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Ong DS, Phan TV, Temple B, Toh ZQ, Nguyen CD, Vientrung K, Nguyen HVA, Thi Trang Dai V, Bright K, Tran HP, Higgins RA, Cheung YB, Vu Nguyen T, Mulholland K, Licciardi PV. Memory B cell responses induced by pneumococcal conjugate vaccine schedules with fewer doses: analysis of a randomised-controlled trial in Viet Nam. Nat Commun 2024; 15:6968. [PMID: 39138203 PMCID: PMC11322157 DOI: 10.1038/s41467-024-51413-7] [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: 05/27/2024] [Accepted: 08/06/2024] [Indexed: 08/15/2024] Open
Abstract
The use of pneumococcal conjugate vaccine (PCV) schedules with fewer doses are being considered to reduce costs and improve access, particularly in low- and middle-income countries. While several studies have assessed their immunogenicity, there are limited data on their potential for long-term immune protection, as assessed by pneumococcal serotype-specific memory B cell (Bmem) responses. This current study reports secondary outcome data that aims to compare Bmem responses following reduced-dose (0 + 1 and 1 + 1) schedules of PCV10 and PCV13 in Vietnamese infants from our randomised-controlled trial (trial registration number NCT03098628). Following vaccination at 12 months of age, Bmem levels for most serotypes peaked seven days post-vaccination and were higher in magnitude for the 1 + 1 than 0 + 1 schedules and for PCV13 than PCV10. Furthermore, Bmem did not wane as rapidly as IgG levels by 24 months of age. Further studies are needed to assess the use of Bmem as markers of long-term protection against pneumococcal carriage and disease, which is crucial to generate data for immunisation program decision-making.
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Affiliation(s)
- Darren Suryawijaya Ong
- Infection, Immunity & Global Health, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Thanh V Phan
- Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Beth Temple
- Infection, Immunity & Global Health, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Zheng Quan Toh
- Infection, Immunity & Global Health, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Cattram Duong Nguyen
- Infection, Immunity & Global Health, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
| | - Kien Vientrung
- Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | | | - Vo Thi Trang Dai
- Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Kathryn Bright
- Infection, Immunity & Global Health, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Hau Phuc Tran
- Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Rachel Ann Higgins
- Infection, Immunity & Global Health, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Yin Bun Cheung
- Centre for Quantitative Medicine and Program in Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Tampere Center for Child, Adolescent and Maternal Health Research, Tampere University, Tampere, Finland
| | - Thuong Vu Nguyen
- Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Kim Mulholland
- Infection, Immunity & Global Health, Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Paul Vincent Licciardi
- Infection, Immunity & Global Health, Murdoch Children's Research Institute, Parkville, VIC, Australia.
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia.
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Gallagher KE, Adetifa IMO, Mburu C, Bottomley C, Akech D, Karani A, Pearce E, Wang Y, Kagucia EW, Goldblatt D, Hammitt LL, Scott JAG. Population immunity to pneumococcal serotypes in Kilifi, Kenya, before and 6 years after the introduction of PCV10 with a catch-up campaign: an observational study of cross-sectional serosurveys. THE LANCET. INFECTIOUS DISEASES 2023; 23:1291-1301. [PMID: 37429307 DOI: 10.1016/s1473-3099(23)00206-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/13/2023] [Accepted: 03/27/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND In Kilifi (Kenya), a pneumococcal conjugate vaccine (PCV10) was introduced in 2011 in infants (aged <1 year, 3 + 0 schedule) with a catch-up campaign in children aged 1-4 years. We aimed to measure the effect of PCV10 on population immunity. METHODS In this observational study, repeated cross-sectional serosurveys were conducted in independent random samples of 500 children younger than 15 years every 2 years between 2009 and 2017. During these surveys, blood samples were collected by venesection. Concentrations of anti-capsular IgGs against vaccine serotypes (VTs) 1, 4, 5, 6B, 7F, 9V, 14, 18C, 19F, and 23F, and against serotypes 6A and 19A, were assayed by ELISA. We plotted the geometric mean concentrations (GMCs) by birth year to visualise age-specific antibody profiles. In infants, IgG concentrations of 0·35 μg/mL or higher were considered protective. FINDINGS Of 3673 volunteers approached, 2152 submitted samples for analysis across the five surveys. Vaccine introduction resulted in an increase in the proportion of young children with protective IgG concentrations, compared with before vaccine introduction (from 0-33% of infants with VT-specific levels over the correlate of protection in 2009, to 60-94% of infants in 2011). However, among those vaccinated in infancy, GMCs of all ten VTs had waned rapidly by the age of 1, but rose again later in childhood. GMCs among children aged 10-14 years were consistently high over time (eg, the range of GMCs across survey rounds were between 0·45 μg/mL and 1·00 μg/mL for VT 23F and between 2·00 μg/mL and 3·11 μg/mL for VT 19F). INTERPRETATION PCV10 in a 3 + 0 schedule elicited protective IgG levels during infancy, when disease risk is high. The high antibody levels in children aged 10-14 years might indicate continued exposure to vaccine serotypes due to residual carriage or to memory responses to cross-reactive antigens. Despite rapid waning of IgG after vaccination, disease incidence among young children in this setting remains low, suggesting that lower thresholds of antibody, or other markers of immunity (eg, memory B cells), may be needed to assess population protection among children who have aged past infancy. FUNDING Gavi, the Vaccine Alliance; Wellcome Trust.
