programs would be cost-effective compared to no vaccination. However, PCV-13 had the lowest incremental cost-effectiveness ratio ($11,464/QALY vs $16,664/QALY for PCV-10 and $18,224/QALY for PCV-7) due to a reduction in overall costs. Our sensitivity analysis revealed that the incremental cost-effectiveness ratios were most sensitive to the utility of acute otitis media, the cost of PCV-13, and the incidence of pneumonia and acute otitis media. CONCLUSIONS The Chinese government should take steps to reduce the burden of pneumococcal diseases among young children through the inclusion of a pneumococcal conjugate vaccine in its EPI. Although all vaccinations would be cost-effective, PCV-13 would save more costs to the healthcare system and would be the preferred strategy.
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Affiliation(s)
- Kristin A Maurer
- Department of Health Management and Policy, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States.
| | - Huey-Fen Chen
- Department of Health Management and Policy, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States.
| | - Abram L Wagner
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States.
| | - Sonia T Hegde
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States.
| | - Tejasi Patel
- Department of Health Management and Policy, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States.
| | - Matthew L Boulton
- Department of Health Management and Policy, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States; Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States; Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Medical School, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, United States.
| | - David W Hutton
- Department of Health Management and Policy, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States.
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Wu Y, Cui J, Zhang X, Gao S, Ma F, Yao H, Sun X, He Y, Yin Y, Xu W. Pneumococcal DnaJ modulates dendritic cell-mediated Th1 and Th17 immune responses through Toll-like receptor 4 signaling pathway. Immunobiology 2016; 222:384-393. [PMID: 27594384 DOI: 10.1016/j.imbio.2016.08.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 08/11/2016] [Accepted: 08/29/2016] [Indexed: 02/02/2023]
Abstract
Pneumococcal DnaJ was recently shown to be a potential protein vaccine antigen that induces strong Th1 and Th17 immune response against streptococcus pneumoniae infection in mice. However, how DnaJ mediates T cell immune response against S. pneumoniae infection has not been addressed. Here, we investigate whether DnaJ contributes to the development of T cell immunity through the activation of bone marrow-derived dendritic cells (BMDCs). We found that endotoxin-free recombinant DnaJ (rDnaJ) induced activation and maturation of BMDCs via recognition of Toll-like receptor 4 (TLR4) and activation of MAPKs, NF-κB and PI3K-Akt pathways. rDnaJ-treated BMDCs effectively stimulated naïve CD4+ T cells to secrete IFN-γ and IL-17A. Splenocytes from mice that were adoptively transferred with rDnaJ-pulsed BMDCs secreted higher levels of IFN-γ and IL-17A compared with those that received PBS-activated BMDCs. Splenocytes from TLR4-/- mice immunized with rDnaJ produced lower levels of IFN-γ and IL-17A compared with those from wild type mice. Our findings indicate that DnaJ can induce Th1 and Th17 immune responses against S. pneumoniae through activation of BMDCs in a TLR4-dependent manner.
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Affiliation(s)
- Yingying Wu
- College of Laboratory Medicine, Chongqing Medical University, Key Laboratory of Laboratory Medical Diagnostics, Ministry of Education, Chongqing 400016, China; Department of Laboratory Medicine, Affiliated Hospital of Southwest Medical University, Luzhou 646000,China
| | - Jingjing Cui
- College of Laboratory Medicine, Chongqing Medical University, Key Laboratory of Laboratory Medical Diagnostics, Ministry of Education, Chongqing 400016, China
| | - Xuemei Zhang
- College of Laboratory Medicine, Chongqing Medical University, Key Laboratory of Laboratory Medical Diagnostics, Ministry of Education, Chongqing 400016, China
| | - Song Gao
- College of Laboratory Medicine, Chongqing Medical University, Key Laboratory of Laboratory Medical Diagnostics, Ministry of Education, Chongqing 400016, China
| | - Feng Ma
- College of Laboratory Medicine, Chongqing Medical University, Key Laboratory of Laboratory Medical Diagnostics, Ministry of Education, Chongqing 400016, China
| | - Hua Yao
- College of Laboratory Medicine, Chongqing Medical University, Key Laboratory of Laboratory Medical Diagnostics, Ministry of Education, Chongqing 400016, China
| | - Xiaoyu Sun
- College of Laboratory Medicine, Chongqing Medical University, Key Laboratory of Laboratory Medical Diagnostics, Ministry of Education, Chongqing 400016, China
| | - Yujuan He
- College of Laboratory Medicine, Chongqing Medical University, Key Laboratory of Laboratory Medical Diagnostics, Ministry of Education, Chongqing 400016, China
| | - Yibing Yin
- College of Laboratory Medicine, Chongqing Medical University, Key Laboratory of Laboratory Medical Diagnostics, Ministry of Education, Chongqing 400016, China
| | - Wenchun Xu
- College of Laboratory Medicine, Chongqing Medical University, Key Laboratory of Laboratory Medical Diagnostics, Ministry of Education, Chongqing 400016, China.
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Kong Y, Zhang W, Jiang Z, Wang L, Li C, Li Y, Xia J. Immunogenicity and safety of a 23-valent pneumococcal polysaccharide vaccine in Chinese healthy population aged >2 years: A randomized, double-blinded, active control, phase III trial. Hum Vaccin Immunother 2016; 11:2425-33. [PMID: 26083953 DOI: 10.1080/21645515.2015.1055429] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Streptococcus pneumoniae is an important pathogen causing invasive diseases such as sepsis, meningitis, and pneumonia. Vaccines have become the most effective way to prevent pneumococcal infections. This phase III trial was designed to evaluate the immunogenicity and safety of a 23-valent pneumococcal polysaccharide vaccine in Chinese healthy population aged >2 years. We conducted a randomized, double-blinded, active-controlled, multicenter trial in which 1660 healthy population (>2 years of age) were randomly assigned in a 1 : 1 ratio to receive 2 intramuscular doses of either the treatment vaccine or the active control vaccine, PNEUMOVAX 23. The surveillance period was 30 days. The primary end point was the 2-fold increase rate of anti-pneumococcal antibody for all 23 included serotypes in each group. In the intention-to-treat cohort, the 2-fold increase rate of anti-pneumococcal antibody for 23 included serotypes varied from 62.47% to 97.01% in the treatment group, and from 51.49% to 95.77% in the control group. According to -10% non-inferiority margin and 95% confidence intervals of rate difference, almost all included serotypes of the treatment group reached non-inferiority to control group except for serotype 6B, the lower limit of rate difference of which was -10.00%, equal to the non-inferiority margin. The 2-fold increase rates of anti-pneumococcal antibody were significantly higher in the treatment group for serotype 2, 3, 4, 10A, 11A and 20. Furthermore, for all 23 serotypes, IgG geometric mean concentrations (GMCs) at day 30 were significantly higher in treatment group for serotype 2, 3, 4, 9 V, 10A, 11A, 15 B, 18C, 19 A, 22 F and 33 F. Higher geometric mean fold increase (GMFI) were also observed in the treatment group correspondingly. Serious adverse events occurred in 3 of 830 participants in the treatment group (0.36%) and 2 of 830 participants in the control group (0.24%). No death occurred during the trial. The frequencies of both solicited and unsolicited adverse events (AEs) were small lower in the treatment group (34.34% vs 35.66% for solicited AEs, 4.34% vs 5.42% for unsolicited AEs). Both vaccines were well tolerated and most AEs were mild or moderate in intensity. The newly vaccine was well tolerated and immunologically non-inferior to the active control vaccine PNEUMOVAX 23 for all 23 vaccine serotypes in the Chinese population (>2 years of age).
