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Almeida SCG, Lo SW, Hawkins PA, Gladstone RA, Cassiolato AP, Klugman KP, Breiman RF, Bentley SD, McGee L, Brandileone MCDC. Genomic surveillance of invasive Streptococcus pneumoniae isolates in the period pre-PCV10 and post-PCV10 introduction in Brazil. Microb Genom 2021; 7. [PMID: 34609274 PMCID: PMC8627213 DOI: 10.1099/mgen.0.000635] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In 2010, Brazil introduced the 10-valent pneumococcal conjugate vaccine (PCV10) into the national children’s immunization programme. This study describes the genetic characteristics of invasive Streptococcus pneumoniae isolates before and after PCV10 introduction. A subset of 466 [pre-PCV10 (2008–2009): n=232, post-PCV10 (2012–2013): n=234;<5 years old: n=310, ≥5 years old: n=156] pneumococcal isolates, collected through national laboratory surveillance, were whole-genome sequenced (WGS) to determine serotype, pilus locus, antimicrobial resistance and genetic lineages. Following PCV10 introduction, in the <5 years age group, non-vaccine serotypes (NVT) serotype 3 and serotype 19A were the most frequent, and serotypes 12F, 8 and 9 N in the ≥5 years old group. The study identified 65 Global Pneumococcal Sequence Clusters (GPSCs): 49 (88 %) were GPSCs previously described and 16 (12 %) were Brazilian clusters. In total, 36 GPSCs (55 %) were NVT lineages, 18 (28 %) vaccine serotypes (VT) and 11 (17 %) were both VT and NVT lineages. In both sampling periods, the most frequent lineage was GPSC6 (CC156, serotypes 14/9V). In the <5 years old group, a decrease in penicillin (P=0.0123) and cotrimoxazole (P<0.0001) resistance and an increase in tetracycline (P=0.019) were observed. Penicillin nonsusceptibility was predicted in 40 % of the isolates; 127 PBP combinations were identified (51 predicted MIC≥0.125 mg l−1); cotrimoxazole (folA and/or folP alterations), macrolide (mef and/or ermB) and tetracycline (tetM, tetO or tetS/M) resistance were predicted in 63, 13 and 21.6 % of pneumococci studied, respectively. The main lineages associated with multidrug resistance in the post-PCV10 period were composed of NVT, GPSC1 (CC320, serotype 19A), and GPSC47 (ST386, serotype 6C). The study provides a baseline for future comparisons and identified important NVT lineages in the post-PCV10 period in Brazil.
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Affiliation(s)
- Samanta C. G. Almeida
- National Reference Laboratory for Meningitis and Pneumococcal Infections, Institute Adolfo Lutz, São Paulo, Brazil
- *Correspondence: Samanta C. G. Almeida,
| | - Stephanie W. Lo
- Parasites and Microbes Programme, Wellcome Sanger Institute, Hinxton, UK
| | - Paulina A. Hawkins
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, USA
| | | | - Ana Paula Cassiolato
- National Reference Laboratory for Meningitis and Pneumococcal Infections, Institute Adolfo Lutz, São Paulo, Brazil
| | - Keith P. Klugman
- Emeritus Professor of Global Health, Emory University, Atlanta, GA, USA
| | | | - Stephen D. Bentley
- Parasites and Microbes Programme, Wellcome Sanger Institute, Hinxton, UK
| | - Lesley McGee
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, USA
