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Cercenado E, Ramos B, Pérez-Abeledo M, Sempere J, Yuste J, Sanz JC. Invasive disease caused simultaneously by two different serotypes of Streptococcus pneumoniae: a microbiological appreciation. Eur J Clin Microbiol Infect Dis 2024; 43:1013-1016. [PMID: 38416289 DOI: 10.1007/s10096-024-04787-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 02/15/2024] [Indexed: 02/29/2024]
Abstract
We report a clinical case of a child with an invasive pneumococcal disease caused by two different pneumococcal serotypes that belonged to different sequence types. She was a 15-month-old girl with pneumonia and pleural effusion in which S. pneumoniae colonies with different morphologies grew, one from the blood culture (characteristic greyish appearance) and the other from the pleural fluid (mucoid appearance). The isolate from blood was serotype 22 F (ST698/CC698/GPSC61), while the isolate from the pleural fluid was serotype 3 (ST180/CC180/GPSC12). The patient fully recovered after treatment with intravenous ampicillin followed by oral amoxicillin.
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Affiliation(s)
- Emilia Cercenado
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
- CIBER of Respiratory Diseases (CIBERES), Madrid, 28029, Spain
| | - Belén Ramos
- Clinical Microbiology Unit, Public Health Regional Laboratory of the Community of Madrid, Directorate General of Public Health, Regional Ministry of Health of Madrid, Madrid, 28055, Spain
| | - Marta Pérez-Abeledo
- Clinical Microbiology Unit, Public Health Regional Laboratory of the Community of Madrid, Directorate General of Public Health, Regional Ministry of Health of Madrid, Madrid, 28055, Spain
| | - Julio Sempere
- CIBER of Respiratory Diseases (CIBERES), Madrid, 28029, Spain
- Spanish Pneumococcal Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Jose Yuste
- CIBER of Respiratory Diseases (CIBERES), Madrid, 28029, Spain
- Spanish Pneumococcal Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Juan Carlos Sanz
- Clinical Microbiology Unit, Public Health Regional Laboratory of the Community of Madrid, Directorate General of Public Health, Regional Ministry of Health of Madrid, Madrid, 28055, Spain.
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, 28029, Spain.
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Sempere J, Yuste J. Nasopharyngeal colonization and invasive disease in Streptococcus pneumoniae: Two critical aspects of the pneumococcal pathogenesis with many similarities. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2024; 42:169-171. [PMID: 38575275 DOI: 10.1016/j.eimce.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 01/10/2024] [Indexed: 04/06/2024]
Affiliation(s)
- Julio Sempere
- Spanish Pneumococcal Reference Laboratory, National Center for Microbiology, Instituto de Salud Carlos III, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Jose Yuste
- Spanish Pneumococcal Reference Laboratory, National Center for Microbiology, Instituto de Salud Carlos III, Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
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de Felipe B, Aboza-García M, González-Galán V, Salamanca de la Cueva I, Martín-Quintero JA, Amil-Pérez B, Coronel-Rodríguez C, Palacios-Soria MÁ, García Ruiz-Santaquiteria MI, Torres-Sánchez MJ, Morón FJ, Cordero-Varela JA, Obando-Pacheco P, Obando I. Molecular epidemiology of pneumococcal carriage in children from Seville, following implementation of the PCV13 immunization program in Andalusia, Spain. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2024; 42:172-178. [PMID: 37085445 DOI: 10.1016/j.eimce.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/18/2022] [Accepted: 11/20/2022] [Indexed: 04/23/2023]
Abstract
INTRODUCTION The 13-valent pneumococcal conjugate vaccine (PCV13) universal vaccination programme was introduced in December 2016 in Andalusia. METHODS A cross-sectional study was conducted on the molecular epidemiology of pneumococcal nasopharyngeal colonization. A total of 397 healthy children were recruited from primary healthcare centres in Seville for the periods 1/4/2018 to 28/2/2020 and 1/11/2021 to 28/2/2022 (PCV13 period). Data from a previous carriage study conducted among healthy and sick children from 1/01/2006 to 30/06/2008 (PCV7 period), were used for comparison of serotype/genotype distributions and antibiotic resistance rates. RESULTS Overall, 76 (19%) children were colonized with S. pneumoniae during the PCV13 period and there were information available from 154 isolates collected during the PCV7 period. Colonization with PCV13 serotypes declined significantly in the PCV13 period compared with historical controls (11% vs 38%, p = 0.0001), being serotypes 19F (8%), 3 (1%) and 6B (1%) the only circulating vaccine types. Serotypes 15B/C and 11A were the most frequently identified non-PCV13 serotypes during the PCV13 period (14% and 11%, respectively); the later one increased significantly between time periods (p = 0.04). Serotype 11A was exclusively associated in the PCV13 period with ampicillin-resistant variants of the Spain9V-ST156 clone (ST6521 and genetically related ST14698), not detected in the preceding period. CONCLUSIONS There was a residual circulation of vaccine types following PCV13 introduction, apart from serotype 19F. Serotype 11A increased between PCV13 and PCV7 periods due to emergence and clonal expansion of ampicillin-resistant genotype ST6521.
