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Howard LM, Huang X, Chen W, Liu Y, Edwards KM, Griffin MR, Zhu Y, Vidal JE, Klugman KP, Gil AI, Soper NR, Thomsen IP, Gould K, Hinds J, Lanata CF, Grijalva CG. Association between nasopharyngeal colonization with multiple pneumococcal serotypes and total pneumococcal colonization density in young Peruvian children. Int J Infect Dis 2023; 134:248-255. [PMID: 37451394 PMCID: PMC10804940 DOI: 10.1016/j.ijid.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/05/2023] [Accepted: 07/09/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVES We examined the association of nasopharyngeal (NP) pneumococcal co-colonization (>1 pneumococcal serotype) and pneumococcal density in young Peruvian children enrolled in a prospective cohort study. METHODS NP swabs collected monthly from children aged <3 years during both asymptomatic and acute respiratory illness (ARI) periods underwent culture-enriched microarray for pneumococcal detection and serotyping and lytA polymerase chain reaction for density assessment. We examined the serotypes commonly associated with co-colonization and the distribution of densities by co-colonization, age, current ARI, and other covariates. The association of co-colonization and pneumococcal density was assessed using a multivariable mixed-effects linear regression model, accounting for repeated measures and relevant covariates. RESULTS A total of 27 children contributed 575 monthly NP samples. Pneumococcus was detected in 302 of 575 (53%) samples, and co-colonization was detected in 61 of these 302 (20%). The total densities were higher during ARI than non-ARI periods and lowest among the youngest children, increasing with age. In the multivariable analysis, there was no significant association between pneumococcal density and co-colonization (coefficient estimate 0.22, 95% confidence interval 0.11-0.55; reference: single-serotype detections). Serotypes 23B and 19F were detected significantly more frequently as single isolates. CONCLUSION Pneumococcal co-colonization was common and not associated with increased pneumococcal density. Differential propensity for co-colonization was observed among individual serotypes.
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Affiliation(s)
- Leigh M Howard
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, USA.
| | - Xiang Huang
- Department of Medicine, Vanderbilt University Medical Center, Nashville, USA
| | - Wencong Chen
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, USA
| | - Yuhan Liu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, USA
| | - Kathryn M Edwards
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, USA
| | - Marie R Griffin
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, USA
| | - Yuwei Zhu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, USA
| | - Jorge E Vidal
- Department of Microbiology and Immunology, University of Mississippi Medical Center, Jackson, USA
| | - Keith P Klugman
- Rollins School of Public Health, Emory University; Atlanta, USA
| | - Ana I Gil
- Instituto de Investigacion Nutricional; Lima, Peru
| | - Nicole R Soper
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, USA
| | - Isaac P Thomsen
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, USA
| | - Katherine Gould
- Institute for Infection and Immunity, St. George's, University of London, London, UK; BUGS Bioscience, London Bioscience Innovation Centre, London, UK
| | - Jason Hinds
- Institute for Infection and Immunity, St. George's, University of London, London, UK; BUGS Bioscience, London Bioscience Innovation Centre, London, UK
| | - Claudio F Lanata
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, USA; Instituto de Investigacion Nutricional; Lima, Peru
| | - Carlos G Grijalva
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, USA; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, USA
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Zuurbier RP, Bogaert D, de Steenhuijsen Piters WAA, Arp K, Chu MLJN, Sanders EAM, van Houten MA. Asymptomatic Viral Presence in Early Life Precedes Recurrence of Respiratory Tract Infections. Pediatr Infect Dis J 2023; 42:59-65. [PMID: 36476532 DOI: 10.1097/inf.0000000000003732] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Respiratory tract infections (RTIs) in infants are often caused by viruses. Although respiratory syncytial virus (RSV), influenza virus and human metapneumovirus (hMPV) can be considered the most pathogenic viruses in children, rhinovirus (RV) is often found in asymptomatic infants as well. Little is known about the health consequences of viral presence, especially early in life. We aimed to examine the dynamics of (a)symptomatic viral presence and relate early viral detection to susceptibility to RTIs in infants. METHODS In a prospective birth cohort of 117 infants, we tested 1304 nasopharyngeal samples obtained from 11 consecutive regular sampling moments, and during acute RTIs across the first year of life for 17 respiratory viruses by quantitative PCR. Associations between viral presence, viral (sub)type, viral load, viral co-detection and symptoms were tested by generalized estimating equation (GEE) models. RESULTS RV was the most detected virus. RV was negatively associated [GEE: adjusted odds ratio (aOR) 0.41 (95% CI 0.18-0.92)], and hMPV, RSV, parainfluenza 2 and 4 and human coronavirus HKU1 were positively associated with an acute RTI. Asymptomatic RV in early life was, however, associated with increased susceptibility to and recurrence of RTIs later in the first year of life (Kaplan-Meier survival analysis: P = 0.022). CONCLUSIONS Respiratory viruses, including the seasonal human coronaviruses, are often detected in infants, and are often asymptomatic. Early life RV presence is, though negatively associated with an acute RTI, associated with future susceptibility to and recurrence of RTIs. Further studies on potential ecologic or immunologic mechanisms are needed to understand these observations.
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Affiliation(s)
- Roy P Zuurbier
- From the Department of Pediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht
- Spaarne Gasthuis Academy, Hoofddorp and Haarlem, The Netherlands
| | - Debby Bogaert
- From the Department of Pediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht
- Medical Research Council and University of Edinburgh Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Kayleigh Arp
- From the Department of Pediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Mei Ling J N Chu
- From the Department of Pediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Elisabeth A M Sanders
- From the Department of Pediatric Immunology and Infectious Diseases, Wilhelmina Children's Hospital/University Medical Center Utrecht, Utrecht
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Marlies A van Houten
- Spaarne Gasthuis Academy, Hoofddorp and Haarlem, The Netherlands
- Department of Pediatrics, Spaarne Gasthuis, Hoofddorp and Haarlem, The Netherlands
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3
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Dherani MK, Pope D, Tafatatha T, Heinsbroek E, Chartier R, Mwalukomo T, Crampin A, Mitsi E, German EL, Nikolaou E, Solórzano C, Ferreira DM, Swarthout TD, Hinds J, Mortimer K, Gordon SB, French N, Bruce NG. Association between household air pollution and nasopharyngeal pneumococcal carriage in Malawian infants (MSCAPE): a nested, prospective, observational study. THE LANCET GLOBAL HEALTH 2022; 10:e246-e256. [PMID: 35063113 PMCID: PMC8789559 DOI: 10.1016/s2214-109x(21)00405-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/12/2021] [Accepted: 08/31/2021] [Indexed: 12/11/2022] Open
Abstract
Background Household air pollution from solid fuels increases the risk of childhood pneumonia. Nasopharyngeal carriage of Streptococcus pneumoniae is a necessary step in the development of pneumococcal pneumonia. We aimed to assess the association between exposure to household air pollution and the prevalence and density of S pneumoniae carriage among children. Methods The Malawi Streptococcus pneumoniae Carriage and Air Pollution Exposure study was a nested, prospective, observational study of children participating in the cluster randomised controlled Cooking and Pneumonia Study (CAPS) in the Karonga Health and Demographic Surveillance System (HDSS) area in northern Malawi. CAPS compared the effects of a cleaner burning biomass-fuelled cookstove (intervention group) with traditional open-fire cooking (control group) on the incidence of pneumonia in children. Eligible children aged 6 weeks or 6 months (those recruited a 6 weeks were also followed up at age 6 months) were identified by the Karonga HDSS centre. Nasopharyngeal swabs were taken to detect S pneumoniae, and infant exposure to particulate matter with a diameter of ≤2·5 μm (PM2·5) exposure was assessed by use of a MicroPEM device. The primary outcome was the prevalence of nasopharyngeal S pneumoniae carriage in all children aged 6 months, assessed in all children with valid data on PM2·5. The effects of the intervention stoves (intention-to-treat analysis) and PM2·5 (adjusted exposure-response analysis) on the prevalence of S pneumoniae carriage were also assessed in the study children. Findings Between Nov 15, 2015, and Nov 2, 2017, 485 children were recruited (240 from the intervention group and 245 from the control group). Of all 450 children with available data at age 6 months, 387 (86% [95% CI 82–89]) were positive for S pneumoniae. Geometric mean PM2·5 exposure was 60·3 μg/m3 (95% CI 55·8–65·3) in S pneumoniae-positive children and 47·0 μg/m3 (38·3–57·7) in S pneumoniae-negative children (p=0·044). In the intention-to-treat analysis, a non-significant increase in the risk of S pneumoniae carriage was observed in intervention group children compared with control group children (odds ratio 1·36 [95% CI 0·95–1·94]; p=0·093). In the exposure-response analysis, a significant association between PM2·5 exposure and S pneumoniae carriage was observed; a one unit increase in decile of PM2·5 was found to significantly increase the risk of S pneumoniae carriage by 10% (1·10 [1·01–1·20]; p=0·035), after adjustment for age, sex, 13-valent pneumococcal conjugate vaccination status, season, current use of antibiotics, and MicroPEM run-time. Interpretation Despite the absence of effect from the intervention cookstove, household air pollution exposure was significantly associated with the prevalence of nasopharyngeal S pneumoniae carriage. These results provide empirical evidence for the potential mechanistic association between exposure to household air pollution and childhood pneumonia. Funding Bill & Melinda Gates Foundation.
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Affiliation(s)
- Mukesh K Dherani
- St Helens and Knowsley Teaching Hospitals NHS Trust, Patterdale Lodge Medical Centre, St Helens, UK; Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK.
| | - Daniel Pope
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Terence Tafatatha
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Ellen Heinsbroek
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Ryan Chartier
- Research Triangle Institute International, Durham, NC, USA
| | | | - Amelia Crampin
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Elena Mitsi
- Liverpool School of Tropical Medicine, Liverpool, UK
| | | | | | | | | | - Todd D Swarthout
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi; NIHR Mucosal Pathogens Research Unit, Research Department of Infection, Division of Infection and Immunity, University College London, London, UK
| | - Jason Hinds
- Institute for Infection and Immunity, St George's University of London, London, UK; BUGS Bioscience, London Bioscience Innovation Centre, London, UK
| | | | - Stephen B Gordon
- Kamuzu University of Health Sciences, Blantyre, Malawi; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Neil French
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK; Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Nigel G Bruce
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
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4
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Nikolaou E, German EL, Blizard A, Howard A, Hitchins L, Chen T, Chadwick J, Pojar S, Mitsi E, Solórzano C, Sunny S, Dunne F, Gritzfeld JF, Adler H, Hinds J, Gould KA, Rylance J, Collins AM, Gordon SB, Ferreira DM. The nose is the best niche for detection of experimental pneumococcal colonisation in adults of all ages, using nasal wash. Sci Rep 2021; 11:18279. [PMID: 34521967 PMCID: PMC8440778 DOI: 10.1038/s41598-021-97807-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/10/2021] [Indexed: 11/09/2022] Open
Abstract
Previous studies have suggested that the pneumococcal niche changes from the nasopharynx to the oral cavity with age. We use an Experimental Human Pneumococcal Challenge model to investigate pneumococcal colonisation in different anatomical niches with age. Healthy adults (n = 112) were intranasally inoculated with Streptococcus pneumoniae serotype 6B (Spn6B) and were categorised as young 18-55 years (n = 57) or older > 55 years (n = 55). Colonisation status (frequency and density) was determined by multiplex qPCR targeting the lytA and cpsA-6A/B genes in both raw and culture-enriched nasal wash and oropharyngeal swab samples collected at 2-, 7- and 14-days post-exposure. For older adults, raw and culture-enriched saliva samples were also assessed. 64% of NW samples and 54% of OPS samples were positive for Spn6B in young adults, compared to 35% of NW samples, 24% of OPS samples and 6% of saliva samples in older adults. Many colonisation events were only detected in culture-enriched samples. Experimental colonisation was detected in 72% of young adults by NW and 63% by OPS. In older adults, this was 51% by NW, 36% by OPS and 9% by saliva. The nose, as assessed by nasal wash, is the best niche for detection of experimental pneumococcal colonisation in both young and older adults.
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Affiliation(s)
- Elissavet Nikolaou
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, 1st Daulby Street, Liverpool, L7 8XZ, UK.
| | - Esther L German
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, 1st Daulby Street, Liverpool, L7 8XZ, UK.
| | - Annie Blizard
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, 1st Daulby Street, Liverpool, L7 8XZ, UK
| | - Ashleigh Howard
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, 1st Daulby Street, Liverpool, L7 8XZ, UK
| | - Lisa Hitchins
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, 1st Daulby Street, Liverpool, L7 8XZ, UK
| | - Tao Chen
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, 1st Daulby Street, Liverpool, L7 8XZ, UK
| | - Jim Chadwick
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, 1st Daulby Street, Liverpool, L7 8XZ, UK
| | - Sherin Pojar
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, 1st Daulby Street, Liverpool, L7 8XZ, UK
| | - Elena Mitsi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, 1st Daulby Street, Liverpool, L7 8XZ, UK
| | - Carla Solórzano
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, 1st Daulby Street, Liverpool, L7 8XZ, UK
| | - Syba Sunny
- Medical Microbiology, Royal Liverpool University Hospital, Liverpool, UK
| | - Felicity Dunne
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, 1st Daulby Street, Liverpool, L7 8XZ, UK.,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Jenna F Gritzfeld
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, 1st Daulby Street, Liverpool, L7 8XZ, UK.,Institute of Life Course and Medical Sciences, University of Liverpool, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Hugh Adler
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, 1st Daulby Street, Liverpool, L7 8XZ, UK
| | - Jason Hinds
- Infection and Immunity Research Institute, St George's University London, London, UK
| | - Katherine A Gould
- Infection and Immunity Research Institute, St George's University London, London, UK
| | - Jamie Rylance
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, 1st Daulby Street, Liverpool, L7 8XZ, UK
| | - Andrea M Collins
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, 1st Daulby Street, Liverpool, L7 8XZ, UK
| | - Stephen B Gordon
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, 1st Daulby Street, Liverpool, L7 8XZ, UK.,College of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Daniela M Ferreira
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, 1st Daulby Street, Liverpool, L7 8XZ, UK
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5
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Narwortey DK, Owusu-Ofori A, Slotved HC, Donkor ES, Ansah PO, Welaga P, Agongo G, Oduro AR. Nasopharyngeal carriage of Streptococcus pneumoniae among healthy children in Kassena-Nankana districts of Northern Ghana. BMC Infect Dis 2021; 21:661. [PMID: 34233627 PMCID: PMC8265090 DOI: 10.1186/s12879-021-06302-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 05/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pneumococcal vaccine immunizations may be responsible for alterations in serotype epidemiology within a region. This study investigated the pneumococcal carriage prevalence and the impact of the 13-valent pneumococcal conjugate vaccine (PCV-13) on circulating serotypes among healthy children in Northern Ghana. METHODS This was a cross sectional study conducted in the Kassena-Nankana districts of Northern Ghana from November to December during the dry season of 2018. Nasopharyngeal swabs collected from 193 participants were cultured per standard microbiological protocols and pneumococcal isolates were serotyped using the latex agglutination technique and the capsular Quellung reaction test. We examined for any association between the demographic characteristics of study participants and pneumococcal carriage using chi-square test and logistic regression. RESULTS Of the 193 participants that were enrolled the mean age was 8.6 years and 54.4% were females. The carriage rate among the participants was 32.6% (63/193), and twenty different serotypes were identified. These included both vaccine serotypes (VT), 35% (7/20) and non-vaccine serotypes (NVT), 65% (13/20). The predominant serotypes (34 and 11A), both of which were NVT, accounted for a prevalence of 12.8%. PCV-13 covered only 35% of serotypes identified whiles 40% of serotypes are covered by PPV 23. CONCLUSION Post-vaccination carriage of S. pneumoniae is high and is dominated by non-vaccine serotypes. There is therefore a need for the conduct of invasive pneumococcal disease surveillance (IPD) to find out if the high non-vaccine serotype carriage translates to disease. And in addition, a review of the currently used PCV-13 vaccine in the country would be considered relevant.
