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Golden AR, Lefebvre B, Deceuninck G, Brousseau N, De Wals P, Quach C, Demczuk WHB, Martin I. Clonal diversity of Streptococcus pneumoniae serotype 19A collected from children < 5 years old in Québec, Canada, 2016-2021. Vaccine 2023; 41:6612-6618. [PMID: 37758569 DOI: 10.1016/j.vaccine.2023.09.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/12/2023] [Accepted: 09/20/2023] [Indexed: 09/29/2023]
Abstract
Streptococcus pneumoniae serotype 19A is a highly diverse, often antimicrobial-resistant Gram-positive bacterium which can cause invasive pneumococcal disease (IPD). In 2021, public health authorities in the Canadian province of Québec observed an increase of serotype 19A IPD in children <5 years. The purpose of this study was to determine the clonal composition of serotype 19A isolates collected from this age group in Québec, from 2016 to 2021. Forty-one and 37 IPD isolates from children <5 years from Québec and the remainder of Canada, respectively, were sequenced using the Illumina NextSeq platform. Phylogenetic analysis using SNVPhyl identified three clusters, corresponding to three common clones of serotype 19A: CC199, CC320 and ST695. CC199, predominantly represented by ST416, accounted for similar proportions of serotype 19A isolates collected from children in Québec (19.5 %) and other Canadian jurisdictions (OCJs, 21.6 %), with significant presence of ermB (62.5 % and 60 % of ST416 isolates, respectively). CC320 was more commonly identified from OCJs in comparison to Québec (18.9 % vs. 7.3 %, respectively), but were highly antimicrobial-resistant regardless of region. ST695 was the most common clone of serotype 19A collected in Québec from children <5 years, representing 65.9 % of isolates collected over the study period (40.5 % of isolates collected in OCJs). Phylogenetic analysis identified geographical differences in ST695 across Canada; including a large clade specific to Québec (with both susceptible and macrolide-resistant [ermB] subclades), and a separate macrolide-resistant (mefA) clade associated with OCJs. The Québec-specific ermB-ST695 clone represented 48.1 % of ST695 collected from the province. Continued genomic surveillance of S. pneumoniae serotype 19A is required to: i) track the prevalence and clonal composition of serotype 19A in Québec in future years; ii) characterize the clonal distribution of serotype 19A in adult populations; and iii) monitor whether the currently geographically restricted ermB-ST695 clone observed in Québec expands to OCJs.
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Affiliation(s)
- Alyssa R Golden
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada.
| | - Brigitte Lefebvre
- Laboratoire de santé publique du Québec, Institut national de santé publique du Québec, Sainte-Anne-de-Bellevue, Québec, Canada
| | - Geneviève Deceuninck
- Centre de recherche du Centre hospitalier universitaire de Québec, Équipe de recherche en vaccination, Québec, QC, Canada
| | - Nicholas Brousseau
- Centre de recherche du Centre hospitalier universitaire de Québec, Équipe de recherche en vaccination, Québec, QC, Canada; Institut national de santé publique du Québec, Direction des risques biologiques, Québec, QC, Canada
| | - Philippe De Wals
- Institut national de santé publique du Québec, Direction des risques biologiques, Québec, QC, Canada; Département de médecine sociale et préventive, Université Laval, Québec, QC, Canada
| | - Caroline Quach
- Department of Microbiology, Infectious Diseases and Immunology, University of Montreal, Montreal, QC, Canada
| | - Walter H B Demczuk
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Irene Martin
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
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McKenna S, Huse KK, Giblin S, Pearson M, Majid Al Shibar MS, Sriskandan S, Matthews S, Pease JE. The Role of Streptococcal Cell-Envelope Proteases in Bacterial Evasion of the Innate Immune System. J Innate Immun 2021; 14:69-88. [PMID: 34649250 PMCID: PMC9082167 DOI: 10.1159/000516956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 04/19/2021] [Indexed: 11/19/2022] Open
Abstract
Bacteria possess the ability to evolve varied and ingenious strategies to outwit the host immune system, instigating an evolutionary arms race. Proteases are amongst the many weapons employed by bacteria, which specifically cleave and neutralize key signalling molecules required for a coordinated immune response. In this article, we focus on a family of S8 subtilisin-like serine proteases expressed as cell-envelope proteases (CEPs) by group A and group B streptococci. Two of these proteases known as Streptococcus pyogenes CEP (SpyCEP) and C5a peptidase cleave the chemokine CXCL8 and the complement fragment C5a, respectively. Both CXCL8 and C5a are potent neutrophil-recruiting chemokines, and by neutralizing their activity, streptococci evade a key defence mechanism of innate immunity. We review the mechanisms by which CXCL8 and C5a recruit neutrophils and the characterization of SpyCEP and C5a peptidase, including both in vitro and in vivo studies. Recently described structural insights into the function of this CEP family are also discussed. We conclude by examining the progress of prototypic vaccines incorporating SpyCEP and C5a peptidase in their preparation. Since streptococci-producing SpyCEP and C5a peptidase are responsible for a considerable global disease burden, targeting these proteases by vaccination strategies or by small-molecule antagonists should provide protection from and promote the resolution of streptococcal infections.
