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Gonzales BE, Mercado EH, Castillo-Tokumori F, Montero AE, Luna-Muschi A, Marcelo-Ragas M, Campos F, Chaparro E, Del Águila O, Castillo ME, Saenz A, Reyes I, Hernandez R, Ochoa TJ. Pneumococcal serotypes and antibiotic resistance in healthy carriage children after introduction of PCV13 in Lima, Peru. Vaccine 2023:S0264-410X(23)00592-3. [PMID: 37270366 DOI: 10.1016/j.vaccine.2023.05.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/23/2023] [Accepted: 05/16/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To determinate the frequency of Streptococcus pneumoniae nasopharyngeal carriers, serotypes and antimicrobial resistance in healthy children in Lima, Peru, post-PCV13 introduction and to compare the results with a similar study conducted between 2006 and 2008 before PCV7 introduction (pre-PCV7). METHODS A cross-sectional multicenter study was conducted between January 2018 and August 2019 in 1000 healthy children under two years of age. We use standard microbiological methods to determinate S. pneumoniae from nasopharyngeal swab, Kirby Bauer and minimum inhibitory concentration methods to determinate antimicrobial susceptibility and whole genomic sequencing to determinate pneumococcal serotypes. RESULTS The pneumococcal carriage rate was 20.8 % vs. 31.1 % in pre-PCV7 (p < 0.001). The most frequent serotypes were 15C, 19A and 6C (12.4 %, 10.9 % and 10.9 % respectively). The carriage of PCV13 serotypes after PCV13 introduction decreased from 59.1 % (before PCV7 introduction) to 18.7 % (p < 0.001). Penicillin resistance was 75.5 %, TMP/SMX 75.5 % and azithromycin 50.0 %, using disk diffusion. Penicillin resistance rates using MIC breakpoint for meningitis (MIC ≥ 0.12) increased from 60.4 % to 74.5 % (p = 0.001). CONCLUSION The introduction of PCV13 in the immunization program in Peru has decreased the pneumococcal nasopharyngeal carriage and the frequency of PCV13 serotypes; however, there has been an increase in non-PCV13 serotypes and antimicrobial resistance.
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Affiliation(s)
- Brayan E Gonzales
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru; Grupo Peruano de Investigación en Neumococo (GPIN), Lima, Peru
| | - Erik H Mercado
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru; Grupo Peruano de Investigación en Neumococo (GPIN), Lima, Peru
| | - Franco Castillo-Tokumori
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru; Grupo Peruano de Investigación en Neumococo (GPIN), Lima, Peru
| | - Andrea E Montero
- Grupo Peruano de Investigación en Neumococo (GPIN), Lima, Peru; Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Alessandra Luna-Muschi
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru; Grupo Peruano de Investigación en Neumococo (GPIN), Lima, Peru
| | - Madhelli Marcelo-Ragas
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru; Grupo Peruano de Investigación en Neumococo (GPIN), Lima, Peru
| | - Francisco Campos
- Grupo Peruano de Investigación en Neumococo (GPIN), Lima, Peru; Departamento de Pediatría, Hospital Nacional Docente Madre-Niño San Bartolomé, Lima, Peru
| | - Eduardo Chaparro
- Grupo Peruano de Investigación en Neumococo (GPIN), Lima, Peru; Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru; Departamento de Pediatría, Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Olguita Del Águila
- Grupo Peruano de Investigación en Neumococo (GPIN), Lima, Peru; Servicio de Pediatría de Especialidades Clínicas, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - María E Castillo
- Grupo Peruano de Investigación en Neumococo (GPIN), Lima, Peru; Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru; Oficina de Epidemiología, Instituto Nacional de Salud del Niño, Lima, Peru
| | - Andrés Saenz
- Grupo Peruano de Investigación en Neumococo (GPIN), Lima, Peru; Departamento de Pediatría, Hospital Nacional Daniel Alcides Carrión, Lima, Peru
| | - Isabel Reyes
- Grupo Peruano de Investigación en Neumococo (GPIN), Lima, Peru; Servicio de Hospitalización, Hospital de Emergencias Pediátricas, Lima, Peru
| | - Roger Hernandez
- Grupo Peruano de Investigación en Neumococo (GPIN), Lima, Peru; Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru; Departamento de Pediatría, Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Theresa J Ochoa
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru; Grupo Peruano de Investigación en Neumococo (GPIN), Lima, Peru; Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru.