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Affiliation(s)
- Deborah K. Narwortey
- Navrongo Health Research Centre, Ghana Health Services, Biomedical Department, P.O. Box 114, Navrongo, Ghana
- Department of Clinical Microbiology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Alex Owusu-Ofori
- Department of Clinical Microbiology, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Hans-Christian Slotved
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Eric S. Donkor
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
| | - Patrick O. Ansah
- Navrongo Health Research Centre, Ghana Health Services, Biomedical Department, P.O. Box 114, Navrongo, Ghana
| | - Paul Welaga
- Navrongo Health Research Centre, Ghana Health Services, Biomedical Department, P.O. Box 114, Navrongo, Ghana
| | - Godfred Agongo
- Navrongo Health Research Centre, Ghana Health Services, Biomedical Department, P.O. Box 114, Navrongo, Ghana
| | - Abraham R. Oduro
- Navrongo Health Research Centre, Ghana Health Services, Biomedical Department, P.O. Box 114, Navrongo, Ghana
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6
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Makenga G, Mtove G, Yin JK, Mziray A, Bwana VM, Kisinza W, Mjema J, Amos B, Antony L, Shingadia D, Oftadeh S, Booy R. Immunogenicity and Efficacy of Pneumococcal Conjugate Vaccine (Prevenar13 ®) in Preventing Acquisition of Carriage of Pneumococcal Vaccine Serotypes in Tanzanian Children With HIV/AIDS. Front Immunol 2021; 12:673392. [PMID: 34220819 PMCID: PMC8248180 DOI: 10.3389/fimmu.2021.673392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 05/31/2021] [Indexed: 11/13/2022] Open
Abstract
In every year, up to one million children die due to pneumococcal disease. Children infected with Human Immunodeficiency Virus (HIV) are mostly affected, as they appear to have higher rates of pneumococcal carriage and invasive disease. Successful immunity is dependent on mounting a sufficient immune response to the vaccine. We conducted a double blinded crossover randomised controlled trial to determine the serum antibody response (≥4-fold and geometric mean concentration) to pneumococcal vaccine (PCV13) serotypes at 3 months after second vaccination. We also determined the number and proportion of children carrying new (not present at baseline) vaccine serotypes of S. pneumoniae isolated from nasopharynx at 6 months post initial vaccination in recipients of Prevenar13® compared with those given Haemophilus influenzae-type b (Hib) vaccine (control). The study was conducted at St Augustine's also known as Teule Hospital in Muheza, Tanga Tanzania. 225 HIV infected children aged 1-14 years were enrolled from Jan 2013 to Nov 2013 and randomised to Prevenar13® or Hib vaccines each given at baseline and 2-3 months later. Nasopharyngeal and serum samples were collected at baseline and 4-6 months later. Serotyping was done by Quellung Reaction using Staten antisera. Serum antibodies were ELISA quantified. The study revealed a non-significant reduction in the acquisition of new vaccine serotypes of S. pneumoniae in the recipients of PCV13 by nearly a third compared to those who received Hib vaccine. The vaccine efficacy was 30.5% (95% confidence interval [CI] -6.4-54.6%, P = 0.100)]. The antibody response was not enough to induce a 4-fold rise in GMC in 7 of the 13 vaccine serotypes. When combining the effects of preventing new acquisition and clearing existing vaccine type carriage, the overall efficacy was 31.5% (95% CI 1.5-52.4%, P = 0.045). In the PCV13 group, the proportion of participants carrying vaccine serotype was significantly lower after 2 doses of PCV13 (30%; 32/107), compared with the baseline proportion (48%; 51/107). The introduction of PCV13 targeting HIV-positive children in a setting similar to Tanzania is likely to be associated with appreciable decrease in the acquisition and carriage of pneumococci, which is an important marker of the likely effect of the vaccine on pneumococcal disease. Clinical Trial Registration https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=335579, identifier ACTRN12610000999033.
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Affiliation(s)
- Geofrey Makenga
- National Institute for Medical Research (NIMR), Amani Research Center, Muheza, Tanzania
| | - George Mtove
- National Institute for Medical Research (NIMR), Amani Research Center, Muheza, Tanzania
| | - J. Kevin Yin
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- National Centre for Immunisation Research and Surveillance, University of Sydney, Sydney, NSW, Australia
| | - Abubakary Mziray
- National Institute for Medical Research (NIMR), Amani Research Center, Muheza, Tanzania
| | - Veneranda M. Bwana
- National Institute for Medical Research (NIMR), Amani Research Center, Muheza, Tanzania
| | - William Kisinza
- National Institute for Medical Research (NIMR), Amani Research Center, Muheza, Tanzania
| | - Julius Mjema
- St Augustine’s, Hospitali Teule, Private Bag, Tanga, Tanzania
| | - Ben Amos
- St Augustine’s, Hospitali Teule, Private Bag, Tanga, Tanzania
| | - Laura Antony
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Delane Shingadia
- Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
| | - Shahin Oftadeh
- NSW and ACT Pneumococcal Reference Laboratory, Centre for Infectious Diseases and Microbiology, Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, NSW, Australia
| | - Robert Booy
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- National Centre for Immunisation Research and Surveillance, University of Sydney, Sydney, NSW, Australia
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7
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Swarthout TD, Gori A, Bar-Zeev N, Kamng'ona AW, Mwalukomo TS, Bonomali F, Nyirenda R, Brown C, Msefula J, Everett D, Mwansambo C, Gould K, Hinds J, Heyderman RS, French N. Evaluation of Pneumococcal Serotyping of Nasopharyngeal-Carriage Isolates by Latex Agglutination, Whole-Genome Sequencing (PneumoCaT), and DNA Microarray in a High-Pneumococcal-Carriage-Prevalence Population in Malawi. J Clin Microbiol 2020; 59:e02103-20. [PMID: 33087431 PMCID: PMC7771446 DOI: 10.1128/jcm.02103-20] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 10/09/2020] [Indexed: 11/24/2022] Open
Abstract
Accurate assessment of the serotype distribution associated with pneumococcal colonization and disease is essential for evaluating and formulating pneumococcal vaccines and for informing vaccine policy. For this reason, we evaluated the concordance between pneumococcal serotyping results by latex agglutination, whole-genome sequencing (WGS) with PneumoCaT, and DNA microarray for samples from community carriage surveillance in Blantyre, Malawi. Nasopharyngeal swabs were collected according to WHO recommendations between 2015 and 2017 by using stratified random sampling among study populations. Participants included healthy children 3 to 6 years old (vaccinated with the 13-valent pneumococcal conjugate vaccine [PCV13] as part of the Expanded Program on Immunization [EPI]), healthy children 5 to 10 years old (age-ineligible for PCV13), and HIV-infected adults (18 to 40 years old) on antiretroviral therapy (ART). For phenotypic serotyping, we used a 13-valent latex kit (Statens Serum Institut [SSI], Denmark). For genomic serotyping, we applied the PneumoCaT pipeline to whole-genome sequence libraries. For molecular serotyping by microarray, we used the BUGS Bioscience Senti-SP microarray. A total of 1,347 samples were analyzed. Concordance was 90.7% (95% confidence interval [CI], 89.0 to 92.2%) between latex agglutination and PneumoCaT, 95.2% (95% CI, 93.9 to 96.3%) between latex agglutination and the microarray, and 96.6% (95% CI, 95.5 to 97.5%) between the microarray and PneumoCaT. By detecting additional vaccine serotype (VT) pneumococci carried at low relative abundances (median, 8%), the microarray increased VT detection by 31.5% over that by latex serotyping. To conclude, all three serotyping methods were highly concordant in identifying dominant serotypes. Latex serotyping is accurate in identifying vaccine serotypes and requires the least expertise and resources for field implementation and analysis. However, WGS, which adds population structure, and microarray, which adds multiple-serotype carriage, should be considered at regional reference laboratories for investigating the importance of vaccine serotypes at low relative abundances in transmission and disease.
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Affiliation(s)
- Todd D Swarthout
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- NIHR Global Health Research Unit on Mucosal Pathogens, Division of Infection and Immunity, University College London, London, United Kingdom
| | - Andrea Gori
- NIHR Global Health Research Unit on Mucosal Pathogens, Division of Infection and Immunity, University College London, London, United Kingdom
| | - Naor Bar-Zeev
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- International Vaccine Access Center, Department of International Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Arox W Kamng'ona
- Department of Biomedical Sciences, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Thandie S Mwalukomo
- Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Farouck Bonomali
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Roseline Nyirenda
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Comfort Brown
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Jacquline Msefula
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Dean Everett
- The Queens Medical Research Institute, University of Edinburgh, Edinburgh, Scotland
| | | | - Katherine Gould
- Institute for Infection and Immunity, St. George's, University of London, London, United Kingdom
- BUGS Bioscience, London Bioscience Innovation Centre, London, United Kingdom
| | - Jason Hinds
- Institute for Infection and Immunity, St. George's, University of London, London, United Kingdom
- BUGS Bioscience, London Bioscience Innovation Centre, London, United Kingdom
| | - Robert S Heyderman
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- NIHR Global Health Research Unit on Mucosal Pathogens, Division of Infection and Immunity, University College London, London, United Kingdom
| | - Neil French
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Centre for Global Vaccine Research, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
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8
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Pomat WS, van den Biggelaar AHJ, Wana S, Francis JP, Solomon V, Greenhill AR, Ford R, Orami T, Passey M, Jacoby P, Kirkham LA, Lehmann D, Richmond PC. Safety and Immunogenicity of Pneumococcal Conjugate Vaccines in a High-risk Population: A Randomized Controlled Trial of 10-Valent and 13-Valent Pneumococcal Conjugate Vaccine in Papua New Guinean Infants. Clin Infect Dis 2020; 68:1472-1481. [PMID: 30184183 PMCID: PMC6481999 DOI: 10.1093/cid/ciy743] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 08/31/2018] [Indexed: 12/31/2022] Open
Abstract
Background There are little data on the immunogenicity of PCV10 and PCV13 in the same high-risk population. Methods PCV10 and PCV13 were studied head-to-head in a randomized controlled trial in Papua New Guinea in which 262 infants received 3 doses of PCV10 or PCV13 at 1, 2, and 3 months of age. Serotype-specific immunoglobulin G (IgG) concentrations, and pneumococcal and nontypeable Haemophilus influenzae (NTHi) carriage were assessed prevaccination and at 4 and 9 months of age. Infants were followed up for safety until 9 months of age. Results One month after the third dose of PCV10 or PCV13, ˃80% of infants had IgG concentrations ≥0.35µg/mL for vaccine serotypes, and 6 months postvaccination IgG concentrations ≥0.35 µg/mL were maintained for 8/10 shared PCV serotypes in > 75% of children vaccinated with either PCV10 or PCV13. Children carried a total of 65 different pneumococcal serotypes (plus nonserotypeable). At 4 months of age, 92% (95% confidence interval [CI] 85–96) of children vaccinated with PCV10 and 81% (95% CI 72–88) vaccinated with PCV13 were pneumococcal carriers (P = .023), whereas no differences were seen at 9 months of age, or for NTHi carriage. Both vaccines were well tolerated and not associated with serious adverse events. Conclusions Infant vaccination with 3 doses of PCV10 or PCV13 is safe and immunogenic in a highly endemic setting; however, to significantly reduce pneumococcal disease in these settings, PCVs with broader serotype coverage and potency to reduce pneumococcal carriage are needed. Clinical Trials Registration NCT01619462.
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Affiliation(s)
| | - Anita H J van den Biggelaar
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute and Centre for Child Health Research, University of Western Australia, Perth
| | - Sandra Wana
- Papua New Guinea Institute of Medical Research, Goroka
| | | | - Vela Solomon
- Papua New Guinea Institute of Medical Research, Goroka
| | - Andrew R Greenhill
- Papua New Guinea Institute of Medical Research, Goroka.,School of Health and Life Sciences, Federation University, Churchill, Victoria
| | - Rebecca Ford
- Papua New Guinea Institute of Medical Research, Goroka
| | - Tilda Orami
- Papua New Guinea Institute of Medical Research, Goroka
| | - Megan Passey
- The University of Sydney, University Centre for Rural Health, School of Public Health, Lismore, New South Wales
| | - Peter Jacoby
- Department of Biostatistics, Telethon Kids Institute and Centre for Child Health Research, University of Western Australia, Perth
| | - Lea-Ann Kirkham
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute and Centre for Child Health Research, University of Western Australia, Perth.,School of Biomedical Sciences, University of Western Australia, Perth
| | - Deborah Lehmann
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute and Centre for Child Health Research, University of Western Australia, Perth
| | - Peter C Richmond
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute and Centre for Child Health Research, University of Western Australia, Perth.,Division of Paediatrics and Child Health, School of Medicine, University of Western Australia, Perth
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9
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Arguedas A, Trzciński K, O'Brien KL, Ferreira DM, Wyllie AL, Weinberger D, Danon L, Pelton SI, Azzari C, Hammitt LL, Sá-Leão R, Brandileone MCC, Saha S, Suaya J, Isturiz R, Jodar L, Gessner BD. Upper respiratory tract colonization with Streptococcus pneumoniae in adults. Expert Rev Vaccines 2020; 19:353-366. [PMID: 32237926 DOI: 10.1080/14760584.2020.1750378] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Most of the current evidence regarding pneumococcal upper respiratory colonization in adults suggests that despite high disease burden, carriage prevalence is low. Contemporary studies on adult pneumococcal colonization have largely followed the pediatric approach by which samples are obtained mostly from the nasopharynx and bacterial detection is evaluated by routine culture alone. Recent evidence suggests that the 'pediatric approach' may be insufficient in adults and pneumococcal detection in this population may be improved by longitudinal studies that include samples from additional respiratory sites combined with more extensive laboratory testing. AREAS COVERED In this article, relevant literature published in peer review journals on adult pneumococcal colonization, epidemiology, detection methods, and recommendations were reviewed. EXPERT OPINION Respiratory carriage of Streptococcus pneumoniae has been underestimated in adults. Contemporary pneumococcal carriage studies in adults that collect samples from alternative respiratory sites such as the oropharynx, saliva, or nasal wash; are culture-enriched for pneumococcus; and use molecular diagnostic methods designed to target two pneumococcal DNA sequences should enhance pneumococcal detection in the adult respiratory tract. This finding may have implications for the interpretation of dynamics of pneumococcal transmission and vaccination.
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Affiliation(s)
- Adriano Arguedas
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc , Collegeville, PA, USA
| | - Krzysztof Trzciński
- Department of Pediatric Immunology and Infectious Diseases, Wilhelmina's Children Hospital, University Medical Centre Utrecht , Utrecht, The Netherlands
| | - Katherine L O'Brien
- Department of International Health, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD, USA
| | | | - Anne L Wyllie
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health , New Haven, CT, USA
| | - Daniel Weinberger
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health , New Haven, CT, USA
| | | | - Stephen I Pelton
- Pediatric Infectious Diseases, Department of Pediatrics, Maxwell Finland Laboratory for Infectious Diseases, Boston Medical Center , Boston, MA, USA
| | - Chiara Azzari
- Meyer Children's Hospital and University of Florence , Florence, Italy
| | - Laura L Hammitt
- Department of International Health, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD, USA
| | - Raquel Sá-Leão
- Instituto De Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa , Oeiras, Portugal
| | | | - Samir Saha
- Child Health Research Foundation , Matuail, Dhaka, Bangladesh
| | - Jose Suaya
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc , New York, NY, USA
| | - Raul Isturiz
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc , Collegeville, PA, USA
| | - Luis Jodar
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc , Collegeville, PA, USA
| | - Bradford D Gessner
- Vaccines Medical Development & Scientific/Clinical Affairs, Pfizer Inc , Collegeville, PA, USA
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10
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Nisar MI, Nayani K, Akhund T, Riaz A, Irfan O, Shakoor S, Muneer S, Muslim S, Hotwani A, Kabir F, Whitney C, Kim L, Srinivasan V, Ali A, Zaidi AKM, Jehan F. Nasopharyngeal carriage of Streptococcus pneumoniae in children under 5 years of age before introduction of pneumococcal vaccine (PCV10) in urban and rural districts in Pakistan. BMC Infect Dis 2018; 18:672. [PMID: 30563483 PMCID: PMC6299586 DOI: 10.1186/s12879-018-3608-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 12/10/2018] [Indexed: 11/10/2022] Open
Abstract
Background Benefits of pneumococcal conjugate vaccine programs have been linked to the vaccine’s ability to disrupt nasopharyngeal carriage and transmission. The 10-valent pneumococcal vaccine (PCV10) was included in the Expanded Program on Immunization (EPI) in Sindh, Pakistan in February 2013. This study was carried out immediately before PCV10 introduction to establish baseline pneumococcal carriage and prevalent serotypes in young children and to determine if carriage differed in urban and rural communities. Methods Nasopharyngeal specimens were collected from a random sample of children 3-11 and 12-59 months of age in an urban community (Karachi) and children 3-11 months of age in a rural community (Matiari). Samples were processed in a research laboratory in Karachi. Samples were transported in STGG media, enriched in Todd Hewitt broth, rabbit serum and yeast extract, cultured on 5% sheep blood agar, and serotyped using the CDC standardized sequential multiplex PCR assay. Serotypes were categorized into PCV10-type and non-vaccine types. Results We enrolled 670 children. Pneumococci were detected in 73.6% and 79.5 % of children in the infant group in Karachi and Matiari, respectively, and 78.2% of children 12 to 59 months of age in Karachi. In infants, 38.9% and 33.5% of those carrying pneumococci in Karachi and Matiari, respectively, had PCV10 types. In the older age group in Karachi, the proportion was 30.7%, not significantly different from infants. The most common serotypes were 6A, 23F, 19A, 6B and 19F. Conclusion We found that about 3 of 4 children carried pneumococci, and this figure did not vary with age group or urban or rural residence. Planned annual surveys in the same communities will inform change in carriage of PCV10 serotype pneumococci after the introduction and uptake of PCV10 in these communities Electronic supplementary material The online version of this article (10.1186/s12879-018-3608-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Muhammad Imran Nisar
- Department of Pediatrics and Child Health, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Kanwal Nayani
- Department of Pediatrics and Child Health, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Tauseef Akhund
- Department of Pediatrics and Child Health, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Atif Riaz
- Department of Pediatrics and Child Health, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Omar Irfan
- Department of Pediatrics and Child Health, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Sadia Shakoor
- Department of Pediatrics and Child Health, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Sehrish Muneer
- Department of Pediatrics and Child Health, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Sana Muslim
- Department of Pediatrics and Child Health, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Aneeta Hotwani
- Department of Pediatrics and Child Health, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Furqan Kabir
- Department of Pediatrics and Child Health, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | | | - Lindsay Kim
- Centre for Disease Control and Prevention, Atlanta, USA
| | | | - Asad Ali
- Department of Pediatrics and Child Health, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Anita K M Zaidi
- Department of Pediatrics and Child Health, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan.,Bill & Melinda Gates Foundation, Seattle, USA
| | - Fyezah Jehan
- Department of Pediatrics and Child Health, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan.