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Affiliation(s)
- Sophie McKenna
- Department of Life Sciences, Imperial College London, London, United Kingdom
| | - Kristin Krohn Huse
- Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Sean Giblin
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Max Pearson
- Department of Infectious Disease, Imperial College London, London, United Kingdom
| | | | - Shiranee Sriskandan
- Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Stephen Matthews
- Department of Life Sciences, Imperial College London, London, United Kingdom
| | - James Edward Pease
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
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Reslan L, Finianos M, Bitar I, Moumneh MB, Araj GF, Zaghlout A, Boutros C, Jisr T, Nabulsi M, Kara Yaccoub G, Hamze M, Osman M, Bou Raad E, Hrabak J, Matar GM, Dbaibo G. The Emergence of Invasive Streptococcus pneumoniae Serotype 24F in Lebanon: Complete Genome Sequencing Reveals High Virulence and Antimicrobial Resistance Characteristics. Front Microbiol 2021; 12:637813. [PMID: 33746930 PMCID: PMC7967862 DOI: 10.3389/fmicb.2021.637813] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 01/29/2021] [Indexed: 12/16/2022] Open
Abstract
Background Invasive pneumococcal disease (IPD) remains a global health problem. IPD incidence has significantly decreased by the use of pneumococcal conjugate vaccines (PCV). Nevertheless, non-PCV serotypes remain a matter of concern. Eight Streptococcus pneumoniae serotype 24F isolates, belonging to a non-PCV serotype, were detected through the Lebanese Inter-Hospital Pneumococcal Surveillance Program. The aim of the study is to characterize phenotypic and genomic features of the 24F isolates in Lebanon. Methods WGS using long reads sequencing (PacBio) was performed to produce complete circular genomes and to determine clonality, antimicrobial resistance and virulence determinants. Results The sequencing results yielded eight closed circular genomes. Three multilocus sequence typing (MLST) types were identified (ST11618, ST14184, ST15253). Both MLST and WGS analyses revealed that these isolates from Lebanon were genetically homogenous belonging to clonal complex CC230 and clustered closely with isolates originating from Canada, United States of America, United Kingdom and Iceland. Their penicillin binding protein profiles correlated with both β-lactam susceptibility patterns and MLST types. Moreover, the isolates harbored the macrolide and tetracycline resistance genes and showed a similar virulence gene profile. To our knowledge, this study represents the first report of complete phenotypic and genomic characterization of the emerging Streptococcus pneumoniae, serotype 24F, in the Middle East and North Africa region.
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Affiliation(s)
- Lina Reslan
- Center for Infectious Diseases Research (CIDR) and WHO Collaborating Center for Reference and Research on Bacterial Pathogens, American University of Beirut, Beirut, Lebanon
| | - Marc Finianos
- Department of Microbiology, Faculty of Medicine and University Hospital in Plzen, Charles University, Plzen, Czechia
| | - Ibrahim Bitar
- Department of Microbiology, Faculty of Medicine and University Hospital in Plzen, Charles University, Plzen, Czechia
| | - Mohamad Bahij Moumneh
- Center for Infectious Diseases Research (CIDR) and WHO Collaborating Center for Reference and Research on Bacterial Pathogens, American University of Beirut, Beirut, Lebanon
| | - George F Araj
- Center for Infectious Diseases Research (CIDR) and WHO Collaborating Center for Reference and Research on Bacterial Pathogens, American University of Beirut, Beirut, Lebanon.,Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Alissar Zaghlout
- Center for Infectious Diseases Research (CIDR) and WHO Collaborating Center for Reference and Research on Bacterial Pathogens, American University of Beirut, Beirut, Lebanon
| | - Celina Boutros
- Center for Infectious Diseases Research (CIDR) and WHO Collaborating Center for Reference and Research on Bacterial Pathogens, American University of Beirut, Beirut, Lebanon
| | - Tamima Jisr
- Department of Laboratory and Blood, Makassed General Hospital, Beirut, Lebanon
| | | | | | - Monzer Hamze
- Department of Microbiology, Nini Hospital, Tripoli, Lebanon
| | - Marwan Osman
- El-Youssef Hospital Center, Department of Clinical Laboratory, Halba, Lebanon
| | - Elie Bou Raad
- El-Youssef Hospital Center, Department of Clinical Laboratory, Halba, Lebanon
| | - Jaroslav Hrabak
- Department of Microbiology, Faculty of Medicine and University Hospital in Plzen, Charles University, Plzen, Czechia
| | - Ghassan M Matar
- Center for Infectious Diseases Research (CIDR) and WHO Collaborating Center for Reference and Research on Bacterial Pathogens, American University of Beirut, Beirut, Lebanon.,Department of Experimental Pathology, Immunology, and Microbiology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Ghassan Dbaibo
- Center for Infectious Diseases Research (CIDR) and WHO Collaborating Center for Reference and Research on Bacterial Pathogens, American University of Beirut, Beirut, Lebanon.,Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
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Emergence of serotype 19A Streptococcus pneumoniae after PCV10 associated with a ST320 in adult population, in Porto Alegre, Brazil. Epidemiol Infect 2020; 147:e93. [PMID: 30869012 PMCID: PMC6518833 DOI: 10.1017/s0950268819000013] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Use of pneumococcal conjugate vaccines has caused emergence of non-vaccine serotypes. No Brazilian data specifically about serotype 19A are available. We aimed to evaluate the frequency of occurrence, susceptibility profile and molecular epidemiology of serotype 19A before and after vaccine introduction in Brazil. Pneumococcal identification was performed by the conventional method. Strain serotype was determined by multiplex polymerase chain reaction (PCR) and/or Quellung reaction. Resistance was determined by Etest® and PCR was performed to determine the presence of macrolide resistance genes, ermB and/or mefA. Pneumococci were typed by Multilocus Sequence Typing. Thirty-eight serotype 19A Streptococcus pneumoniae were recovered, mostly from invasive diseases. Prevalence of serotype 19A increased following vaccination (from 3.5% before vaccination to 8.1% after, p = 0.04196). Non-susceptibility increased to most antimicrobials after vaccine introduction and was associated with clonal complex (CC)320. MLST showed nine different STs, which were grouped in one main CC: CC320 (63.9%). During the post-vaccination era, the frequency of this serotype increased significantly from 1.2% in 2011 to 18.5% in 2014 (p = 0.00001), with a concomitant decrease in the genetic variability: ST320 consistently predominated after vaccine-introduction (61.1%). Overall, our results showed a post-PCV10 increase in the frequency of serotype 19A. This was accompanied by a selection of CC320 and antimicrobial resistance.