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Garcia Quesada M, Yang Y, Bennett JC, Hayford K, Zeger SL, Feikin DR, Peterson ME, Cohen AL, Almeida SCG, Ampofo K, Ang M, Bar-Zeev N, Bruce MG, Camilli R, Chanto Chacón G, Ciruela P, Cohen C, Corcoran M, Dagan R, De Wals P, Desmet S, Diawara I, Gierke R, Guevara M, Hammitt LL, Hilty M, Ho PL, Jayasinghe S, Kleynhans J, Kristinsson KG, Ladhani SN, McGeer A, Mwenda JM, Nuorti JP, Oishi K, Ricketson LJ, Sanz JC, Savrasova L, Setchanova LP, Smith A, Valentiner-Branth P, Valenzuela MT, van der Linden M, van Sorge NM, Varon E, Winje BA, Yildirim I, Zintgraff J, Knoll MD. Serotype Distribution of Remaining Pneumococcal Meningitis in the Mature PCV10/13 Period: Findings from the PSERENADE Project. Microorganisms 2021; 9:microorganisms9040738. [PMID: 33916227 PMCID: PMC8066874 DOI: 10.3390/microorganisms9040738] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/26/2021] [Accepted: 03/28/2021] [Indexed: 11/16/2022] Open
Abstract
Pneumococcal conjugate vaccine (PCV) introduction has reduced pneumococcal meningitis incidence. The Pneumococcal Serotype Replacement and Distribution Estimation (PSERENADE) project described the serotype distribution of remaining pneumococcal meningitis in countries using PCV10/13 for least 5-7 years with primary series uptake above 70%. The distribution was estimated using a multinomial Dirichlet regression model, stratified by PCV product and age. In PCV10-using sites (N = 8; cases = 1141), PCV10 types caused 5% of cases <5 years of age and 15% among ≥5 years; the top serotypes were 19A, 6C, and 3, together causing 42% of cases <5 years and 37% ≥5 years. In PCV13-using sites (N = 32; cases = 4503), PCV13 types caused 14% in <5 and 26% in ≥5 years; 4% and 13%, respectively, were serotype 3. Among the top serotypes are five (15BC, 8, 12F, 10A, and 22F) included in higher-valency PCVs under evaluation. Other top serotypes (24F, 23B, and 23A) are not in any known investigational product. In countries with mature vaccination programs, the proportion of pneumococcal meningitis caused by vaccine-in-use serotypes is lower (≤26% across all ages) than pre-PCV (≥70% in children). Higher-valency PCVs under evaluation target over half of remaining pneumococcal meningitis cases, but questions remain regarding generalizability to the African meningitis belt where additional data are needed.
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Affiliation(s)
| | - Yangyupei Yang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Julia C Bennett
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Kyla Hayford
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Scott L Zeger
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | | | - Meagan E Peterson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Adam L Cohen
- World Health Organization, 1202 Geneva, Switzerland
| | - Samanta C G Almeida
- Center of Bacteriology, National Laboratory for Meningitis and Pneumococcal Infections, Institute Adolfo Lutz (IAL), São Paulo 01246-902, Brazil
| | - Krow Ampofo
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Utah Health Sciences Center, Salt Lake City, UT 84132, USA
| | - Michelle Ang
- National Centre for Infectious Diseases, National Public Health Laboratory, Singapore 308442, Singapore
| | - Naor Bar-Zeev
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, P.O. Box 30096, Chichiri, Blantyre 3, Malawi
| | - Michael G Bruce
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Arctic Investigations Program, Division of Preparedness and Emerging Infections, Anchorage, AK 99508, USA
| | - Romina Camilli
- Department of Infectious Diseases, Italian National Institute of Health (Istituto Superiore di Sanità, ISS), 00161 Rome, Italy
| | - Grettel Chanto Chacón
- Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud, Tres Ríos, 30301 Cartago, Costa Rica
| | - Pilar Ciruela
- CIBER Epidemiología y Salud Pública, (CIBERESP), 28029 Madrid, Spain