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11
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Robust demarcation of fourteen different species groups within the genus Streptococcus based on genome-based phylogenies and molecular signatures. INFECTION GENETICS AND EVOLUTION 2018; 66:130-151. [DOI: 10.1016/j.meegid.2018.09.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 09/12/2018] [Accepted: 09/19/2018] [Indexed: 11/21/2022]
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12
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Morpeth SC, Munywoki P, Hammitt LL, Bett A, Bottomley C, Onyango CO, Murdoch DR, Nokes DJ, Scott JAG. Impact of viral upper respiratory tract infection on the concentration of nasopharyngeal pneumococcal carriage among Kenyan children. Sci Rep 2018; 8:11030. [PMID: 30038420 PMCID: PMC6056465 DOI: 10.1038/s41598-018-29119-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 07/02/2018] [Indexed: 01/08/2023] Open
Abstract
Viral upper respiratory tract infection (URTI) predisposes to bacterial pneumonia possibly by facilitating growth of bacteria such as Streptococcus pneumoniae colonising the nasopharynx. We investigated whether viral URTI is temporally associated with an increase in nasopharyngeal pneumococcal concentration. Episodes of symptomatic RSV or rhinovirus URTI among children <5 years were identified from a longitudinal household study in rural Kenya. lytA and alu PCR were performed on nasopharyngeal samples collected twice-weekly, to measure the pneumococcal concentration adjusted for the concentration of human DNA present. Pneumococcal concentration increased with a fold-change of 3.80 (95%CI 1.95-7.40), with acquisition of RSV or rhinovirus, during 51 URTI episodes among 42 children. In repeated swabs from the baseline period, in the two weeks before URTI developed, within-episode variation was broad; within +/-112-fold range of the geometric mean. We observed only a small increase in nasopharyngeal pneumococcal concentration during RSV or rhinovirus URTI, relative to natural variation. Other factors, such as host response to viral infection, may be more important than nasopharyngeal pneumococcal concentration in determining risk of invasive disease.
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Affiliation(s)
- Susan C Morpeth
- KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya.
- Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7FZ, United Kingdom.
- Department of Infectious Disease Epidemiology, the London School of Hygiene and Tropical Medicine, London, WC1E 7HT, United Kingdom.
- Microbiology Laboratory, Middlemore Hospital, Counties Manukau District Health Board, Private Bag 93311, Otahuhu, Auckland, 1640, New Zealand.
| | | | - Laura L Hammitt
- KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, 21205, USA
| | - Anne Bett
- KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Christian Bottomley
- Department of Infectious Disease Epidemiology, the London School of Hygiene and Tropical Medicine, London, WC1E 7HT, United Kingdom
| | - Clayton O Onyango
- KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
- Kenya Medical Research Institute (KEMRI), Centre for Global Health Research; KEMRI - CGHR, Kisumu, Kenya
| | - David R Murdoch
- Department of Pathology, University of Otago, Christchurch, New Zealand
- Microbiology Unit, Canterbury Health Laboratories, Christchurch, 8011, New Zealand
| | - D James Nokes
- KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
- School of Life Sciences and Zeeman Institute (SBIDER), University of Warwick, Coventry, CV4 7AL, United Kingdom
| | - J Anthony G Scott
- KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7FZ, United Kingdom
- Department of Infectious Disease Epidemiology, the London School of Hygiene and Tropical Medicine, London, WC1E 7HT, United Kingdom
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13
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Pavlinac PB, Singa BO, John-Stewart GC, Richardson BA, Brander RL, McGrath CJ, Tickell KD, Amondi M, Rwigi D, Babigumira JB, Kariuki S, Nduati R, Walson JL. Azithromycin to prevent post-discharge morbidity and mortality in Kenyan children: a protocol for a randomised, double-blind, placebo-controlled trial (the Toto Bora trial). BMJ Open 2017; 7:e019170. [PMID: 29289941 PMCID: PMC5778294 DOI: 10.1136/bmjopen-2017-019170] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Child mortality due to infectious diseases remains unacceptably high in much of sub-Saharan Africa. Children who are hospitalised represent an accessible population at particularly high risk of death, both during and following hospitalisation. Hospital discharge may be a critical time point at which targeted use of antibiotics could reduce morbidity and mortality in high-risk children. METHODS AND ANALYSIS In this randomised, double-blind, placebo-controlled trial (Toto Bora Trial), 1400 children aged 1-59 months discharged from hospitals in Western Kenya, in Kisii and Homa Bay, will be randomised to either a 5-day course of azithromycin or placebo to determine whether a short course of azithromycin reduces rates of rehospitalisation and/or death in the subsequent 6-month period. The primary analysis will be modified intention-to-treat and will compare the rates of rehospitalisation or death in children treated with azithromycin or placebo using Cox proportional hazard regression. The trial will also evaluate the effect of a short course of azithromycin on enteric and nasopharyngeal infections and cause-specific morbidities. We will also identify risk factors for postdischarge morbidity and mortality and subpopulations most likely to benefit from postdischarge antibiotic use. Antibiotic resistance in Escherichia coli and Streptococcus pneumoniae among enrolled children and their primary caregivers will also be assessed, and cost-effectiveness analyses will be performed to inform policy decisions. ETHICS AND DISSEMINATION Study procedures were reviewed and approved by the institutional review boards of the Kenya Medical Research Institute, the University of Washington and the Kenyan Pharmacy and Poisons Board. The study is being externally monitored, and a data safety and monitoring committee has been assembled to monitor patient safety and to evaluate the efficacy of the intervention. The results of this trial will be published in peer-reviewed scientific journals and presented at relevant academic conferences and to key stakeholders. TRIAL REGISTRATION NUMBER NCT02414399.
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Affiliation(s)
- Patricia B Pavlinac
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Benson O Singa
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
| | - Grace C John-Stewart
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Department of Allergy and Infectious Disease, University of Washington, Seattle, Washington, USA
| | - Barbra A Richardson
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Rebecca L Brander
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Christine J McGrath
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Kirkby D Tickell
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
| | - Mary Amondi
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Doreen Rwigi
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Joseph B Babigumira
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Sam Kariuki
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Ruth Nduati
- Department of Pediatrics, School of Medicine, University of Nairobi, Nairobi, Kenya
| | - Judd L Walson
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Childhood Acute Illness and Nutrition Network, Nairobi, Kenya
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Department of Allergy and Infectious Disease, University of Washington, Seattle, Washington, USA
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14
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Bosch AATM, Piters WAADS, van Houten MA, Chu MLJN, Biesbroek G, Kool J, Pernet P, de Groot PKCM, Eijkemans MJC, Keijser BJF, Sanders EAM, Bogaert D. Maturation of the Infant Respiratory Microbiota, Environmental Drivers, and Health Consequences. A Prospective Cohort Study. Am J Respir Crit Care Med 2017; 196:1582-1590. [DOI: 10.1164/rccm.201703-0554oc] [Citation(s) in RCA: 175] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Astrid A. T. M. Bosch
- Department of Pediatric Immunology and Infectious Diseases, Wilhelmina Children’s Hospital/University Medical Center Utrecht, Utrecht, the Netherlands
- Spaarne Gasthuis Academy, Hoofddorp, the Netherlands
| | - Wouter A. A. de Steenhuijsen Piters
- Department of Pediatric Immunology and Infectious Diseases, Wilhelmina Children’s Hospital/University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
- Medical Research Council/University of Edinburgh Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Mei Ling J. N. Chu
- Department of Pediatric Immunology and Infectious Diseases, Wilhelmina Children’s Hospital/University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Giske Biesbroek
- Department of Pediatric Immunology and Infectious Diseases, Wilhelmina Children’s Hospital/University Medical Center Utrecht, Utrecht, the Netherlands
- Spaarne Gasthuis Academy, Hoofddorp, the Netherlands
| | - Jolanda Kool
- Microbiology and Systems Biology Group, Netherlands Organisation for Applied Scientific Research, Zeist, the Netherlands
| | - Paula Pernet
- Department of Obstetrics and Gynaecology, Spaarne Gasthuis, Hoofddorp, the Netherlands
| | | | - Marinus J. C. Eijkemans
- Biostatistics and Research Support, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; and
| | - Bart J. F. Keijser
- Microbiology and Systems Biology Group, Netherlands Organisation for Applied Scientific Research, Zeist, the Netherlands
- Department of Preventive Dentistry, Academic Center for Dentistry Amsterdam, University of Amsterdam and Vrije University Amsterdam, Amsterdam, the Netherlands
| | - Elisabeth A. M. Sanders
- Department of Pediatric Immunology and Infectious Diseases, Wilhelmina Children’s Hospital/University Medical Center Utrecht, Utrecht, the Netherlands
| | - Debby Bogaert
- Department of Pediatric Immunology and Infectious Diseases, Wilhelmina Children’s Hospital/University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
- Medical Research Council/University of Edinburgh Centre for Inflammation Research, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
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15
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Principi N, Esposito S. Development of pneumococcal vaccines over the last 10 years. Expert Opin Biol Ther 2017; 18:7-17. [DOI: 10.1080/14712598.2018.1384462] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Nicola Principi
- Pediatric Highly Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Susanna Esposito
- Paediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia, Italy
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16
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Slotved HC, Dayie NTKD, Banini JAN, Frimodt-Møller N. Carriage and serotype distribution of Streptococcus agalactiae in third trimester pregnancy in southern Ghana. BMC Pregnancy Childbirth 2017; 17:238. [PMID: 28732495 PMCID: PMC5520380 DOI: 10.1186/s12884-017-1419-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 07/16/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to determine the prevalence of Streptococcus agalactiae (group B streptococci, GBS) among healthy, pregnant women attending antenatal care at different study sites in the Greater Accra Region, Ghana. METHODS Between 2010 and June 2013, recto-vaginal swab samples were collected from pregnant women attending antenatal care from two study sites in southern Ghana. The samples were collected within 35 and 37 weeks of the gestation period. These were inoculated into Todd-Hewitt broth followed by sub-culturing onto a sheep-blood agar plate. Identification was performed on a single subcultured colony. Gram staining was performed, and isolates were evaluated for beta-haemolytic reactions. Furthermore, the isolates were serotyped using the GBS latex serotyping kit. RESULTS The carriage rates were found to be 25.5% (95% CI: 19.6-32.1) to 28.0% (95% CI: 21.9-34.8) for the two collection sites. The most common serotypes were serotypes VII and IX. The data showed that women below 20 years of age or above 30 years of age have a significantly (p = 0.037) higher risk of carrying GBS compared to women from the age group of 20 to 30 years. CONCLUSIONS The findings of this study revealed that prevalence of GBS colonization in pregnant women in Greater Accra region is high and comparable to rates observed in South Africa and Western countries. The most prevalent serotypes were serotypes VII and IX, which have not been observed before in West Africa.
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Affiliation(s)
- Hans-Christian Slotved
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Artillerivej 5, -2300, Copenhagen, DK, Denmark.
| | - Nicholas T K D Dayie
- Department of Medical Microbiology, School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
| | - Josephine A N Banini
- Department of Medical Microbiology, School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
| | - Niels Frimodt-Møller
- Department of Clinical Microbiology, University Hospital, Hvidovre, Copenhagen, Denmark
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17
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Comparison of traditional culture and molecular qPCR for detection of simultaneous carriage of multiple pneumococcal serotypes in African children. Sci Rep 2017; 7:4628. [PMID: 28680083 PMCID: PMC5498530 DOI: 10.1038/s41598-017-04915-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 05/22/2017] [Indexed: 11/29/2022] Open
Abstract
S. pneumoniae is a common colonizer of the human nasopharynx in high income and low-middle income countries. Due to limitations of standard culture methods, the prevalence of concurrent colonization with multiple serotypes is unclear. We evaluated the use of multiplex quantitative PCR (qPCR) to detect multiple pneumococcal serotypes/group colonization in archived nasopharyngeal swabs of pneumococcal conjugate vaccine naive children who had previously been investigated by traditional culture methods. Overall the detection of pneumococcal colonization was higher by qPCR (82%) compared to standard culture (71%; p < 0.001), with a high concordance (kappa = 0.73) of serotypes/groups identified by culture also being identified by qPCR. Also, qPCR was more sensitive in detecting multiple serotype/groups among colonized cases (28.7%) compared to culture (4.5%; p < 0.001). Of the additional serotypes detected only by qPCR, the majority were of lower density (<104 CFU/ml) than the dominant colonizing serotype, with serotype/group 6A/B, 19B/F and 23F being the highest density colonizers, followed by serotype 5 and serogroup 9A/L/N/V being the most common second and third colonizers respectively. The ability of qPCR to detect multiple pneumococcal serotypes at a low carriage density might provide better insight into underlying mechanism for changes in serotype colonization in PCV vaccinated children.
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Roca A, Bojang A, Camara B, Oluwalana C, Lette K, West P, D'Alessandro U, Bottomley C. Maternal colonization with Staphylococcus aureus and Group B streptococcus is associated with colonization in newborns. Clin Microbiol Infect 2017; 23:974-979. [PMID: 28478240 PMCID: PMC5714057 DOI: 10.1016/j.cmi.2017.04.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 04/12/2017] [Accepted: 04/19/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Although Staphylococcus aureus and Group B streptococcus (GBS) are major causes of neonatal sepsis in sub-Saharan Africa, it is unclear how these bacteria are transmitted to the neonate. METHODS In a cohort of 377 Gambian women and their newborns, nasopharyngeal swabs were collected at delivery (day 0), and 3, 6, 14 and 28 days later. Breast milk samples and vaginal swabs were collected from the mother. Staphylococcus aureus and GBS were isolated using conventional microbiological methods. RESULTS Most women were carriers of S. aureus (264 out of 361 with all samples collected, 73.1%) at some point during follow up and many were carriers of GBS (114 out of 361, 31.6%). Carriage of S. aureus was common in all three maternal sites and GBS was common in the vaginal tract and breast milk. Among newborns, carriage of S. aureus peaked at day 6 (238 out of 377, 63.1%) and GBS at day 3 (39 out of 377, 10.3%). Neonatal carriage of S. aureus at day 6 was associated with maternal carriage in the breast milk adjusted OR 2.54; 95% CI 1.45-4.45, vaginal tract (aOR 2.55; 95% CI 1.32-4.92) and nasopharynx (aOR 2.49; 95% CI 1.56-3.97). Neonatal carriage of GBS at day 6 was associated with maternal carriage in the breast milk (aOR 3.75; 95% CI 1.32-10.65) and vaginal tract (aOR 3.42; 95% CI 1.27-9.22). CONCLUSIONS Maternal colonization with S. aureus or GBS is a risk factor for bacterial colonization in newborns.