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Affiliation(s)
- Beatriz de Felipe
- Alteraciones Congénitas de la Inmunidad, Instituto de Biomedicina de Sevilla (IBIS), Universidad de Sevilla/Hospital Universitario Virgen del Rocío (HUVR)/CSIC, Sevilla, Spain
| | - Marta Aboza-García
- Alteraciones Congénitas de la Inmunidad, Instituto de Biomedicina de Sevilla (IBIS), Universidad de Sevilla/Hospital Universitario Virgen del Rocío (HUVR)/CSIC, Sevilla, Spain; Centro de Salud Polígono Norte, Sevilla, Spain
| | | | | | | | - Benito Amil-Pérez
- Servicio de Pediatría, Grupo Instituto Hispalense de Pediatría, Sevilla, Spain
| | - Cristóbal Coronel-Rodríguez
- Centro de Salud Amante Laffón, Distrito de Atención Primaria Sevilla, Servicio Andaluz de Salud, Sevilla, Spain
| | | | | | | | - Francisco Javier Morón
- Unidad de Genómica, Instituto de Biomedicina de Sevilla, Universidad de Sevilla/Hospital Universitario Virgen del Rocío/CSIC, Sevilla, Spain
| | - Juan A Cordero-Varela
- Unidad de Bioinformática, Instituto de Biomedicina de Sevilla, Universidad de Sevilla/Hospital Universitario Virgen del Rocío/CSIC, Sevilla, Spain
| | | | - Ignacio Obando
- Alteraciones Congénitas de la Inmunidad, Instituto de Biomedicina de Sevilla (IBIS), Universidad de Sevilla/Hospital Universitario Virgen del Rocío (HUVR)/CSIC, Sevilla, Spain; Sección de Infectología e Inmunopatologías Pediátricas, Hospital Universitario Virgen de Valme, Sevilla, Spain
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Shinjoh M, Togo K, Hayamizu T, Yonemoto N, Morii J, Perdrizet J, Kamei K. Cost-effectiveness analysis of 20-valent pneumococcal conjugate vaccine for routine pediatric vaccination programs in Japan. Expert Rev Vaccines 2024; 23:485-497. [PMID: 38682661 DOI: 10.1080/14760584.2024.2345670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/17/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND The Japanese National Immunization Program currently includes the pediatric 13 valent pneumococcal conjugate vaccine (PCV13) to prevent pneumococcal infections. We aimed to evaluate the cost-effectiveness of 20-valent PCV (PCV20) as a pediatric vaccine versus PCV13. METHODS A decision-analytic Markov model was used to estimate expected costs, quality-adjusted life-years (QALYs), and prevented cases and deaths caused by invasive pneumococcal disease, pneumonia, and acute otitis media over a ten-year time horizon from the societal and healthcare payer perspectives. RESULTS PCV20 was dominant, i.e. less costly and more effective, over PCV13 (gained 294,599 QALYs and reduced Japanese yen [JPY] 352.6 billion [2.6 billion United States dollars, USD] from the societal perspective and JPY 178.9 billion [USD 1.4 billion] from the payer perspective). Sensitivity and scenario analyses validated the robustness of the base scenario results. When comparing PCV20 with PCV13, the threshold analysis revealed an incremental cost-effectiveness ratio that was within the threshold value (JPY 5 million/QALY) at a maximum acquisition cost of JPY 74,033 [USD 563] (societal perspective) and JPY 67,758 [USD 515] (payer perspective). CONCLUSIONS As a pediatric vaccine, PCV20 was dominant over PCV13 regardless of the study perspective.
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Affiliation(s)
- Masayoshi Shinjoh
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Kanae Togo
- Health and Value, Pfizer Japan Inc, Tokyo, Japan
| | | | | | - Junko Morii
- HEOR, Real World Evidence, IQVIA Solutions G.K, Tokyo, Japan
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Ryman J, Sachs JR, Yee KL, Banniettis N, Weaver J, Weiss T. Predicted serotype-specific effectiveness of pneumococcal conjugate vaccines V114 and PCV20 against invasive pneumococcal disease in children. Expert Rev Vaccines 2024; 23:60-68. [PMID: 38073483 DOI: 10.1080/14760584.2023.2292773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/05/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Next-generation, higher-valency pneumococcal conjugate vaccines (PCVs), 15-valent PCV V114 and 20-valent PCV (PCV20), have been assessed by comparing their immune responses across serotypes shared with the 13-valent PCV (PCV13). Without efficacy or real-world vaccine effectiveness (VE) it becomes important to relate IgG titers to VE to aid in the interpretation of the immune response elicited by V114 and PCV20. METHODS We estimated the protective antibody concentrations for each serotype in 7-valent PCV (PCV7) and PCV13 which were then used to predict the serotype-specific VE for each PCV7 and PCV13 non PCV7 serotype present in V114 and PCV20. RESULTS The predicted effectiveness of V114 was comparable to PCV7 and PCV13 for 11 of the 13 shared serotypes (1, 4, 5, 6B, 7F, 9 V, 14, 18C, 19A, 19F, and 23F), with improved effectiveness against serotype 3 and decreased effectiveness against serotype 6A. PCV20 had predicted effectiveness comparable to PCV7 and PCV13 for 7 of the 13 shared serotypes (5, 6A, 7F, 9 V, 18C, 19F, and 23F), with decreased effectiveness against the remaining serotypes (1, 3, 4, 6B, 14, and 19A). CONCLUSIONS Prediction of serotype-specific VE values suggests that V114 retains greater effectiveness than PCV20 toward most serotypes present in PCV7 and PCV13.