- Surveillance and Public Health Emergency Response, Public Health Agency of Catalonia, 08005 Barcelona, Spain
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, 2192 Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 2000 Johannesburg, South Africa
| | - Mary Corcoran
- Irish Meningitis and Sepsis Reference Laboratory, Children's Health Ireland at Temple Street, Temple Street, D01 YC76 Dublin 1, Ireland
| | - Ron Dagan
- Distinguished Professor of Pediatrics and Infectious Diseases, The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Philippe De Wals
- Department of Social and Preventive Medicine, Laval University, Québec, QC G1V 0A6, Canada
| | - Stefanie Desmet
- Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium
- National Reference Centre for Streptococcus Pneumoniae, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Idrissa Diawara
- Faculty of Sciences and Health Techniques, Mohammed VI University of Health Sciences (UM6SS) of Casablanca, 20250 Casablanca, Morocco
- National Reference Laboratory, Mohammed VI University of Health Sciences (UM6SS), 82403 Casablanca, Morocco
| | - Ryan Gierke
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Marcela Guevara
- CIBER Epidemiología y Salud Pública, (CIBERESP), 28029 Madrid, Spain
- Instituto de Salud Pública de Navarra-IdiSNA, 31003 Pamplona, Spain
| | - Laura L Hammitt
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Markus Hilty
- Swiss National Reference Centre for Invasive Pneumococci, Institute for Infectious Diseases, University of Bern, 3012 Bern, Switzerland
| | - Pak-Leung Ho
- Department of Microbiology and Carol Yu Centre for Infection, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Sanjay Jayasinghe
- National Centre for Immunisation Research and Surveillance and Discipline of Child and Adolescent Health, Faculty of Medicine and Health, Children's Hospital Westmead Clinical School, University of Sydney, Westmead, NSW 2145, Australia
| | - Jackie Kleynhans
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, 2192 Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 2000 Johannesburg, South Africa
| | - Karl G Kristinsson
- Department of Clinical Microbiology, Landspitali-The National University Hospital, Hringbraut, 101 Reykjavik, Iceland
| | - Shamez N Ladhani
- Immunisation and Countermeasures Division, Public Health England, London NW9 5EQ, UK
| | - Allison McGeer
- Toronto Invasive Bacterial Diseases Network, and Department of Laboratory, Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Jason M Mwenda
- World Health Organization Regional Office for Africa, P.O. Box 06, Brazzaville, Congo
| | - J Pekka Nuorti
- Department of Health Security, Finnish Institute for Health and Welfare, 00271 Helsinki, Finland
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, 33100 Tampere, Finland
| | - Kazunori Oishi
- Toyama Institute of Health, Imizu, Toyama 939-0363, Japan
| | - Leah J Ricketson
- Department of Pediatrics, University of Calgary, Calgary, AB T3B 6A8, Canada
| | - Juan Carlos Sanz
- Laboratorio Regional de Salud Pública, Dirección General de Salud Pública, Comunidad de Madrid, 28053 Madrid, Spain
| | - Larisa Savrasova
- Centre for Disease Prevention and Control of Latvia, 1005 Riga, Latvia
- Doctoral Studies Department, Riga Stradinš University, 1007 Riga, Latvia
| | - Lena Petrova Setchanova
- Department of Medical Microbiology, Faculty of Medicine, Medical University of Sofia, 1431 Sofia, Bulgaria
| | - Andrew Smith
- Bacterial Respiratory Infection Service, Scottish Microbiology Reference Laboratory, NHS GG&C, Glasgow G4 0SF, UK
