Clonal similarities and sequence-type diversity of invasive and carriage Streptococcus pneumoniae in India among children under 5 Years

Background: Pneumococcal pneumonia is one of the major causes of mortality in children less than 5 years in Asia, especially in India. Available PCVs have less serotype coverage in India compared to western countries. Moreover, the baseline pneumococcal serotype and sequence type data is limited and available data doesn't represent the entire India. With this background we aimed to characterize invasive and carriage isolates of S. pneumoniae from a tertiary care hospital in South India. Materials and Methods: A total of 221 S. pneumoniae isolates, invasive (n=138) and carriage (n=83) between the time period of 2012-2018 were included. Isolates was identified and confirmed using standard laboratory protocols. Serotyping was performed by Customized sequential multiplex PCR and MLST as described in www.pubmlst.org. Results: The major serotypes were 19F, 6B, 14, 6A and 19A and the sequence types (ST) were ST63, 236 and 230. Predominant STs in invasive was ST 63 whereas in carriage were ST4894 and 1701. High level ST diversity in carriage was observed. Majority of the STs were SLVs or DLVs of previously reported STs or PMEN clones. Phylogenetic analyses of the STs revealed gradual expansion of three PMEN CCs CC320, 63 and 230. Conclusion: The vaccine serotypes were the predominant ones found to be associated with IPD, PMEN clones, new STs and antimicrobial resistance. Accordingly, PCV13 is expected to provide invasive serotype coverage of 75% in Indian children less than 5 years. This study provides baseline serotype and sequence type data prior to the introduction of PCV in South India.

La nueva vacuna cubana antineumocócica, de las evidencias científicas disponibles, a la estrategia de evaluación clínica y de impacto / New Cuban pneumococcal vaccine, from available scientific evidence to the strategy of clinical and impact evaluation

Este trabajo resume el marco de evidencias que sustenta el actual uso de las vacunas antineumocócicas conjugadas en términos de seguridad, inmunogenicidad, eficacia y efectividad. Presenta una nueva alternativa para prevenir la enfermedad neumocócica en la población infantil basada en el nuevo candidato vacunal cubano contra neumococo. Expone los principios básicos que definen la estrategia para su introducción en Cuba, y los avances derivados de la aplicación de un modelo integrado para la evaluación clínica e impacto en salud en fase de implementación, el cual busca proveer las evidencias científicas que soporten la decisión del sistema nacional de salud para su introducción en el esquema nacional de inmunizaciones y su posterior comercialización en la era de las vacunas conjugadas antineumocócicas. Se presentan los resultados preliminares de estudios concluidos, y se elaboran conclusiones sobre los aportes científicos y prácticos de la estrategia de implementación y el modelo de evaluación para la nueva vacuna(AU)

This paper summarized the group of evidence that supports the present use of the pneumococcal conjugate vaccines in terms of safety, immunogenicity, efficacy and effectiveness. It offers a new alternative to prevent the pneumococcal disease in the infant population on the basis of a new Cuban vaccinal candidate against pneumococci. It set out the basic principles that define the strategy for the introduction of this vaccine in Cuba and the advances resulting from the use of an integrated model for the clinical evaluation and the impact on health, in its implementation phase, which seeks to provide the scientific evidence backing up the decision of the national health care system to introduce this vaccine in the national immunization schedule and its further commercialization in the era of pneumococcal conjugate vaccines. Preliminary results of finished studies were presented and the conclusions on the scientific and practical contributions of the strategy of implementation and the evaluation model for the new vaccine were worked out(AU)

Changes in the Serotype Distribution among Antibiotic Resistant Carriage Streptococcus pneumoniae Isolates in Children after the Introduction of the Extended-Valency Pneumococcal Conjugate Vaccine