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Ritchie ND, Ritchie R, Bayes HK, Mitchell TJ, Evans TJ. IL-17 can be protective or deleterious in murine pneumococcal pneumonia. PLoS Pathog 2018; 14:e1007099. [PMID: 29813133 PMCID: PMC5993294 DOI: 10.1371/journal.ppat.1007099] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/08/2018] [Accepted: 05/14/2018] [Indexed: 12/21/2022] Open
Abstract
Streptococcus pneumoniae is the major bacterial cause of community-acquired pneumonia, and the leading agent of childhood pneumonia deaths worldwide. Nasal colonization is an essential step prior to infection. The cytokine IL-17 protects against such colonization and vaccines that enhance IL-17 responses to pneumococcal colonization are being developed. The role of IL-17 in host defence against pneumonia is not known. To address this issue, we have utilized a murine model of pneumococcal pneumonia in which the gene for the IL-17 cytokine family receptor, Il17ra, has been inactivated. Using this model, we show that IL-17 produced predominantly from γδ T cells protects mice against death from the invasive TIGR4 strain (serotype 4) which expresses a relatively thin capsule. However, in pneumonia produced by two heavily encapsulated strains with low invasive potential (serotypes 3 and 6B), IL-17 significantly enhanced mortality. Neutrophil uptake and killing of the serotype 3 strain was significantly impaired compared to the serotype 4 strain and depletion of neutrophils with antibody enhanced survival of mice infected with the highly encapsulated SRL1 strain. These data strongly suggest that IL-17 mediated neutrophil recruitment to the lungs clears infection from the invasive TIGR4 strain but that lung neutrophils exacerbate disease caused by the highly encapsulated pneumococcal strains. Thus, whilst augmenting IL-17 immune responses against pneumococci may decrease nasal colonization, this may worsen outcome during pneumonia caused by some strains.
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MESH Headings
- Animals
- Bacteremia/immunology
- Bacteremia/microbiology
- Bacterial Capsules/immunology
- Bacterial Capsules/ultrastructure
- Bronchoalveolar Lavage Fluid/cytology
- Bronchoalveolar Lavage Fluid/microbiology
- Disease Models, Animal
- Interleukin-17/immunology
- Lung/cytology
- Lung/enzymology
- Lung/immunology
- Mice
- Mice, Inbred C57BL
- Mice, Knockout
- Microscopy, Electron, Transmission
- Microscopy, Fluorescence
- Nasopharynx/microbiology
- Neutrophils/cytology
- Neutrophils/immunology
- Peroxidase/metabolism
- Phagocytosis
- Pneumonia, Pneumococcal/immunology
- Pneumonia, Pneumococcal/mortality
- Pneumonia, Pneumococcal/prevention & control
- Receptors, Antigen, T-Cell, gamma-delta/genetics
- Receptors, Antigen, T-Cell, gamma-delta/immunology
- Receptors, Interleukin-17/genetics
- Specific Pathogen-Free Organisms
- Streptococcus pneumoniae/immunology
- Streptococcus pneumoniae/ultrastructure
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Affiliation(s)
- Neil D. Ritchie
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Ryan Ritchie
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Hannah K. Bayes
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Tim J. Mitchell
- Institute of Microbiology and Infection, College of Medical and Dental Sciences University of Birmingham, Birmingham, United Kingdom
| | - Tom J. Evans
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
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Neves FPG, Cardoso NT, Snyder RE, Marlow MA, Cardoso CAA, Teixeira LM, Riley LW. Pneumococcal carriage among children after four years of routine 10-valent pneumococcal conjugate vaccine use in Brazil: The emergence of multidrug resistant serotype 6C. Vaccine 2017; 35:2794-2800. [PMID: 28431817 DOI: 10.1016/j.vaccine.2017.04.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 04/09/2017] [Accepted: 04/10/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND In 2010, the 10-valent pneumococcal conjugate vaccine (PCV10) was introduced free of charge in Brazil as part of the public immunization program. Here we investigated the carriage prevalence, colonization risk factors, capsular types, and antimicrobial resistance among pneumococcal isolates obtained from children in Brazil four years after routine PCV10 use. METHODS Between September and December 2014, we conducted a cross-sectional study among children<6years old who attended one public and two private clinics in Niterói, RJ, Brazil to evaluate pneumococcal nasopharyngeal carriage. Antimicrobial susceptibility and capsular types were determined for all isolates. RESULTS Of 522 children, 118 (22.6%) were pneumococcal carriers. Being≥2years old, attending childcare center, presenting with any symptoms, having acute or chronic respiratory disease, and residing in a slum were associated with pneumococcal carriage. The most prevalent capsular types were 6C (14.5%), 15B/C (11.5%), 11A/D (9.2%), and 6A (7.6%). PCV10 serotypes represented 2.5%. All isolates were susceptible to levofloxacin, rifampicin, and vancomycin. Penicillin non-susceptible pneumococci (PNSP) comprised 39%, with penicillin and ceftriaxone MICs ranging from 0.12-8.0μg/ml and 0.012-1.0μg/ml, respectively. The 33 (28%) erythromycin-resistant isolates (MICs of 1.5 to >256μg/ml) displayed the cMLSB (72.7%) or M (27.3%) phenotypes, harboring the erm(B) and/or mef(A/E) genes. High non-susceptibility rates (>20%) to clindamycin, erythromycin, penicillin, and tetracycline were largely explained by the prevalence of multidrug resistant (MDR) serotype 6C isolates. CONCLUSIONS Effects of universal childhood PCV10 use on carriage were evident, with the near elimination of PCV10 serotypes. The emergence of MDR serotype 6C isolates, however, is a concern. Ongoing surveillance to monitor serotype 6C increase in invasive diseases is warranted.
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Affiliation(s)
- Felipe P G Neves
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, 530E Li Ka Shing Center, Berkeley, CA 94720, USA; Instituto Biomédico, Universidade Federal Fluminense, Rua Professor Hernani Melo, 101 São Domingos, Niterói, RJ 24210-130, Brazil.
| | - Nayara T Cardoso
- Instituto Biomédico, Universidade Federal Fluminense, Rua Professor Hernani Melo, 101 São Domingos, Niterói, RJ 24210-130, Brazil.
| | - Robert E Snyder
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, 530E Li Ka Shing Center, Berkeley, CA 94720, USA.
| | - Mariel A Marlow
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, 530E Li Ka Shing Center, Berkeley, CA 94720, USA.
| | - Claudete A A Cardoso
- Faculdade de Medicina, Universidade Federal Fluminense, Av. Marquês do Paraná, 303 Centro, Niterói, RJ 24033-900, Brazil.
| | - Lúcia M Teixeira
- Instituto de Microbiologia Paulo de Góes, Universidade Federal do Rio de Janeiro, Av. Carlos Chagas Filho, 373 - bloco I, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, RJ 21941-902, Brazil.
| | - Lee W Riley
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, 530E Li Ka Shing Center, Berkeley, CA 94720, USA.