- College of Medical, Veterinary & Life Sciences, Glasgow Dental Hospital & School, University of Glasgow, Glasgow G2 3JZ, UK
| | - Palle Valentiner-Branth
- Infectious Disease Epidemiology and Prevention, Statens Serum Institut, DK-2300 Copenhagen S, Denmark
| | - Maria Teresa Valenzuela
- Department of Public Health and Epidemiology, Faculty of Medicine, Universidad de Los Andes, 12455 Santiago, Chile
| | - Mark van der Linden
- National Reference Center for Streptococci, Department of Medical Microbiology, University Hospital RWTH Aachen, 52074 Aachen, Germany
| | - Nina M van Sorge
- Medical Microbiology and Infection Prevention, Netherlands Reference Laboratory for Bacterial Meningitis, Amsterdam University Medical Centers, Location AMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Emmanuelle Varon
- National Reference Centre for Pneumococci, Centre Hospitalier Intercommunal de Créteil, 94000 Créteil, France
| | - Brita A Winje
- Department of Infection Control and Vaccine, Norwegian Institute of Public Health, 0456 Oslo, Norway
| | - Inci Yildirim
- Department of Pediatrics, Yale New Haven Children's Hospital, New Haven, CT 06504, USA
| | - Jonathan Zintgraff
- Servicio de Bacteriología Clínica, Departamento de Bacteriología, INEI-ANLIS "Dr. Carlos G. Malbrán", C1282 AFF Buenos Aires, Argentina
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Fontana NS, Ibrahim KY, Bonazzi PR, Rossi F, Almeida SCG, Tengan FM, Brandileone MCC, Abdala E. Fluoroquinolone treatment as a protective factor for 10-day mortality in Streptococcus pneumoniae bacteremia in cancer patients. Sci Rep 2021; 11:3699. [PMID: 33580101 PMCID: PMC7881156 DOI: 10.1038/s41598-021-81415-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 11/30/2020] [Indexed: 11/30/2022] Open
Abstract
To evaluate the prognostic factors in adult cancer patients with pneumococcal bacteremia, describe episode features and the phenotypic characteristics of the isolated strains. We evaluated the episodes in patients admitted to a cancer hospital between 2009 and 2015. The outcomes were defined as 48 h mortality and mortality within 10 days after the episode. The variables evaluated were: age, sex, ethnicity, ECOG, Karnofsky score, SOFA, cancer type, metastasis, chemotherapy, radiotherapy, neutropenia, previous antibiotic therapy, community or healthcare-acquired infection, comorbidities, smoking, pneumococcal vaccination, infection site, presence of fever, polymicrobial infection, antimicrobial susceptibility, serotype and treatment. 165 episodes were detected in 161 patients. The mean age was 61.3 years; solid tumors were the most prevalent (75%). 48 h and 10-day mortality were 21% (34/161) and 43% (70/161) respectively. The 48 h mortality- associated risk factors were SOFA and polymicrobial bacteremia; 10-day mortality-associated risk factors were fever, neutropenia, ECOG 3/4, SOFA and fluoroquinolones as a protective factor. Pneumococcal bacteremia presented high mortality in cancer patients, with prognosis related to intrinsic host factors and infection episodes features. Fluoroquinolone treatment, a protective factor in 10-day mortality, has potential use for IPDs and severe community-acquired pneumonia in cancer patients.
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Affiliation(s)
- Naihma Salum Fontana
- Instituto do Câncer do Estado de São Paulo da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. .,Departamento de Moléstias Infecciosas e Parasitarias da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. .,, Rua Pandiá Calógeras, 445, Jardim Vergueiro, Sorocaba, São Paulo, CEP 18030030, Brazil.