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Affiliation(s)
- A Roca
- Medical Research Council Unit The Gambia, Banjul, Gambia; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
| | - A Bojang
- Medical Research Council Unit The Gambia, Banjul, Gambia
| | - B Camara
- Medical Research Council Unit The Gambia, Banjul, Gambia
| | - C Oluwalana
- Medical Research Council Unit The Gambia, Banjul, Gambia
| | - K Lette
- Medical Research Council Unit The Gambia, Banjul, Gambia
| | - P West
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - U D'Alessandro
- Medical Research Council Unit The Gambia, Banjul, Gambia; Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; Institute of Tropical Medicine, Antwerp, Belgium
| | - C Bottomley
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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Kobayashi M, Conklin LM, Bigogo G, Jagero G, Hampton L, Fleming-Dutra KE, Junghae M, Carvalho MDG, Pimenta F, Beall B, Taylor T, Laserson KF, Vulule J, Van Beneden C, Kim L, Feikin DR, Whitney CG, Breiman RF. Pneumococcal carriage and antibiotic susceptibility patterns from two cross-sectional colonization surveys among children aged <5 years prior to the introduction of 10-valent pneumococcal conjugate vaccine - Kenya, 2009-2010. BMC Infect Dis 2017; 17:25. [PMID: 28056828 PMCID: PMC5217209 DOI: 10.1186/s12879-016-2103-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 12/08/2016] [Indexed: 12/12/2022] Open
Abstract
Background Pneumococci are spread by persons with nasopharyngeal colonization, a necessary precursor to invasive disease. Pneumococcal conjugate vaccines can prevent colonization with vaccine serotype strains. In 2011, Kenya became one of the first African countries to introduce the 10-valent pneumococcal conjugate vaccine (PCV10) into its national immunization program. Serial cross-sectional colonization surveys were conducted to assess baseline pneumococcal colonization, antibiotic resistance patterns, and factors associated with resistance. Methods Annual surveys were conducted in one urban and one rural site during 2009 and 2010 among children aged <5 years. To reflect differences in vaccine target population, recruitment was age-stratified in Kibera, whereas a simple random sample of children was drawn in Lwak. Nasopharyngeal swabs were collected from eligible children. Pneumococci were isolated and serotyped. Antibiotic susceptibility testing was performed using the 2009 isolates. Antibiotic nonsusceptibility was defined as intermediate susceptibility or resistance to ≥1 antibiotics (i.e., penicillin, chloramphenicol, levofloxacin, erythromycin, tetracycline, cotrimoxazole, and clindamycin); multidrug resistance (MDR) was defined as nonsusceptibility to ≥3 antibiotics. Weighted analysis was conducted when appropriate. Modified Poisson regression was used to calculate factors associated with antibiotic nonsusceptibility. Results Of 1,087 enrolled (Kibera: 740, Lwak: 347), 90.0% of these were colonized with pneumococci, and 37.3% were colonized with PCV10 serotypes. There were no differences by survey site or year. Of 657 (of 730; 90%) isolates tested for antibiotic susceptibility, nonsusceptibility to cotrimoxazole and penicillin was found in 98.6 and 81.9% of isolates, respectively. MDR was found in 15.9% of isolates and most often involved nonsusceptibility to cotrimoxazole and penicillin; 40.4% of MDR isolates were PCV10 serotypes. In the multivariable model, PCV10 serotypes were independently associated with penicillin nonsusceptibility (Prevalence Ratio: 1.2, 95% CI 1.1–1.3), but not with MDR. Conclusions Before PCV10 introduction, nearly all Kenyan children aged <5 years were colonized with pneumococci, and PCV10 serotype colonization was common. PCV10 serotypes were associated with penicillin nonsusceptibility. Given that colonization with PCV10 serotypes is associated with greater risk for invasive disease than colonization with other serotypes, successful PCV10 introduction in Kenya is likely to have a substantial impact in reducing vaccine-type pneumococcal disease and drug-resistant pneumococcal infection. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-2103-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Miwako Kobayashi
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA. .,Division of Bacterial Diseases, Centers for Diseases Control and Prevention, 1600 Clifton Road NE, MS C-25, Atlanta, GA, 30329-4027, USA.
| | - Laura M Conklin
- Division of Bacterial Diseases, Centers for Diseases Control and Prevention, 1600 Clifton Road NE, MS C-25, Atlanta, GA, 30329-4027, USA
| | - Godfrey Bigogo
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.,International Emerging Infections Program, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Geofrey Jagero
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.,International Emerging Infections Program, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Lee Hampton
- Division of Bacterial Diseases, Centers for Diseases Control and Prevention, 1600 Clifton Road NE, MS C-25, Atlanta, GA, 30329-4027, USA
| | - Katherine E Fleming-Dutra
- Division of Bacterial Diseases, Centers for Diseases Control and Prevention, 1600 Clifton Road NE, MS C-25, Atlanta, GA, 30329-4027, USA
| | - Muthoni Junghae
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.,International Emerging Infections Program, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Maria da Gloria Carvalho
- Division of Bacterial Diseases, Centers for Diseases Control and Prevention, 1600 Clifton Road NE, MS C-25, Atlanta, GA, 30329-4027, USA
| | - Fabiana Pimenta
- Division of Bacterial Diseases, Centers for Diseases Control and Prevention, 1600 Clifton Road NE, MS C-25, Atlanta, GA, 30329-4027, USA
| | - Bernard Beall
- Division of Bacterial Diseases, Centers for Diseases Control and Prevention, 1600 Clifton Road NE, MS C-25, Atlanta, GA, 30329-4027, USA
| | - Thomas Taylor
- Division of Bacterial Diseases, Centers for Diseases Control and Prevention, 1600 Clifton Road NE, MS C-25, Atlanta, GA, 30329-4027, USA
| | - Kayla F Laserson
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.,Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - John Vulule
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Chris Van Beneden
- Division of Bacterial Diseases, Centers for Diseases Control and Prevention, 1600 Clifton Road NE, MS C-25, Atlanta, GA, 30329-4027, USA
| | - Lindsay Kim
- Division of Bacterial Diseases, Centers for Diseases Control and Prevention, 1600 Clifton Road NE, MS C-25, Atlanta, GA, 30329-4027, USA
| | - Daniel R Feikin
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.,International Emerging Infections Program, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Cynthia G Whitney
- Division of Bacterial Diseases, Centers for Diseases Control and Prevention, 1600 Clifton Road NE, MS C-25, Atlanta, GA, 30329-4027, USA
| | - Robert F Breiman
- International Emerging Infections Program, Centers for Disease Control and Prevention, Nairobi, Kenya.,Emory Global Health Institute, Emory University, Atlanta, GA, USA
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20
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Francis JP, Richmond PC, Michael A, Siba PM, Jacoby P, Hales BJ, Thomas WR, Lehmann D, Pomat WS, van den Biggelaar AHJ. A longitudinal study of natural antibody development to pneumococcal surface protein A families 1 and 2 in Papua New Guinean Highland children: a cohort study. Pneumonia (Nathan) 2016; 8:12. [PMID: 28702291 PMCID: PMC5471893 DOI: 10.1186/s41479-016-0014-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 08/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pneumococcal surface protein A (PspA), a conserved virulence factor essential for Streptococcus pneumoniae attachment to upper respiratory tract (URT) epithelia, is a potential vaccine candidate for preventing colonisation. METHODS This cohort study was conducted in the Asaro Valley in the Eastern Highlands Province of Papua New Guinea, of which Goroka town is the provincial capital. The children included in the analysis were participants in a neonatal pneumococcal conjugate vaccine trial (ClinicalTrials.gov NCT00219401) that was conducted between 2005 and 2009. We investigated the development of anti-PspA antibodies in the first 18 months of life relative to URT pneumococcal carriage in Papua New Guinean infants who experience one of the earliest and highest colonisation rates in the world. Blood samples and nasopharyngeal swabs were collected from a cohort of 88 children at ages 3, 9, and 18 months to quantify immunoglobulin G (IgG) levels to PspA families 1 and 2 using an enzyme-linked immunosorbent assay and to determine URT carriage. RESULTS Seventy-three per cent (64/88) of infants carried S. pneumoniae at age 3 months; 85 % (75/88) at 9 months, and 83 % (73/88) at 18 months. PspA-IgG levels declined between ages 3 and 9 months (p < 0.001), then increased between 9 and 18 months (p < 0.001). At age 3 months, pneumococcal carriers showed lower PspA1-IgG levels (geometric mean concentration [GMC] 602 arbitrary units [AU]/ml, 95 % confidence interval [CI] 497-728) than non-carriers (GMC 1058 AU/ml [95 % CI 732-1530]; p = 0.008), while at 9 months, PspA1- and PspA2-IgG levels were significantly higher in carriers (PspA1: 186 AU/ml, 95 % CI 136-256; PspA2: 284 AU/ml, 95 % CI 192-421) than in non-carriers (PspA1 87 AU/ml, 95 % CI 45-169; PspA2 74 AU/ml, 95 % CI 34-159) (PspA1: p = 0.037, PspA2: p = 0.003). CONCLUSION Our findings confirm that PspA is immunogenic and indicate that natural anti-PspA immune responses are acquired through exposure and develop with age. PspA may be a useful candidate in an infant pneumococcal vaccine to prevent early URT colonisation.
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Affiliation(s)
- Jacinta P Francis
- Papua New Guinea Institute of Medical Research, Goroka, EHP Papua New Guinea
| | - Peter C Richmond
- School of Paediatrics and Child Health, The University of Western Australia, Perth, WA Australia.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA Australia
| | - Audrey Michael
- Papua New Guinea Institute of Medical Research, Goroka, EHP Papua New Guinea
| | - Peter M Siba
- Papua New Guinea Institute of Medical Research, Goroka, EHP Papua New Guinea
| | - Peter Jacoby
- Centre for Biostatistics, Telethon Kids Institute, The University of Western Australia, Perth, WA Australia
| | - Belinda J Hales
- Division of Molecular Biotechnology, Telethon Kids Institute, The University of Western Australia, Perth, WA Australia
| | - Wayne R Thomas
- Division of Molecular Biotechnology, Telethon Kids Institute, The University of Western Australia, Perth, WA Australia
| | - Deborah Lehmann
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA Australia
| | - William S Pomat
- Papua New Guinea Institute of Medical Research, Goroka, EHP Papua New Guinea
| | - Anita H J van den Biggelaar
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, WA Australia
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21
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Principi N, Esposito S. Serological criteria and carriage measurement for evaluation of new pneumococcal vaccines. Hum Vaccin Immunother 2016; 11:1494-500. [PMID: 25970715 DOI: 10.1080/21645515.2015.1033600] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
The best method of evaluating the efficacy of a vaccine is to compare the incidence of the disease against which it is prepared in randomized, placebo-controlled clinical trials involving vaccinated and unvaccinated subjects. In the case of Streptococcus pneumoniae, the proposed alternatives are evaluations of the so-called "correlates of protection" (i.e. markers of the vaccine-induced immune response that predict protection from infection and disease) and nasopharyngeal carriage. The aim of this paper is to discuss the most important limitations of the immunological criteria suggested for licensing new pneumococcal vaccines, and comment on the use of carriage as an endpoint for evaluating efficacy. Data showed why the use of a single serological correlate of protection cannot be considered the best means of evaluating pneumococcal vaccines and highlighted the importance of using carriage for efficacy evaluation but in the meantime the need to develop new sensitive and specific methods.
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Affiliation(s)
- Nicola Principi
- a Pediatric Highly Intensive Care Unit; Department of Pathophysiology and Transplantation; Università degli Studi di Milano; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico ; Milan , Italy
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22
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Conklin LM, Bigogo G, Jagero G, Hampton L, Junghae M, da Gloria Carvalho M, Pimenta F, Beall B, Taylor T, Plikaytis B, Laserson KF, Vulule J, Van Beneden C, Whitney CG, Breiman RF, Feikin DR. High Streptococcus pneumoniae colonization prevalence among HIV-infected Kenyan parents in the year before pneumococcal conjugate vaccine introduction. BMC Infect Dis 2016; 16:18. [PMID: 26774803 PMCID: PMC4715316 DOI: 10.1186/s12879-015-1312-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 12/07/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Streptococcus pneumoniae is a leading cause of pneumonia, meningitis and sepsis in developing countries, particularly among children and HIV-infected persons. Pneumococcal oropharyngeal (OP) or nasopharyngeal (NP) colonization is a precursor to development of invasive disease. New conjugate vaccines hold promise for reducing colonization and disease. METHODS Prior to introduction of 10-valent pneumococcal conjugate vaccine (PCV10), we conducted a cross-sectional survey among HIV-infected parents of children <5 years old in rural Kenya. Other parents living with an HIV-infected adult were also enrolled. After broth enrichment, NP and OP swabs were cultured for pneumococcus. Serotypes were identified by Quellung. Antimicrobial susceptibility was performed using broth microdilution. RESULTS We enrolled 973 parents; 549 (56.4%) were HIV-infected, 153 (15.7%) were HIV-uninfected and 271 (27.9%) had unknown HIV status. Among HIV-infected parents, the median age was 32 years (range 15-74) and 374/549 (68%) were mothers. Pneumococci were isolated from 237/549 (43.2%) HIV-infected parents and 41/153 (26.8%) HIV-non-infected parents (p = 0.0003). Colonization with PCV10 serotypes was not significantly more frequent in HIV-infected (12.9%) than HIV-uninfected parents (11.8%; p = 0.70). Among HIV-infected parents, cooking site separate from sleeping area and CD4 count >250 were protective (OR = 0.6; 95% CI 0.4, 0.9 and OR = 0.5; 95% CI 0.2, 0.9, respectively); other associations were not identified. Among 309 isolates tested from all parents, 255 (80.4%) were penicillin non-susceptible (MIC ≥0.12 μg/ml). CONCLUSIONS Prevalence of pneumococcal colonization is high among HIV-infected parents in rural Kenya. If young children are the pneumococcal reservoir for this population, PCV10 introduction may reduce vaccine-type colonization and disease among HIV-infected parents through indirect protection.
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Affiliation(s)
- Laura M Conklin
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA. .,Respiratory Diseases Branch, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS C-25, Atlanta, GA, 30333, USA.
| | - Godfrey Bigogo
- Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya. .,KEMRI/CDC Research Collaboration, P. O. Box 1578, Kisumu, 40100, Kenya.
| | - Geofrey Jagero
- Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya.
| | - Lee Hampton
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Muthoni Junghae
- Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya.
| | | | - Fabiana Pimenta
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Bernard Beall
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Thomas Taylor
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Brian Plikaytis
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Kayla F Laserson
- Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya.
| | - John Vulule
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
| | - Chris Van Beneden
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Cynthia G Whitney
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Robert F Breiman
- Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya.
| | - Daniel R Feikin
- Kenya Medical Research Institute/Centers for Disease Control and Prevention, Kisumu, Kenya.
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23
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Howard LM, Johnson M, Gil AI, Griffin MR, Edwards KM, Lanata CF, Williams JV, Grijalva CG. Molecular Epidemiology of Rhinovirus Detections in Young Children. Open Forum Infect Dis 2016; 3:ofw001. [PMID: 26900577 PMCID: PMC4759584 DOI: 10.1093/ofid/ofw001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 01/01/2016] [Indexed: 02/06/2023] Open
Abstract
Background. Human rhinoviruses (HRVs) are frequently detected in children with acute respiratory illnesses (ARIs) but also in asymptomatic children. We compared features of ARI with HRV species (A, B, C) and determined genotypes associated with repeated HRV detections within individuals. Methods. We used clinical data and respiratory samples obtained from children <3 years old during weekly active household-based surveillance. A random subset of samples in which HRV was detected from individuals during both ARI and an asymptomatic period within 120 days of the ARI were genotyped. Features of ARI were compared among HRV species. Concordance of genotype among repeated HRV detections within individuals was assessed. Results. Among 207 ARI samples sequenced, HRV-A, HRV-B, and HRV-C were detected in 104 (50%), 20 (10%), and 83 (40%), respectively. Presence of fever, decreased appetite, and malaise were significantly higher in children with HRV-B. When codetections with other viruses were excluded (n = 155), these trends persisted, but some did not reach statistical significance. When 58 paired sequential HRV detections during asymptomatic and ARI episodes were sequenced, only 9 (16%) were identical genotypes of HRV. Conclusions. Clinical features may differ among HRV species. Repeated HRV detections in young children frequently represented acquisition of new HRV strains.
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Affiliation(s)
- Leigh M Howard
- Division of Infectious Diseases, Department of Pediatrics; Vanderbilt Vaccine Research Program, Nashville, Tennessee
| | - Monika Johnson
- Department of Pediatrics , University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center , Pennsylvania
| | - Ana I Gil
- Instituto de Investigacion Nutricional , Lima , Peru
| | - Marie R Griffin
- Department of Health Policy , Vanderbilt University, Tennessee
| | - Kathryn M Edwards
- Division of Infectious Diseases, Department of Pediatrics; Vanderbilt Vaccine Research Program, Nashville, Tennessee
| | - Claudio F Lanata
- Division of Infectious Diseases, Department of Pediatrics; Instituto de Investigacion Nutricional, Lima, Peru
| | - John V Williams
- Department of Pediatrics , University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center , Pennsylvania
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Esposito S, Mari D, Bergamaschini L, Orenti A, Terranova L, Ruggiero L, Ierardi V, Gambino M, Croce FD, Principi N. Pneumococcal colonization in older adults. IMMUNITY & AGEING 2016; 13:2. [PMID: 26759599 PMCID: PMC4709868 DOI: 10.1186/s12979-016-0057-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 01/05/2016] [Indexed: 11/23/2022]
Abstract
Background Little is known about pneumococcal carrier states in older adults. The main aim of this study was to evaluate pneumococcal colonization patterns among older adults in two centres in Milan, Italy, before the widespread use of the 13-valent pneumococcal vaccine (PCV13) in this age group, to investigate demographic and clinical features that are associated with pneumococcal colonization and to estimate the potential coverage offered by PCV13. Results Among 417 adults ≥65 years old (171, 41.1 %, ≥75 years), 41 (9.8 %) were pneumococcal carriers. Univariate and multivariate analyses revealed that pneumococcal colonization was significantly less common among individuals with underlying co-morbidities than among those without (odds ratio [OR] 0.453, 95 % confidence interval [CI] 0.235–0.875, p = 0.018; adjusted OR 0.503, 95 % CI 0.255–0.992, p = 0.047). Moreover, among these patients, those with cardiac disease had a significantly lower risk of colonization (OR 0.308, 95 % CI 0.119–0.795, p = 0.015; adjusted OR 0.341, 95 % CI 0.13–0.894, p = 0.029). Only one vaccinated subject who received 23-valent polysaccharide pneumococcal vaccine (PPV23) was colonized. Twenty-five (89.3 %) of the subjects who were <75 years old and 9 (75.0 %) of those who were ≥75 years old were colonized by at least one of the serotypes that is included in PCV13, with serotype 19 F being the most common. Respiratory allergies as well as overall co-morbidities were more common in subjects who were positive for only non-PCV13 serotypes compared with negative subjects and those who were carriers of only PCV13 serotypes. Conclusions Although this study included a relatively small number of subjects and has been performed in a limited geographic setting, results showed that pneumococcal colonization in older people is common, and the monitoring of carriers can offer useful information about the circulation of this pathogen among older people and the potential protective effect of pneumococcal vaccines. Because the colonization in most cases involves the strains that are included in PCV13, this vaccine could be useful in the prevention of pneumococcal infections in the overall population of older people. In subjects with respiratory allergies and in those with co-morbidities, the addition of the PPV23 to PCV13 should be recommended. Due to the low vaccination coverage, urgent educational programmes are required to inform older adults and their medical doctors of the risks of pneumococcal infection and the efficacy and safety of the available pneumococcal vaccines.