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Affiliation(s)
- Josiah Ryman
- Quantitative Pharmacology and Pharmacometrics, Rahway, NJ, USA
| | - Jeffrey R Sachs
- Quantitative Pharmacology and Pharmacometrics, Rahway, NJ, USA
| | - Ka Lai Yee
- Quantitative Pharmacology and Pharmacometrics, Rahway, NJ, USA
| | | | - Jessica Weaver
- Center for Observational and Real-World Evidence,Merck & Co, Inc, Rahway, NJ, USA
| | - Thomas Weiss
- Center for Observational and Real-World Evidence,Merck & Co, Inc, Rahway, NJ, USA
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Menéndez R, Torres A, España PP, Fernández-Villar JA, Marimón JM, Méndez R, Cilloniz C, Egurrola M, Botana-Rial M, Ercibengoa M, Méndez C, Cifuentes I, Gessner BD. Pneumococcal Serotypes Associated with Community-Acquired Pneumonia Hospitalizations in Adults in Spain, 2016-2020: The CAPA Study. Microorganisms 2023; 11:2781. [PMID: 38004792 PMCID: PMC10673231 DOI: 10.3390/microorganisms11112781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/08/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
Newer higher valency pneumococcal conjugate vaccines (PCVs) have the potential to reduce the adult community-acquired pneumonia (CAP) burden. We describe the evolution and distribution of adult community-acquired pneumonia (CAP) serotypes in Spain, focusing on serotypes contained in the 20-valent PCV (PCV20). This was a prospective, observational study of chest X-ray (CXR)-confirmed CAP in immunocompetent adults hospitalized in one of four Spanish hospitals between November 2016 and November 2020. Pneumococci were isolated from cultures and detected in urine using BinaxNow® and Pfizer serotype-specific urinary antigen tests UAD1 and UAD2. We included 1948 adults hospitalized with CXR-CAP. The median age was 69.0 years (IQR: 24 years). At least one comorbidity was present in 84.8% (n = 1653) of patients. At admission, 76.1% of patients had complicated pneumonia. Pneumococcus was identified in 34.9% (n = 680) of study participants. The PCV20 vaccine-type CAP occurred in 23.9% (n = 465) of all patients, 68.4% (n = 465) of patients with pneumococcal CAP, and 82.2% (83/101) of patients who had pneumococcus identified by culture. Serotypes 8 (n = 153; 7.9% of all CAP) and 3 (n = 152; 7.8% of all CAP) were the most frequently identified. Pneumococcus is a common cause of hospitalized CAP among Spanish adults and serotypes contained in PCV20 caused the majority of pneumococcal CAP.
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Affiliation(s)
- Rosario Menéndez
- Hospital Universitario y Politécnico la Fe, 46026 Valencia, Spain; (R.M.); (R.M.)
- Biomedical Research Center Network for Respiratory Diseases (CIBERES), 28029 Madrid, Spain
| | - Antoni Torres
- Biomedical Research Center Network for Respiratory Diseases (CIBERES), 28029 Madrid, Spain
- Hospital Clinic, 08036 Barcelona, Spain;
| | | | - Jose Alberto Fernández-Villar
- Hospital Alvaro Cunqueiro, Instituto de Investigación Biomédica Galicia Sur, 36312 Vigo, Spain; (J.A.F.-V.); (M.B.-R.)
| | - José María Marimón
- Biodonostia, Hospital Universitario Donostia, 20014 San Sebastián, Spain; (J.M.M.); (M.E.)
| | - Raúl Méndez
- Hospital Universitario y Politécnico la Fe, 46026 Valencia, Spain; (R.M.); (R.M.)
- Biomedical Research Center Network for Respiratory Diseases (CIBERES), 28029 Madrid, Spain
| | - Catia Cilloniz
- Hospital Clinic, 08036 Barcelona, Spain;
- Faculty of Health Sciences, Continental University, Huancayo 12001, Peru
| | - Mikel Egurrola
- Hospital Galdakao-Usansolo, 48960 Galdácano, Spain; (P.P.E.); (M.E.)
| | - Maribel Botana-Rial
- Hospital Alvaro Cunqueiro, Instituto de Investigación Biomédica Galicia Sur, 36312 Vigo, Spain; (J.A.F.-V.); (M.B.-R.)
| | - María Ercibengoa
- Biodonostia, Hospital Universitario Donostia, 20014 San Sebastián, Spain; (J.M.M.); (M.E.)