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Affiliation(s)
- Yujia Kong
- a Department of Health Statistics ; School of Preventive Medicine; Fourth Military Medical University ; Xi'an , Shaanxi , China
| | - Wei Zhang
- a Department of Health Statistics ; School of Preventive Medicine; Fourth Military Medical University ; Xi'an , Shaanxi , China
| | - Zhiwei Jiang
- a Department of Health Statistics ; School of Preventive Medicine; Fourth Military Medical University ; Xi'an , Shaanxi , China
| | - Ling Wang
- a Department of Health Statistics ; School of Preventive Medicine; Fourth Military Medical University ; Xi'an , Shaanxi , China
| | - Chanjuan Li
- a Department of Health Statistics ; School of Preventive Medicine; Fourth Military Medical University ; Xi'an , Shaanxi , China
| | - Yanping Li
- b Center for Disease Control and Prevention of the Guangxi Zhuang Autonomous Region ; Nanning , China
| | - Jielai Xia
- a Department of Health Statistics ; School of Preventive Medicine; Fourth Military Medical University ; Xi'an , Shaanxi , China
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DeAntonio R, Yarzabal JP, Cruz JP, Schmidt JE, Kleijnen J. Epidemiology of community-acquired pneumonia and implications for vaccination of children living in developing and newly industrialized countries: A systematic literature review. Hum Vaccin Immunother 2016; 12:2422-40. [PMID: 27269963 PMCID: PMC5027706 DOI: 10.1080/21645515.2016.1174356] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
This systematic review evaluated the epidemiology of community-acquired pneumonia in children <6 y of age within 90 developing and newly industrialized countries. Literature searches (1990–2011), based on MEDLINE, EMBASE, Cochrane, CAB Global Health, WHO, UNICEF, country-specific websites, conferences, health-technology-assessment agencies, and the reference lists of included studies, yielded 8,734 records; 62 of 340 studies were included in this review. The highest incidence rate among included studies was 0.51 episodes/child-year, for children <5 y of age in Bangladesh. The highest prevalence was in Chinese children <6 months of age (37.88%). The main bacterial pathogens were Streptococcus pneumoniae, Haemophilus influenzae and Mycoplasma pneumoniae and the main viral pathogens were respiratory syncytial virus, adenovirus and rhinovirus. Community-acquired pneumonia remains associated with high rates of morbidity and mortality. Improved and efficient surveillance and documentation of the epidemiology and burden of community-acquired pneumonia across various geographical regions is warranted.
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Affiliation(s)
| | | | | | | | - Jos Kleijnen
- d School for Public Health and Primary Care (CAPHRI), Maastricht University , Maastricht , The Netherlands.,e Kleijnen Systematic Reviews Ltd , York , United Kingdom
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Jin P, Wu L, Oftadeh S, Kudinha T, Kong F, Zeng Q. Using a practical molecular capsular serotype prediction strategy to investigate Streptococcus pneumoniae serotype distribution and antimicrobial resistance in Chinese local hospitalized children. BMC Pediatr 2016; 16:53. [PMID: 27118458 PMCID: PMC4847217 DOI: 10.1186/s12887-016-0589-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 04/16/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND China is one of ten countries with the highest prevalence rate of pneumococcal infections. However, there is limited serotype surveillance data for Streptococcus pneumoniae, especially from the community or rural regions, partly due to limited serotyping capacity because Quellung serotyping is only available in few centers in China. The aim of this study was to develop a simple, practical and economic pneumococcal serotype prediction strategy suitable for future serotype surveillance in China. METHODS In this study, 193 S. pneumoniae isolates were collected from hospitalized children, 96.9 % of whom were < 5 years old. The cpsB sequetyping, complemented by selective and modified USA CDC sequential multiplex-PCR, was performed on all the isolates, and serotypes 6A-6D specific PCRs were done on all serogroup 6 isolates. Based on systematic analysis of available GenBank cpsB sequences, we established a more comprehensive cpsB sequence database than originally published for cpsB sequetyping. Antibiotic susceptibility of all isolates was determined using the disk diffusion or E-test assays. RESULTS We built up a comprehensive S. pneumoniae serotype cpsB sequetyping database for all the 95 described serotypes first, and then developed a simple strategy for serotype prediction based on the improved cpsB sequetyping and selective multiplex-PCR. Using the developed serotype prediction strategy, 191 of 193 isolates were successfully "serotyped", and only two isolates were "non-serotypeable". Sixteen serotypes were identified among the 191 "serotypeable" isolates. The serotype distribution of the isolates from high to low was: 19 F (34.7 %), 23 F (17.1 %), 19A (11.9 %), 14 (7.3 %), 15B/15C (6.7 %), 6B (6.7 %), 6A (6.2 %), 9 V/9A (1.6 %); serotypes 6C, 3, 15 F/15A, 23A and 20 (each 1.1 %); serotypes 10B, 28 F/28A and 34 (each 0.5 %). The prevalence of parenteral penicillin resistance was 1.0 % in the non-meningitis isolates and 88.6 % in meningitis isolates. The total rate of multidrug resistance was 86.8 %. CONCLUSIONS The integrated cpsB sequetyping supplemented with selective mPCR and serotypes 6A-6D specific PCRs "cocktail" strategy is practical, simple and cost-effective for use in pneumococcal infection serotype surveillance in China. For hospitalized children with non-meningitis penicillin-susceptible pneumococcal infections, clinicians still can use narrow-spectrum and cheaper penicillin, using the parenteral route, rather than using broader-spectrum and more expensive antimicrobials.
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Affiliation(s)
- Ping Jin
- Pediatric Center, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, P. R. China.,Paediatric Intensive Care Unit, Bao'an Maternity & Child Health Hospital affiliated with Jinan University, Shenzhen, P. R. China
| | - Lijuan Wu
- Department of Clinical Laboratory, Bao'an Maternity & Child Health Hospital affiliated with Jinan University, Shenzhen, P. R. China
| | - Shahin Oftadeh
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR - Pathology West, University of Sydney, Westmead Hospital, Darcy Road, Westmead, NSW, Australia
| | - Timothy Kudinha
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR - Pathology West, University of Sydney, Westmead Hospital, Darcy Road, Westmead, NSW, Australia.,Charles Sturt University, Leeds Parade, Orange, NSW, Australia
| | - Fanrong Kong
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR - Pathology West, University of Sydney, Westmead Hospital, Darcy Road, Westmead, NSW, Australia
| | - Qiyi Zeng
- Pediatric Center, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, P. R. China.
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Hu J, Sun X, Huang Z, Wagner AL, Carlson B, Yang J, Tang S, Li Y, Boulton ML, Yuan Z. Streptococcus pneumoniae and Haemophilus influenzae type b carriage in Chinese children aged 12-18 months in Shanghai, China: a cross-sectional study. BMC Infect Dis 2016; 16:149. [PMID: 27080523 PMCID: PMC4831093 DOI: 10.1186/s12879-016-1485-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 03/24/2016] [Indexed: 12/04/2022] Open
Abstract
Background The bacteria Streptococcus pneumoniae (pneumococcus) and Haemophilus influenzae type b (Hib) are leading causes of childhood pneumonia and meningitis and are major contributors to worldwide mortality in children younger than 5 years of age. Asymptomatic nasopharyngeal carriage of pneumococcus and Hib was determined for healthy children in Shanghai in 2009. Methods Children from 5 immunization clinics were enrolled in this study. Specimens from the nasopharynx were collected and cultured in Columbia and chocolate agar to identify pneumococcal and Hib carriage. Pneumococcal specimens were serotyped with the Neufeld test, and antibiotic resistance for pneumococcal and Hib specimens used the E-test method. Significance of risk factors for carriage was assessed through chi-square tests. Results Among 614 children, 16.6 % had pneumococcal carriage and 8.0 % Hib carriage. The predominant serotype of pneumococcus that was isolated was 19 F (52.9 %); serotype coverage was 68.6 % for both 7-valent pneumococcal conjugate vaccine (PCV) and PCV-10, and 82.3 % for PCV-13. Household residency and father’s education were both significantly related to pneumococcal and Hib carriage. The majority of S. pneumoniae isolates were sensitive to most antimicrobials but there were high levels of resistance to azithromycin (51.0 %) and erythromycin (51.0 %). Haemophilus influenzae isolates were sensitive to almost all antimicrobials tested although 12.2 % of isolates were resistant to ampicillin. Conclusions The pneumococcal and Hib vaccines require payment, and the children with the highest burden of disease may not be receiving these vaccines. Moreover, the presence of high antibiotic susceptibility towards pneumococcus, and to a lesser extent towards Hib, underscores the need for preventive protection against these diseases. Public funding of pneumococcal and Hib vaccines would be one mechanism to increase uptake of these vaccines.
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Affiliation(s)
- Jiayu Hu
- Shanghai Centers for Disease Control and Prevention, 1380 Zhongshan West Road, Shanghai, 200336, China
| | - Xiaodong Sun
- Shanghai Centers for Disease Control and Prevention, 1380 Zhongshan West Road, Shanghai, 200336, China
| | - Zhuoying Huang
- Shanghai Centers for Disease Control and Prevention, 1380 Zhongshan West Road, Shanghai, 200336, China
| | - Abram L Wagner
- Department of Epidemiology, University of Michigan, 1415 Washington Heights, SPH II, Ann Arbor, MI, 48109, USA
| | - Bradley Carlson
- Department of Epidemiology, University of Michigan, 1415 Washington Heights, SPH II, Ann Arbor, MI, 48109, USA
| | - Jianping Yang
- Shanghai Centers for Disease Control and Prevention, 1380 Zhongshan West Road, Shanghai, 200336, China
| | - Suwen Tang
- Shanghai Centers for Disease Control and Prevention, 1380 Zhongshan West Road, Shanghai, 200336, China
| | - Yunyi Li
- Shanghai Centers for Disease Control and Prevention, 1380 Zhongshan West Road, Shanghai, 200336, China
| | - Matthew L Boulton
- Department of Epidemiology, University of Michigan, 1415 Washington Heights, SPH II, Ann Arbor, MI, 48109, USA.
| | - Zhengan Yuan
- Shanghai Centers for Disease Control and Prevention, 1380 Zhongshan West Road, Shanghai, 200336, China.