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Affiliation(s)
- Susanna Esposito
- Department of Pathophysiology and Transplantation, Pediatric Highly Intensive Care Unit, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122 Milan, Italy
| | - Daniela Mari
- Department of Medical Sciences and Community Health, Geriatric Unit, Università degli Studi di Milano, Milan, Italy
| | - Luigi Bergamaschini
- Department of Biomedical and Clinical Sciences "Luigi Sacco", Università degli Studi di Milano, Milan, Italy
| | - Annalisa Orenti
- Department of Clinical Sciences and Community Health, Laboratory of Medical Statistics, Epidemiology and Biometry "G.A. Maccacaro", Università degli Studi di Milano, Milan, Italy
| | - Leonardo Terranova
- Department of Pathophysiology and Transplantation, Pediatric Highly Intensive Care Unit, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122 Milan, Italy
| | - Luca Ruggiero
- Department of Pathophysiology and Transplantation, Pediatric Highly Intensive Care Unit, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122 Milan, Italy
| | - Valentina Ierardi
- Department of Pathophysiology and Transplantation, Pediatric Highly Intensive Care Unit, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122 Milan, Italy
| | - Monia Gambino
- Department of Pathophysiology and Transplantation, Pediatric Highly Intensive Care Unit, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122 Milan, Italy
| | | | - Nicola Principi
- Department of Pathophysiology and Transplantation, Pediatric Highly Intensive Care Unit, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122 Milan, Italy
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25
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Roca A, Oluwalana C, Camara B, Bojang A, Burr S, Davis TME, Bailey R, Kampmann B, Mueller J, Bottomley C, D'Alessandro U. Prevention of bacterial infections in the newborn by pre-delivery administration of azithromycin: Study protocol of a randomized efficacy trial. BMC Pregnancy Childbirth 2015; 15:302. [PMID: 26585192 PMCID: PMC4653934 DOI: 10.1186/s12884-015-0737-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 11/10/2015] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Neonatal deaths, estimated at approximately 4 million annually, now account for almost 40% of global mortality in children aged under-five. Bacterial sepsis is a leading cause of neonatal mortality. Assuming the mother is the main source for bacterial transmission to newborns, the primary objective of the trial is to determine the impact of one oral dose of azithromycin, given to women in labour, on the newborn's bacterial carriage in the nasopharynx. Secondary objectives include the impact of the intervention on bacterial colonization in the baby and the mother during the first month of life. METHODS/DESIGN This is a Phase III, double -blind, placebo controlled randomized clinical trial in which 830 women in labour were randomized to either a single dose of 2 g oral azithromycin or placebo (ratio 1:1). The trial included pregnant women in labour aged 18 to 45 years attending study health centres in the Western Gambia. A post-natal check of the mother and baby was conducted at the health centre by study clinicians before discharge and 8-10 days after delivery. Home follow up visits were conducted daily during the first week and then weekly until week 8 after delivery. Vaginal swabs and breast milk samples were collected from the mothers, and the pathogens Streptococcus pneumoniae, Group B Streptococcus (GBS) and Staphylococcus aureus were isolated from the study samples. For bacterial isolates, susceptibility pattern to azithromycin was determined using disk diffusion and E-test. Eye swabs were collected from newborns with eye discharge during the follow up period, and Chlamydial infection was assessed using molecular methods. DISCUSSION This is a proof-of-concept study to assess the impact of antibiotic preventive treatment of women during labour on bacterial infections in the newborn. If the trial confirms this hypothesis, the next step will be to assess the impact of this intervention on neonatal sepsis. The proposed intervention should be easily implementable in developing countries. TRIAL REGISTRATION ClinicalTrials.gov Identifier--NCT01800942--First received: February 26, 2013.
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Affiliation(s)
- Anna Roca
- Medical Research Council Unit, Fajara, The Gambia.
- London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | | | - Bully Camara
- Medical Research Council Unit, Fajara, The Gambia.
| | | | - Sarah Burr
- London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Timothy M E Davis
- School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia.
| | - Robin Bailey
- London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | | | | | | | - Umberto D'Alessandro
- Medical Research Council Unit, Fajara, The Gambia.
- London School of Hygiene and Tropical Medicine, London, United Kingdom.
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Binks MJ, Moberley SA, Balloch A, Leach AJ, Nelson S, Hare KM, Wilson C, Morris PS, Nelson J, Chatfield MD, Tang ML, Torzillo P, Carapetis JR, Mulholland EK, Andrews RM. PneuMum: Impact from a randomised controlled trial of maternal 23-valent pneumococcal polysaccharide vaccination on middle ear disease amongst Indigenous infants, Northern Territory, Australia. Vaccine 2015; 33:6579-87. [DOI: 10.1016/j.vaccine.2015.10.101] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 10/22/2015] [Accepted: 10/24/2015] [Indexed: 10/22/2022]
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Abstract
BACKGROUND Viruses are commonly detected in children with acute respiratory illnesses (ARIs) and in asymptomatic children. Longitudinal studies of viral detections during asymptomatic periods surrounding ARI could facilitate interpretation of viral detections but are currently scant. METHODS We used reverse transcription polymerase chain reaction to analyze respiratory samples from young Andean children for viruses during asymptomatic periods within 8-120 days of index ARI (cough or fever). We compared viral detections over time within children and explored reverse transcription polymerase chain reaction cycle thresholds (CTs) as surrogates for viral loads. RESULTS At least 1 respiratory virus was detected in 367 (43%) of 859 samples collected during asymptomatic periods, with more frequent detections in periods with rhinorrhea (49%) than those without (34%, P < 0.001). Relative to index ARI with human rhinovirus (HRV), adenovirus (AdV), respiratory syncytial virus (RSV) and parainfluenza virus detected, the same viruses were also detected during 32, 22, 10 and 3% of asymptomatic periods, respectively. RSV was only detected 8-30 days after index RSV ARI, whereas HRV and AdV were detected throughout asymptomatic periods. Human metapneumovirus and influenza were rarely detected during asymptomatic periods (<3%). No significant differences were observed in the CT for HRV or AdV during asymptomatic periods relative to ARI. For RSV, CTs were significantly lower during ARI relative to the asymptomatic period (P = 0.03). CONCLUSIONS These findings indicate that influenza, human metapneumovirus, parainfluenza virus and RSV detections in children with an ARI usually indicate a causal relationship. When HRV or AdV is detected during ARI, the causal relationship is less certain.
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Bojang A, Jafali J, Egere UE, Hill PC, Antonio M, Jeffries D, Greenwood BM, Roca A. Seasonality of Pneumococcal Nasopharyngeal Carriage in Rural Gambia Determined within the Context of a Cluster Randomized Pneumococcal Vaccine Trial. PLoS One 2015; 10:e0129649. [PMID: 26132206 PMCID: PMC4488590 DOI: 10.1371/journal.pone.0129649] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 05/08/2015] [Indexed: 11/18/2022] Open
Abstract
Background We conducted an ancillary study among individuals who had participated in a PCV-7 trial in rural Gambia, to determine the influence of season on the prevalence of pneumococcal carriage. Methods 636 individuals above 30 months of age were followed from 4 to 20 months after vaccination with PCV-7 or meningococcal-conjugate-vaccine. Nasopharyngeal swabs were collected periodically between November 2006 and June 2008. Overall, 4,495 NPS were collected. Results Prevalence of pneumococcal nasopharyngeal carriage in the study subjects (median age 11 years) was 55.0%; this prevalence decreased linearly with increasing age (p = 0.001). Prevalence of carriage was significantly higher during the dry than the rainy season for any pneumococcal carriage [57.6% versus 47.8% (p<0.001)], pneumococcal vaccine serotype carriage [10.3% versus 6.5% (p< 0.001)] and non-vaccine serotype carriage [49.7% versus 42.7% (p<0.001)]. Differences remained significant in the adjusted analysis. Conclusions In areas of Africa with marked variation in rainfall, seasonality of pneumococcal carriage needs to be considered when interpreting carriage data.
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Affiliation(s)
| | - James Jafali
- Medical Research Council Unit, Fajara, The Gambia
| | | | - Phillip C. Hill
- Medical Research Council Unit, Fajara, The Gambia
- Centre for International Health, School of Medicine, University of Otago, Dunedin, New Zealand
| | | | | | - Brian M. Greenwood
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Anna Roca
- Medical Research Council Unit, Fajara, The Gambia
- * E-mail:
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Numminen E, Chewapreecha C, Turner C, Goldblatt D, Nosten F, Bentley SD, Turner P, Corander J. Climate induces seasonality in pneumococcal transmission. Sci Rep 2015; 5:11344. [PMID: 26067932 PMCID: PMC4464306 DOI: 10.1038/srep11344] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 05/21/2015] [Indexed: 01/31/2023] Open
Abstract
Streptococcus pneumoniae is a significant human pathogen and a leading cause of infant mortality in developing countries. Considerable global variation in the pneumococcal carriage prevalence has been observed and the ecological factors contributing to it are not yet fully understood. We use data from a cohort of infants in Asia to study the effects of climatic conditions on both acquisition and clearance rates of the bacterium, finding significantly higher transmissibility during the cooler and drier months. Conversely, the length of a colonization period is unaffected by the season. Independent carriage data from studies conducted on the African and North American continents suggest similar effects of the climate on the prevalence of this bacterium, which further validates the obtained results. Further studies could be important to replicate the findings and explain the mechanistic role of cooler and dry air in the physiological response to nasopharyngeal acquisition of the pneumococcus.
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Affiliation(s)
- Elina Numminen
- Department of Mathematics and Statistics, University of Helsinki, Helsinki, Finland
| | - Claire Chewapreecha
- Pathogen Genomics Group, Wellcome Trust Sanger Institute, Hinxton, CB10 1SA, UK
| | - Claudia Turner
- 1] Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand [2] Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - David Goldblatt
- Immunobiology Unit, Institute of Child Health, University College London, UK
| | - Francois Nosten
- 1] Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand [2] Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Stephen D Bentley
- Pathogen Genomics Group, Wellcome Trust Sanger Institute, Hinxton, CB10 1SA, UK
| | - Paul Turner
- 1] Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand [2] Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Jukka Corander
- Department of Mathematics and Statistics, University of Helsinki, Helsinki, Finland
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Esposito S, Colombo C, Tosco A, Montemitro E, Volpi S, Ruggiero L, Lelii M, Bisogno A, Pelucchi C, Principi N. Streptococcus pneumoniae oropharyngeal colonization in children and adolescents with cystic fibrosis. J Cyst Fibros 2015; 15:366-71. [PMID: 26049740 DOI: 10.1016/j.jcf.2015.05.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 05/18/2015] [Accepted: 05/19/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND This study was designed to evaluate Streptococcus pneumoniae (S. pneumoniae) carriage rates in patients with cystic fibrosis (CF). METHODS An oropharyngeal swab was obtained from 212 CF children and adolescents enrolled during routine clinical visits. DNA from swabs was analyzed by real-time polymerase chain reaction. RESULTS A total of 42 (19.8%) CF patients (mean age±standard deviation [SD], 12.0±3.3years) were colonized by S. pneumoniae. Carriage was more common in younger patients and tended to decline with age. Administration of systemic and/or inhaled antibiotics in the last 3months significantly correlated with a reduced carrier state [odds ratio (OR) 0.23, 95% confidence interval (CI) 0.07-0.69, and OR 0.26, 95% CI 0.08-0.77, respectively]. Vitamin D serum levels ≥30ng/mL were less common in carriers than that in non-carriers (OR 0.35; 95% CI 0.08-1.49). In both the vaccinated and unvaccinated subjects, serotypes 19F, 5, 4, and 9V were the most commonly carried serotypes. CONCLUSIONS S. pneumoniae carrier state of school-age children and adolescents with CF is more prevalent than previously thought, and pneumococcal conjugate vaccination administered in the first year of life does not reduce the risk of re-colonization in later childhood and adolescence.
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Affiliation(s)
- Susanna Esposito
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Carla Colombo
- Cystic Fibrosis Center, Lombardia Region, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonella Tosco
- Cystic Fibrosis Center, Campania Region, Pediatric Section, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Enza Montemitro
- Cystic Fibrosis Center, IRCCS Bambino Gesù Hospital, Rome, Italy
| | - Sonia Volpi
- Cystic Fibrosis Center, Veneto Region, University and Hospital Trust of Verona, Verona, Italy
| | - Luca Ruggiero
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Mara Lelii
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Arianna Bisogno
- Cystic Fibrosis Center, Lombardia Region, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Claudio Pelucchi
- Department of Epidemiology, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Nicola Principi
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Single-plex quantitative assays for the detection and quantification of most pneumococcal serotypes. PLoS One 2015; 10:e0121064. [PMID: 25798884 PMCID: PMC4370668 DOI: 10.1371/journal.pone.0121064] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 01/27/2015] [Indexed: 12/04/2022] Open
Abstract
Streptococcus pneumoniae globally kills more children than any other infectious disease every year. A prerequisite for pneumococcal disease and transmission is colonization of the nasopharynx. While the introduction of pneumococcal conjugate vaccines has reduced the burden of pneumococcal disease, understanding the impact of vaccination on nasopharyngeal colonization has been hampered by the lack of sensitive quantitative methods for the detection of >90 known S. pneumoniae serotypes. In this work, we developed 27 new quantitative (q)PCR reactions and optimized 26 for a total of 53 qPCR reactions targeting pneumococcal serotypes or serogroups, including all vaccine types. Reactions proved to be target-specific with a limit of detection of 2 genome equivalents per reaction. Given the number of probes required for these assays and their unknown shelf-life, the stability of cryopreserved reagents was evaluated. Our studies demonstrate that two-year cryopreserved probes had similar limit of detection as freshly-diluted probes. Moreover, efficiency and limit of detection of 1-month cryopreserved, ready-to-use, qPCR reaction mixtures were similar to those of freshly prepared mixtures. Using these reactions, our proof-of-concept studies utilizing nasopharyngeal samples (N=30) collected from young children detected samples containing ≥2 serotypes/serogroups. Samples colonized by multiple serotypes/serogroups always had a serotype that contributes at least 50% of the pneumococcal load. In addition, a molecular approach called S6-q(PCR)2 was developed and proven to individually detect and quantify epidemiologically-important serogroup 6 strains including 6A, 6B, 6C and 6D. This technology will be useful for epidemiological studies, diagnostic platforms and to study the pneumobiome.
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Mameli C, Fabiano V, Daprai L, Bedogni G, Faccini M, Garlaschi ML, Penagini F, Dilillo D, Torresani E, Gramegna M, Zuccotti GV. A longitudinal study of streptococcus pneumoniae carriage in healthy children in the 13-valent pneumococcal conjugate vaccine era. Hum Vaccin Immunother 2015; 11:811-7. [PMID: 25751237 PMCID: PMC4514434 DOI: 10.1080/21645515.2015.1010945] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 12/29/2014] [Accepted: 01/11/2015] [Indexed: 01/27/2023] Open
Abstract
Few epidemiological data are available after the introduction of the 13-valent pneumococcal vaccine (PCV13) in 2010. We performed repeat nasopharyngeal swabs and evaluated the serotype distribution of Streptococcus pneumoniae (SP) and its association with PCV13 vaccine status in healthy Italian children aged 3-59 months. SP serotypes were assessed by the Quellung reaction. 618 children appropriately (28%) or incompletely (72%) vaccinated for age with PCV13 were available at baseline (T0). 515 were re-evaluated at 6 months from baseline (T6) and 436 at 12 months from baseline (T12). The percentage of appropriately vaccinated subjects at T0, T6 and T12 was 28%, 67% and 92%, respectively. Random effects logistic regression models with robust 95% confidence intervals was used to estimate the time-related changes in SP and PCV13 carriage and marginal probabilities were obtained from such models. The age-corrected probability of SP carriage was 0.31 (95% CI 0.22 - 0.41) at T0, 0.32 (0.24 - 0.40) at T6 and 0.28 (0.20 - 0.35) at T12. The probability of PCV13 serotypes carriage was 0.025 (0.001 - 0.050) at T0, 0.018 (0.001 - 0.039) at T6 and 0.010 (0.001 - 0.023) at T12. A decrease in PCV13 serotypes and a shift in non-PCV13 serotypes colonization was observed. In particular, the 15A serotype accounted for 4%, 8% and 23% of SP isolates at T0, T6 and T12, respectively. In conclusion, the benefits of the PCV13 vaccination on SP carriage increase with increasing coverage rates. The shift of SP isolates toward non-PCV13 serotypes needs to be studied further.