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Li T, Huang J, Yang S, Chen J, Yao Z, Zhong M, Zhong X, Ye X. Pan-Genome-Wide Association Study of Serotype 19A Pneumococci Identifies Disease-Associated Genes. Microbiol Spectr 2023; 11:e0407322. [PMID: 37358412 PMCID: PMC10433855 DOI: 10.1128/spectrum.04073-22] [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: 10/06/2022] [Accepted: 06/04/2023] [Indexed: 06/27/2023] Open
Abstract
Despite the widespread implementation of pneumococcal vaccines, hypervirulent Streptococcus pneumoniae serotype 19A is endemic worldwide. It is still unclear whether specific genetic elements contribute to complex pathogenicity of serotype 19A isolates. We performed a large-scale pan-genome-wide association study (pan-GWAS) of 1,292 serotype 19A isolates sampled from patients with invasive disease and asymptomatic carriers. To address the underlying disease-associated genotypes, a comprehensive analysis using three methods (Scoary, a linear mixed model, and random forest) was performed to compare disease and carriage isolates to identify genes consistently associated with disease phenotype. By using three pan-GWAS methods, we found consensus on statistically significant associations between genotypes and disease phenotypes (disease or carriage), with a subset of 30 consistently significant disease-associated genes. The results of functional annotation revealed that these disease-associated genes had diverse predicted functions, including those that participated in mobile genetic elements, antibiotic resistance, virulence, and cellular metabolism. Our findings suggest the multifactorial pathogenicity nature of this hypervirulent serotype and provide important evidence for the design of novel protein-based vaccines to prevent and control pneumococcal disease. IMPORTANCE It is important to understand the genetic and pathogenic characteristics of S. pneumoniae serotype 19A, which may provide important information for the prevention and treatment of pneumococcal disease. This global large-sample pan-GWAS study has identified a subset of 30 consistently significant disease-associated genes that are involved in mobile genetic elements, antibiotic resistance, virulence, and cellular metabolism. These findings suggest the multifactorial pathogenicity nature of hypervirulent S. pneumoniae serotype 19A isolates and provide implications for the design of novel protein-based vaccines.
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Affiliation(s)
- Ting Li
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Jiayin Huang
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Shimin Yang
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Jianyu Chen
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Zhenjiang Yao
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Minghao Zhong
- Department of Prevention and Health Care, The Sixth People’s Hospital of Dongguan City, Guangdong, China
| | - Xinguang Zhong
- Department of Prevention and Health Care, The Sixth People’s Hospital of Dongguan City, Guangdong, China
| | - Xiaohua Ye
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
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de Miguel S, Pérez-Abeledo M, Ramos B, García L, Arce A, Martínez-Arce R, Yuste J, Sanz JC. Distribution of Multidrug-Resistant Invasive Serotypes of Streptococcus pneumoniae during the Period 2007-2021 in Madrid, Spain. Antibiotics (Basel) 2023; 12:antibiotics12020342. [PMID: 36830253 PMCID: PMC9951976 DOI: 10.3390/antibiotics12020342] [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: 12/29/2022] [Revised: 01/31/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023] Open
Abstract
After the systematic use of conjugate vaccines, the invasive pneumococcal disease (IPD) was included into the Madrid Notifiable Diseases Surveillance System through an Epidemiological Surveillance Network. Furthermore, Streptococcus pneumoniae was included in the Spanish Plan of Antibiotic Resistance. The aim of this study was to analyse the multidrug-resistant (MDR) phenotype distribution among invasive strains of Streptococcus pneumoniae isolated during 2007-2021 from usually sterile clinical samples in Madrid, Spain. A total number of 7133 invasive pneumococcal isolates were studied during the period from February 2007 to December 2021. Serotyping was characterised using the Pneumotest-Latex and by the Quellung reaction. Antibiotic susceptibility testing to penicillin (PEN), erythromycin (ERY), and levofloxacin (LVX) was performed using the E-test according to the EUCAST guidelines and breakpoints. Combination of non-susceptibility to PEN at standard dosing regimen (PNSSDR), resistance to ERY (ERYR) and to LVX (LVXR) was considered to be multidrug-resistant at standard dosing regimen of penicillin (MRPSDR), whereas the combination of resistance to PEN (PENR), ERYR, and LVXR was considered multidrug-resistant (MDR). The number of MDRPSDR and or MDR strains in the entire population (n = 7133) during the complete period (2007-2021) were 51 (0.7%) and 6 (0.1%), respectively. All MDRPSDR and/or MDR strains belonged to nine serotypes: 19A (n = 13), 15A (n = 12), 9V (n = 12), 14 (n = 7), 24F (n = 3), 15F (n = 1), 19F (n = 1), 6B (n = 1) and 6C (n = 1). Only two serotypes (9V and 19A) were found among MDR strains, and most of them (5/6) belonged to serotype 9V. Only 12.4% of the strains typified as serotype 9V were MDRPSDR and only 5.2% as MDR. The levels of pneumococcal MDRPSDR and/or MDR in this study were low and all six MDR strains were isolated between 2014 and 2018. These results reinforce the importance of monitoring the evolution of non-susceptible serotypes including those with MDR in the coming years, especially after the introduction of new conjugate vaccines of a broader spectrum.