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Tai SS. Streptococcus pneumoniae Serotype Distribution and Pneumococcal Conjugate Vaccine Serotype Coverage among Pediatric Patients in East and Southeast Asia, 2000-2014: a Pooled Data Analysis. Vaccines (Basel) 2016; 4:E4. [PMID: 26907356 PMCID: PMC4810056 DOI: 10.3390/vaccines4010004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 01/24/2016] [Accepted: 02/14/2016] [Indexed: 11/29/2022] Open
Abstract
Pneumococcal infection is one of the leading causes of death worldwide, especially in children of developing and underdeveloped countries. Capsular polysaccharide-based vaccines are available for the prevention of this disease. A 7-valent pneumococcal conjugate vaccine (PCV7) was licensed in 2000 for use in children less than two years of age. Subsequently, to broaden the protection, 10-valent (PCV10) and 13-valent (PCV13) vaccines were licensed in 2009 and 2010, respectively. All of these conjugate vaccines elicit an immune response that only provides protection against the infection of S. pneumoniae serotypes included in the formulation. Profiles of S. pneumoniae serotype distribution and serotype coverage for both PCV7 and PCV13 have been reported in some Asian countries/territories. But the published results cannot provide conclusive information due to the difference in studied population and geographic areas. The goals of this review are to obtain an accurate estimate of serotype coverage for PCV7, PCV10, and PCV13 and examine the change in the S. pneumoniae serotype distribution after PCV7 use among pediatric patients in East and Southeast Asia through the analysis of pooled data that were published in the English literature between 2000 and 2014.
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Affiliation(s)
- Stanley S Tai
- Department of Microbiology, College of Medicine, Howard University, Washington, DC 20059, USA.
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He M, Yao K, Shi W, Gao W, Yuan L, Yu S, Yang Y. Dynamics of serotype 14 Streptococcus pneumoniae population causing acute respiratory infections among children in China (1997-2012). BMC Infect Dis 2015; 15:266. [PMID: 26163293 PMCID: PMC4499228 DOI: 10.1186/s12879-015-1008-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 07/06/2015] [Indexed: 01/24/2023] Open
Abstract
Background In the last decade, the Streptococcus pneumoniae population has changed, mainly due to the abuse of antibiotics. The aim of this study was to determine the genetic structure of 144 S. pneumonia serotype 14 isolates collected from children with acute respiratory infections during 1997–2012 in China. Methods All isolated pneumococci were tested for their sensitivity to 11 kinds of antibiotics with the E-test method or disc diffusion. The macrolides resistance genes ermB and mefA, as well as the sulfamethoxazole-trimethoprim resistance gene dihydrofolate reductase (DHFR) were detected by polymerase chain reaction (PCR). The sequence types (STs) were analyzed with multilocus sequence typing (MLST). Results From 1997 to 2012, the percentage of serotype 14 S. pneumonia isolates in the whole isolates increased. All of the 144 serotype 14 S. pneumonia isolates were susceptible to amoxicillin-clavulanic acid, vancomycin and levofloxacin. No penicillin resistant isolate was found, and the intermediate rate was as low as 0.7 %. Erythromycin resistance was confirmed among 143 isolates. The ermB gene was determined in all erythromycin resistant isolates, and the mefA gene was positive additionally in 13 of them. The non-susceptibility rate to the tested cephalosporins increased from 1997–2012. All trimethoprim-resistant isolates contained the Ile100-Leu mutation. Overall, 30 STs were identified, among which ST876 was the most prevalent, followed by ST875. During the study period, the percentage of CC876 increased from 0 % in 1997–2000 to 96.4 % in 2010–2012, whereas CC875 decreased from 84.2 to 0 %. CC876 showed higher non-susceptibility rates to β-lactam antibiotics than CC875. Conclusion The percentage of serotype 14 S. pneumonia isolates increased over time in China. The increase of resistance to β-lactam antibiotics in this serotype isolates was associated with the spread of CC876.
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Affiliation(s)
- Mingming He
- Key Laboratory of Major Diseases in Children and National Key Discipline of Pediatrics, Ministry of Education, Beijing Pediatric Research Institute, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing, P. R. China.
| | - Kaihu Yao
- Key Laboratory of Major Diseases in Children and National Key Discipline of Pediatrics, Ministry of Education, Beijing Pediatric Research Institute, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing, P. R. China.
| | - Wei Shi
- Key Laboratory of Major Diseases in Children and National Key Discipline of Pediatrics, Ministry of Education, Beijing Pediatric Research Institute, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing, P. R. China.
| | - Wei Gao
- Key Laboratory of Major Diseases in Children and National Key Discipline of Pediatrics, Ministry of Education, Beijing Pediatric Research Institute, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing, P. R. China.
| | - Lin Yuan
- Key Laboratory of Major Diseases in Children and National Key Discipline of Pediatrics, Ministry of Education, Beijing Pediatric Research Institute, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing, P. R. China.
| | - Sangjie Yu
- Key Laboratory of Major Diseases in Children and National Key Discipline of Pediatrics, Ministry of Education, Beijing Pediatric Research Institute, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing, P. R. China.
| | - Yonghong Yang
- Key Laboratory of Major Diseases in Children and National Key Discipline of Pediatrics, Ministry of Education, Beijing Pediatric Research Institute, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing, P. R. China.
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Phongsamart W, Srifeungfung S, Chatsuwan T, Nunthapisud P, Treerauthaweeraphong V, Rungnobhakhun P, Sricharoenchai S, Chokephaibulkit K. Changing trends in serotype distribution and antimicrobial susceptibility of Streptococcus pneumoniae causing invasive diseases in Central Thailand, 2009-2012. Hum Vaccin Immunother 2015; 10:1866-73. [PMID: 25424794 DOI: 10.4161/hv.28675] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
To describe the trends in serotype distribution and antimicrobial susceptibility of S. pneumoniae causing invasive pneumococcal diseases (IPD) we tested 238 pneumococci isolates from normally sterile sites between 2009 and 2012 and compared these findings with previous data collected within our network. Serotyping was performed for 15 serotypes contained in the 7-,10-, 13-, and experimental 15-valent pneumococcal conjugate vaccines (PCV). The most common serotypes found were 6B (13.9%), 19A (12.6%), 14 (8.0%), 18C (5.9%), and 6A (3.8%); and 39.9% were non-PCV15 serotypes. One of 81 patients with available data had breakthrough infection with vaccine serotype (19F). There was a significant increase of serotype 19A among children ≤5 years (5.6% in 2000-2009 vs 18.3% in 2009-2012, P = 0.003). The all-age serotype coverage was 36.4%, 41.5%, 59.3%, and 59.7% for PCV7, PCV10, PCV13, and PCV 15, respectively. The corresponding coverage in children ≤5 years were 46.4%, 48.8%, 73.2%, and 73.2% respectively. High susceptibilities to penicillin (89.7%), cefotaxime (95.7%), cefditoren (90.2% by Spanish breakpoints), ofloxacin (97.9%), and levofloxacin (100%), but low to cefdinir (50.0%), cefditoren (45.1% by US-FDA breakpoints), macrolides (<50%), clindamycin (67.7%), tetracycline (41.4%), and trimethoprim-sulfamethoxazole (32.4%) were observed. Serotype 19A was less susceptible to penicillin (80.0 vs 91.2%, P = 0.046), cefditoren (66.7 vs 95.5% by Spanish breakpoints, P = 0.004), and tetracycline (9.1 vs 45.5%, P = 0.024) than non-19A isolates. These data emphasize the need for continued surveillance to monitor changes in serotypes as well as antimicrobial susceptibilities in order to guide strategies for prevention and treatment.