| | - Karim Yaqub Ibrahim
- Instituto do Câncer do Estado de São Paulo da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - P R Bonazzi
- Instituto do Câncer do Estado de São Paulo da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - F Rossi
- Divisão de Laboratório Central do Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil
| | - S C G Almeida
- Laboratório Nacional Para Meningites e Infecções Pneumocócicas do Instituto Adolfo Lutz, São Paulo, Brazil
| | - F M Tengan
- Departamento de Moléstias Infecciosas e Parasitarias da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - M C C Brandileone
- Laboratório Nacional Para Meningites e Infecções Pneumocócicas do Instituto Adolfo Lutz, São Paulo, Brazil
| | - E Abdala
- Instituto do Câncer do Estado de São Paulo da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Departamento de Moléstias Infecciosas e Parasitarias da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Brandileone MCDC, Zanella RC, Almeida SCG, Brandao AP, Ribeiro AF, Carvalhanas TRMP, Sato H, Andrade AL, Verani JR. Effect of 10-valent pneumococcal conjugate vaccine on nasopharyngeal carriage of Streptococcus pneumoniae and Haemophilus influenzae among children in São Paulo, Brazil. Vaccine 2016; 34:5604-5611. [PMID: 27692770 DOI: 10.1016/j.vaccine.2016.09.027] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 09/13/2016] [Accepted: 09/15/2016] [Indexed: 10/20/2022]
Abstract
In March 2010, Brazil introduced the 10-valent pneumococcal conjugate vaccine (PCV10) in the routine infant immunization program using a 4-dose schedule and catch-up for children <23months. We investigated PCV10 effect on nasopharyngeal carriage with vaccine-type Streptococcus pneumoniae (Spn) and non-typeable Haemophilus influenzae (NTHi) among children in São Paulo city. Cross-sectional surveys were conducted in 2010 (baseline) and 2013 (post-PCV10). Healthy PCV-naïve children aged 12-23months were recruited from primary health centers during immunization campaigns. Nasopharyngeal swabs were collected and tested for Hi; for Spn, all baseline and a stratified random sample of 400 post-PCV10 swabs were tested. We compared vaccine-type Spn and NTHi carriage prevalence pre-/post-PCV10, and used logistic regression to estimate PCV10 effectiveness (1-adjusted odds ratio×100%). Overall 501 children were included in the baseline and 1167 in the post-PCV10 survey (including 400 tested for Spn). Spn was detected in 40.3% of children at baseline and 48.8% post-PCV10; PCV10 serotypes were found in 19.8% and 1.8% respectively, representing a decline of 90.9% (p<0.0001). Carriage of vaccine-related serotypes increased (10.8-21.0%, p<0.0001), driven primarily by a rise in serotype 6C (1.8-11.2%, p<0.0001); carriage of serotypes 6A and 19A did not significantly change. PCV10 effectiveness (4 doses) against vaccine-type carriage was 97.3% (95% confidence interval 88.7-99.3). NTHi prevalence increased from 26.0% (130/501) to 43.6% (509/1167, p<0.0001); PCV10 vaccination seemed significantly associated with NTHi carriage, even after adjusting for other known risk factors. Carriage with PCV10 serotypes among toddlers declined dramatically following PCV10 introduction in São Paulo, Brazil. No protection of PCV10 against NTHi was observed. Our findings contribute to a growing body of evidence of PCV10 impact on vaccine-type carriage and highlight the importance of PCV10 as a tool to reduce the burden of pneumococcal disease in Brazil and globally.
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Affiliation(s)
- Maria-Cristina de C Brandileone
- National Laboratory for Meningitis and Pneumococcal Infections, Center of Bacteriology, Institute Adolfo Lutz (IAL), São Paulo, Brazil.
| | - Rosemeire C Zanella
- National Laboratory for Meningitis and Pneumococcal Infections, Center of Bacteriology, Institute Adolfo Lutz (IAL), São Paulo, Brazil.
| | - Samanta C G Almeida
- National Laboratory for Meningitis and Pneumococcal Infections, Center of Bacteriology, Institute Adolfo Lutz (IAL), São Paulo, Brazil.
| | - Angela P Brandao
- National Laboratory for Meningitis and Pneumococcal Infections, Center of Bacteriology, Institute Adolfo Lutz (IAL), São Paulo, Brazil; Oswaldo-Cruz Foundation, Rio de Janeiro, Brazil.
| | - Ana F Ribeiro
- Institute of Infectious Diseases Emilio Ribas, São Paulo, Brazil.
| | | | - Helena Sato
- Center of Epidemiologic Surveillance, Secretary of Health of the State of São Paulo, Brazil.
| | - Ana-Lúcia Andrade
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goias, Brazil.
| | - Jennifer R Verani
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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