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Affiliation(s)
- Sara de Miguel
- Epidemiology Department, Directorate General of Public Health, Regional Ministry of Health of Madrid, 28002 Madrid, Spain
- Department of Preventive Medicine, University Hospital 12 de Octubre, 28041 Madrid, Spain
- CIBER of Respiratory Diseases (CIBERES), 28029 Madrid, Spain
- Departamento de Epidemiología y Salud Pública, Epidemiología de las Enfermedades Infecciosas, Universidad de Alcalá, Alcalá de Henares, 28881 Madrid, Spain
| | - Marta Pérez-Abeledo
- Clinical Microbiology Unit, Public Health Regional Laboratory of the Community of Madrid, Directorate General of Public Health, Regional Ministry of Health of Madrid, 28055 Madrid, Spain
| | - Belén Ramos
- Clinical Microbiology Unit, Public Health Regional Laboratory of the Community of Madrid, Directorate General of Public Health, Regional Ministry of Health of Madrid, 28055 Madrid, Spain
| | - Luis García
- Epidemiology Department, Directorate General of Public Health, Regional Ministry of Health of Madrid, 28002 Madrid, Spain
| | - Araceli Arce
- Epidemiology Department, Directorate General of Public Health, Regional Ministry of Health of Madrid, 28002 Madrid, Spain
| | - Rodrigo Martínez-Arce
- Clinical Microbiology Unit, Public Health Regional Laboratory of the Community of Madrid, Directorate General of Public Health, Regional Ministry of Health of Madrid, 28055 Madrid, Spain
| | - Jose Yuste
- CIBER of Respiratory Diseases (CIBERES), 28029 Madrid, Spain
- Spanish Pneumococcal Reference Laboratory, National Center for Microbiology, Instituto de Salud Carlos III, 28222 Madrid, Spain
| | - Juan Carlos Sanz
- Clinical Microbiology Unit, Public Health Regional Laboratory of the Community of Madrid, Directorate General of Public Health, Regional Ministry of Health of Madrid, 28055 Madrid, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Correspondence:
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de Miguel S, Pérez-Abeledo M, Ramos B, García L, Arce A, Martínez-Arce R, Yuste J, Sanz JC. Evolution of Antimicrobial Susceptibility to Penicillin in Invasive Strains of Streptococcus pneumoniae during 2007-2021 in Madrid, Spain. Antibiotics (Basel) 2023; 12:antibiotics12020289. [PMID: 36830208 PMCID: PMC9952450 DOI: 10.3390/antibiotics12020289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/27/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
The use of pneumococcal conjugate vaccines has affected the epidemiology and distribution of Streptococcus pneumoniae serotypes causing Invasive Pneumococcal Disease (IPD). The aim of this study was to analyze the evolution of the phenotypical profiles of antimicrobial susceptibility to penicillin (PEN) in all IPD strains isolated in Madrid, Spain, during 2007-2021. In total, 7133 invasive clinical isolates were characterized between 2007 and 2021. Levels of PENR and PNSSDR were 2.0% and 24.2%, respectively. In addition, 94.4% of all the PENR belonged to four serotypes, including 11A (33.6%), 19A (30.8%), 14 (20.3%) and 9V (9.8%). All the strains of serotype 11A, which is a non-PCV13 serotype, were detected after the year 2011. Serotypes 6C, 15A, 23B, 24F, 35B, 19F, 16F, 6B, 23F, 24B, 24A, 15F and a limited number of strains of serogroups 16 and 24 (non-typed at serotype level) were associated with PNSSDR (p < 0.05). PNSSDR strains of non-PCV13 serotypes 11A, 24F, 23B, 24B, 23A and 16F were more frequent from 2014 to 2021. The changes in S. pneumoniae serotype distribution associated with the use of conjugate vaccines had caused in our region the emergence of non-PCV13 pneumococcal strains with different PENR or PNSSDR patterns. The emergence of serotype 11A resistant to penicillin as the most important non-PCV13 serotype is a worrisome event with marked relevance from the clinical and epidemiological perspective.
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Affiliation(s)
- Sara de Miguel
- Epidemiology Department, Directorate General of Public Health, Regional Ministry of Health of Madrid, 28002 Madrid, Spain
- Department of Preventive Medicine, University Hospital 12 de Octubre, 28041 Madrid, Spain
- CIBER of Respiratory Diseases (CIBERES), 28029 Madrid, Spain
- Departamento de Epidemiología y Salud Pública, Epidemiología de las Enfermedades Infecciosas, Universidad de Alcalá, Alcalá de Henares, 28801 Madrid, Spain
| | - Marta Pérez-Abeledo
- Clinical Microbiology Unit, Public Health Regional Laboratory of the Community of Madrid, Directorate General of Public Health, Regional Ministry of Health of Madrid, 28055 Madrid, Spain
| | - Belén Ramos
- Clinical Microbiology Unit, Public Health Regional Laboratory of the Community of Madrid, Directorate General of Public Health, Regional Ministry of Health of Madrid, 28055 Madrid, Spain
| | - Luis García
- Epidemiology Department, Directorate General of Public Health, Regional Ministry of Health of Madrid, 28002 Madrid, Spain
| | - Araceli Arce
- Epidemiology Department, Directorate General of Public Health, Regional Ministry of Health of Madrid, 28002 Madrid, Spain
| | - Rodrigo Martínez-Arce
- Clinical Microbiology Unit, Public Health Regional Laboratory of the Community of Madrid, Directorate General of Public Health, Regional Ministry of Health of Madrid, 28055 Madrid, Spain