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Affiliation(s)
- Katherine E Gallagher
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
| | - Ifedayo M O Adetifa
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Christian Bottomley
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Donald Akech
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Angela Karani
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Emma Pearce
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Yanyun Wang
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | | | - David Goldblatt
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Laura L Hammitt
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - J Anthony G Scott
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Higgins RA, Temple B, Dai VTT, Phan TV, Toan NT, Spry L, Toh ZQ, Nation ML, Ortika BD, Uyen DY, Cheung YB, Nguyen CD, Bright K, Hinds J, Balloch A, Smith-Vaughan H, Huu TN, Mulholland K, Satzke C, Licciardi PV. IMMUNOGENICITY AND IMPACT ON NASOPHARYNGEAL CARRIAGE OF A SINGLE DOSE OF PCV10 GIVEN TO VIETNAMESE CHILDREN AT 18 MONTHS OF AGE. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2021; 16:100273. [PMID: 34590071 PMCID: PMC8453212 DOI: 10.1016/j.lanwpc.2021.100273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/12/2021] [Accepted: 08/24/2021] [Indexed: 11/04/2022]
Abstract
Background This study investigated the immunogenicity and impact on nasopharyngeal carriage of a single dose of PCV10 given to 18-month-old Vietnamese children. This information is important for countries considering catch-up vaccination during PCV introduction and in the context of vaccination during humanitarian crises. Methods Two groups of PCV-naïve children within the Vietnam Pneumococcal Project received PCV10 (n=197) or no PCV (unvaccinated; n=199) at 18 months of age. Blood samples were collected at 18, 19, and 24 months of age, and nasopharyngeal swabs at 18 and 24 months of age. Immunogenicity was assessed by measuring serotype-specific IgG, opsonophagocytosis (OPA) and memory B cells (Bmem). Pneumococci were detected and quantified using real-time PCR and serotyped by microarray. Findings At 19 months of age, IgG and OPA responses were higher in the PCV10 group compared with the unvaccinated group for all PCV10 serotypes and cross-reactive serotypes 6A and 19A. This was sustained out to 24 months of age, at which point PCV10-type carriage was 60% lower in the PCV10 group than the unvaccinated group. Bmem levels increased between 18 and 24 months of age in the vaccinated group. Interpretation We demonstrate strong protective immune responses in vaccinees following a single dose of PCV10 at 18 months of age, and a potential impact on herd protection through a substantial reduction in vaccine-type carriage. A single dose of PCV10 in the second year of life could be considered as part of catch-up campaigns or in humanitarian crises to protect children at high-risk of pneumococcal disease.
