Distribution of Streptococcus pneumoniae serotypes in the northeast macro-region of São Paulo state/Brazil after the introduction of conjugate vaccine.

BACKGROUND: Infections caused by Streptococcus pneumoniae (Spn) still challenge health systems around the world, even with advances in vaccination programs. The present study evaluated the frequency of various Spn serotypes isolated in Regional Health Care Network 13 (RRAS 13), which includes the regional health departments (RHDs) of Araraquara, Barretos, Franca and Ribeirão Preto, especially after the introduction of 10-valent pneumococcal conjugate vaccine (PCV10) in 2010. METHODS: The analyzed Spn strains were isolated from patients with invasive pneumococcal diseases (IPDs) and then sent to Adolfo Lutz Institute (ALI) for further confirmative identification tests during the period from 1998 to 2013. The samples were from the cities in RRAS13, which is located in the Northeast region of São Paulo State, and totals 90 municipalities. RESULTS: We analyzed strains isolated from 796 patients. They were predominantly: men (58.9%); 20 to 60 years old (32.2%); evaluated from 2003 to 2010 (60.2%); and diagnosed with meningitis (45.7%) and pneumonia (45.0%), the most common invasive pneumococcal diseases. In 2010, serotypes 3, 19F, 1, 23F, 6A and 6B were among the most frequent, while serotypes 3, 12F, 14, 6A, 18C, 8 and 6B were more common after the introduction of PCV10. Serotypes 14, 19F and 3 were more frequent in meningitis, while serotypes 14, 3 and 1 prevailed in pneumonia. After 2010, there was a decrease in serotypes 14, 1, 23F and 5 and an increase in serotypes 3, 12F, 11A and 8, which were not present in the vaccine. CONCLUSIONS: The present study noted the increase in serotypes 3, 12F, 11A and 8 after vaccination. None of those serotypes are included in the available conjugate vaccines, which highlights the importance of continued monitoring of IPDs in order to measure the disease burden in the population in the long term and provide new epidemiological information to determine the impact of PCV10 in Brazil.

Prevalence of pneumococcal serotypes and resistance to antimicrobial agents in patients with meningitis: ten-year analysis.

OBJECTIVES: To determine the prevalence of pneumococcal serotypes and antimicrobial susceptibility in patients with meningitis, and to evaluate the implications for vaccine coverage. METHODS: Pneumococcal strains obtained from normally sterile fluids from patients admitted with meningitis were isolated at the Hospital de Clínicas of the Universidade Federal de Uberlândia, Minas Gerais State, and sent to the Instituto Adolfo Lutz, city of São Paulo, São Paulo State, for further identification, serotyping, and antimicrobial susceptibility determination. RESULTS: From April 1999 to April 2009, 338 pneumococcal strains were isolated, and 72 obtained from patients with meningitis, were analyzed. Patients' ages varied from one month to 82.2 years (mean of 18.4 ± 22.9 years; median of 5.2 years) and 46 (63.9%) patients were male. Strains were isolated from cerebrospinal fluid [66 occasions (91.7%)] and blood [6 occasions (8.3%)]. The most commonly identified serotypes were 14, 19F, 3, 7F, 6A, 6B, 10A, 18C, 23F, 5, and 34. Of the 20 [27.8%] oxacillin-resistant strains, 17 [23.6%] were resistant to penicillin and nine [12.5%] to ceftriaxone, both resistance patterns being more common in children aged two years or less and during the 2005-2009 period. CONCLUSIONS: Resistance to penicillin and ceftriaxone was detected in 23.6% and 12.5% of the strains, respectively, and predominated in children aged two years or less and during the 2005-2009 period. There were 24 different serotypes of pneumococcus and 79.8% of the serotypes were represented in the 7-valent conjugated vaccine [PVC7].

Prevalence of pneumococcal serotypes and resistance to antimicrobial agents in patients with meningitis: ten-year analysis

OBJECTIVES: To determine the prevalence of pneumococcal serotypes and antimicrobial susceptibility in patients with meningitis, and to evaluate the implications for vaccine coverage. METHODS: Pneumococcal strains obtained from normally sterile fluids from patients admitted with meningitis were isolated at the Hospital de Clínicas of the Universidade Federal de Uberlândia, Minas Gerais State, and sent to the Instituto Adolfo Lutz, city of São Paulo, São Paulo State, for further identification, serotyping, and antimicrobial susceptibility determination. RESULTS: From April 1999 to April 2009, 338 pneumococcal strains were isolated, and 72 obtained from patients with meningitis, were analyzed. Patients' ages varied from one month to 82.2 years (mean of 18.4 ± 22.9 years; median of 5.2 years) and 46 (63.9 percent) patients were male. Strains were isolated from cerebrospinal fluid [66 occasions (91.7 percent)] and blood [6 occasions (8.3 percent)]. The most commonly identified serotypes were 14, 19F, 3, 7F, 6A, 6B, 10A, 18C, 23F, 5, and 34. Of the 20 [27.8 percent] oxacillin-resistant strains, 17 [23.6 percent] were resistant to penicillin and nine [12.5 percent] to ceftriaxone, both resistance patterns being more common in children aged two years or less and during the 2005-2009 period. CONCLUSIONS: Resistance to penicillin and ceftriaxone was detected in 23.6 percent and 12.5 percent of the strains, respectively, and predominated in children aged two years or less and during the 2005-2009 period. There were 24 different serotypes of pneumococcus and 79.8 percent of the serotypes were represented in the 7-valent conjugated vaccine [PVC7].