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Affiliation(s)
- Wanatpreeya Phongsamart
- a Department of Pediatrics; Faculty of Medicine Siriraj Hospital; Mahidol University; Bangkok, Thailand
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Wu L, Yin X, Zheng L, Zou J, Jin P, Hu Y, Kudinha T, Kong F, Chen X, Wang Q. Practical Prediction of Ten Common Streptococcus pneumoniae Serotypes/Serogroups in One PCR Reaction by Multiplex Ligation-Dependent Probe Amplification and Melting Curve (MLPA-MC) Assay in Shenzhen, China. PLoS One 2015; 10:e0130664. [PMID: 26151828 PMCID: PMC4495002 DOI: 10.1371/journal.pone.0130664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 05/22/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Streptococcus pneumoniae has more than 95 distinct serotypes described to date. However, only certain serotypes are more likely to cause pneumococcal diseases. Thus serotype surveillance is important for vaccine formula design as well as in post-vaccine serotype shift monitor. The goal of this study was to develop a practical screening assay for ten Shenzhen China common pneumococcal serotypes/serogroups in one molecular reaction. METHODS A molecular assay, based on multiplex ligation-dependent probe amplification (MLPA) and melting curve (MC) analysis, was developed in an integrated approach (MLPA-MC) for the detection of ten capsular serotypes/serogroups 4, 6 (6A/6B/6C/6D), 9V/9A, 14, 15F/15A, 15B/15C, 18 (18F/18A/18B/18C), 19F, 19A and 23F. We designed serotype/serogroup-specific MLPA probes and fluorescent detection probes to discriminate the different serotypes/serogroups in one molecular reaction. The three steps of MLPA-MC assay are continuous reactions in one well detected by LightCycler 480. A total of 210 S. pneumoniae isolates from our local Maternity and Child Health Hospital were randomly chosen to evaluate the assay against published multiplex PCR assays. RESULTS Our results showed that 198 (94.3%) of S. pneumoniae isolates were type-able by our assays and the results were in complete concordance with the published multiplex PCRs. Using the MLPA-MC assay, 96 S. pneumoniae isolates could be typed within 3 hours with limited hands-on time. This serotype/serogroup-screening assay can be easily modified or extended by modification of the serotype/serogroup-specific MLPA probes combinations according to the needs of different laboratories. CONCLUSIONS We recommend use of this assay as a starting point for screening serotype/serogroup frequencies. There is a need for this assay to be combined with other molecular typing assays, like published serotype specific PCRs, or even the Quellung reaction for serotype confirmation.
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Affiliation(s)
- Lijuan Wu
- Laboratory Medical Centre, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
- Clinical Laboratory, Bao’an Maternity and Child Health Hospital, Shenzhen, Guangdong Province, China
| | - Xiaomao Yin
- Clinical Laboratory, The Fifth Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong Province, China
| | - Lei Zheng
- Laboratory Medical Centre, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Jianhua Zou
- Clinical Laboratory, Bao’an Maternity and Child Health Hospital, Shenzhen, Guangdong Province, China
| | - Ping Jin
- Clinical Laboratory, Bao’an Maternity and Child Health Hospital, Shenzhen, Guangdong Province, China
| | - Yanwei Hu
- Laboratory Medical Centre, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Timothy Kudinha
- Charles Sturt University, Leeds Parade, Orange, New South Wales, Australia
| | - Fanrong Kong
- Centre for Infectious Diseases and Microbiology, Institute of Clinical Pathology and Medical Research–Pathology West, Westmead Hospital, New South Wales, Australia
| | - Xu Chen
- Clinical Laboratory, Bao’an Maternity and Child Health Hospital, Shenzhen, Guangdong Province, China
| | - Qian Wang
- Laboratory Medical Centre, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
- * E-mail:
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Wysocki J, Brzostek J, Szymański H, Tetiurka B, Toporowska-Kowalska E, Wasowska-Królikowska K, Sarkozy DA, Giardina PC, Gruber WC, Emini EA, Scott DA. Immunogenicity and safety of a 13-valent pneumococcal conjugate vaccine administered to older infants and children naïve to pneumococcal vaccination. Vaccine 2015; 33:1719-25. [PMID: 25698485 DOI: 10.1016/j.vaccine.2015.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Revised: 01/22/2015] [Accepted: 02/04/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Streptococcus pneumoniae infections are a major cause of morbidity and mortality in children <5 years old worldwide. To increase serotype coverage globally, a 13-valent pneumococcal conjugate vaccine (PCV13) has been developed and approved in many countries worldwide. OBJECTIVE Assess the safety and immunogenicity of PCV13 in healthy older infants and children naïve to previous pneumococcal vaccination. METHODS This was a phase 3, open-label, multicenter study conducted in Polish children (N=354) who were vaccinated according to 3 age-appropriate catch-up schedules: Group 1 (aged 7 to <12 months) received two PCV13 doses with a booster at 12-16 months of age; Group 2 (aged 12 to <24 months) received two vaccine doses only; and Group 3 (aged 24 to <72 months) received a single dose of PCV13. Statistical analyses were descriptive. The proportion of immunological "responders" achieving serotype-specific antipneumococcal polysaccharide concentrations ≥0.35μg/mL, 1-month after the last dose of vaccine, was determined for each vaccine serotype. In addition, antipolysaccharide immunoglobulin (Ig) G geometric mean concentrations (GMCs) were calculated. Safety assessments included systemic and local reactions, and adverse events. RESULTS The proportion of immunological responders was ≥88% across groups for all serotypes. Antipolysaccharide IgG GMCs were generally similar across groups. Each schedule elicited immune response levels against all 13 serotypes comparable to or greater than levels previously reported in infants after a 3-dose series. The 3 catch-up schedules had similar tolerability and safety profiles; a trend was present towards greater local tenderness with increasing age and subsequent dose administration. CONCLUSIONS Immunological responses and safety results support the use of PCV13 for catch-up schedules in older infants and children naïve to pneumococcal vaccination.
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Affiliation(s)
- Jacek Wysocki
- Department of Preventive Medicine, Poznan University of Medical Sciences, ul. Smoluchowskiego 11, 60-179 Poznan, Poland.
| | | | - Henryk Szymański
- NZOZ Praktyka Lekarza, Rodzinnego Alina Grocka-Wlaźlak, Oborniki Śląskie, Poland.
| | | | - Ewa Toporowska-Kowalska
- Department of Paediatric Allergology, Gastroenterology and Nutrition, Medical University of Lodz, Lodz, Poland.
| | | | | | - Peter C Giardina
- Vaccine Clinical Research, Pfizer Inc., 401 North Middletown Road, Pearl River, NY 10965, USA.
| | - William C Gruber
- Vaccine Clinical Research, Pfizer Inc., 401 North Middletown Road, Pearl River, NY 10965, USA.
| | - Emilio A Emini
- Vaccine Clinical Research, Pfizer Inc., 401 North Middletown Road, Pearl River, NY 10965, USA.
| | - Daniel A Scott
- Vaccine Clinical Research, Pfizer Inc., 401 North Middletown Road, Pearl River, NY 10965, USA.
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Pneumococcal wall teichoic acid is required for the pathogenesis of Streptococcus pneumoniae in murine models. J Microbiol 2015; 53:147-54. [PMID: 25626371 DOI: 10.1007/s12275-015-4616-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 12/10/2014] [Accepted: 12/12/2014] [Indexed: 10/24/2022]
Abstract
Pneumococcal asymptomatic colonization of the respiratory tracts is a major risk for invasive pneumococcal disease. We have previously shown that pneumococcal wall teichoic acid (WTA) was involved in pneumococcal infection of sepsis and adherence to epithelial and endothelial cells. In this study, we investigated the contribution of pneumococcal WTA to bacterial colonization and dissemination in murine models. The result showed that nasopharynx colonizing D39 bacterial cells have a distinct phenotype showing an increased exposure of teichoic acids relative to medium-grown bacteria. The WTA-deficient mutants were impaired in their colonization to the nasopharynx and lungs, and led to a mild inflammation in the lungs at 36 h post-inoculation. Pretreatment of the murine nares with WTA reduced the ability of wild type D39 bacteria to colonize the nasopharynx. In addition, the WTA-deficient strain was impaired in its ability to invade the blood and brain following intranasal administration. WTA-deficient D39 strain was reduced in C3 deposition but was more susceptible to the killing by the neutrophils as compared with its parent strain. Our results also demonstrated that the WTA enhanced pneumococcal colonization and dissemination independently of the host strains. These results indicate that WTA plays an important role in pneumococcal pathogenesis, both in colonization and dissemination processes.