| | - Jose Yuste
- CIBER of Respiratory Diseases (CIBERES), 28029 Madrid, Spain
- Spanish Pneumococcal Reference Laboratory, National Center for Microbiology, Instituto de Salud Carlos III, 28222 Madrid, Spain
| | - Juan Carlos Sanz
- Clinical Microbiology Unit, Public Health Regional Laboratory of the Community of Madrid, Directorate General of Public Health, Regional Ministry of Health of Madrid, 28055 Madrid, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Correspondence:
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Vaccination against Community-Acquired Pneumonia in Spanish Adults: Practical Recommendations by the NeumoExperts Prevention Group. Antibiotics (Basel) 2023; 12:antibiotics12010138. [PMID: 36671339 PMCID: PMC9854614 DOI: 10.3390/antibiotics12010138] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 12/30/2022] [Accepted: 01/05/2023] [Indexed: 01/12/2023] Open
Abstract
In the adult population, community-acquired pneumonia (CAP) is a serious disease that is responsible for high morbidity and mortality rates, being frequently associated with multidrug resistant pathogens. The aim of this review is to update a practical immunization prevention guideline for CAP in Spain caused by prevalent respiratory pathogens, based on the available scientific evidence through extensive bibliographic review and expert opinion. The emergence of COVID-19 as an additional etiological cause of CAP, together with the rapid changes in the availability of vaccines and recommendations against SARS-CoV-2, justifies the need for an update. In addition, new conjugate vaccines of broader spectrum against pneumococcus, existing vaccines targeting influenza and pertussis or upcoming vaccines against respiratory syncytial virus (RSV) will be very useful prophylactic tools to diminish the burden of CAP and all of its derived complications. In this manuscript, we provide practical recommendations for adult vaccination against the pathogens mentioned above, including their contribution against antibiotic resistance. This guide is intended for the individual perspective of protection and not for vaccination policies, as we do not pretend to interfere with the official recommendations of any country. The use of vaccines is a realistic approach to fight these infections and ameliorate the impact of antimicrobial resistance. All of the recently available scientific evidence included in this review gives support to the indications established in this practical guide to reinforce the dissemination and implementation of these recommendations in routine clinical practice.
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de Felipe B, Aboza-García M, González-Galán V, Salamanca de la Cueva I, Martín-Quintero JA, Amil-Pérez B, Coronel-Rodríguez C, Palacios-Soria MÁ, García Ruiz-Santaquiteria MI, Torres-Sánchez MJ, Morón FJ, Cordero-Varela JA, Obando-Pacheco P, Obando I. Epidemiología molecular de la colonización nasofaríngea neumocócica en niños de Sevilla, tras la implementación del programa de vacunación con VNC13 en Andalucía (España). Enferm Infecc Microbiol Clin 2023. [DOI: 10.1016/j.eimc.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Hansen K, Rünow E, Torisson G, Theilacker C, Palmborg A, Pan K, Jiang Q, Southern J, Beavon R, Gessner BD, Riesbeck K, Ahl J. Radiographically confirmed community-acquired pneumonia in hospitalized adults due to pneumococcal vaccine serotypes in Sweden, 2016-2018-The ECAPS study. Front Public Health 2023; 11:1086648. [PMID: 36875379 PMCID: PMC9981934 DOI: 10.3389/fpubh.2023.1086648] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/24/2023] [Indexed: 02/19/2023] Open
Abstract
Objectives In Sweden, pneumococcal serotype distribution in adults with community-acquired pneumonia (CAP) and potential coverage of currently licensed pneumococcal conjugate vaccines (PCVs) is unknown. Methods During 2016-2018, patients aged ≥18 years hospitalized with radiologically confirmed (RAD+) CAP were enrolled at Skåne University Hospital in a study on the etiology of CAP in Sweden (ECAPS). Urine samples and blood cultures were collected per-protocol. Streptococcus pneumoniae (Spn) culture isolates were serotyped and urine samples tested for the pan-pneumococcal urinary antigen (PUAT) and multiplex urine antigen detection (UAD) assay, detecting 24 serotypes. Results Analyses included 518 participants with RAD+CAP; 67.4% were ≥65 years of age, 73.4% were either immunocompromised or had an underlying chronic medical condition. The proportion of CAP due to Spn identified by any method was 24.3% of which 9.3% was detected by UAD alone. The most frequently identified serotypes were 3 (26 cases, 5.0% of all CAP), and 8, 11A and 19A (10 cases each, 1.9%). In individuals aged 18-64 and ≥65 years, respectively, PCV20 serotypes contributed to 35 of 169 (20.7%) and 53 of 349 cases of all CAP (15.2%), and PCV13 serotypes caused 21 of 169 (12.4%) and 35 of 349 (10.0%) cases. PCV15 coverage was 23 of 169 (13.6%) and 42 of 349 (12.0%) in individuals aged 18-64 and ≥65 years, respectively. Overall, PCV20 increases the coverage of all CAP from 10.8% (PCV13) to 17.0%. Conclusion Compared to earlier pneumococcal vaccines, PCV20 expands the coverage of all-cause CAP. Routine diagnostic tests underestimate the proportion of CAP caused by Spn.