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Genomic Epidemiology of Penicillin-Nonsusceptible Pneumococci with Nonvaccine Serotypes Causing Invasive Disease in the United States. J Clin Microbiol 2017; 55:1104-1115. [PMID: 28100596 DOI: 10.1128/jcm.02453-16] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 01/11/2017] [Indexed: 12/20/2022] Open
Abstract
Conjugate vaccination against seven pneumococcal serotypes (PCV7) reduced disease prevalence due to antibiotic-resistant strains throughout the 2000s. However, diseases caused by resistant nonvaccine type (NVT) strains increased. Some of these emerging strains were derived from vaccine types (VT) that had changed their capsule by recombination. The introduction of a vaccine targeting 13 serotypes (PCV13) in 2010 has led to concern that this scenario will repeat itself. We generated high-quality draft genomes from 265 isolates of NVT pneumococci not susceptible to penicillin (PNSP) in 2009 and compared them with the genomes of 581 isolates from 2012 to 2013 collected by the Active Bacterial Core surveillance (ABCs) of the Centers for Disease Control and Prevention (CDC). Of the seven sequence clusters (SCs) identified, three SCs fell into a single lineage associated with serogroup 23, which had an origin in 1908 as dated by coalescent analysis and included isolates with a divergent 23B capsule locus. Three other SCs represented relatively deep-branching lineages associated with serotypes 35B, 15A, and 15BC. In all cases, the resistant clones originated prior to 2010, indicating that PNSP are at present dominated by descendants of NVT clones present before vaccination. With one exception (15BC/ST3280), these SCs were related to clones identified by the Pneumococcal Molecular Epidemiology Network (PMEN). We conclude that postvaccine diversity in NVT PNSP between 2009 and 2013 was driven mainly by the persistence of preexisting strains rather than through de novo adaptation, with few cases of serotype switching. Future surveillance is essential for documenting the long-term dynamics and resistance of NVT PNSP.
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Liu EYM, Chang JC, Lin JC, Chang FY, Fung CP. Important Mutations Contributing to High-Level Penicillin Resistance in Taiwan 19F-14, Taiwan 23F-15, and Spain 23F-1 of Streptococcus pneumoniae Isolated from Taiwan. Microb Drug Resist 2016; 22:646-654. [PMID: 27042760 DOI: 10.1089/mdr.2015.0261] [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: 11/12/2022] Open
Abstract
Penicillin-resistant Streptococcus pneumoniae is a serious concern worldwide. In this study, we analyzed the cause of β-lactam resistance in pandemic multidrug-resistant clones. A total of 41 penicillin-nonsusceptible clinical isolates were collected from 1996 to 2012. Sero- and molecular typing confirmed that these isolates were clonal types of Taiwan19F-14, Taiwan23F-15, and Spain23F-1. Sero-switching was found in four isolates. All isolates were multidrug resistant. Sequencing analysis of the penicillin binding proteins (PBPs) was performed on PBP1a, 2b, and 2x, and a large number of mutations were identified in comparing to clinical penicillin-susceptible isolates and the recipient strain R6 used for homologous recombination. The T451A substitution was the key amino acid in PBP2b that contributed to penicillin resistance. T338A in PBP2x played a role in resistance and reached the highest level of resistance when combined with other mutations in PBP2x. High-level penicillin resistance could not be obtained without the combination of mutations in PBP1a with PBP2b and 2x. The amino acid substitutions in PBP1a, 2b, and 2x were the crucial factors for β-lactam resistance.
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Affiliation(s)
- Esther Yip-Mei Liu
- 1 Institute of Clinical Medicine, School of Medicine, National Yang-Ming University , Taipei, Taiwan
| | - Jen-Chang Chang
- 2 Institute of Infectious Diseases and Vaccinology, National Health Research Institutes , Zhunan, Taiwan
| | - Jung-Chung Lin
- 3 Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center , Taipei, Taiwan
| | - Feng-Yee Chang
- 3 Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center , Taipei, Taiwan
| | - Chang-Phone Fung
- 1 Institute of Clinical Medicine, School of Medicine, National Yang-Ming University , Taipei, Taiwan .,4 Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital and National Yang-Ming University , Taipei, Taiwan
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9
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Modified MLVA for Genotyping Queensland Invasive Streptococcus pneumoniae. PLoS One 2015; 10:e0121870. [PMID: 25923909 PMCID: PMC4414480 DOI: 10.1371/journal.pone.0121870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 02/20/2015] [Indexed: 11/25/2022] Open
Abstract
Background Globally, over 800 000 children under five die each year from infectious diseases caused by Streptococcus pneumoniae. To understand genetic relatedness between isolates, study transmission routes, assess the impact of human interventions e.g. vaccines, and determine infection sources, genotyping methods are required. The ‘gold standard’ genotyping method, Multi-Locus Sequence Typing (MLST), is useful for long-term and global studies. Another genotyping method, Multi-Locus Variable Number of Tandem Repeat Analysis (MLVA), has emerged as a more discriminatory, inexpensive and faster technique; however there is no universally accepted method and it is currently suitable for short-term and localised epidemiology studies. Currently Australia has no national MLST database, nor has it adopted any MLVA method for short-term or localised studies. This study aims to improve S. pneumoniae genotyping methods by modifying the existing MLVA techniques to be more discriminatory, faster, cheaper and technically less demanding than previously published MLVA methods and MLST. Methods Four different MLVA protocols, including a modified method, were applied to 317 isolates of serotyped invasive S. pneumoniae isolated from sterile body sites of Queensland children under 15 years from 2007–2012. MLST was applied to 202 isolates for comparison. Results The modified MLVA4 is significantly more discriminatory than the ‘gold standard’ MLST method. MLVA4 has similar discrimination compared to other MLVA techniques in this study). The failure to amplify particular loci in previous MLVA methods were minimised in MLVA4. Failure to amplify BOX-13 and Spneu19 were found to be serotype specific. Conclusion We have modified a highly discriminatory MLVA technique for genotyping Queensland invasive S. pneumoniae. MLVA4 has the ability to enhance our understanding of the pneumococcal epidemiology and the changing genetics of the pneumococcus in localised and short-term studies.