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Lemay JA, Ricketson LJ, Kellner JD. Trends in Asymptomatic Nasopharyngeal Streptococcus pneumoniae Carriage with qPCR and Culture Analysis. Microorganisms 2022; 10:microorganisms10102074. [PMID: 36296350 PMCID: PMC9607440 DOI: 10.3390/microorganisms10102074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/15/2022] [Accepted: 10/19/2022] [Indexed: 11/26/2022] Open
Abstract
We previously reported trends in pneumococcal nasopharyngeal carriage in the post-PCV13 era as detected by conventional culture methods. Our current aim is to assess if there are fundamental differences in the clinical and demographic features of children who have pneumococcal carriage detected by qPCR compared with culture analysis. The CASPER team conducted point-prevalence surveys in 2016 in healthy children in Calgary to determine trends in overall and serotype-specific pneumococcal nasopharyngeal carriage. Being 18 months of age (p = 0.009), having at least one sibling under 2 years of age (p = 0.04), having only sibling(s) over 2 years of age (p = 0.001), and childcare attendance (p = 0.005) were associated with carriage by qPCR methods only. Having only sibling(s) older than 2 years of age was associated with carriage detected by both qPCR and culture methods (p = 0.001). No clinical factors were associated with carriage detected by both qPCR and culture compared to qPCR methods only. Both analyses are suitable methods to detect carriage; however, qPCR analysis is more sensitive and more cost-effective. As there are no fundamental differences in the children that have pneumococcal nasopharyngeal carriage detectable by qPCR methods compared to conventional culture methods, molecular analysis may be a preferable option for future carriage studies.
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Affiliation(s)
- Julie-Anne Lemay
- Department of Pediatrics, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Leah J. Ricketson
- Department of Pediatrics, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - James D. Kellner
- Department of Pediatrics, University of Calgary, Calgary, AB T2N 1N4, Canada
- Department of Community Health Sciences and Department of Microbiology, Immunology & Infectious Diseases, University of Calgary, Calgary, AB T2N 1N4, Canada
- Alberta Children’s Hospital Research Institute, Calgary, AB T3B 6A8, Canada
- Correspondence:
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Ceyhan M, Karadag-Oncel E, Hascelik G, Ustundag G, Gurbuz V, Samlioglu P, Yilmaz N, Ozsurekci Y, Yilmaz E, Aykac K, Oz FN, Uzum O, Orsdemir-Hortu H, Tanir G, Yilmaz-Ciftdogan D, Kurugol Z. Nasopharyngeal carriage of Streptococcus pneumoniae in healthy children aged less than five years. Vaccine 2021; 39:2041-2047. [PMID: 33741188 DOI: 10.1016/j.vaccine.2021.03.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/05/2021] [Accepted: 03/07/2021] [Indexed: 01/17/2023]
Abstract
PURPOSE In Turkey, pneumococcal conjugate vaccine (PCV) was introduced to the national immunization program as PCV7 in 2008, and was replaced with PCV13 in 2011. The aim of the study was to demonstrate the pneumococcal carriage rate and the serotype distribution in healthy children under 5 years in Turkey who were vaccinated with PCV13. METHODS We conducted a cross-sectional study including the collection of questionnaire data and nasopharyngeal (NP) specimens among children aged <5 years from five centers from March 2019 to March 2020. Pneumococcal isolates were identified using optochin sensitivity and bile solubility. Serotyping was performed using a latex agglutination kit and Quellung reaction. RESULTS NP swab samples were collected from 580 healthy children. The observed overall carriage rate was 17.8%. None of the hypothesised predictors of S. pneumoniae carriage, except maternal education level was statistically significant (p = 0.017). High maternal education level appeared to decrease the risk (lower vs. higher maternal education OR: 1.992 [95% CI; 1.089-3.643], p = 0.025). The overall NP S. pneumoniae carriage prevalence for the PCV13-vaccinated children was 17.8% (103/580). The most common serotypes detected were serotype 15B (n = 10, 9.7%), serotype 23F (n = 9, 8.7%), serotype 23A (n = 9, 8.7%), serotype 11A (n = 7, 6.7%), serotype 19F (n = 5, 4.8%) and serotype 15F (n = 5, 4.8%). Of the isolates, 28 (27.2%) were in PCV13 vaccine strains (VSs), and 75 (72.8%) strains were non-VS. The serotype coverage rate was 27.2% for PCV13. CONCLUSION The overall S. pneumoniae carriage rate was higher than in earlier studies from Turkey. Post-vaccine era studies from around the world have reported a decrease in VS serotypes and a 'serotype replacement' to non-VS serotypes, as we determined in our study.