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Affiliation(s)
- Karin Hansen
- Section of Infectious Diseases, Department Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden.,Section of Clinical Microbiology, Department Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Elisabeth Rünow
- Section of Infectious Diseases, Department Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden.,Section of Clinical Microbiology, Department Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Gustav Torisson
- Section of Infectious Diseases, Department Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Christian Theilacker
- Vaccines Global Medical Development, Scientific and Clinical Affairs, Pfizer, Collegeville, PA, United States
| | - Andreas Palmborg
- Pfizer Vaccines, Medical Development, Scientific and Clinical Affairs, Stockholm, Sweden
| | - Kaijie Pan
- Vaccines Global Medical Development, Scientific and Clinical Affairs, Pfizer, Collegeville, PA, United States
| | - Qin Jiang
- Vaccines Global Medical Development, Scientific and Clinical Affairs, Pfizer, Collegeville, PA, United States
| | - Jo Southern
- Vaccines Global Medical Development, Scientific and Clinical Affairs, Pfizer, Collegeville, PA, United States
| | - Rohini Beavon
- Vaccines Global Medical Development, Scientific and Clinical Affairs, Pfizer, Collegeville, PA, United States
| | - Bradford D Gessner
- Vaccines Global Medical Development, Scientific and Clinical Affairs, Pfizer, Collegeville, PA, United States
| | - Kristian Riesbeck
- Section of Clinical Microbiology, Department Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Jonas Ahl
- Section of Infectious Diseases, Department Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden.,Section of Clinical Microbiology, Department Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden
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Effect of pneumococcal conjugate vaccines and SARS-CoV-2 on antimicrobial resistance and the emergence of Streptococcus pneumoniae serotypes with reduced susceptibility in Spain, 2004-20: a national surveillance study. THE LANCET. MICROBE 2022; 3:e744-e752. [PMID: 35932764 PMCID: PMC9348823 DOI: 10.1016/s2666-5247(22)00127-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/08/2022] [Accepted: 05/06/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Epidemiological studies are necessary to explore the effect of current pneumococcal conjugate vaccines (PCVs) against antibiotic resistance, including the rise of non-vaccine serotypes that are resistant to antibiotics. Hence, epidemiological changes in the antimicrobial pattern of Streptococcus pneumoniae before and during the first year of the COVID-19 pandemic were studied. METHODS In this national surveillance study, we characterised the antimicrobial susceptibility to a panel of antibiotics in 3017 pneumococcal clinical isolates with reduced susceptibility to penicillin during 2004-20 in Spain. This study covered the early and late PCV7 periods; the early, middle, and late PCV13 periods; and the first year of the COVID-19 pandemic, to evaluate the contribution of PCVs and the pandemic to the emergence of non-vaccine serotypes associated with antibiotic resistance. FINDINGS Serotypes included in PCV7 and PCV13 showed a decline after the introduction of PCVs in Spain. However, an increase in non-PCV13 serotypes (mainly 11A, 24F, and 23B) that were not susceptible to penicillin promptly appeared. A rise in the proportion of pneumococcal strains with reduced susceptibility to β-lactams and erythromycin was observed in 2020, coinciding with the emergence of SARS-CoV-2. Cefditoren was the β-lactam with the lowest minimum inhibitory concentration (MIC)50 or MIC90 values, and had the highest proportion of susceptible strains throughout 2004-20. INTERPRETATION The increase in non-PCV13 serotypes associated with antibiotic resistance is concerning, especially the increase of penicillin resistance linked to serotypes 11A and 24F. The future use of PCVs with an increasingly broad spectrum (such as PCV20, which includes serotype 11A) could reduce the impact of antibiotic resistance for non-PCV13 serotypes. The use of antibiotics to prevent co-infections in patients with COVID-19 might have affected the increased proportion of pneumococcal-resistant strains. Cefotaxime as a parenteral option, and cefditoren as an oral choice, were the antibiotics with the highest activity against non-PCV20 serotypes. FUNDING The Spanish Ministry of Science and Innovation and Meiji-Pharma Spain. TRANSLATION For the Spanish translation of the abstract see Supplementary Materials section.
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Ryman J, Weaver J, Yee KL, Sachs JR. Predicting effectiveness of the V114 vaccine against invasive pneumococcal disease in children. Expert Rev Vaccines 2022; 21:1515-1521. [PMID: 35997125 DOI: 10.1080/14760584.2022.2112179] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The potential impact of new pneumococcal conjugate vaccines (PCVs) is assessed by using immune responses to predict their effectiveness against invasive pneumococcal disease (IPD). This analysis predicted the serotype-specific effectiveness against IPD of a new 15-valent PCV (V114) for the serotypes shared with a 13-valent PCV (PCV13), in a US pediatric population given a 3 + 1 dosing regimen. METHODS Beginning with the known serotype-specific antibody concentrations after vaccination with placebo, 7-valent PCV (PCV7) and PCV13, reverse cumulative distribution curves were used, along with published serotype-specific vaccine effectiveness of PCV7 and PCV13, to derive a protective antibody concentration (Cp) for each PCV13 serotype in V114. Serotype-specific effectiveness was predicted using the Cp estimates and the respective serotype-specific antibody concentrations of placebo and V114 recipients in recent pediatric clinical trials. RESULTS Predicted serotype-specific V114 effectiveness values ranged from 86% to 99% for PCV7 serotypes and from 59% to 97% for (non-PCV7) PCV13 serotypes. CONCLUSIONS V114 serotype-specific effectiveness against IPD in a US pediatric population was predicted to be largely comparable to that of PCV7 and PCV13 for shared serotypes, with models suggesting likelihood of high overall benefit gained from increased serotype 3 effectiveness, and additional protection against serotypes 22 F and 33 F.