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Andam CP, Hanage WP. Mechanisms of genome evolution of Streptococcus. INFECTION GENETICS AND EVOLUTION 2014; 33:334-42. [PMID: 25461843 DOI: 10.1016/j.meegid.2014.11.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 11/05/2014] [Accepted: 11/07/2014] [Indexed: 10/24/2022]
Abstract
The genus Streptococcus contains 104 recognized species, many of which are associated with human or animal hosts. A globally prevalent human pathogen in this group is Streptococcus pneumoniae (the pneumococcus). While being a common resident of the upper respiratory tract, it is also a major cause of otitis media, pneumonia, bacteremia and meningitis, accounting for a high burden of morbidity and mortality worldwide. Recent findings demonstrate the importance of recombination and selection in driving the population dynamics and evolution of different pneumococcal lineages, allowing them to successfully evade the impacts of selective pressures such as vaccination and antibiotic treatment. We highlight the ability of pneumococci to respond to these pressures through processes including serotype replacement, capsular switching and horizontal gene transfer (HGT) of antibiotic resistance genes. The challenge in controlling this pathogen also lies in the exceptional genetic and phenotypic variation among different pneumococcal lineages, particularly in terms of their pathogenicity and resistance to current therapeutic strategies. The widespread use of pneumococcal conjugate vaccines, which target only a small subset of the more than 90 pneumococcal serotypes, provides us with a unique opportunity to elucidate how the processes of selection and recombination interact to generate a remarkable level of plasticity and heterogeneity in the pneumococcal genome. These processes also play an important role in the emergence and spread of multi-resistant strains, which continues to pose a challenge in disease control and/or eradication. The application of population of genomic approaches at different spatial and temporal scales will help improve strategies to control this global pathogen, and potentially other pathogenic streptococci.
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Affiliation(s)
- Cheryl P Andam
- Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA
| | - William P Hanage
- Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA.
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11
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[Pleuropneumonia and septic shock due to multiresistant Streptococcus pneumoniae serotype 19A treated with linezolid]. An Pediatr (Barc) 2014; 81:e22-3. [PMID: 24534007 DOI: 10.1016/j.anpedi.2013.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 12/18/2013] [Accepted: 12/26/2013] [Indexed: 11/20/2022] Open
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Increase of pneumococcal serotype 19A in Italy is due to expansion of the piliated clone ST416/CC199. J Med Microbiol 2013; 62:1220-1225. [DOI: 10.1099/jmm.0.061242-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The emergence of Streptococcus pneumoniae serotype 19A, following use of the heptavalent pneumococcal conjugate vaccine (PCV7), has been favoured by multiple antibiotic resistance of this serotype and by other unknown factors. The aim of this study was to examine 19A isolates from invasive pneumococcal diseases (IPD) obtained before and after PCV7 implementation to ascertain which characteristics, including the presence of pili, might have favoured the emergence of this serotype in Italy. All S. pneumoniae isolates from IPD collected at the Italian National Institute of Health in the years 2001–2003 and 2006–2009 were serotyped. The 19A isolates were submitted to antimicrobial susceptibility testing by Etest and were genotyped by a combination of pulsed field gel electrophoresis (PFGE) and Multi Locus Sequence Typing (MLST). The presence of the pilus islets PI-1 and PI-2 was detected by PCR assays targeting a marker gene in each islet. The proportion of 19A isolates from IPD significantly increased from 4 % in 2001–2003 to 12 % in 2006–2009. This was largely due to the expansion of a clone characterized by sequence type (ST) 416, clonal complex (CC) 199, already present in Italy before PCV7 implementation. This clone included isolates susceptible to penicillin and containing PI-1 genes. Other CCs contributed to the emergence of serotype 19A: CC63 and CC193, already present in 2001–2003, and new-emerging CCs or clones such as CC230, CC320 and ST5204, that include drug-resistant and/or pilus-positive isolates. The expansion of serotype 19A in Italy might have been favoured not only by antibiotic resistance, but also by other bacterial factors such as the presence of pili.
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Lamb KE, Flasche S, Diggle M, Inverarity D, Greenhalgh D, Jefferies JM, Smith A, Edwards GFS, Denham B, McMenamin J, McDonald E, Mitchell TJ, Clarke SC, Robertson C. Trends in serotypes and sequence types among cases of invasive pneumococcal disease in Scotland, 1999-2010. Vaccine 2013; 32:4356-63. [PMID: 23806244 DOI: 10.1016/j.vaccine.2013.05.079] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 04/22/2013] [Accepted: 05/20/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The 7-valent pneumococcal conjugate vaccine (Prevenar(®), Wyeth; PCV7) was introduced to the UK paediatric immunisation schedule in 2006. This study investigates trends in serotypes and multi locus sequence types (STs) among cases of invasive pneumococcal disease (IPD) in Scotland prior to, and following, the introduction of PCV7. METHODS Scottish Invasive Pneumococcal Disease Enhanced Surveillance has records of all cases of IPD in Scotland since 1999. Cases diagnosed from blood or cerebrospinal fluid isolates until 2010 were analysed. Logistic and poisson regression modelling was used to assess trends prior to and following the introduction of PCV7. RESULTS Prior to PCV7 use, on average 650 cases of IPD were reported each year; 12% occurred in those aged <5 years and 35% affected those aged over 65 years. Serotypes in PCV7 represented 47% of cases (68% in <5 year olds). The serotype and ST distribution was relatively stable with only serotype 1 and associated ST 306 showing an increasing trend. PCV7 introduction was associated with a 69% (95% CI: 50%, 80%) reduction in the incidence of IPD among those aged <5 years, a 57% (95% CI: 47%, 66%) reduction among those aged 5-64 years but no significant change among those aged 65 years and over where increases in non-PCV7 serotypes were observed. Serotypes which became more prevalent post-PCV7 are those which were associated with STs related to the PCV7 serotypes. CONCLUSIONS Routine serotyping and sequence typing in Scotland allowed the assessment of the relationship between the capsule and the clones in the post vaccination era. Changes in the distribution of serotypes post PCV7 introduction appear to be driven by associations between serotypes and STs prior to PCV7 introduction. This has implications for the possible effects of the introduction of higher valency vaccines and could aid in predicting replacement serotypes in IPD.