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Liyanapathirana V, Nelson EAS, Ang I, Subramanian R, Ma H, Ip M. Emergence of serogroup 15 Streptococcus pneumoniae of diverse genetic backgrounds following the introduction of pneumococcal conjugate vaccines in Hong Kong. Diagn Microbiol Infect Dis 2014; 81:66-70. [PMID: 25445117 DOI: 10.1016/j.diagmicrobio.2014.09.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 09/26/2014] [Accepted: 09/29/2014] [Indexed: 10/24/2022]
Abstract
Serogroup 15 pneumococcal isolates from nasopharyngeal carriage of hospitalized children admitted to a teaching hospital in Hong Kong from April 2009 to September 2013 were characterized by pulse-field gel electrophoresis (PFGE), multilocus sequence typing, and antimicrobial non-susceptibility testing. The overall proportion of serogroup 15 isolates in the pre-PCV7 and post-PCV13 periods rose from 5.7% to 20.0%. The increase in trend for serotype 15B/C was statistically significant among children presented with pneumonia; bronchiolitis; upper respiratory tract infection; and febrile, non-respiratory diseases and for serotype 15A/F, among children with bronchiolitis and febrile, non-respiratory diseases. The predominant PFGE cluster of serotype 15B/C belonged to sequence type (ST) 199. Replacement of this more susceptible cluster (Ery and Tet non-susceptibilities of 32.2% and 25.4%) with the non-susceptible cluster, ST8859 (Ery and Tet non-susceptibilities of 91.7% and 87.5%) was noted. ST63 was the predominant serotype 15A cluster (Ery and Tet non-susceptibilities of 97.4% and 92.3%). Serogroup 15 subtypes have emerged in the post-PCV13 era, and these non-susceptible clusters warrant closer monitoring as candidates for incorporation to future pneumococcal vaccines.
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Affiliation(s)
| | - E Anthony S Nelson
- Department of Paediatrics, Faculty of Medicine, the Chinese University of Hong Kong, Hong Kong
| | - Irene Ang
- Department of Microbiology, the Chinese University of Hong Kong, Hong Kong
| | - Reema Subramanian
- Department of Microbiology, the Chinese University of Hong Kong, Hong Kong
| | - Helen Ma
- Department of Microbiology, the Chinese University of Hong Kong, Hong Kong
| | - Margaret Ip
- Department of Microbiology, the Chinese University of Hong Kong, Hong Kong.
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A novel protein, RafX, is important for common cell wall polysaccharide biosynthesis in Streptococcus pneumoniae: implications for bacterial virulence. J Bacteriol 2014; 196:3324-34. [PMID: 25002545 DOI: 10.1128/jb.01696-14] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Teichoic acid (TA), together with peptidoglycan (PG), represents a highly complex glycopolymer that ensures cell wall integrity and has several crucial physiological activities. Through an insertion-deletion mutation strategy, we show that ΔrafX mutants are impaired in cell wall covalently attached TA (WTA)-PG biosynthesis, as evidenced by their abnormal banding patterns and reduced amounts of WTA in comparison with wild-type strains. Site-directed mutagenesis revealed an essential role for external loop 4 and some highly conserved amino acid residues in the function of RafX protein. The rafX gene was highly conserved in closely related streptococcal species, suggesting an important physiological function in the lifestyle of streptococci. Moreover, a strain D39 ΔrafX mutant was impaired in bacterial growth, autolysis, bacterial division, and morphology. We observed that a strain R6 ΔrafX mutant was reduced in adhesion relative to the wild-type R6 strain, which was supported by an inhibition assay and a reduced amount of CbpA protein on the ΔrafX mutant bacterial cell surface, as shown by flow cytometric analysis. Finally, ΔrafX mutants were significantly attenuated in virulence in a murine sepsis model. Together, these findings suggest that RafX contributes to the biosynthesis of WTA, which is essential for full pneumococcal virulence.
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Wu K, Yao R, Wang H, Pang D, Liu Y, Xu H, Zhang S, Zhang X, Yin Y. Mucosal and systemic immunization with a novel attenuated pneumococcal vaccine candidate confer serotype independent protection against Streptococcus pneumoniae in mice. Vaccine 2014; 32:4179-88. [PMID: 24945468 DOI: 10.1016/j.vaccine.2014.05.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 03/06/2014] [Accepted: 05/01/2014] [Indexed: 12/13/2022]
Abstract
Despite the availability of effective vaccines, Streptococcus pneumoniae is still one of the major infectious diseases causing substantial morbidity and mortality in children under 5 years old. In this study, we demonstrate the protective efficacy of S. pneumoniae SPY1, a novel live attenuated vaccine strain against pneumococcal infection in murine models. This strain was characterized by defects in three important pneumococcal virulence factors including capsule, teichoic acids and pneumolysin. The lactate dehydrogenase assays and in vivo animal experiments demonstrated a significantly attenuated virulence and a reduced nasopharyngeal colonization for the SPY1 strain. We also show that mucosal and systemic immunization with the live SPY1 strain induced protective immune responses against pneumococci. Mucosal immunization with SPY1 offered better protection against colonization challenge with strains TIGR4 and serotype 19F than systemic SPY1 immunization. In invasive infection models, mucosal vaccination with the SPY1 strain conferred complete protection against D39 and clinical serotype 6B and 3 strains. Notably, intranasal vaccination with the SPY1 strain conferred superior protection against pneumococcal invasive disease compared with the commercial available vaccines. SPY1 strain was shown to elicit high levels of serotype-independent antibodies and a mixed cellular immune response. Besides, the SPY1 serum was able to passively protect mice against invasive challenge with D39 strain, indicating the protective effect of the antibody-mediated responses. Together, the SPY1 strain may be a promising live vaccine strain to protect pneumococcal infection.
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Affiliation(s)
- Kaifeng Wu
- Key Laboratory of Diagnostic Medicine designated by the Ministry of Education, Chongqing Medical University, Chongqing 400016, PR China
| | - Run Yao
- Department of Transfusion, XiangYa Hospital, Central South University, Changsha 410008, PR China
| | - Hong Wang
- Key Laboratory of Diagnostic Medicine designated by the Ministry of Education, Chongqing Medical University, Chongqing 400016, PR China
| | - Dan Pang
- Key Laboratory of Diagnostic Medicine designated by the Ministry of Education, Chongqing Medical University, Chongqing 400016, PR China
| | - Yusi Liu
- Key Laboratory of Diagnostic Medicine designated by the Ministry of Education, Chongqing Medical University, Chongqing 400016, PR China
| | - Hongmei Xu
- Key Laboratory of Diagnostic Medicine designated by the Ministry of Education, Chongqing Medical University, Chongqing 400016, PR China
| | - Shuai Zhang
- Key Laboratory of Diagnostic Medicine designated by the Ministry of Education, Chongqing Medical University, Chongqing 400016, PR China
| | - Xuemei Zhang
- Key Laboratory of Diagnostic Medicine designated by the Ministry of Education, Chongqing Medical University, Chongqing 400016, PR China.
| | - Yibing Yin
- Key Laboratory of Diagnostic Medicine designated by the Ministry of Education, Chongqing Medical University, Chongqing 400016, PR China.
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Serotype-independent protection against pneumococcal infections elicited by intranasal immunization with ethanol-killed pneumococcal strain, SPY1. J Microbiol 2014; 52:315-23. [PMID: 24682994 DOI: 10.1007/s12275-014-3583-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 01/28/2014] [Accepted: 02/10/2014] [Indexed: 02/08/2023]
Abstract
The 23-valent polysaccharide vaccine and the 7-valent pneumococcal conjugate vaccine are licensed vaccines that protect against pneumococcal infections worldwide. However, the incidence of pneumococcal diseases remains high in low-income countries. Whole-cell vaccines with high safety and strong immunogenicity may be a favorable choice. We previously obtained a capsule-deficient Streptococcus pneumoniae mutant named SPY1 derived from strain D39. As an attenuated live pneumococcal vaccine, intranasal immunization with SPY1 elicits broad serotype-independent protection against pneumococcal infection. In this study, for safety consideration, we inactivated SPY1 with 70% ethanol and intranasally immunized BALB/c mice with killed SPY1 plus cholera toxin adjuvant for four times. Results showed that intranasal immunization with inactivated SPY1 induced strong humoral and cellular immune responses. Intranasal immunization with inactivated SPY1 plus cholera toxin adjuvant elicited effective serotype-independent protection against the colonization of pneumococcal strains 19F and 4 as well as lethal infection of pneumococcal serotypes 2, 3, 14, and 6B. The protection rates provided by inactivated SPY1 against lethal pneumococcal infection were comparable to those of currently used polysaccharide vaccines. In addition, vaccine-specific B-cell and T-cell immune responses mediated the protection elicited by SPY1. In conclusion, the 70% ethanol-inactivated pneumococcal whole-cell vaccine SPY1 is a potentially safe and less complex vaccine strategy that offers broad protection against S. pneumoniae.