Prevalência de sorotipos e resistência antimicrobiana de cepas invasivas do pneumococo em crianças: análise de 9 anos / Prevalence of serotypes and antimicrobial resistance of invasive strains of pneumococcus in children: analysis of 9 years

OBJETIVO: Avaliar o perfil de sorotipos e a sensibilidade aos antimicrobianos de cepas de pneumococo obtidas de crianças e as implicações na formulação de vacinas pneumocócicas. MÉTODOS: Cepas de pneumococo isoladas no Hospital de Clínicas da Universidade Federal de Uberlândia, Uberlândia (MG), a partir de pacientes com doença invasiva, foram enviadas ao Instituto Adolfo Lutz, São Paulo (SP), para confirmação da identificação, sorotipagem e determinação da sensibilidade aos antimicrobianos. RESULTADOS: De abril de 1999 a dezembro de 2008, foram avaliadas 142 cepas de pneumococo obtidas de crianças de até 5 anos de idade. Setenta e cinco (52,8 por cento) eram de pacientes do sexo masculino, e a idade variou de 1 a 60 meses (média de 19±15,4 meses e mediana de 15 meses). Os diagnósticos clínicos mais comuns foram pneumonia [92 casos (64,8 por cento)] e meningite [33 casos (23,2 por cento)], e as principais fontes de recuperação foram sangue [61 amostras (43 por cento)], líquido pleural [52 (36,6 por cento)] e liquor [28 (19,7 por cento)]. Os sorotipos mais comuns foram o 14, 5, 6B, 1, 6A, 18C, 19A, 3, 9V, 19F, 23F, 9N e 10A. Foram detectadas 14 (9,9 por cento) cepas penicilina-resistentes, restritas aos sorotipos 14, 6B, 19F, 19A e 23F e predominantes no período de 2004 a 2008 (p = 0,000). Foi detectada sensibilidade diminuída ao cotrimoxazol (79,5 por cento), à eritromicina e à clindamicina (11,3 por cento cada) e à ceftriaxona (5,6 por cento). CONCLUSÕES: A resistência à penicilina foi detectada em 9,9 por cento das cepas e predominou no período de 2004 a 2008. Foram identificados 20 diferentes sorotipos de pneumococo, e a cifra de cobertura pela vacina 7-valente atualmente disponível (PN CRM7) é de 71,9 por cento.

OBJECTIVE: To determine the prevalence of serotypes and antimicrobial susceptibility of strains of pneumococcus in children and to evaluate the implications for vaccine formulation. METHODS: Strains of pneumococcus obtained from children admitted with invasive diseases were isolated at Hospital de Clínicas of Universidade Federal de Uberlândia, Uberlândia, Brazil, and sent to Instituto Adolfo Lutz, São Paulo, Brazil, for further identification, serotyping, and determination of antimicrobial susceptibility. RESULTS: From April 1999 to December 2008, 142 strains of pneumococcus, obtained from children under 5 years of age, were analyzed. Seventy-five (52.8 percent) patients were male, and the age ranged from 1 to 60 months (mean age = 19±15.4 months; median = 15 months). The most common diagnoses were pneumonia [92 cases (64.8 percent)] and meningitis [33 cases (23.2 percent)]. The strains were mostly isolated from blood [61 samples (43 percent)], pleural fluid [52 samples (36.6 percent)], and cerebrospinal fluid [28 samples (19.7 percent)]. The most common serotypes were 14, 5, 6B, 1, 6A, 18C, 19A, 3, 9V, 19F, 23F, 9N, and 10A. There were 14 [9.9 percent] penicillin-resistant strains, which was detected only in the following serotypes: 14, 6B, 19F, 19A, and 23F, being predominant from 2004 to 2008 (p = 0.000). There was reduced susceptibility to co-trimoxazole (79.5 percent), erythromycin and clindamycin (11.3 percent each), and ceftriaxone (5.6 percent). CONCLUSIONS: Penicillin resistance was detected in 9.9 percent of the strains, being predominant from 2004 to 2008. Twenty different pneumococcal serotypes were identified, and 71.9 percent of the serotypes were represented in the 7-valent conjugate vaccine (PN CRM7) currently available.

Prevalence of serotypes and antimicrobial resistance of invasive strains of pneumococcus in children: analysis of 9 years.

OBJECTIVE: To determine the prevalence of serotypes and antimicrobial susceptibility of strains of pneumococcus in children and to evaluate the implications for vaccine formulation. METHODS: Strains of pneumococcus obtained from children admitted with invasive diseases were isolated at Hospital de Clínicas of Universidade Federal de Uberlândia, Uberlândia, Brazil, and sent to Instituto Adolfo Lutz, São Paulo, Brazil, for further identification, serotyping, and determination of antimicrobial susceptibility. RESULTS: From April 1999 to December 2008, 142 strains of pneumococcus, obtained from children under 5 years of age, were analyzed. Seventy-five (52.8%) patients were male, and the age ranged from 1 to 60 months (mean age = 19+/-15.4 months; median = 15 months). The most common diagnoses were pneumonia [92 cases (64.8%)] and meningitis [33 cases (23.2%)]. The strains were mostly isolated from blood [61 samples (43%)], pleural fluid [52 samples (36.6%)], and cerebrospinal fluid [28 samples (19.7%)]. The most common serotypes were 14, 5, 6B, 1, 6A, 18C, 19A, 3, 9V, 19F, 23F, 9N, and 10A. There were 14 [9.9%] penicillin-resistant strains, which was detected only in the following serotypes: 14, 6B, 19F, 19A, and 23F, being predominant from 2004 to 2008 (p = 0.000). There was reduced susceptibility to co-trimoxazole (79.5%), erythromycin and clindamycin (11.3% each), and ceftriaxone (5.6%). CONCLUSIONS: Penicillin resistance was detected in 9.9% of the strains, being predominant from 2004 to 2008. Twenty different pneumococcal serotypes were identified, and 71.9% of the serotypes were represented in the 7-valent conjugate vaccine (PN CRM7) currently available.