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Affiliation(s)
- Karen E Lamb
- Department of Mathematics and Statistics, University of Strathclyde, 26 Richmond Street, Glasgow, United Kingdom; Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, VIC, Australia.
| | - Stefan Flasche
- Department of Mathematics and Statistics, University of Strathclyde, 26 Richmond Street, Glasgow, United Kingdom; Immunisation, Hepatitis and Blood Safety Department, Health Protection Agency, 61 Colindale Avenue, London, United Kingdom
| | - Mathew Diggle
- Molecular Diagnostics East Midlands Pathology Clinical Microbiology Department, Queens Medical Centre, Nottingham, United Kingdom
| | - Donald Inverarity
- Department of Microbiology, Monklands Hospital, Monkscourt Avenue, Airdrie, United Kingdom
| | - David Greenhalgh
- Department of Mathematics and Statistics, University of Strathclyde, 26 Richmond Street, Glasgow, United Kingdom
| | - Johanna M Jefferies
- Molecular Microbiology Group, Sir Henry Wellcome Laboratories, Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom; Southampton NIHR Respiratory Biomedical Research Unit, University Hospital Southampton Foundation NHS Trust, Southampton, United Kingdom
| | - Andrew Smith
- Infection and Immunity Research Group, Glasgow Dental School, Faculty of Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Giles F S Edwards
- Scottish Haemophilus, Legionella, Meningococcus and Pneumococcus Reference Laboratory, Stobhill General Hospital, Glasgow, United Kingdom
| | - Barbara Denham
- Scottish Haemophilus, Legionella, Meningococcus and Pneumococcus Reference Laboratory, Stobhill General Hospital, Glasgow, United Kingdom
| | | | | | - Tim J Mitchell
- Institute of Microbiology and Infection, School of Immunity and Infection, University of Birmingham, Birmingham, United Kingdom
| | - Stuart C Clarke
- Molecular Microbiology Group, Sir Henry Wellcome Laboratories, Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom; Health Protection Agency, Southampton, United Kingdom; Southampton NIHR Respiratory Biomedical Research Unit, University Hospital Southampton Foundation NHS Trust, Southampton, United Kingdom
| | - Chris Robertson
- Department of Mathematics and Statistics, University of Strathclyde, 26 Richmond Street, Glasgow, United Kingdom; Health Protection Scotland, Glasgow, United Kingdom.
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Pneumococcal serotypes causing acute otitis media among children in Barcelona (1992-2011): emergence of the multiresistant clone ST320 of serotype 19A. Pediatr Infect Dis J 2013. [PMID: 23190779 DOI: 10.1097/inf.0b013e31827c54dc] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is scarce information about changes in serotypes and clonal types of Streptococcus pneumoniae causing acute otitis media (AOM) in recent years, particularly in European countries. METHODS Pneumococcal serotypes and clones from S. pneumoniae strains isolated from children with AOM who were attended at Hospital Sant Joan de Déu, Barcelona (1992 to 2011), were studied. Heptavalent pneumococcal conjugate vaccine (PCV7) was introduced in June 2001. We defined 3 periods: prevaccine period 1992 to 2001, early vaccine period 2002 to 2006 and late vaccine period 2007 to 2011. RESULTS There were 376 pneumococcal strains causing AOM, and 373 (99.2%) of them were serotyped. AOM caused by PCV7 serotypes declined significantly: 161 of 245 (65.7%) episodes in 1992 to 2001 versus 22 of 67 (32.8%) in 2002 to 2006 versus 8 of 61 (13.1%) in 2007 to 2011 P < 0.001. In the last period (2007 to 2011), the potential serotype coverage for the PCV10 was 16.4% and for the PCV13 was 68.9% (P < 0.001). Serotype 19A increased from 5.7% in 1992 to 2001 to 42.6% in 2007 to 2011 (P < 0.001). Among strains with penicillin minimal inhibitory concentration ≥0.12 μg/mL (n = 241), serotype 19A rose from 2.3% in the first period to 57.9 % in the last period (P < 0.001). The clonal-type ST320 was initially detected in 2005, and in the period 2007 to 2011, the ST320 was found in 72.7% of nonsusceptible serotype 19A isolates. CONCLUSIONS Among children with AOM, a rapid expansion of the multiresistant clone ST320 expressing serotype 19A has been observed in Barcelona. The implementation of PCV13, which includes this serotype, may decrease the prevalence of AOM and reduce antimicrobial resistance.
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Wyres KL, Lambertsen LM, Croucher NJ, McGee L, von Gottberg A, Liñares J, Jacobs MR, Kristinsson KG, Beall BW, Klugman KP, Parkhill J, Hakenbeck R, Bentley SD, Brueggemann AB. Pneumococcal capsular switching: a historical perspective. J Infect Dis 2013; 207:439-49. [PMID: 23175765 PMCID: PMC3537446 DOI: 10.1093/infdis/jis703] [Citation(s) in RCA: 134] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 09/18/2012] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Changes in serotype prevalence among pneumococcal populations result from both serotype replacement and serotype (capsular) switching. Temporal changes in serotype distributions are well documented, but the contribution of capsular switching to such changes is unknown. Furthermore, it is unclear to what extent vaccine-induced selective pressures drive capsular switching. METHODS Serotype and multilocus sequence typing data for 426 pneumococci dated from 1937 through 2007 were analyzed. Whole-genome sequence data for a subset of isolates were used to investigate capsular switching events. RESULTS We identified 36 independent capsular switch events, 18 of which were explored in detail with whole-genome sequence data. Recombination fragment lengths were estimated for 11 events and ranged from approximately 19.0 kb to ≥ 58.2 kb. Two events took place no later than 1960, and the imported DNA included the capsular locus and the nearby penicillin-binding protein genes pbp2x and pbp1a. CONCLUSIONS Capsular switching has been a regular occurrence among pneumococcal populations throughout the past 7 decades. Recombination of large DNA fragments (>30 kb), sometimes including the capsular locus and penicillin-binding protein genes, predated both vaccine introduction and widespread antibiotic use. This type of recombination has likely been an intrinsic feature throughout the history of pneumococcal evolution.