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Che D, Zhou H, He J, Wu B. Modeling the impact of the 7-valent pneumococcal conjugate vaccine in Chinese infants: an economic analysis of a compulsory vaccination. BMC Health Serv Res 2014; 14:56. [PMID: 24507480 PMCID: PMC3918139 DOI: 10.1186/1472-6963-14-56] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Accepted: 01/28/2014] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of this study was to compare, from a Chinese societal perspective, the projected health benefits, costs, and cost-effectiveness of adding pneumococcal conjugate heptavalent vaccine (PCV-7) to the routine compulsory child immunization schedule. Methods A decision-tree model, with data and assumptions adapted for relevance to China, was developed to project the health outcomes of PCV-7 vaccination (compared with no vaccination) over a 5-year period as well as a lifetime. The vaccinated birth cohort included 16,000,000 children in China. A 2 + 1 dose schedule at US$136.51 per vaccine dose was used in the base-case analysis. One-way sensitivity analysis was used to test the robustness of the model. The impact of a net indirect effect (herd immunity) was evaluated. Outcomes are presented in terms of the saved disease burden, costs, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio. Results In a Chinese birth cohort, a PCV-7 vaccination program would reduce the number of pneumococcus-related infections by at least 32% and would prevent 2,682 deaths in the first 5 years of life, saving $1,190 million in total costs and gaining an additional 9,895 QALYs (discounted by 3%). The incremental cost per QALY was estimated to be $530,354. When herd immunity was taken into account, the cost per QALY was estimated to be $95,319. The robustness of the model was influenced mainly by the PCV-7 cost per dose, effectiveness herd immunity and incidence of pneumococcal diseases. With and without herd immunity, the break-even costs in China were $29.05 and $25.87, respectively. Conclusions Compulsory routine infant vaccination with PCV-7 is projected to substantially reduce pneumococcal disease morbidity, mortality, and related costs in China. However, a universal vaccination program with PCV-7 is not cost-effective at the willingness-to-pay threshold that is currently recommended for China by the World Health Organization.
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Affiliation(s)
| | | | | | - Bin Wu
- Medical Decision and Economic Group, Department of Pharmacy, Renji Hospital, affiliated with the School of Medicine, Shanghai Jiaotong University, Shanghai, China.
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Le CF, Jefferies JM, Yusof MYM, Sekaran SD, Clarke SC. The epidemiology of pneumococcal carriage and infections in Malaysia. Expert Rev Anti Infect Ther 2014; 10:707-19. [DOI: 10.1586/eri.12.54] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Zhao C, Zhang F, Chu Y, Liu Y, Cao B, Chen M, Yu Y, Liao K, Zhang L, Sun Z, Hu B, Lei J, Hu Z, Zhang X, Wang H. Phenotypic and genotypic characteristic of invasive pneumococcal isolates from both children and adult patients from a multicenter surveillance in China 2005-2011. PLoS One 2013; 8:e82361. [PMID: 24349263 PMCID: PMC3859574 DOI: 10.1371/journal.pone.0082361] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 10/23/2013] [Indexed: 11/21/2022] Open
Abstract
Streptococcus pneumoniae is an important pathogen in both children and the elderly, but previous studies in China have provided limited information about invasive pneumococcal disease (IPD). A total of 240 IPD S. pneumoniae strains (from 105 children and 135 adults) were collected from 12 cities in China in 2005–2011. Their phenotypes and genetic characteristics were analyzed. Streptococcus pneumoniae remained highly resistant to macrolides, tetracycline, and cotrimoxazole each year. Serotypes were assigned to the 240 isolates, and 19A (22.1%), 19F (21.7%), 14 (7.5%), 3 (7.1%), and 23F (5.4%) were the most prevalent, accounting for 63.8% of all strains. Serogroup 19 strains were significantly more common among children than among adults (58.7% vs 32.4%, respectively; P < 0.001). Serotypes 19F and 19A demonstrated higher resistance to β-lactams and cephalosporins than the other serotypes. The coverage of PCV13 was superior to that calculated for PCV7 and PCV10 (77.9% vs 40.8% and 47.1%, respectively), and coverage was higher in children than in adults (85.6% vs 72.1%, respectively; P = 0.012). A multilocus sequence typing analysis revealed great diversity, with nine clonal complexes and 83 singletons among all the strains. Specifically, CC271 was more common in children, whereas singletons were more prevalent in adults. Among the serogroup 19 strains, 84.7% were ST271, ST320, or ST236, belonging to CC271. The homogeneous genetic background of 19F and 19A, together with the high resistance of these strains, suggests that clonal spread is responsible for the high prevalence of serogroup 19 in IPD. This is the first large study to investigate IPD strains in both children and adults in China.
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Affiliation(s)
- Chunjiang Zhao
- Department of Clinical Laboratory, Peking University People’s Hospital, Beijing, China
| | - Feifei Zhang
- Department of Clinical Laboratory, Peking University People’s Hospital, Beijing, China
| | - Yunzhuo Chu
- Department of Clinical Laboratory, the First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yong Liu
- Department of Clinical Laboratory, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Bin Cao
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital of Capital Medical University, Beijing, China
| | - Minjun Chen
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Beijing, China
| | - Yunsong Yu
- The First Affiliated Hospital of Medical School of Hangzhou University, Hangzhou, Zhejiang, China
| | - Kang Liao
- Department of Clinical Laboratory, The First Affiliated Hospital of Sun Yatsen University, Guangzhou, Guangdong, China
| | - Liyan Zhang
- Department of Clinical Laboratory, Guangdong General Hospital, Guangzhou, Guangdong, China
| | - Ziyong Sun
- Tongji Hospital, Tongji Medical College Huazhong University of Science & Technology, Wuhan, Hubei, China
| | - Bijie Hu
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jin’e Lei
- Department of Clinical Laboratory, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Zhidong Hu
- Department of Clinical Laboratory, General Hospital, Tianjin Medical University, Tianjin, China
| | - Xiaobing Zhang
- Department of Clinical Laboratory, Southwest Hospital, Chongqing, China
| | - Hui Wang
- Department of Clinical Laboratory, Peking University People’s Hospital, Beijing, China
- * E-mail:
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Guo Q, Zhuo C, Xu Y, Huang W, Wang C, Zhang S, Huang J, Hu F, Zhu D, Yang F, Wang M. Genetic diversity of fluoroquinolone-nonsusceptible Streptococcus pneumoniae clinical isolates and the first identification of serotype 20B in China. Eur J Clin Microbiol Infect Dis 2013; 33:465-70. [PMID: 24091745 DOI: 10.1007/s10096-013-1979-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 09/04/2013] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to investigate the genetic characteristics of fluoroquinolone-nonsusceptible Streptococcus pneumoniae clinical isolates in China. A total of 377 S. pneumoniae clinical isolates, including 307 pediatric strains and 70 adult strains, were collected from eight centers in China. The minimal inhibitory concentrations (MICs) of 10 antimicrobial agents were determined by agar dilution. Multilocus sequence typing (MLST), serotyping, and quinolone resistance-determining region (QRDR) variations were conducted in levofloxacin-nonsusceptible isolates by polymerase chain reaction (PCR)-based methods. Seven levofloxacin-nonsusceptible isolates were found, with an overall resistance rate of 1.9 % (7/377) and 8.6 % (6/70) in adults. Sequence analyses of parC, gyrA, and parE QRDRs in levofloxacin-resistant isolates demonstrated mutations in dual target sites at the hot spots. These seven strains represented multiple clones: two strains were serotype 19F (Taiwan(19F)-14) and MLST clonal complex (CC) 271/320, two were typed as 23F (Spain(23F)-1) and CC81, two were determined as serotype 20B and a new sequence type of ST6935, and one non-serotypeable pediatric strain belonged to a new sequence type of ST6946. Two serotype 19F strains possessed a variety of characteristic alterations of viridans group streptococci in gyrA (Ser114Gly) or parC (Ser52Gly, Asn91Asp). Fluoroquinolone-nonsusceptible S. pneumoniae isolates showed a substantial degree of genetic diversity and belonged to pre-existing epidemic clones together with native clones. S. pneumoniae strains with serotype 20B was recovered for the first time to be associated with levofloxacin resistance in China.
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Affiliation(s)
- Q Guo
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, 200040, China
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Serotypes and patterns of antibiotic resistance in strains causing invasive pneumococcal disease in children less than 5 years of age. PLoS One 2013; 8:e54254. [PMID: 23342111 PMCID: PMC3544833 DOI: 10.1371/journal.pone.0054254] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 12/10/2012] [Indexed: 11/19/2022] Open
Abstract
Objective The serotypes and patterns of antibiotic resistance of Streptococcus pneumoniae (S. pneumoniae) strains that cause invasive pneumococcal disease (IPD) in infants were analyzed to provide guidance for clinical disease prevention and treatment. Methods The clinical features of confirmed IPD were evaluated in 61 patients, less than 5 years of age, who were admitted to our hospital between January 2009 and December 2011. The serotypes and antibiotic resistance of strains of S.pneumoniae were determined using the capsular swelling method and the E-test. Results A total of 61 invasive strains were isolated. The serotype distribution of those isolates were 19A (41.0%), 14 (19.7%), 19F (11.5%), 23F (9.8%), 8 (4.9%), 9V (4.9%), 1 (3.3%), and 4, 6B, and 20 (each 1.6%). The percentage of S. pneumoniae strains resistant to erythromycin, clindamycin, and cotrimoxazole were 100%, 86.9%, and 100%, respectively. The percentage of S. pneumoniae strains resistant to penicillin, amoxicillin/clavulanic acid, cefuroxime, ceftriaxone, cefotaxime, cefepime, and meropenem were 42.6%, 18.0%, 82.0%, 18.0%, 13.1%, 13.1%, and 36.1%, respectively. The percentage of multidrug-resistant strains was 95.6%. Strains of all serotypes isolated in this study were highly resistant to erythromycin, cotrimoxazole, and clindamycin. Strains with serotype 19A had the highest rates of resistance. Conclusions Serotype 19A strains were most frequently isolated from children with IPD treated in our hospital. The strains causing IPD are highly resistant to antibiotics.