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Affiliation(s)
- Rachel A Higgins
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia
| | - Beth Temple
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia.,Global Health, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.,Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Vo Thi Trang Dai
- Microbiology and Immunology, Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Thanh V Phan
- Microbiology and Immunology, Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nguyen Trong Toan
- Department of Disease Control and Prevention, Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Leena Spry
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia
| | - Zheng Quan Toh
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Monica L Nation
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia
| | - Belinda D Ortika
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia
| | - Doan Y Uyen
- Department of Disease Control and Prevention, Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Yin Bun Cheung
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore.,Centre for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Cattram D Nguyen
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Kathryn Bright
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia
| | - Jason Hinds
- Institute for Infection and Immunity, St George's, University of London, London, UK.,BUGS Bioscience, London Bioscience Innovation Centre, London, UK
| | - Anne Balloch
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia
| | - Heidi Smith-Vaughan
- Global Health, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Tran Ngoc Huu
- Department of Disease Control and Prevention, Pasteur Institute of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Kim Mulholland
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Catherine Satzke
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia.,Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, The University of Melbourne, Australia
| | - Paul V Licciardi
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Australia
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Fecher P, Caspell R, Naeem V, Karulin AY, Kuerten S, Lehmann PV. B Cells and B Cell Blasts Withstand Cryopreservation While Retaining Their Functionality for Producing Antibody. Cells 2018; 7:E50. [PMID: 29857548 PMCID: PMC6028916 DOI: 10.3390/cells7060050] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 05/02/2018] [Accepted: 05/22/2018] [Indexed: 12/18/2022] Open
Abstract
In individuals who have once developed humoral immunity to an infectious/foreign antigen, the antibodies present in their body can mediate instant protection when the antigen re-enters. Such antigen-specific antibodies can be readily detected in the serum. Long term humoral immunity is, however, also critically dependent on the ability of memory B cells to engage in a secondary antibody response upon re-exposure to the antigen. Antibody molecules in the body are short lived, having a half-life of weeks, while memory B cells have a life span of decades. Therefore, the presence of serum antibodies is not always a reliable indicator of B cell memory and comprehensive monitoring of humoral immunity requires that both serum antibodies and memory B cells be assessed. The prevailing view is that resting memory B cells and B cell blasts in peripheral blood mononuclear cells (PBMC) cannot be cryopreserved without losing their antibody secreting function, and regulated high throughput immune monitoring of B cell immunity is therefore confined to-and largely limited by-the need to test freshly isolated PBMC. Using optimized protocols for freezing and thawing of PBMC, and four color ImmunoSpot® analysis for the simultaneous detection of all immunoglobulin classes/subclasses we show here that both resting memory B cells and B cell blasts retain their ability to secrete antibody after thawing, and thus demonstrate the feasibility of B cell immune monitoring using cryopreserved PBMC.
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Affiliation(s)
- Philipp Fecher
- Research & Development Department, Cellular Technology Limited, Shaker Heights, OH 44122, USA.
- Institute of Anatomy and Cell Biology, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany.
| | - Richard Caspell
- Research & Development Department, Cellular Technology Limited, Shaker Heights, OH 44122, USA.
| | - Villian Naeem
- Research & Development Department, Cellular Technology Limited, Shaker Heights, OH 44122, USA.
| | - Alexey Y Karulin
- Research & Development Department, Cellular Technology Limited, Shaker Heights, OH 44122, USA.
| | - Stefanie Kuerten
- Institute of Anatomy and Cell Biology, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany.
| | - Paul V Lehmann
- Research & Development Department, Cellular Technology Limited, Shaker Heights, OH 44122, USA.
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Nayakwadi Singer M, Heath C, Muinde J, Gildengorin V, Mutuku FM, Vu D, Mukoko D, King CL, Malhotra IJ, King CH, LaBeaud AD. Pneumococcal Vaccine Response After Exposure to Parasites in Utero, in Infancy, or Mid-Childhood. Pediatrics 2017; 139:peds.2016-2781. [PMID: 28302673 PMCID: PMC5369673 DOI: 10.1542/peds.2016-2781] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Streptococcus pneumoniae is a leading cause of mortality before age 5, but few studies examine details of childhood response to pneumococcal vaccine in less-developed settings. Although malnutrition, HIV, and concurrent infections can impair response, evidence suggests that chronic parasitic infections can also contribute to poor vaccination results. The objective of this study was to determine whether response to pneumococcal vaccine varied among children either exposed to parasitic infections in utero, previously infected in infancy, or infected at the time of immunization. METHODS Children from a 2006 to 2010 maternal-infant cohort were eligible for the current study. Children were screened for malaria, schistosomiasis, filariasis, intestinal helminths, and protozoa. Data on in utero exposure and early life infections were linked, and baseline antipneumococcal immunoglobulin G levels and nasopharyngeal carrier status were determined. Participants received decavalent pneumococcal vaccine, and 4 weeks later, serology was repeated to assess vaccine response. RESULTS A total of 281 children were included. Preimmunity was associated with greater postvaccination increments in anti-pneumococcal polysaccharide immunoglobulin G, especially serotypes 4, 7, 9, 18C, and 19. Present-day growth stunting was independently associated with weaker responses to 1, 4, 6B, 7, 9V, and 19. Previous exposure to Trichuris was associated with stronger responses to 1, 5, 6B, 7, 18C, and 23, but other parasite exposures were not consistently associated with response. CONCLUSIONS In our cohort, hyporesponsiveness to pneumococcal conjugate vaccine was associated with growth stunting but not parasite exposure. Parasite-related vaccine response deficits identified before age 3 do not persist into later childhood.