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Affiliation(s)
| | - Lotte M. Lambertsen
- Department of Microbiology Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark
| | - Nicholas J. Croucher
- Pathogen Genomics Team, Wellcome Trust Sanger Institute, Hinxton, United Kingdom
| | - Lesley McGee
- Streptococcus Laboratory, Centers for Disease Control and Prevention, and
| | - Anne von Gottberg
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Gauteng, South Africa
| | - Josefina Liñares
- Department of Microbiology, Bellvitge Hospital-CIBERes-IDIBELL-UB, Barcelona, Spain
| | - Michael R. Jacobs
- Department of Pathology, Case Western Reserve University, Cleveland, Ohio
| | - Karl G. Kristinsson
- Clinical Microbiology Department, Landspitali University Hospital and University of Iceland, Reykjavik;
| | - Bernard W. Beall
- Streptococcus Laboratory, Centers for Disease Control and Prevention, and
| | - Keith P. Klugman
- Hubert Department of Global Health, Emory University, Atlanta, Georgia
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Gauteng, South Africa
| | - Julian Parkhill
- Pathogen Genomics Team, Wellcome Trust Sanger Institute, Hinxton, United Kingdom
| | | | - Stephen D. Bentley
- Pathogen Genomics Team, Wellcome Trust Sanger Institute, Hinxton, United Kingdom
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Song JY, Nahm MH, Moseley MA. Clinical implications of pneumococcal serotypes: invasive disease potential, clinical presentations, and antibiotic resistance. J Korean Med Sci 2013; 28:4-15. [PMID: 23341706 PMCID: PMC3546102 DOI: 10.3346/jkms.2013.28.1.4] [Citation(s) in RCA: 127] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 11/08/2012] [Indexed: 12/27/2022] Open
Abstract
Streptococcus pneumoniae can asymptomatically colonize the nasopharynx and cause a diverse range of illnesses. This clinical spectrum from colonization to invasive pneumococcal disease (IPD) appears to depend on the pneumococcal capsular serotype rather than the genetic background. According to a literature review, serotypes 1, 4, 5, 7F, 8, 12F, 14, 18C, and 19A are more likely to cause IPD. Although serotypes 1 and 19A are the predominant causes of invasive pneumococcal pneumonia, serotype 14 remains one of the most common etiologic agents of non-bacteremic pneumonia in adults, even after 7-valent pneumococcal conjugate vaccine (PCV7) introduction. Serotypes 1, 3, and 19A pneumococci are likely to cause empyema and hemolytic uremic syndrome. Serotype 1 pneumococcal meningitis is prevalent in the African meningitis belt, with a high fatality rate. In contrast to the capsule type, genotype is more closely associated with antibiotic resistance. CC320/271 strains expressing serotype 19A are multidrug-resistant (MDR) and prevalent worldwide in the era of PCV7. Several clones of MDR serotype 6C pneumococci emerged, and a MDR 6D clone (ST282) has been identified in Korea. Since the pneumococcal epidemiology of capsule types varies geographically and temporally, a nationwide serosurveillance system is vital to establishing appropriate vaccination strategies for each country.
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Affiliation(s)
- Joon Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
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Changes in molecular epidemiology of streptococcus pneumoniae causing meningitis following introduction of pneumococcal conjugate vaccination in England and Wales. J Clin Microbiol 2012; 51:820-7. [PMID: 23269742 DOI: 10.1128/jcm.01917-12] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) in September 2006 has markedly reduced the burden of invasive pneumococcal disease (IPD) including meningitis in England and Wales. This study examined changes in the molecular epidemiology of pneumococcal isolates causing meningitis from July 2004 to June 2009. The Health Protection Agency conducts enhanced pneumococcal surveillance in England and Wales. In addition to serotyping, pneumococcal isolates causing meningitis were genotyped by multilocus sequence typing (MLST). A total of 1,030 isolates were both serotyped and genotyped over the 5-year period. Fifty-two serotypes, 238 sequence types (STs), and 87 clonal complexes were identified, with no significant difference in the yearly Simpson's diversity index values (range, 0.974 to 0.984). STs commonly associated with PCV7 serotypes declined following PCV implementation, with a proportionally greater decline in ST124 (commonly associated with serotype 14). No other ST showed significant changes in distribution, even within individual serotypes. Replacement disease following PCV7 introduction was mainly due to serotypes 1, 3, 7F, 19A, 22F, and 33F through clonal expansion. A single instance of possible capsule switching was identified where one ST4327 clone expressed a serotype 14 capsule in 2005 and a serotype 28A capsule in 2009. In 2008 to 2009, ST191 (7F) became the most prevalent clone causing meningitis (10.3%). Case fatality (145 fatalities/1,030 cases; 14.1%) was high across all age groups and serotype groups. Thus, the introduction of PCV7 resulted in an increase in non-PCV7 serotypes, including some not covered by the 13-valent vaccine, such as serotypes 22F and 33F, emphasizing the importance of long-term epidemiological and molecular surveillance.
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Esposito S, Marchese A, Tozzi AE, Rossi GA, Da Dalt L, Bona G, Pelucchi C, Schito GC, Principi N. Bacteremic pneumococcal community-acquired pneumonia in children less than 5 years of age in Italy. Pediatr Infect Dis J 2012; 31:705-10. [PMID: 22426300 DOI: 10.1097/inf.0b013e31825384ae] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study was designed to determine the proportion of bacteremic pneumococcal cases in a group of pediatric subjects with community-acquired pneumonia (CAP), the importance of the different serotypes and the impact of the currently available pneumococcal conjugate vaccines (PCVs). METHODS The study involved children who were ≤5 years with radiographically confirmed CAP admitted to hospital in Italy between September 2008 and March 2011. A diagnosis of laboratory-confirmed bacteremic pneumococcal CAP was made in the presence of a culture and/or real-time polymerase chain reaction (PCR) positive for Streptococcus pneumoniae. RESULTS A total of 510 children were included in the study. Pneumococcal CAP was diagnosed in 73 cases (14.3%): S. pneumoniae was identified by means of positive real-time PCR in 67 cases (91.8%), a positive blood culture in 1 (1.4%) and both in 5 (6.8%). Complicated pneumonia was observed significantly more often in the pneumococcal-positive cases (P=0.02) and empyema was the main complication (P=0.007). Serotype 19A was most frequently encountered (17 cases; 25.8%), followed by serotypes 14 (10 cases, 15.1%), 4 (5 cases, 7.6%) and 3 (4 cases, 6.1%). The theoretical coverage offered by the available PCVs was calculated to be 31% for PCV7, 37% for PCV10 and 71% for PCV13. CONCLUSIONS In Italy, bacteremic pneumococcal CAP accounts for a significant number of CAP cases in children who were ≤5 years, with serotypes 19A and 14 being the most frequent. This suggests that PCV13 is the best means of preventing pneumococcal CAP.