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Affiliation(s)
- Josiah Ryman
- Quantitative Pharmacology and Pharmacometrics, Merck & Co., Inc, Rahway, NJ, USA
| | - Jessica Weaver
- Center for Observational and Real-World Evidence, Merck & Co., Inc, Rahway, NJ, USA
| | - Ka Lai Yee
- Quantitative Pharmacology and Pharmacometrics, Merck & Co., Inc, Rahway, NJ, USA
| | - Jeffrey R Sachs
- Quantitative Pharmacology and Pharmacometrics, Merck & Co., Inc, Rahway, NJ, USA
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Tamura K, Chang B, Shimbashi R, Watanabe H, Tanabe Y, Kuronuma K, Oshima K, Maruyama T, Fujita J, Abe S, Kasahara K, Nishi J, Kubota T, Kinjo Y, Fujikura H, Fukusumi M, Shimada T, Sunagawa T, Suzuki M, Yamamoto Y, Oishi K. Dynamic changes in clinical characteristics and serotype distribution of invasive pneumococcal disease among adults in Japan after introduction of the pediatric 13-valent pneumococcal conjugate vaccine in 2013-2019. Vaccine 2022; 40:3338-3344. [PMID: 35489986 DOI: 10.1016/j.vaccine.2022.04.062] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 04/13/2022] [Accepted: 04/17/2022] [Indexed: 11/29/2022]
Abstract
Nationwide population-based surveillance for invasive pneumococcal disease (IPD) is being conducted in few Asian countries. We aimed to evaluate the clinical characteristics and serotype distribution among Japanese adult patients with IPD after introduction of the pediatric 13-valent pneumococcal conjugate vaccine (PCV13) in 2013. IPD surveillance was conducted among adults between 2013 and 2019, and 1,995 patients were analyzed by time period (early, 2013-2015; middle, 2016-2017; late, 2018-2019). We found that the period of 2018-2019 was independently associated with a lower risk of fatal outcome, compared with the period of 2013-2015. The proportion of those with serotype PCV13-nonPCV7 decreased significantly in patients aged 15-64 years and in those aged ≥ 65 years within 3 years after the introduction of pediatric PCV13. By contrast, the proportion of those with nonvaccine serotype increased significantly in those aged ≥ 65 years, but not in those aged 15-64 years. No significant change was found in the proportion of 23-valent polysaccharide pneumococcal vaccine (PPSV23)-nonPCV13 in both of adults aged 15-64 years and ≥ 65 years. The proportions of PCV15-, PCV20- and PCV24-covered serotypes were 38%, 56% and 58% in adult patients with IPD aged ≥ 65 years during the late period. Our data on the serotype distribution support an indirect effect from pediatric PCV13 use among adults, and afford a basis for estimates of protection against IPD by vaccination with newly developed PCVs in older adults in Japan.
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Affiliation(s)
- Kosuke Tamura
- Department of Research Planning, Toyama Institute of Health, Toyama, Japan
| | - Bin Chang
- Department of Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Reiko Shimbashi
- Center for Surveillance, Immunization, and Epidemiologic Research, National Institute of Infectious Diseases, Tokyo, Japan
| | - Hiroshi Watanabe
- Department of Infection Control and Prevention, Kurume University School of Medicine, Fukuoka, Japan
| | - Yoshinari Tanabe
- Department of Respiratory Medicine, Niigata Prefectural Shibata Hospital, Niigata, Japan
| | - Koji Kuronuma
- Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Hokkaido, Japan
| | - Kengo Oshima
- Department of Infectious Disease, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | | | - Jiro Fujita
- Department of Infectious, Respiratory and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Shuichi Abe
- Department of Infectious Diseases and Infection Control, Yamagata Prefectural Central Hospital, Japan
| | - Kei Kasahara
- Center for Infectious Diseases, Nara Medical University, Nara, Japan
| | - Junichiro Nishi
- Department of Microbiology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Tetsuya Kubota
- Department of Respiratory Medicine and Allergology, Kochi Medical School, Kochi University, Kochi, Japan
| | - Yuki Kinjo
- Department of Bacteriology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroyuki Fujikura
- Center for Infectious Diseases, Nara Medical University, Nara, Japan
| | - Munehisa Fukusumi
- Center for Field Epidemic Intelligence, Research and Professional Development, National Institute of Infectious Diseases, Tokyo, Japan
| | - Tomoe Shimada
- Center for Field Epidemic Intelligence, Research and Professional Development, National Institute of Infectious Diseases, Tokyo, Japan
| | - Tomimasa Sunagawa
- Center for Field Epidemic Intelligence, Research and Professional Development, National Institute of Infectious Diseases, Tokyo, Japan
| | - Motoi Suzuki
- Center for Surveillance, Immunization, and Epidemiologic Research, National Institute of Infectious Diseases, Tokyo, Japan
| | - Yoshihiro Yamamoto
- Department of Clinical Infectious Diseases, Toyama University Graduate School of Medicine and Pharmaceutical Sciences, Toyama, Japan
| | - Kazunori Oishi
- Department of Bacteriology, Toyama Institute of Health, Toyama, Japan.
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