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Yu H, Yang W, Varma JK. To Save Children’s Lives, China Should Adopt An Initiative To Speed Introduction Of Pneumonia Vaccines. Health Aff (Millwood) 2012; 31:2545-53. [DOI: 10.1377/hlthaff.2011.1272] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Hongjie Yu
- Hongjie Yu is director of the Division of Infectious Diseases at the Chinese Centers for Disease Control and Prevention, in Beijing
| | - Weizhong Yang
- Weizhong Yang (
) is deputy director general of the Chinese Centers for Disease Control and Prevention
| | - Jay K. Varma
- Jay K. Varma is deputy commissioner for disease control in the New York City Department of Health and Mental Hygiene
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40
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Zhao C, Sun H, Wang H, Liu Y, Hu B, Yu Y, Sun Z, Chu Y, Cao B, Liao K, Lei J, Hu Z, Zhang L, Zhang X, Xu Y, Wang Z, Chen M. Antimicrobial resistance trends among 5608 clinical Gram-positive isolates in China: results from the Gram-Positive Cocci Resistance Surveillance program (2005–2010). Diagn Microbiol Infect Dis 2012; 73:174-81. [DOI: 10.1016/j.diagmicrobio.2012.03.003] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 03/03/2012] [Accepted: 03/07/2012] [Indexed: 12/01/2022]
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Zhong W, Xu W, Wang H, Huang Y, Cao J, Gong Y, Xu X, Min X, Zhang Y, Dong J, Yin Y, Zhang X. Mucosal immunization with caseinolytic protease X elicited cross-protective immunity against pneumococcal infection in mice. Exp Biol Med (Maywood) 2012; 237:694-702. [DOI: 10.1258/ebm.2012.011383] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Streptococcus pneumoniae resides on the mucosal surface of the upper respiratory tract and is ready to spread and trigger clinical diseases. Hence the vaccine that can eliminate the nasopharyngeal colonization was thought to be an ideal protective strategy against pneumococcal invasive diseases. Caseinolytic protease X (ClpX), a pneumococcal caseinolytic protease ATPase subunit, was shown to be a non-transmembrane protein by bioinformatics analysis. Consistent with the in silico prediction, the secretory expression of ClpX, instead of surface exposure, was further confirmed by flow cytometry and Western blot. Furthermore, ClpX was highly conserved in nine different serotypes of S. pneumoniae at both gene and protein concentrations. In addition, the anti-ClpX IgG antibody levels in human serum samples were much higher in healthy children, compared with pediatric patients, and displayed an age-related increase. Finally, ClpX protein antigen was introduced to BALB/c mice through a mucosal route, and protection against nasopharyngeal colonization and lethal infection caused by different S. pneumoniae serotypes was successfully elicited. Our findings suggest that ClpX is a potential candidate antigen that could be incorporated in pneumococcal protein vaccines.
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Affiliation(s)
- Wen Zhong
- Key Laboratory of Diagnostic Medicine designated by the Ministry of Education, Department of Laboratory Medicine
| | - Wenchun Xu
- Key Laboratory of Diagnostic Medicine designated by the Ministry of Education, Department of Laboratory Medicine
| | - Hong Wang
- Key Laboratory of Diagnostic Medicine designated by the Ministry of Education, Department of Laboratory Medicine
| | - Yuanshuai Huang
- Key Laboratory of Diagnostic Medicine designated by the Ministry of Education, Department of Laboratory Medicine
| | - Ju Cao
- The First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, People's Republic of China
| | - Yi Gong
- Key Laboratory of Diagnostic Medicine designated by the Ministry of Education, Department of Laboratory Medicine
| | - Xiuyu Xu
- Key Laboratory of Diagnostic Medicine designated by the Ministry of Education, Department of Laboratory Medicine
| | - Xun Min
- Key Laboratory of Diagnostic Medicine designated by the Ministry of Education, Department of Laboratory Medicine
| | - Yanqing Zhang
- Key Laboratory of Diagnostic Medicine designated by the Ministry of Education, Department of Laboratory Medicine
| | - Jie Dong
- Key Laboratory of Diagnostic Medicine designated by the Ministry of Education, Department of Laboratory Medicine
| | - Yibing Yin
- Key Laboratory of Diagnostic Medicine designated by the Ministry of Education, Department of Laboratory Medicine
| | - Xuemei Zhang
- Key Laboratory of Diagnostic Medicine designated by the Ministry of Education, Department of Laboratory Medicine
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Ilić K, Jakovljević E, Skodrić-Trifunović V. Social-economic factors and irrational antibiotic use as reasons for antibiotic resistance of bacteria causing common childhood infections in primary healthcare. Eur J Pediatr 2012; 171:767-77. [PMID: 21987082 DOI: 10.1007/s00431-011-1592-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 09/21/2011] [Indexed: 11/28/2022]
Abstract
The most prevalent childhood bacterial infections in primary healthcare are respiratory, gastrointestinal and urogenital infections. The main aim of this paper was to consider factors (socio-economic factors and irrational antibiotic use) that contribute to the development of bacterial resistance, as well as measures that resulted in a reduction of this problem. Computerized search through the Medline of published articles on antibiotic resistance from 1996 to 2011 in English or Serbian was completed in August 2011. Combinations of used terms were antimicrobial/antibacterial/antibiotic and resistance/susceptibility in pediatric/children, and Streptococcus pneumoniae/Streptococci/Haemophilus influenzae/Salmonellae/Escherichia coli/Shigella/Staphylococcus aureus as well as antibiotics/antimicrobials/antibacterials and consumption/utilization/use. In many developing countries, antibiotic dispensing and its use in medicine, cattle breeding and agriculture are inadequately regulated, or existing laws are not being appropriately implemented. In addition, human travel contributes to antimicrobial drug resistance around the world. All of these factors have led to a very high level of bacterial resistance. On the contrary, in countries with a clearly defined and implemented legal framework concerning antibiotic prescribing, dispensing and utilization, the use of antibiotics is under constant surveillance. That resulted in a significantly lower antibacterial resistance. In conclusion, bacterial resistance could be reduced by the implementation of systemic and long-term measures at a country level as well as at all levels of healthcare. In order to reduce bacterial resistance, antibiotic use needs to be precisely regulated, and regulations should be coherent with practice. The international community must have a more active role in solving this global problem.
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Affiliation(s)
- Katarina Ilić
- Department of Pharmacology, School of Pharmacy, University of Belgrade, PO BOX 146, Vojvode Stepe 450, 11221, Belgrade, Republic of Serbia.
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Grimprel E, Laudat F, Patterson S, Baker S, Sidhu M, Gruber W, Emini E, Scott D. Immunogenicity and safety of a 13-valent pneumococcal conjugate vaccine (PCV13) when given as a toddler dose to children immunized with PCV7 as infants. Vaccine 2011; 29:9675-83. [DOI: 10.1016/j.vaccine.2011.10.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Revised: 09/16/2011] [Accepted: 10/05/2011] [Indexed: 10/16/2022]
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Lim FF, Chang HM, Lue KH, Sheu JN. Pneumococcal pneumonia complicating purulent pericarditis in a previously healthy girl: a rare yet possible fatal complication in the antibiotic era. Pediatr Emerg Care 2011; 27:751-3. [PMID: 21822088 DOI: 10.1097/pec.0b013e318226e07b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Purulent pericarditis is an extremely rare complication of invasive Streptococcus pneumoniae infection among children in the antibiotic era, and its mortality remains high if left untreated. This report involves a 4½-year-old girl who presented to our emergency department with productive cough, shortness of breath, and left-sided chest pain with a diagnosis of pneumococcal pneumonia. She subsequently developed life-threatening conditions including bilateral empyema with respiratory failure, purulent pericarditis, and multiple organ failure leading to death. The case highlights that purulent pericarditis is a rare yet possible disorder complicating pneumococcal disease in the antibiotic era. The increase in strains resistant to penicillin should alert emergency physicians to the potential for reemergence of pneumococcal pericarditis in children.