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Affiliation(s)
- Monica Nayakwadi Singer
- Division of Pediatric Infectious Diseases, UCSF Benioff Children's Hospital Oakland and Children's Hospital Oakland Research Institute, Oakland, California;
| | - Claire Heath
- Division of Pediatric Infectious Diseases, Stanford School of Medicine, Palo Alto, California
| | - Jackson Muinde
- Division of Vector Borne and Neglected Tropical Diseases, Ministry of Public Health and Sanitation, Nairobi, Kenya
| | - Virginia Gildengorin
- Division of Pediatric Infectious Diseases, UCSF Benioff Children’s Hospital Oakland and Children’s Hospital Oakland Research Institute, Oakland, California
| | | | - David Vu
- Division of Pediatric Infectious Diseases, Stanford School of Medicine, Palo Alto, California
| | - Dunstan Mukoko
- Division of Vector Borne and Neglected Tropical Diseases, Ministry of Public Health and Sanitation, Nairobi, Kenya
| | - Christopher L. King
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio
| | - Indu J. Malhotra
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio
| | - Charles H. King
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio
| | - A. Desirée LaBeaud
- Division of Pediatric Infectious Diseases, Stanford School of Medicine, Palo Alto, California
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Lindstrand A, Kalyango J, Alfvén T, Darenberg J, Kadobera D, Bwanga F, Peterson S, Henriques-Normark B, Källander K. Pneumococcal Carriage in Children under Five Years in Uganda-Will Present Pneumococcal Conjugate Vaccines Be Appropriate? PLoS One 2016; 11:e0166018. [PMID: 27829063 PMCID: PMC5102345 DOI: 10.1371/journal.pone.0166018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 09/21/2016] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Pneumonia is the major cause of death in children globally, with more than 900,000 deaths annually in children under five years of age. Streptococcus pneumoniae causes most deaths, most often in the form of community acquired pneumonia. Pneumococcal conjugate vaccines (PCVs) are currently being implemented in many low-income countries. PCVs decrease vaccine-type pneumococcal carriage, a prerequisite for invasive pneumococcal disease, and thereby affects pneumococcal disease and transmission. In Uganda, PCV was launched in 2014, but baseline data is lacking for pneumococcal serotypes in carriage. OBJECTIVES To study pneumococcal nasopharyngeal carriage and serotype distribution in children under 5 years of age prior to PCV introduction in Uganda. METHODS Three cross-sectional pneumococcal carriage surveys were conducted in 2008, 2009 and 2011, comprising respectively 150, 587 and 1024 randomly selected children aged less than five years from the Iganga/Mayuge Health and Demographic Surveillance Site. The caretakers were interviewed about illness history of the child and 1723 nasopharyngeal specimens were collected. From these, 927 isolates of S. pneumoniae were serotyped. RESULTS Overall, the carriage rate of S. pneumoniae was 56% (957/1723). Pneumococcal carriage was associated with illness on the day of the interview (OR = 1.50, p = 0.04). The most common pneumococcal serotypes were in descending order 19F (16%), 23F (9%), 6A (8%), 29 (7%) and 6B (7%). One percent of the strains were non-typeable. The potential serotype coverage rate for PCV10 was 42% and 54% for PCV13. CONCLUSION About half of circulating pneumococcal serotypes in carriage in the Ugandan under-five population studied was covered by available PCVs.
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Affiliation(s)
- Ann Lindstrand
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Public Health Agency of Sweden, Stockholm, Sweden
- * E-mail:
| | - Joan Kalyango
- Makerere University School of Public Health, Kampala, Uganda
| | - Tobias Alfvén
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Sachs’ Children and Youth Hospital, Stockholm, Sweden
| | | | - Daniel Kadobera
- Makerere University School of Public Health, Kampala, Uganda
- Ministry of Health, Kampala, Uganda
- Health and Demographic Surveillance Site, Iganga/Mayuge, Uganda
| | - Freddie Bwanga
- Makerere University Faculty of Medicine, Kampala, Uganda
| | - Stefan Peterson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Makerere University School of Public Health, Kampala, Uganda
- Department of International Maternal and Child health, Women´s and children´s health, Uppsala University, Uppsala, Sweden
| | - Birgitta Henriques-Normark
- Public Health Agency of Sweden, Stockholm, Sweden
- Department of Microbiology, Tumor and Cellbiology, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Microbiology, Karolinska University hospital, Stockholm, Sweden
| | - Karin Källander
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Makerere University School of Public Health, Kampala, Uganda
- Malaria Consortium, London, United Kingdom
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