This study investigated the serotype distribution and antimicrobial resistance of 3,820 nasopharyngeal Streptococcus pneumoniae isolates from infants and children who presented with respiratory symptoms at Seoul National University Children's Hospital from July 2010 to June 2015 after the introduction of the extended-valency pneumococcal conjugate vaccines (PCVs). Serotypes and antimicrobial susceptibility were determined using the Quellung reaction and E-test, respectively. S. pneumoniae was isolated from 397 (10.4%) specimens. The most common serotypes were 19A (14.0%), 23A (12.8%), 15B/C (10.7%), 11A (10.1%), 6C (7.8%), and 6A (6.3%) among the typeable pneumococci (n = 335). The PCV serotype proportions significantly decreased (59.1% in 2010/11 to 17.0% in 2014/15, P < 0.001), whereas the non-PCV serotype proportions significantly increased (40.9% in 2010/11 to 83.0% in 2014/15, P < 0.001). The non-susceptibility rates for penicillin (oral), penicillin (parenteral, non-meningitis), cefotaxime, and erythromycin were 97.8%, 22.8%, 27.7%, and 95.5%, respectively. The proportions of PCV serotypes responsible for non-susceptibility to penicillin (parenteral, non-meningitis) and multidrug resistance significantly decreased (80.8% to 21.1%, P < 0.001 and 64.3% to 12.3%, P < 0.001, respectively), whereas the non-PCV serotype proportions significantly increased (19.2% to 78.9%, P < 0.001 and 35.7% to 87.7%, P < 0.001, respectively). Serotypes 23A and 15B/C demonstrated significant proportional increase among the antibiotics resistant strains. Thus, the PCV serotype proportions decreased and the non-PCV serotype proportions increased among nasopharyngeal carriage pneumococci after the introduction of extended-valency PCVs in Korea. Antimicrobial non-susceptibility rates for penicillin and erythromycin remain high despite the decrease in the proportion of PCV serotypes responsible for antimicrobial resistance over time.

Serotipos invasivos de Streptococcus pneumoniae en niños menores de 5 anos en Venezuela: 1999-2007 / Serotype distribution of invasive isolates of Streptococcus pneumoniae from Venezuelan children under 5 years of age between: 1999-2007

Introduccion: La enfermedad neumococica es una de las principales causas de mortalidad infantil en el mundo. Ob je - tivo: Determinar los serotipos de Streptococcus pneumoniae que producen enfermedad invasiva en ninos menores de 5 anos en Venezuela. Materiales y Metodos: Se establecieron 7 hospitales centinelas. El estudio incluyo variables demograficas y epidemiologicas. El Instituto Nacional de Higiene Rafael Rangel realizo la confirmacion y serotipificacion de las cepas. Resultados: Entre 1999-2007 fueron se - ro tipificadas 493 cepas de S. pneumoniae. Los serotipos mas frecuentes fueron el 14 (34,9%), 6B (13,8%), 5 (9,1%), 1 (6,1%) y 19A (6,1%), que correspondieron al 70% de las cepas. La cobertura global de la vacuna polisacarida conjugada heptavalente seria de 66,9% en bacteriemias, 56,6% en neumonias y 64,6% en meningitis. La va cuna decavalente tendria una cobertura teorica global de 76,9%, con valores similares en las tres entidades clinicas y la trecevalente tendria una cobertura potencial teorica de 90%. Conclu sio - nes: Esta investigacion reporta la distribucion de los serotipos invasivos de S. pneumoniae en Venezuela y permiten in ferir que la introduccion de vacunas neumococicas conjugadas en nuestra poblacion pediatrica ten drian un impacto positivo en la prevencion de la enfermedad.

Background: Pneumococcal disease is the principal cause of morbidity and mortality in children. Objective: To determi - ne the serotype distribution of invasive S. pneumoniae strains isolated from children under 5 years in Venezuela. Ma terials and Methods: 7 hospitals settled down sentries. The study included demographic variables and epidemiologists. The National Institute of Higiene gRafael Rangelh rea li - sed the confirmation and serotyping of the strains. Results: Bet ween 1999-2007 493 strains of S. pneumoniae were se - ro typing. The most frequent serotypes, with 70% of all the strains belonging to these 5 serotypes were: 14 (34,9%), 6B (13,8%), 5 (9,1%), 1 (6,1%) and 19A (6,1%). The potential co verage of the 7-valent conjugate vaccine is 66,9% for bacteriemia, 56,6% for pneumonias and 64,6% for meningitis respectively. The potential coverage of the 10-valent conjugate vaccine is (76,9%) with similar values for the three clini cal manifestations and the 13-valent has a potential coverage of 90%. Conclusions: This investigation reports the distribution of invasive S. pneumoniae serotypes in Venezuela and allow to infer that the conjugated vaccines introduction in our pediatric population could have a positive impact on the prevention of pneumococcal disease.