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Affiliation(s)
- Fong-Fong Lim
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan
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Xiao YH, Giske CG, Wei ZQ, Shen P, Heddini A, Li LJ. Epidemiology and characteristics of antimicrobial resistance in China. Drug Resist Updat 2011; 14:236-50. [PMID: 21807550 DOI: 10.1016/j.drup.2011.07.001] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 07/05/2011] [Indexed: 10/26/2022]
Abstract
A comprehensive surveillance system for bacterial resistance in tertiary hospitals has been established in China that involves tertiary hospitals in distinct regions nationwide, enabling the collection of a large amount of antimicrobial surveillance data. Antimicrobial resistance in China has become a serious healthcare problem, with high resistance rates of most common bacteria to clinically important antimicrobial agents. Methicillin-resistant S. aureus, ESBL-producing Enterobacteriaceae and carbapenem-resistant Acinetobacter baumannii represent more than 50% of microbial isolates. Additionally, bacterial resistance to fluoroquinolones, macrolides and third-generation cephalosporins is of serious concern. The molecular epidemiology and resistance mechanisms of the antimicrobial strains in China exhibited regional specificity, as well as the influence of dissemination of international clonal complexes. The molecular characteristics of MRSA, ESBL- and carbapenemase-producing Enterobacteriaceae, and macrolide-resistant gram-positive Streptococci in China were significantly different from those in other countries and regions, while S. pneumoniae serotypes appear to have been affected by the global spread of prevalent clones in other parts of the world. Moreover, important antimicrobial resistant bacteria such as community-acquired-MRSA, multidrug-resistant P. aeruginosa and extensive-resistant A. baumannii, and the antimicrobial resistance in primary healthcare and outpatient setting should be intensely monitored and investigated in the future.
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Affiliation(s)
- Yong-Hong Xiao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China.
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Zangeneh TT, Baracco G, Al-Tawfiq JA. Impact of conjugate pneumococcal vaccines on the changing epidemiology of pneumococcal infections. Expert Rev Vaccines 2011; 10:345-53. [PMID: 21434802 DOI: 10.1586/erv.11.1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Streptococcus pneumoniae-related infections have a major global impact on healthcare, especially in the developing world, and are considered the number one vaccine-preventable cause of death in children. There are more than 90 pneumococcal serotypes and 46 serogroups. The first capsular polysaccharide pneumococcal vaccine was licensed in the USA in 1977 for individuals older than 2 years of age at high risk for pneumococcal disease. Two decades later, the first 7-valent pneumococcal polysaccharide-protein conjugate vaccine completed the required clinical trials and was introduced as part of the national immunization program of various countries. New-generation vaccines that include emerging serotypes, while maintaining protection against the 7-valent pneumococcal serotypes, have recently been approved. With the addition of these serotypes, the majority of potential pneumococcal serotypes causing invasive disease in most parts of the world could be covered.
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Affiliation(s)
- Tirdad T Zangeneh
- Division of Infectious Diseases, University of Miami Miller School of Medicine and the Miami Veterans Affairs Healthcare System, Miami, FL, USA
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47
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Lubell Y, Turner P, Ashley EA, White NJ. Susceptibility of bacterial isolates from community-acquired infections in sub-Saharan Africa and Asia to macrolide antibiotics. Trop Med Int Health 2011; 16:1192-205. [PMID: 21740488 DOI: 10.1111/j.1365-3156.2011.02837.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To review the literature on the susceptibility of common community pathogens in sub-Saharan Africa and Asia to the macrolide antibiotics. METHODS Inclusion criteria required that isolates were collected since 2004 to ensure results were of contemporary relevance. The data were aggregated by region, age group and sterility of site of culture sample. RESULTS A total of 51 studies were identified, which reported the macrolide antimicrobial susceptibilities of common bacterial pathogens isolated since 2004. In general, there was less macrolide resistance in African than in Asian isolates. Most African studies reported high levels of macrolide susceptibility in Streptococcus pneumoniae, whereas most Chinese studies reported high levels of resistance. There was very little information available for Gram-negative organisms. CONCLUSIONS Susceptibility of the pneumococcus to macrolides in SSA remains high in many areas, and good activity of azithromycin has been shown against Salmonellae spp. in Asia. In urban areas where high antibiotic consumption is prevalent, there was evidence of increased resistance to macrolides. However, there is no information on susceptibility from large areas in both continents.
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Affiliation(s)
- Yoel Lubell
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
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48
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Yasin RMD, Zin NM, Hussin A, Nawi SH, Hanapiah SMD, Wahab ZA, Raj G, Shafie N, Peng NP, Chu KK, Aziz MN, Maning N, Mohamad JS, Benjamin A, Salleh MABM, Zahari SS, Francis A, Ahmad N, Karunakaran R. Current trend of pneumococcal serotypes distribution and antibiotic susceptibility pattern in Malaysian hospitals. Vaccine 2011; 29:5688-93. [PMID: 21723357 DOI: 10.1016/j.vaccine.2011.06.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Revised: 03/15/2011] [Accepted: 06/05/2011] [Indexed: 11/15/2022]
Abstract
From January 2008 to December 2009, 433 Streptococcus pneumoniae strains were examined to determine the serotype distribution and susceptibility to selected antibiotics. About 50% of them were invasive isolates. The strains were isolated from patients of all age groups and 33.55% were isolated from children below 5 years. The majority was isolated from blood (48.53%) and other sterile specimens (6.30%). Community acquired pneumonia (41.70%) is the most common diagnosis followed by sepsis (9.54%). Serotyping was done using Pneumotest Plus-Kit and antibiotic susceptibility pattern was determined by modified Kirby-Bauer disk diffusion method and measurement of minimum inhibitory concentration (MIC) using E-test strip. Ten most common serotypes were 19F (15.02%), 6B (10.62%), 19A (6.93%), 14 (6.70%), 1 (5.08%), 6A (5.08%), 23F (4.85%), 18C (3.93%), 3 (2.08%) and 5 (1.85%). Penicillin MIC ranged between ≤ 0.012-4 μg/ml with MIC₉₀ of 1 μg/ml. Penicillin resistant rate is 31.78%. The majority of penicillin less-susceptible strains belonged to serotype 19F followed by 19A and 6B. Based on the serotypes distribution 22 (44.00%), 28 (56.00%) and 39 (78.00%) of the invasive isolates from children ≤ 2 years were belonged to serotypes included in the PCV7, PCV10 and PCV13, respectively.
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Affiliation(s)
- Rohani M D Yasin
- Specialised Diagnostic Centre, Institute for Medical Research, Kuala Lumpur, Malaysia.
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49
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Gadzinowski J, Albrecht P, Hasiec B, Konior R, Dziduch J, Witor A, Mellelieu T, Tansey SP, Jones T, Sarkozy D, Emini EA, Gruber WC, Scott DA. Phase 3 trial evaluating the immunogenicity, safety, and tolerability of manufacturing scale 13-valent pneumococcal conjugate vaccine. Vaccine 2011; 29:2947-55. [DOI: 10.1016/j.vaccine.2011.02.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Revised: 02/01/2011] [Accepted: 02/02/2011] [Indexed: 10/18/2022]
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50
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McIntosh EDG, Reinert RR. Global prevailing and emerging pediatric pneumococcal serotypes. Expert Rev Vaccines 2011; 10:109-29. [PMID: 21162625 DOI: 10.1586/erv.10.145] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Streptococcus pneumoniae is the leading cause of vaccine-preventable deaths among children younger than 5 years of age worldwide. The 7-valent pneumococcal conjugate vaccine (PCV7) is currently licensed in more than 90 countries and has contributed to significant declines in the incidence of invasive pneumococcal disease (IPD). Recent studies report an increased incidence of IPD caused by non-PCV7 vaccine serotypes (NVTs). Seroepidemiology of IPD caused by NVTs following the introduction of PCV7 is of interest, and this article provides a comprehensive global summary of the prevailing and emerging serotypes causing IPD in children. Currently, globally emerging or persistent NVTs include serotypes 1, 3, 5, 6A, 7F and 19A. Serotypes included in the recently licensed 10-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine (PCV10) and 13-valent pneumococcal conjugate vaccine (PCV13) account for pneumococcal disease burdens in most developed countries of 65-85% and 80-90%, respectively. The seroprevalence of NVTs after widespread use of PCV10 and PCV13 requires ongoing monitoring.
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Affiliation(s)
- E David G McIntosh
- Novartis Vaccines, Hullenbergweg 83-85, Amsterdam 1101CL, The Netherlands.
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