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Affiliation(s)
- Chiara Mameli
- Department of Pediatrics; Children's Hospital “V. Buzzi"; University of Milan; Milan, Italy
| | - Valentina Fabiano
- Department of Pediatrics; Children's Hospital “V. Buzzi"; University of Milan; Milan, Italy
| | - Laura Daprai
- Microbiology Laboratory; IRCCS Cà Granda Ospedale Maggiore Policlinico Foundation; Milan, Italy
| | - Giorgio Bedogni
- Clinical Epidemiology Unit; Liver Research Center; Basovizza, Trieste, Italy
| | - Marino Faccini
- Prevention Department; Local Health Authority; Milan, Italy
| | - Maria Laura Garlaschi
- Microbiology Laboratory; IRCCS Cà Granda Ospedale Maggiore Policlinico Foundation; Milan, Italy
| | - Francesca Penagini
- Department of Pediatrics; Children's Hospital “V. Buzzi"; University of Milan; Milan, Italy
| | - Dario Dilillo
- Department of Pediatrics; Children's Hospital “V. Buzzi"; University of Milan; Milan, Italy
| | - Erminio Torresani
- Microbiology Laboratory; IRCCS Cà Granda Ospedale Maggiore Policlinico Foundation; Milan, Italy
| | - Maria Gramegna
- Unità Organizzativa Governo della Prevenzione e Tutela sanitaria; Direzione Generale Sanità; Milan, Italy
| | - Gian Vincenzo Zuccotti
- Department of Pediatrics; Children's Hospital “V. Buzzi"; University of Milan; Milan, Italy
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Dhoubhadel BG, Yasunami M, Nguyen HAT, Suzuki M, Vu TH, Thi Thuy Nguyen A, Dang DA, Yoshida LM, Ariyoshi K. Bacterial load of pneumococcal serotypes correlates with their prevalence and multiple serotypes is associated with acute respiratory infections among children less than 5 years of age. PLoS One 2014; 9:e110777. [PMID: 25360707 PMCID: PMC4216008 DOI: 10.1371/journal.pone.0110777] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 09/18/2014] [Indexed: 12/03/2022] Open
Abstract
Background Among pneumococcal serotypes, some serotypes are more prevalent in the nasopharynx than others; determining factors for higher prevalence remain to be fully explored. As non-vaccine serotypes have emerged after the introduction of 7-valent conjugate vaccines, study of serotype specific epidemiology is in need. When two or more serotypes co-colonize, they evolve rapidly to defend host's immune responses; however, a clear association of co-colonization with a clinical outcome is lacking. Methods Children less than 5 years old who were admitted to hospital due to acute respiratory infections (ARI) (n = 595) and healthy children (n = 350) were recruited. Carriage of pneumococcus was determined by culture and lytA PCR in the nasopharyngeal samples. Serotype/serogroup detection and its quantification were done by the nanofluidic real time PCR system. Spearman's correlation and logistic regression were used to examine a correlation of serotype/serogroup specific bacterial load with its prevalence and an association of co-colonization with ARI respectively. Results Serotype/serogroup specific bacterial load was correlated with its prevalence, both in ARI cases (Spearman's rho = 0.44, n = 186; P<0.0001) and healthy children (Spearman's rho = 0.41, n = 115; P<0.0001). The prevalence of multiple serotypes was more common in ARI cases than in healthy children (18.5% vs 7.1%; aOR 2.92, 95% CI: 1.27–6.71; P = 0.01). The dominant serotype in the co-colonization had a 2 log10 higher bacterial load than the subdominant serotype, both in ARI cases (P<0.001) and healthy children (P<0.05). Conclusions High bacterial load in the nasopharynx may help transmit pneumococci among hosts, and increase the chance of successful acquisition and colonization. Co-colonization of multiple serotypes of pneumococci is linked with ARI, which infers the interactions of multiple serotypes may increase their pathogenicity; however, they may compete for growth in number.
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Affiliation(s)
- Bhim Gopal Dhoubhadel
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Michio Yasunami
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Hien Anh Thi Nguyen
- Department of Bacteriology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Motoi Suzuki
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Thu Huong Vu
- Department of Bacteriology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Ai Thi Thuy Nguyen
- Department of Microbiology, Khanh Hoa General Hospital, NhaTrang, Vietnam
| | - Duc Anh Dang
- Department of Bacteriology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Lay-Myint Yoshida
- Department of Pediatric Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- * E-mail:
| | - Koya Ariyoshi
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
- Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
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Rupa V, Isaac R, Jalagandeeswaran R, Manoharan A, Rebekah G. Epidemiology of nasopharyngeal colonization by S. pneumoniae in Indian infants in the first 2 years of life. Int J Pediatr Otorhinolaryngol 2014; 78:1701-6. [PMID: 25112164 DOI: 10.1016/j.ijporl.2014.07.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 07/15/2014] [Accepted: 07/17/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Streptococcus pneumoniae is a leading cause of invasive disease in developing countries like India. Although the 13 valent pneumococcal vaccine has already been introduced in the country, there is very little epidemiological data regarding S. pneumoniae colonization and antibiotic susceptibility in Indian infants. METHODS We studied serogroup/serotype (SGT) distribution and antibiotic susceptibility pattern of S. pneumoniae in unvaccinated Indian infants by performing monthly nasopharyngeal swabbing of a birth cohort for 2 years. RESULTS Colonization began soon after birth and was complete in the first year of life in the majority of those colonized. Carriage rates increased during winter (p<0.01) and in those with upper respiratory infection (URI) (p<0.01). The most frequently (76.1%) isolated SGT were 19, 6, 15, 23, 9, 35 and 10. Vaccine SGT accounted for 60.5% of all colonizers. Antibiotic resistance was maximum for cotrimoxazole (94.3%) and least for erythromycin (11.2%) with no penicillin resistance. Ten of the commonest SGT which cause invasive disease among Indian infants comprised 46.9% of the colonizers. Serogroups 1, 5, 45 and 12 which cause invasive disease in under-fives were not seen in this birth cohort in the first year. CONCLUSIONS S. pneumoniae colonization in Indian infants commences soon after birth and chiefly occurs in the first year of life. The 13 valent vaccine may protect against a little less than half the commonly seen invasive SGT of S. pneumoniae.
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Affiliation(s)
- Vedantam Rupa
- Department of ENT, Christian Medical College, Vellore, India.
| | - Rita Isaac
- Department of RUHSA, Christian Medical College, Vellore, India
| | | | - Anand Manoharan
- Department of Medicine (Infectious Diseases Unit), Christian Medical College, Vellore, India
| | - Grace Rebekah
- Department of Biostatistics, Christian Medical College, Vellore, India
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Adegbola RA, DeAntonio R, Hill PC, Roca A, Usuf E, Hoet B, Greenwood BM. Carriage of Streptococcus pneumoniae and other respiratory bacterial pathogens in low and lower-middle income countries: a systematic review and meta-analysis. PLoS One 2014; 9:e103293. [PMID: 25084351 PMCID: PMC4118866 DOI: 10.1371/journal.pone.0103293] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 06/27/2014] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Infection with Streptococcus pneumoniae is a major cause of childhood morbidity and mortality worldwide, especially in low income countries where pneumococcal conjugate vaccines (PCVs) are still underused. In countries where PCVs have been introduced, much of their efficacy has resulted from their impact on nasopharyngeal carriage in vaccinated children. Understanding the epidemiology of carriage for S. pneumoniae and other common respiratory bacteria in developing countries is crucial for implementing appropriate vaccination strategies and evaluating their impact. METHODS AND FINDINGS We have systematically reviewed published studies reporting nasopharyngeal or oropharyngeal carriage of S. pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus, and Neisseria meningitidis in children and adults in low and lower-middle income countries. Studies reporting pneumococcal carriage for healthy children <5 years of age were selected for a meta-analysis. The prevalences of carriage for S. pneumoniae, H. influenzae, and M. catarrhalis were generally higher in low income than in lower-middle income countries and were higher in young children than in adults. The prevalence of S. aureus was high in neonates. Meta-analysis of data from young children before the introduction of PCVs showed a pooled prevalence estimate of 64.8% (95% confidence interval, 49.8%-76.1%) in low income countries and 47.8% (95% confidence interval, 44.7%-50.8%) in lower-middle income countries. The most frequent serotypes were 6A, 6B, 19A, 19F, and 23F. CONCLUSIONS In low and lower-middle income countries, pneumococcal carriage is frequent, especially in children, and the spectrum of serotypes is wide. However, because data are limited, additional studies are needed to adequately assess the impact of PCV introduction on carriage of respiratory bacteria in these countries.
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Affiliation(s)
| | | | - Philip C. Hill
- Medical Research Council Unit, Banjul, The Gambia
- Centre for International Health, School of Medicine, University of Otago, Dunedin, New Zealand
| | - Anna Roca
- Medical Research Council Unit, Banjul, The Gambia
| | - Effua Usuf
- Medical Research Council Unit, Banjul, The Gambia
| | | | - Brian M. Greenwood
- Faculty of Infectious & Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Hanieh S, Hamaluba M, Kelly DF, Metz JA, Wyres KL, Fisher R, Pradhan R, Shakya D, Shrestha L, Shrestha A, Joshi A, Habens J, Maharjan BD, Thorson S, Bohler E, Yu LM, Kelly S, Plested E, John T, Werno AM, Adhikari N, Murdoch DR, Brueggemann AB, Pollard AJ. Streptococcus pneumoniae carriage prevalence in Nepal: evaluation of a method for delayed transport of samples from remote regions and implications for vaccine implementation. PLoS One 2014; 9:e98739. [PMID: 24905574 PMCID: PMC4048273 DOI: 10.1371/journal.pone.0098739] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Accepted: 05/07/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pneumococcal disease is a significant cause of morbidity and mortality in young children in Nepal, and currently available pneumococcal conjugate vaccines offer moderate coverage of invasive disease isolates. METHODS A prevalence study of children aged 1.5 to 24 months in urban and rural Nepal was conducted. In the urban group, nasopharyngeal swabs (NPS) were transported using silica desiccant packages (SDP) with delayed processing (2 weeks), or skim-milk-tryptone-glucose-glycerin (STGG) with immediate processing (within 8 hours). Pneumococcal nasopharyngeal carriage prevalence, serogroup/type distribution and isolate genotypes (as defined by multilocus sequence typing) were determined. RESULTS 1101 children were enrolled into the study: 574 in the urban group and 527 in the rural group. Overall carriage prevalence based on culture from specimens transported and stored in STGG was 58.7% (337/574), compared to 40.9% (235/574) in SDP. There was concordance of detection of pneumococcus in 67% of samples. Using the SDP method, pneumococcal carriage prevalence was higher in the rural population (69.2%; 364/526) compared to the urban population (40.9%; 235/574). Serogroup/type distribution varied with geographical location. Over half of the genotypes identified in both the urban and rural pneumococcal populations were novel. CONCLUSION The combination of delayed culture and transport using SDP underestimates the prevalence of pneumococcal carriage; however, in remote areas, this method could still provide a useful estimate of carriage prevalence and serogroup/type distribution. Vaccine impact is unpredictable in a setting with novel genotypes and limited serotype coverage as described here. Consequently, continued surveillance of pneumococcal isolates from carriage and disease in Nepali children following the planned introduction of pneumococcal conjugate vaccines introduction will be essential.
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Affiliation(s)
- Sarah Hanieh
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
- Patan Academy Paediatric Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Mainga Hamaluba
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
- Patan Academy Paediatric Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Dominic F. Kelly
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Jane A. Metz
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
- Patan Academy Paediatric Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Kelly L. Wyres
- Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - Roberta Fisher
- Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - Rahul Pradhan
- Patan Academy Paediatric Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Disuja Shakya
- Patan Academy Paediatric Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Lochan Shrestha
- Patan Academy Paediatric Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Amrita Shrestha
- Patan Academy Paediatric Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Anip Joshi
- Patan Academy Paediatric Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Jocelyn Habens
- Patan Academy Paediatric Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Bishnu D. Maharjan
- Patan Academy Paediatric Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Stephen Thorson
- Patan Academy Paediatric Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Erik Bohler
- Okhaldhunga Community Hospital, Okhaldhunga, Nepal
| | - Ly-Mee Yu
- Nuffield Department of Primary Care and Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Sarah Kelly
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Emma Plested
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Tessa John
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Anja M. Werno
- Department of Pathology, University of Otago, Christchurch, New Zealand
- Canterbury Health Laboratories, Christchurch, New Zealand
| | - Neelam Adhikari
- Patan Academy Paediatric Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - David R. Murdoch
- Department of Pathology, University of Otago, Christchurch, New Zealand
- Canterbury Health Laboratories, Christchurch, New Zealand
| | | | - Andrew J. Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
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Grijalva CG, Griffin MR, Edwards KM, Johnson M, Gil AI, Verástegui H, Lanata CF, Williams JV. Concordance between RT-PCR-based detection of respiratory viruses from nasal swabs collected for viral testing and nasopharyngeal swabs collected for bacterial testing. J Clin Virol 2014; 60:309-12. [PMID: 24875136 DOI: 10.1016/j.jcv.2014.04.011] [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: 03/07/2014] [Revised: 04/07/2014] [Accepted: 04/16/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Epidemiologic studies of respiratory infections frequently rely on separate sample collections for the detection of bacteria and viruses. The requirement for two specimens presents cost, logistical, and acceptability challenges. OBJECTIVES To determine the agreement in detection of respiratory viruses using RT-PCR between two different types of samples collected on the same day: nasal swabs preserved in viral transport medium (NS) and nasopharyngeal swabs preserved in skim milk-tryptone-glucose-glycerol [STGG] medium (NP), the current standard for pneumococcal colonization studies. STUDY DESIGN Paired NS and NP samples were collected between May 2009 and September 2011 as part of the RESPIRA-PERU study, a large prospective cohort of Andean children <3 years of age. NS samples used polyester swabs and viral transport medium whereas NP samples used rayon wire-handled swabs and STGG medium. Samples were tested for influenza, human metapneumovirus (MPV), respiratory syncytial virus (RSV), human rhinovirus (HRV), parainfluenza virus 3 (PIV3) and adenovirus (ADV) using real-time RT-PCR. We calculated the agreement, and compared cycle thresholds (CT) between NP and NS samples. RESULTS Among 226 paired NP-NS samples, we observed very high agreement with a Kappa statistic ranging from 0.71 for ADV to 0.97 for MPV. CT values were similar for both strategies. CONCLUSIONS NP samples preserved in STGG provide a simple and reliable strategy for identification of both pneumococcus and respiratory viruses. This single specimen collection strategy could be used for epidemiologic studies, especially in resource-limited settings. Furthermore, archived NP-STGG specimens from previous studies could be reliably tested by RT-PCR for viruses.
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Affiliation(s)
- Carlos G Grijalva
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, United States.
| | - Marie R Griffin
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Kathryn M Edwards
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Monika Johnson
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Ana I Gil
- Instituto de Investigación Nutricional, Lima, Peru
| | | | | | - John V Williams
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, United States; Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, TN, United States
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38
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Grijalva CG, Griffin MR, Edwards KM, Williams JV, Gil AI, Verastegui H, Hartinger SM, Vidal JE, Klugman KP, Lanata CF. The role of influenza and parainfluenza infections in nasopharyngeal pneumococcal acquisition among young children. Clin Infect Dis 2014; 58:1369-76. [PMID: 24621951 PMCID: PMC4001292 DOI: 10.1093/cid/ciu148] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Animal models suggest that influenza infection favors nasopharyngeal acquisition of pneumococci. We assessed this relationship with influenza and other respiratory viruses in young children. METHODS A case-control study was nested within a prospective cohort study of acute respiratory illness (ARI) in Andean children <3 years of age (RESPIRA-PERU study). Weekly household visits were made to identify ARI and obtain nasal swabs for viral detection using real-time reverse-transcription polymerase chain reaction. Monthly nasopharyngeal (NP) samples were obtained to assess pneumococcal colonization. We determined whether specific respiratory viral ARI episodes occurring within the interval between NP samples increased the risk of NP acquisition of new pneumococcal serotypes. RESULTS A total of 729 children contributed 2128 episodes of observation, including 681 pneumococcal acquisition episodes (new serotype, not detected in prior sample), 1029 nonacquisition episodes (no colonization or persistent colonization with the same serotype as the prior sample), and 418 indeterminate episodes. The risk of pneumococcal acquisition increased following influenza-ARI (adjusted odds ratio [AOR], 2.19; 95% confidence interval [CI], 1.02-4.69) and parainfluenza-ARI (AOR, 1.86; 95% CI, 1.15-3.01), when compared with episodes without ARI. Other viral infections (respiratory syncytial virus, human metapneumovirus, human rhinovirus, and adenovirus) were not associated with acquisition. CONCLUSIONS Influenza and parainfluenza ARIs appeared to facilitate pneumococcal acquisition among young children. As acquisition increases the risk of pneumococcal diseases, these observations are pivotal in our attempts to prevent pneumococcal disease.