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Affiliation(s)
- Susanna Esposito
- Department of Maternal and Pediatric Sciences, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Santagati M, Scillato M, Patanè F, Aiello C, Stefani S. Bacteriocin-producing oral streptococci and inhibition of respiratory pathogens. ACTA ACUST UNITED AC 2012; 65:23-31. [DOI: 10.1111/j.1574-695x.2012.00928.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Revised: 12/21/2011] [Accepted: 01/04/2012] [Indexed: 11/29/2022]
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Song JH, Dagan R, Klugman KP, Fritzell B. The relationship between pneumococcal serotypes and antibiotic resistance. Vaccine 2012; 30:2728-37. [DOI: 10.1016/j.vaccine.2012.01.091] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 01/31/2012] [Accepted: 01/31/2012] [Indexed: 10/28/2022]
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Salter SJ, Hinds J, Gould KA, Lambertsen L, Hanage WP, Antonio M, Turner P, Hermans PWM, Bootsma HJ, O'Brien KL, Bentley SD. Variation at the capsule locus, cps, of mistyped and non-typable Streptococcus pneumoniae isolates. MICROBIOLOGY-SGM 2012; 158:1560-1569. [PMID: 22403189 PMCID: PMC3541774 DOI: 10.1099/mic.0.056580-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The capsule polysaccharide locus (cps) is the site of the capsule biosynthesis gene cluster in encapsulated Streptococcus pneumoniae. A set of pneumococcal samples and non-pneumococcal streptococci from Denmark, the Gambia, the Netherlands, Thailand, the UK and the USA were sequenced at the cps locus to elucidate serologically mistyped or non-typable isolates. We identified a novel serotype 33B/33C mosaic capsule cluster and previously unseen serotype 22F capsule genes, disrupted and deleted cps clusters, the presence of aliB and nspA genes that are unrelated to capsule production, and similar genes in the non-pneumococcal samples. These data provide greater understanding of diversity at a locus which is crucial to the antigenic diversity of the pathogen and current vaccine strategies.
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Affiliation(s)
- S J Salter
- Wellcome Trust Sanger Institute, Hinxton, UK
| | - J Hinds
- St George's, University of London, UK
| | - K A Gould
- St George's, University of London, UK
| | | | - W P Hanage
- Harvard School of Public Health, Boston, MA, USA
| | - M Antonio
- Medical Research Council Laboratories, Fajara, The Gambia
| | - P Turner
- Centre for Tropical Medicine, University of Oxford, UK.,Shoklo Malaria Research Unit, Mae Sot, Thailand
| | - P W M Hermans
- Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - H J Bootsma
- Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - K L O'Brien
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - S D Bentley
- Wellcome Trust Sanger Institute, Hinxton, UK
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Rodgers GL, Klugman KP. The future of pneumococcal disease prevention. Vaccine 2012; 29 Suppl 3:C43-8. [PMID: 21896352 DOI: 10.1016/j.vaccine.2011.07.047] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 07/15/2011] [Indexed: 11/30/2022]
Abstract
Pneumococcal disease (PD) is the leading cause of vaccine preventable deaths in children <5 years of age worldwide, with most of the deaths occurring in the developing world. Prevention of PD in children has been achieved by vaccination with pneumococcal conjugate vaccine (PCV), the basis for which is induction of a protective antibody response against the bacterial polysaccharide capsule. Conjugation of the polysaccharide capsule to a protein carrier enables the generation of an immunologic response to the vaccine in young children, leading to protection against infection. The heptavalent PCV, which contains 7 of the 93 known pneumococcal serotypes (4, 6B, 9V, 14, 18C, 19F, 23F) was the first PCV available, licensed in the US in 2000 and subsequently in many countries worldwide, including Latin American and Caribbean countries. Since its introduction, PCV7 has been documented effective for reducing invasive PD mortality and burden, as well as that of pneumonia and otitis media. Additionally, PD caused by the vaccine serotypes has decreased in the unimmunized population due to herd immunity induced by PCV7. Despite this success, significant disease burden still exists globally due to serotypes not included in PCV7. Currently there are 2 new PCVs that have been approved for use in children, a 10-valent vaccine (includes PCV7 serotypes plus serotypes 1, 5 and 7F) and a 13-valent vaccine (includes PCV7 serotypes plus serotypes 1, 3, 5, 6A, 7F and 19A). The selection of new serotypes to be included was based on importance of these serotypes as causes of PD. An additional 15-valent vaccine (includes PCV 7 serotypes plus serotypes 1, 3, 5, 6A, 7F, 19A, 22F and 33F) is undergoing clinical trial testing. In view of the 93 serotypes that are currently known, it seems clear that vaccines with greater coverage, likely based on proteins common to all serotypes, will be needed in the future. Technical and regulatory challenges to the development and approval of newer PCVs include a need for licensing criteria of common protein vaccines, establishment of correlates of protection for disease manifestations other than invasive disease, comparative efficacy data, and clinical trial testing of concomitant immunization of higher valency PCVs with other vaccines.
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Affiliation(s)
- Gail L Rodgers
- Scientific Affairs, Vaccines, Pfizer Inc., 500 Arcola Road, Collegeville, PA 19426, USA.
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Ho PL, Chiu SS, Chan MY, Ang I, Chow KH, Lau YL. Changes in nasopharyngeal carriage and serotype distribution of antibiotic-resistant Streptococcus pneumoniae before and after the introduction of 7-valent pneumococcal conjugate vaccine in Hong Kong. Diagn Microbiol Infect Dis 2011; 71:327-34. [DOI: 10.1016/j.diagmicrobio.2011.09.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Revised: 08/30/2011] [Accepted: 09/07/2011] [Indexed: 10/16/2022]
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Siira L, Jalava J, Tissari P, Vaara M, Kaijalainen T, Virolainen A. Clonality behind the increase of multidrug-resistance among non-invasive pneumococci in Southern Finland. Eur J Clin Microbiol Infect Dis 2011; 31:867-71. [DOI: 10.1007/s10096-011-1386-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 08/11/2011] [Indexed: 10/17/2022]
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