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Affiliation(s)
- Mehmet Ceyhan
- Hacettepe University School of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Eda Karadag-Oncel
- University of Health Sciences, Tepecik Training and Research Hospital, Department of Pediatric Infectious Diseases, İzmir, Turkey
| | - Gulsen Hascelik
- Hacettepe University School of Medicine, Department of Medical Microbiology, Ankara, Turkey
| | - Gulnihan Ustundag
- University of Health Sciences, Tepecik Training and Research Hospital, Department of Pediatric Infectious Diseases, İzmir, Turkey.
| | - Venhar Gurbuz
- Hacettepe University School of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Pinar Samlioglu
- University of Health Sciences, Tepecik Training and Research Hospital, Department of Medical Microbiology, İzmir, Turkey
| | - Nisel Yilmaz
- University of Health Sciences, Tepecik Training and Research Hospital, Department of Medical Microbiology, İzmir, Turkey
| | - Yasemin Ozsurekci
- Hacettepe University School of Medicine, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Elif Yilmaz
- Ege University School of Medicine, Department of Pediatric Infectious Diseases, İzmir, Turkey
| | - Kubra Aykac
- University of Health Sciences, Ankara Training and Research Hospital, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Fatma Nur Oz
- University of Health Sciences, Sami Ulus Training and Research Hospital, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Ozlem Uzum
- University of Health Sciences, Tepecik Training and Research Hospital, Department of Pediatrics, İzmir, Turkey
| | - Hacer Orsdemir-Hortu
- University of Health Sciences, Tepecik Training and Research Hospital, Department of Pediatrics, İzmir, Turkey
| | - Gonul Tanir
- University of Health Sciences, Sami Ulus Training and Research Hospital, Department of Pediatric Infectious Diseases, Ankara, Turkey
| | - Dilek Yilmaz-Ciftdogan
- University of Health Sciences, Tepecik Training and Research Hospital, Department of Pediatric Infectious Diseases, İzmir, Turkey
| | - Zafer Kurugol
- Ege University School of Medicine, Department of Pediatric Infectious Diseases, İzmir, Turkey
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Post-Vaccination Streptococcus pneumoniae Carriage and Virulence Gene Distribution among Children Less Than Five Years of Age, Cape Coast, Ghana. Microorganisms 2020; 8:microorganisms8121987. [PMID: 33322236 PMCID: PMC7764876 DOI: 10.3390/microorganisms8121987] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 11/27/2020] [Accepted: 12/10/2020] [Indexed: 01/01/2023] Open
Abstract
In 2012, Ghana introduced PCV13 into its childhood immunization program. To monitor the pneumococcus after PCV13 vaccination, we analyzed serotypes, antibiotic resistance, and virulence genes of pneumococcal carriage isolates among children under five years of age. We obtained nasopharyngeal swabs from 513 children from kindergartens and immunization centers in Cape Coast, Ghana. Pneumococcal serotypes were determined by multiplex-PCR and Quellung reaction. Antibiotic resistance and virulence genes prevalence were determined by disc diffusion and PCR respectively. Overall, carriage prevalence was 29.4% and PCV13 coverage was 38.4%. Over 60% of the isolates were non-PCV13 serotypes and serotype 23B was the most prevalent. One isolate showed full resistance to penicillin, while 35% showed intermediate resistance. Resistance to erythromycin and clindamycin remained low, while susceptibility to ceftriaxone, levofloxacin and vancomycin remained high. Penicillin resistance was associated with PCV13 serotypes. Forty-three (28.5%) strains were multidrug-resistant. Virulence genes pavB, pcpA, psrP, pilus-1, and pilus-2 were detected in 100%, 87%, 62.9%, 11.9%, and 6.6% of the strains, respectively. The pilus islets were associated with PCV13 and multidrug-resistant serotypes. PCV13 vaccination had impacted on pneumococcal carriage with a significant increase in non-PCV13 serotypes and lower penicillin resistance. Including PcpA and PsrP in pneumococcal protein-based vaccines could be beneficial to Ghanaian children.
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