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Licciardi PV, Russell FM, Balloch A, Burton RL, Nahm MH, Gilbert G, Tang MLK, Mulholland EK. Impaired serotype-specific immune function following pneumococcal vaccination in infants with prior carriage. Vaccine 2014; 32:2321-7. [PMID: 24613524 DOI: 10.1016/j.vaccine.2014.02.064] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 02/11/2014] [Accepted: 02/14/2014] [Indexed: 01/07/2023]
Abstract
The impact of prior nasopharyngeal carriage on serotype-specific IgG responses following immunization with pneumococcal conjugate vaccines (PCV) has recently been described. This report extends these findings to describe the attenuation of functional immune responses following 23-valent pneumococcal polysaccharide vaccination (PPS). We report the attenuation of immune responses following booster with the 23-valent pneumococcal polysaccharide vaccination (PPS) in infants with prior nasopharyngeal carriage of Streptococcus pneumoniae. Fijian infants who were part of a phase II randomized, controlled trial of reduced dose PCV7 schedules were the basis of this study. Pneumococcal carriage was determined at 6, 9 and 12 months of age, prior to PPS immunization. Serum samples collected at 18 weeks (post-PCV7), 12 months (pre-PPS), 12.5 months and 17 months (post-PPS) of age were assessed for serotype-specific IgG and opsonophagocytic responses. The most frequently carried serotypes were 6B (N=11), 19F (N=14) and 23F (N=23). Significantly lower serotype-specific IgG for 19F, 23F but not 6B post-PPS were detected in infants with homologous serotype carriage prior to PPS compared with non-carriers (N=230). However, OPA levels for 6B and 23F were lower in infants that carried these serotypes. Pneumococcal carriage with 19F or 23F at any time prior to PPS immunization in infants at 12 months of age who were previously primed with PCV resulted in serotype-specific hyporesponsiveness that persisted until 17 months of age. These results may have implications for the timing of infant vaccine schedules, particularly in high disease burden settings.
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Affiliation(s)
- Paul V Licciardi
- Pneumococcal Research Group, Australia; Allergy and Immune Disorders Group, Murdoch Childrens Research Institute, Australia.
| | - Fiona M Russell
- Pneumococcal Research Group, Australia; Centre for International Child Health, Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Anne Balloch
- Pneumococcal Research Group, Australia; Allergy and Immune Disorders Group, Murdoch Childrens Research Institute, Australia
| | - Robert L Burton
- Department of Pathology, University of Alabama at Birmingham, USA; Department of Microbiology, University of Alabama at Birmingham, USA
| | - Moon H Nahm
- Department of Pathology, University of Alabama at Birmingham, USA; Department of Microbiology, University of Alabama at Birmingham, USA
| | - Gwendolyn Gilbert
- Westmead Millennium Institute for Medical Research, University of Sydney, Australia
| | - Mimi L K Tang
- Pneumococcal Research Group, Australia; The Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Edward K Mulholland
- Pneumococcal Research Group, Australia; Menzies School of Health Research, Darwin, Australia; London School of Hygiene and Tropical Medicine, London, United Kingdom
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40
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Chewapreecha C, Harris SR, Croucher NJ, Turner C, Marttinen P, Cheng L, Pessia A, Aanensen DM, Mather AE, Page AJ, Salter SJ, Harris D, Nosten F, Goldblatt D, Corander J, Parkhill J, Turner P, Bentley SD. Dense genomic sampling identifies highways of pneumococcal recombination. Nat Genet 2014; 46:305-309. [PMID: 24509479 PMCID: PMC3970364 DOI: 10.1038/ng.2895] [Citation(s) in RCA: 271] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Accepted: 01/15/2014] [Indexed: 11/24/2022]
Abstract
Evasion of clinical interventions by Streptococcus pneumoniae occurs through selection of non-susceptible genomic variants. We report whole-genome sequencing of 3,085 pneumococcal carriage isolates from a 2.4-km(2) refugee camp. This sequencing provides unprecedented resolution of the process of recombination and its impact on population evolution. Genomic recombination hotspots show remarkable consistency between lineages, indicating common selective pressures acting at certain loci, particularly those associated with antibiotic resistance. Temporal changes in antibiotic consumption are reflected in changes in recombination trends, demonstrating rapid spread of resistance when selective pressure is high. The highest frequencies of receipt and donation of recombined DNA fragments were observed in non-encapsulated lineages, implying that this largely overlooked pneumococcal group, which is beyond the reach of current vaccines, may have a major role in genetic exchange and the adaptation of the species as a whole. These findings advance understanding of pneumococcal population dynamics and provide information for the design of future intervention strategies.
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Affiliation(s)
- Claire Chewapreecha
- The Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, CB10 1SA, UK
| | - Simon R Harris
- The Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, CB10 1SA, UK
| | - Nicholas J Croucher
- Department of Infectious Disease Epidemiology, Imperial College London, St. Mary’s Hospital, London, W2 1PG, UK
| | - Claudia Turner
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Maesot 63110, Thailand
- Cambodia-Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
- Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7LJ, UK
| | - Pekka Marttinen
- Helsinki Institute for Information Technology HIIT, Department of Information and Computer Science, Aalto University, 00076, Finland
| | - Lu Cheng
- Department of Mathematics and Statistics, University of Helsinki, 00014, Finland
| | - Alberto Pessia
- Department of Mathematics and Statistics, University of Helsinki, 00014, Finland
| | - David M Aanensen
- Department of Infectious Disease Epidemiology, Imperial College London, St. Mary’s Hospital, London, W2 1PG, UK
| | - Alison E Mather
- The Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, CB10 1SA, UK
| | - Andrew J Page
- The Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, CB10 1SA, UK
| | - Susannah J. Salter
- The Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, CB10 1SA, UK
| | - David Harris
- The Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, CB10 1SA, UK
| | - Francois Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Maesot 63110, Thailand
- Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7LJ, UK
| | - David Goldblatt
- Immunobiology Unit, Institute of Child Health, University College London, WC1N 1EH, UK
| | - Jukka Corander
- Department of Mathematics and Statistics, University of Helsinki, 00014, Finland
- Department of Medicine, University of Cambridge, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, UK
| | - Julian Parkhill
- The Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, CB10 1SA, UK
| | - Paul Turner
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Maesot 63110, Thailand
- Cambodia-Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
- Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7LJ, UK
| | - Stephen D Bentley
- The Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, CB10 1SA, UK
- Department of Medicine, University of Cambridge, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, UK
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Zuccotti G, Mameli C, Daprai L, Garlaschi ML, Dilillo D, Bedogni G, Faccini M, Gramegna M, Torresani E, Ballerini E, Benincaso A, Bonvissuto M, Bricalli D, Brioschi M, Calloni CS, Camiletti MI, Colella G, De Angelis L, Decarlis S, Di Nello F, Dozzi M, Galli E, Gandini V, Giuliani MG, Laviola F, Loda B, Macedoni M, Mazzucchi E, Metta MG, Moscatiello A, Nannini P, Petruzzi M, Picicco D, Picciotti M, Pisanelli S, Porta N, Ramponi G, Redaelli F, Rubini R, Sala N, Saitta V, Scelza G, Tiso RM, Tomasetto M, Torcoletti M, Travaini M, Valentini M, Vessia C. Serotype distribution and antimicrobial susceptibilities of nasopharyngeal isolates of Streptococcus pneumoniae from healthy children in the 13-valent pneumococcal conjugate vaccine era. Vaccine 2013; 32:527-34. [PMID: 24342249 DOI: 10.1016/j.vaccine.2013.12.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 11/25/2013] [Accepted: 12/02/2013] [Indexed: 10/25/2022]
Abstract
Few epidemiological data are available since the introduction of 13-valent pneumococcal vaccine (PCV13) in 2010. We conducted a cross-sectional study to estimate the prevalence of Streptococcus pneumoniae (SP) nasopharyngeal carriage in healthy Italian infants and young children and to evaluate the impact of PCV13 on pneumococcal colonization. In the trimester September-December 2011 nasopharyngeal swabs were collected from healthy children aged 3-59 months presenting for routine well careat 16 primary care pediatricians in Milan. SP carriage isolates were serotyped and tested for antimicrobial resistance using EUCAST breakpoints. Among 1250 enrolled children, 618 had received at least 1 dose of PCV13, 292 at least 1 dose of PCV7, 94 a combination of the two vaccines and 246 were not vaccinated. The prevalence of SP carriage was 27% (95% confidence interval [CI] 25-30). At multivariable analysis, age≥25 months (prevalence ratio [PR]=0.74) and use of antibiotics in the previous 3 months (PR=0.67) were associated with lower SP carriage prevalence. Having siblings (PR=1.79 for 1 sibling and PR=2.23 for ≥2 siblings), day-care attendance (PR=2.27) and respiratory tract infections in the previous 3 months (PR=1.39) were associated with higher SP carriage prevalence. The immunization status for SP was not associated with SP carriage at univariable or at multivariable analysis. The most common carriage isolates were 6C, 19A and 23A. The prevalence of the six additional PCV13 serotypes carriage in children appropriately vaccinated with PCV13 was lower than in children appropriately vaccinated with PCV7 (0 vs. 0.060); the greater reduction in prevalence of carriage was observed for serotype 19A (0 vs. 0.041). Serotype 6C was the most common drug-resistant serotype (17.2%). Further epidemiological studies are needed to assess changes in circulating SP serotypes following the large-scale introduction of PCV13.
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Affiliation(s)
| | - Chiara Mameli
- Department of Paediatrics, L. Sacco Hospital, University of Milan, Italy
| | - Laura Daprai
- Microbiology Laboratory, Policlinico, Cà Granda Ospedale Maggiore Foundation, Milan, Italy
| | - Maria Laura Garlaschi
- Microbiology Laboratory, Policlinico, Cà Granda Ospedale Maggiore Foundation, Milan, Italy
| | - Dario Dilillo
- Department of Paediatrics, L. Sacco Hospital, University of Milan, Italy
| | - Giorgio Bedogni
- Clinical Epidemiology Unit, Liver Research Center, Trieste, Italy
| | - Marino Faccini
- Prevention Department, Local Health Authority, Milan, Italy
| | - Maria Gramegna
- Unità Organizzativa Governo della prevenzione e tutela sanitaria, Direzione Generale Sanità, Regione Lombardia, Milan, Italy
| | - Erminio Torresani
- Microbiology Laboratory, Policlinico, Cà Granda Ospedale Maggiore Foundation, Milan, Italy
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Principi N, Terranova L, Zampiero A, Manzoni F, Senatore L, Rios WP, Esposito S. Oropharyngeal and nasopharyngeal sampling for the detection of adolescent Streptococcus pneumoniae carriers. J Med Microbiol 2013; 63:393-398. [PMID: 24298049 DOI: 10.1099/jmm.0.068726-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Monitoring the dynamics of pneumococcal carriage makes it possible to evaluate the epidemiological characteristics of Streptococcus pneumoniae disease and the theoretical coverage offered by pneumococcal vaccines. It has been demonstrated that the nasopharyngeal (NP) sampling of respiratory secretions is superior to oropharyngeal (OP) sampling for identifying pneumococci carried by younger children, but adult data are conflicting and there are no published studies of adolescents. In order to compare the efficiency of OP and NP sampling in identifying and quantifying S. pneumoniae carriage in healthy adolescents, 2 swab samples were obtained from 530 adolescents aged 15-19 years, the first taken from the posterior pharyngeal wall through the mouth (OP) and the second through the nose (NP). Bacterial genomic DNA was tested for the autolysin-A-encoding gene (lytA) and wzg (cpsA) gene of S. pneumoniae in order to evaluate pneumococcal carrier status. All of the positive cases were serotyped. S. pneumoniae was identified in 35.8% of the OP swabs and 3.5% of the NP swabs (P<0.0001). The serotypes included in the 13-valent pneumococcal conjugate vaccine (PCV13) were found in all but two OP samples (98.9%) and only 64.7% of the NP samples (P<0.0001). The most frequently identified PCV13 serotype in both groups was 19F, followed by serotypes 5 and 9V. In conclusion, OP sampling appeared significantly more effective than NP sampling in identifying and characterizing pneumococcal carrier status in adolescents. This suggests that OP sampling should be used when evaluating the dynamics of pneumococcal carriage among adolescents and the theoretical coverage offered by PCV13.
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Affiliation(s)
- Nicola Principi
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Leonardo Terranova
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Zampiero
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca Manzoni
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Senatore
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Walter Peves Rios
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Susanna Esposito
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Dayie NTKD, Arhin RE, Newman MJ, Dalsgaard A, Bisgaard M, Frimodt-Møller N, Slotved HC. Penicillin resistance and serotype distribution of Streptococcus pneumoniae in Ghanaian children less than six years of age. BMC Infect Dis 2013; 13:490. [PMID: 24148091 PMCID: PMC4015758 DOI: 10.1186/1471-2334-13-490] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 10/15/2013] [Indexed: 11/29/2022] Open
Abstract
Background The objective of this study was to determine the prevalence of nasopharyngeal carriage, serotype distribution, and penicillin resistance of Streptococcus pneumoniae in children ≤6 years of age in Ghana. Methods A cross-sectional study was carried out on a cluster-randomized sample of children ≤6 years of age attending nurseries and kindergartens in Accra and Tamale, Ghana. Basic data on age, sex and exposure to antimicrobials in the previous month were collected on all study subjects. Nasopharyngeal swabs were obtained from participants and all pneumococcal isolates were characterized by serotyping and their penicillin resistance determined. Results The overall prevalence of pneumococcal carriage among the children was 34% in Accra and 31% in Tamale. The predominant serotypes were 19F, 6B, 23F, and 6A with 23% of the isolates being non-typable in Accra and 12% in Tamale. Only two isolates (serotypes 19F and 6B) from Tamale had a MIC >2 μg/ml and were classified as fully penicillin resistant with 45% of the isolates having intermediate resistance. Conclusions These findings indicate that the 13-valent pneumococcal conjugate vaccine (PCV-13) recently introduced in Ghana will cover 48% and 51% of the serotypes identified in Accra and Tamale, respectively. The 23-valent pneumococcal polysaccharide vaccine (PPV-23) will cover 54% of all serotypes detected. The two penicillin resistant isolates (MIC 32 μg/ml) were serotypes included in both PCV-13 and PPV-23. A nationwide monitoring system of penicillin susceptibility patterns and pneumococcal serotypes is recommended.
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Affiliation(s)
| | | | | | | | | | | | - Hans-Christian Slotved
- Department of Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark.
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Smith-Vaughan HC, Binks MJ, Marsh RL, Kaestli M, Ward L, Hare KM, Pizzutto SJ, Thornton RB, Morris PS, Leach AJ. Dominance of Haemophilus influenzae in ear discharge from Indigenous Australian children with acute otitis media with tympanic membrane perforation. BMC EAR, NOSE, AND THROAT DISORDERS 2013; 13:12. [PMID: 24099576 PMCID: PMC3852835 DOI: 10.1186/1472-6815-13-12] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 10/01/2013] [Indexed: 11/10/2022]
Abstract
Background Indigenous Australian children living in remote communities experience high rates of acute otitis media with tympanic membrane perforation (AOMwiP). Otitis media in this population is associated with dense nasopharyngeal colonization of three primary otopathogens; Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis. Little is known about the relative abundance of these pathogens during infection. The objective of this study was to estimate the abundance and concordance of otopathogens in ear discharge and paired nasopharyngeal swabs from children with AOMwiP (discharge of not more than 6 weeks’ duration and perforation size <2%). Methods Culture and quantitative PCR (qPCR) estimation of H. influenzae, S. pneumoniae, M. catarrhalis and total bacterial load were performed on paired nasopharyngeal and ear discharge swabs from 55 Indigenous children with AOMwiP aged 3.5 – 45.6 months and resident in remote communities. Results By culture, H. influenzae, S. pneumoniae, and M. catarrhalis were detected in 80%, 84% and 91% of nasopharyngeal swabs, and 49%, 33% and 4% of ear discharge swabs, respectively. Using qPCR, H. influenzae, S. pneumoniae, and M. catarrhalis were detected in 82%, 82%, and 93% of nasopharyngeal swabs, and 89%, 41% and 18% of ear discharge swabs, respectively. Relative abundance of H. influenzae in ear discharge swabs was 0-68% of the total bacterial load (median 2.8%); whereas S. pneumoniae and M. catarrhalis relative abundances were consistently <2% of the total bacterial load. S. pneumoniae and M. catarrhalis abundances were significantly lower in ear discharge compared with nasopharyngeal swabs (p = 0.001, p < 0.001); no significant difference was observed in H. influenzae mean abundance at the two sites. Conclusions H. influenzae was the dominant otopathogen detected in ear discharge swabs collected from children with AOMwiP. High prevalence and abundance of S. pneumoniae and M. catarrhalis in the nasopharynx did not predict ear discharge prevalence and abundances of these pathogens. PCR was substantially more sensitive than culture for ear discharge, and a necessary adjunct to standard microbiology. Quantitative methods are required to understand species abundance in polymicrobial infections and may be needed to measure accurately the microbiological impact of interventions and to provide a better understanding of clinical failure in these children.
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Affiliation(s)
- Heidi C Smith-Vaughan
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
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45
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O’Grady KAF, Grimwood K, Cripps A, Mulholland EK, Morris P, Torzillo PJ, Wood N, Smith-Vaughan H, Revell A, Wilson A, Van Asperen P, Richmond P, Thornton R, Rablin S, Chang AB. Does a 10-valent pneumococcal-Haemophilus influenzae protein D conjugate vaccine prevent respiratory exacerbations in children with recurrent protracted bacterial bronchitis, chronic suppurative lung disease and bronchiectasis: protocol for a randomised controlled trial. Trials 2013; 14:282. [PMID: 24010917 PMCID: PMC3846146 DOI: 10.1186/1745-6215-14-282] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 08/23/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recurrent protracted bacterial bronchitis (PBB), chronic suppurative lung disease (CSLD) and bronchiectasis are characterised by a chronic wet cough and are important causes of childhood respiratory morbidity globally. Haemophilus influenzae and Streptococcus pneumoniae are the most commonly associated pathogens. As respiratory exacerbations impair quality of life and may be associated with disease progression, we will determine if the novel 10-valent pneumococcal-Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) reduces exacerbations in these children. METHODS A multi-centre, parallel group, double-blind, randomised controlled trial in tertiary paediatric centres from three Australian cities is planned. Two hundred six children aged 18 months to 14 years with recurrent PBB, CSLD or bronchiectasis will be randomised to receive either two doses of PHiD-CV or control meningococcal (ACYW₁₃₅) conjugate vaccine 2 months apart and followed for 12 months after the second vaccine dose. Randomisation will be stratified by site, age (<6 years and ≥6 years) and aetiology (recurrent PBB or CSLD/bronchiectasis). Clinical histories, respiratory status (including spirometry in children aged ≥6 years), nasopharyngeal and saliva swabs, and serum will be collected at baseline and at 2, 3, 8 and 14 months post-enrolment. Local and systemic reactions will be recorded on daily diaries for 7 and 30 days, respectively, following each vaccine dose and serious adverse events monitored throughout the trial. Fortnightly, parental contact will help record respiratory exacerbations. The primary outcome is the incidence of respiratory exacerbations in the 12 months following the second vaccine dose. Secondary outcomes include: nasopharyngeal carriage of H. influenzae and S. pneumoniae vaccine and vaccine- related serotypes; systemic and mucosal immune responses to H. influenzae proteins and S. pneumoniae vaccine and vaccine-related serotypes; impact upon lung function in children aged ≥6 years; and vaccine safety. DISCUSSION As H. influenzae is the most common bacterial pathogen associated with these chronic respiratory diseases in children, a novel pneumococcal conjugate vaccine that also impacts upon H. influenzae and helps prevent respiratory exacerbations would assist clinical management with potential short- and long-term health benefits. Our study will be the first to assess vaccine efficacy targeting H. influenzae in children with recurrent PBB, CSLD and bronchiectasis. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Registry (ANZCTR) number: ACTRN12612000034831.
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Affiliation(s)
- Kerry-Ann F O’Grady
- Queensland Children’s Medical Research Institute, Royal Children’s Hospital, The University of Queensland, Brisbane, QLD, Australia
| | - Keith Grimwood
- Queensland Children’s Medical Research Institute, Royal Children’s Hospital, The University of Queensland, Brisbane, QLD, Australia
| | - Allan Cripps
- School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - Edward K Mulholland
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
- London School of Hygiene & Tropical Medicine, London, UK
| | - Peter Morris
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
- Department of Paediatrics, Royal Darwin Hospital, Darwin, NT, Australia
| | | | - Nicholas Wood
- National Centre for Immunisation Research & Surveillance, University of Sydney, Westmead, NSW, Australia
| | - Heidi Smith-Vaughan
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Amber Revell
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Andrew Wilson
- Department of Respiratory Medicine, Princess Margaret Hospital, Perth, WA, Australia
| | - Peter Van Asperen
- Department of Respiratory Medicine, The Children’s Hospital at Westmead and Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Peter Richmond
- School of Paediatrics and Child Health, University of Western Australia, Perth, WA, Australia
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, WA, Australia
| | - Ruth Thornton
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, WA, Australia
| | - Sheree Rablin
- Queensland Children’s Medical Research Institute, Royal Children’s Hospital, The University of Queensland, Brisbane, QLD, Australia
| | - Anne B Chang
- Queensland Children’s Medical Research Institute, Royal Children’s Hospital, The University of Queensland, Brisbane, QLD, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
- Queensland Children’s Respiratory Centre, Royal Children’s Hospital, Brisbane, QLD, Australia
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46
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Lai JYR, Cook H, Yip TW, Berthelsen J, Gourley S, Krause V, Smith H, Leach AJ, Smith-Vaughan H. Surveillance of pneumococcal serotype 1 carriage during an outbreak of serotype 1 invasive pneumococcal disease in central Australia 2010-2012. BMC Infect Dis 2013; 13:409. [PMID: 24138669 PMCID: PMC3766201 DOI: 10.1186/1471-2334-13-409] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Accepted: 08/15/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND An outbreak of serotype 1 invasive pneumococcal disease (IPD) occurred in Central Australia from October 2010 to the latter part of 2012. Surveillance of serotype 1 carriage was conducted to determine epidemiological features of asymptomatic carriage that could potentially be driving the outbreak. METHODS 130 patients and accompanying persons presenting at Alice Springs Hospital Emergency Department consented to nasopharyngeal swab (NPS) collection. NPS were processed by standard methods, including culture, pneumococcal lytA quantitative real-time PCR, serotype 1-specific real-time PCR and multi-locus sequence typing (MLST). RESULTS Pneumococcal carriage was detected in 16% of participants. Carriage was highest in the under 10 year olds from remote communities surrounding Alice Springs (75%). Four NPS were positive for serotype 1 DNA by PCR; 3 were also culture-positive for serotype 1 pneumococci. Serotype 1 isolates had atypical colony morphology on primary culture. All serotype 1 carriers were healthy children 5 to 8 years of age from remote communities. By MLST, serotype 1 isolates were ST306, as were IPD isolates associated with this outbreak. CONCLUSIONS During an outbreak of serotype 1 ST306 IPD, carriage of the outbreak strain was detected in 3% NPS collected. All carriers were healthy children 5 to 8 years of age.
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Affiliation(s)
- Jana YR Lai
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Heather Cook
- Department of Health, Centre for Disease Control, Darwin, NT, Australia
| | - Teem-Wing Yip
- Department of Health, Centre for Disease Control, Darwin, NT, Australia
- Flinders University Northern Territory Clinical School, Adelaide, NT, Australia
| | | | - Stephen Gourley
- Flinders University Northern Territory Clinical School, Adelaide, NT, Australia
- Alice Springs Hospital Emergency Department, Alice Springs, NT, Australia
| | - Vicki Krause
- Department of Health, Centre for Disease Control, Darwin, NT, Australia
- Flinders University Northern Territory Clinical School, Adelaide, NT, Australia
| | - Helen Smith
- Forensic & Scientific Services, Queensland Health, Brisbane, QLD, Australia
| | - Amanda J Leach
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Heidi Smith-Vaughan
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
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47
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Association of Streptococcus pneumoniae common protein antigen (CPA) antibodies and pneumococcal nasopharyngeal colonization in HIV-infected and HIV-uninfected African children. Vaccine 2013; 31:4421-7. [DOI: 10.1016/j.vaccine.2013.06.097] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 06/20/2013] [Accepted: 06/25/2013] [Indexed: 11/22/2022]
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Goldblatt D, Ramakrishnan M, O'Brien K. Using the impact of pneumococcal vaccines on nasopharyngeal carriage to aid licensing and vaccine implementation; a PneumoCarr meeting report March 27-28, 2012, Geneva. Vaccine 2013; 32:146-52. [PMID: 23933374 DOI: 10.1016/j.vaccine.2013.06.040] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Revised: 06/07/2013] [Accepted: 06/11/2013] [Indexed: 11/28/2022]
Abstract
An international consultation was convened in March 2012 to provide feedback on the Case for Carriage, a summary statement by the Pneumococcal Carriage Consortium (PneumoCarr) proposing nasopharyngeal (NP) colonization as a supplementary or alternative endpoint in vaccine licensure. PneumoCarr members provided information to vaccine manufacturers, regulators and the WHO on the evidence for NP carriage as a precursor to pneumococcal disease, standardization of laboratory methods for the detection of multiple serotype carriage, definition and estimation of pneumococcal vaccine efficacy against carriage (VE-col), and the direct and indirect impact of vaccination on carriage. Manufacturers and regulators had the opportunity to respond to the information compiled by PneumoCarr and share their perspectives. VE-col as a licensure endpoint may be more useful for the next generation pneumococcal vaccine products, particularly those for which the immunological correlate of protection is not established, whereas it may be less needed for pneumococcal conjugate vaccines which have an established licensure pathway. The consultation supported the importance of NP carriage data as a critical element linking vaccine impact on the individual direct risk of disease to the population-level impact: indirect effects such as herd protection and serotype replacement. The indirect effects of vaccination, however, are not currently established as part of the licensure process and to include them would be a paradigm shift for regulatory agencies who currently consider this information in the post-licensure setting. More discussion and consensus-building is needed around the rationale and optimal mechanism to include carriage data in the licensure pathway for new pneumococcal vaccines. The WHO and national advisory groups on immunization policy may have an important role in considering the evidence for the indirect benefit of vaccination as informed by its impact on NP carriage.
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Affiliation(s)
- David Goldblatt
- University College London, Institute of Child Health, London, UK.
| | | | - Katherine O'Brien
- Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Auranen K, Rinta-Kokko H, Goldblatt D, Nohynek H, O'Brien KL, Satzke C, Simell B, Tanskanen A, Käyhty H. Design questions for Streptococcus pneumoniae vaccine trials with a colonisation endpoint. Vaccine 2013; 32:159-64. [PMID: 23871614 DOI: 10.1016/j.vaccine.2013.06.105] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 04/12/2013] [Accepted: 06/26/2013] [Indexed: 11/16/2022]
Abstract
Evaluation of vaccine efficacy for protection against colonisation (VEcol) with Streptococcus pneumoniae and other bacterial pathogens is often based on a cross-sectional study design, in which only one nasopharyngeal sample is obtained per study subject. Here we investigate the feasibility of this study design by investigating a number of practical design problems. Specific questions are related to the timing of colonisation measurement with respect to the time of vaccination, the adjustment for the within-host replacement of vaccine-type colonisation by the non-vaccine type pneumococci, and the impact of multiple serotype colonisation on VEcol estimation. We also discuss the issue of choosing the control vaccine, including comparison of two active pneumococcal vaccines, as well as the sample size and the statistical power of colonisation endpoint trials. In addition, the statistical design with the specific aim to include information about VEcol in the licensure process of new pneumococcal vaccine products is discussed.
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Affiliation(s)
- Kari Auranen
- Department of Vaccination and Immune Protection, National Institute for Health and Welfare (THL), P.O. Box 30, FI-00271 Helsinki, Finland.
| | - Hanna Rinta-Kokko
- Department of Vaccination and Immune Protection, National Institute for Health and Welfare (THL), P.O. Box 30, FI-00271 Helsinki, Finland
| | - David Goldblatt
- University College London Medical School, Institute of Child Health, London, UK
| | - Hanna Nohynek
- Department of Vaccination and Immune Protection, National Institute for Health and Welfare (THL), P.O. Box 30, FI-00271 Helsinki, Finland
| | | | - Catherine Satzke
- Pneumococcal Research and Infectious Diseases and Microbiology, Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, VIC, Australia; Department of Microbiology and Immunology, The University of Melbourne, Parkville, VIC, Australia
| | - Birgit Simell
- Department of Vaccination and Immune Protection, National Institute for Health and Welfare (THL), P.O. Box 30, FI-00271 Helsinki, Finland
| | - Antti Tanskanen
- Department of Vaccination and Immune Protection, National Institute for Health and Welfare (THL), P.O. Box 30, FI-00271 Helsinki, Finland
| | - Helena Käyhty
- Department of Vaccination and Immune Protection, National Institute for Health and Welfare (THL), P.O. Box 30, FI-00271 Helsinki, Finland
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50
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Grijalva CG, Griffin MR, Edwards KM, Williams JV, Gil AI, Verastegui H, Hartinger SM, Vidal JE, Klugman KP, Lanata CF. Cohort profile: The study of respiratory pathogens in Andean children. Int J Epidemiol 2013; 43:1021-30. [PMID: 23771719 DOI: 10.1093/ije/dyt065] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We investigated respiratory pathogens in a prospective cohort study of young children living in the Peruvian Andes. In the study we assessed viral respiratory infections among young children, and explored interactions of viruses with common respiratory bacteria, especially Streptococcus pneumoniae. Through weekly household visits, data were collected on the signs and symptoms of acute respiratory illness (ARI), nasal samples were collected to test for viruses during episodes of ARI, and nasopharyngeal samples were collected on a monthly basis to monitor bacterial colonisation. We also collected data on vaccination coverage, patterns of social mixing, geographic information, and environmental and socio-demographic variables. Understanding the interaction of respiratory viruses with bacteria and its impact on the burden and severity of ARIs in rural areas of developing countries is critical to designing strategies for preventing such infections.
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Affiliation(s)
- Carlos G Grijalva
- Departments of Preventive Medicine, Vanderbilt University School of Medicine, Nashville TN, USA, Pediatrics-Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville TN, USA, Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville TN, USA, Instituto de Investigación Nutricional, Lima, Perú, Swiss Tropical and Public Health Institute, Basel, Switzerland and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta GA, USA
| | - Marie R Griffin
- Departments of Preventive Medicine, Vanderbilt University School of Medicine, Nashville TN, USA, Pediatrics-Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville TN, USA, Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville TN, USA, Instituto de Investigación Nutricional, Lima, Perú, Swiss Tropical and Public Health Institute, Basel, Switzerland and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta GA, USA
| | - Kathryn M Edwards
- Departments of Preventive Medicine, Vanderbilt University School of Medicine, Nashville TN, USA, Pediatrics-Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville TN, USA, Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville TN, USA, Instituto de Investigación Nutricional, Lima, Perú, Swiss Tropical and Public Health Institute, Basel, Switzerland and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta GA, USA
| | - John V Williams
- Departments of Preventive Medicine, Vanderbilt University School of Medicine, Nashville TN, USA, Pediatrics-Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville TN, USA, Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville TN, USA, Instituto de Investigación Nutricional, Lima, Perú, Swiss Tropical and Public Health Institute, Basel, Switzerland and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta GA, USADepartments of Preventive Medicine, Vanderbilt University School of Medicine, Nashville TN, USA, Pediatrics-Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville TN, USA, Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville TN, USA, Instituto de Investigación Nutricional, Lima, Perú, Swiss Tropical and Public Health Institute, Basel, Switzerland and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta GA, USA
| | - Ana I Gil
- Departments of Preventive Medicine, Vanderbilt University School of Medicine, Nashville TN, USA, Pediatrics-Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville TN, USA, Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville TN, USA, Instituto de Investigación Nutricional, Lima, Perú, Swiss Tropical and Public Health Institute, Basel, Switzerland and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta GA, USA
| | - Héctor Verastegui
- Departments of Preventive Medicine, Vanderbilt University School of Medicine, Nashville TN, USA, Pediatrics-Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville TN, USA, Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville TN, USA, Instituto de Investigación Nutricional, Lima, Perú, Swiss Tropical and Public Health Institute, Basel, Switzerland and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta GA, USA
| | - Stella M Hartinger
- Departments of Preventive Medicine, Vanderbilt University School of Medicine, Nashville TN, USA, Pediatrics-Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville TN, USA, Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville TN, USA, Instituto de Investigación Nutricional, Lima, Perú, Swiss Tropical and Public Health Institute, Basel, Switzerland and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta GA, USADepartments of Preventive Medicine, Vanderbilt University School of Medicine, Nashville TN, USA, Pediatrics-Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville TN, USA, Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville TN, USA, Instituto de Investigación Nutricional, Lima, Perú, Swiss Tropical and Public Health Institute, Basel, Switzerland and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta GA, USA
| | - Jorge E Vidal
- Departments of Preventive Medicine, Vanderbilt University School of Medicine, Nashville TN, USA, Pediatrics-Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville TN, USA, Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville TN, USA, Instituto de Investigación Nutricional, Lima, Perú, Swiss Tropical and Public Health Institute, Basel, Switzerland and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta GA, USA
| | - Keith P Klugman
- Departments of Preventive Medicine, Vanderbilt University School of Medicine, Nashville TN, USA, Pediatrics-Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville TN, USA, Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville TN, USA, Instituto de Investigación Nutricional, Lima, Perú, Swiss Tropical and Public Health Institute, Basel, Switzerland and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta GA, USA
| | - Claudio F Lanata
- Departments of Preventive Medicine, Vanderbilt University School of Medicine, Nashville TN, USA, Pediatrics-Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville TN, USA, Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville TN, USA, Instituto de Investigación Nutricional, Lima, Perú, Swiss Tropical and Public Health Institute, Basel, Switzerland and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta GA, USA
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