TY - JOUR
T1 - Measuring the effects of pneumococcal conjugate vaccine (PCV7) on Streptococcus pneumoniae carriage and antibiotic resistance
T2 - The Palestinian-Israeli Collaborative Research (PICR)
AU - PICR study groupa
AU - Daana, Muhannad
AU - Rahav, Galia
AU - Hamdan, Ayob
AU - Thalji, Amin
AU - Jaar, Fuad
AU - Abdeen, Ziad
AU - Jaber, Hanaa
AU - Goral, Aviva
AU - Huppert, Amit
AU - Raz, Meir
AU - Regev-Yochay, Gili
AU - Abullaish, Izzeldin
AU - Affiffi, Muhammed
AU - Amit, Yair
AU - Bassem, Yunes
AU - Cohen, Adi
AU - Dandis, Ibrahim
AU - ElHam-dany, Abedalla
AU - Hasselton, Samantha
AU - Hupert, Amit
AU - Husseini, Muhammed
AU - Kawather, Laduyeh
AU - Osher, Marian
AU - Rodity, Avraham
AU - Roizin, Hector
AU - Siag, Waeel
AU - Stern, Ora
AU - Yakirevitch, Luba
AU - Zecayra, Khairi
N1 - Publisher Copyright:
© 2015 Elsevier Ltd.
PY - 2015/2/18
Y1 - 2015/2/18
N2 - Background: The Palestinian-Israeli Collaborative Research (PICR) cross-conflict setting provided a unique opportunity to study overall and indirect effects of pneumococcal conjugate vaccine (PCV7), in two closely related Palestinian populations governed by two distinct health authorities with distinct vaccination policies. Here, PCV7 effects on pneumococcal carriage, serotype distribution and antibiotic resistance are reported. Methods: Annual cross-sectional surveys of pneumococcal carriage were performed during 2009-2011 among Palestinian children (≤5 years) (a) under Palestinian-Authority (PA) health policy (Ramallah, Nablus and Bethlehem), where PCV7 was unlicensed (b) under Israeli health policy (East-Jerusalem (EJ)) where PCV7 was rapidly implemented from July 2009. Clinical data were collected, pneumococci identified and characterized for antibiotic susceptibilities and serotype. Analyses included multivariate logistic models with an interaction term for PCV7-effect. Results: Altogether, 2755 children from PA (n= 1772) and EJ (n= 983) were enrolled, of which ~30% were pneumococcal carriers. While overall carriage was not affected by vaccination policy, carriage of vaccine-type (VT7) strains decreased from 52% to 22% (p< 0.001) in EJ, where PCV was implemented, but not in PA. This was accompanied by an increase in non-VT13 strains from 34% to 65% (p< 0.001) in EJ, but not in PA. Furthermore, within two years post-PCV7 introduction, proportion of multi-drug resistant strains, which was initially 23% in both populations, decreased significantly in EJ, to 10%, while simultaneously it increased in PA to 33% (p< 0.001). Similar trends were observed for resistance to most antibiotic groups. The proportion of resistant isolates among non-VT13 strains did not change during the study period. Conclusions: The unique study design distinguishes secular and seasonal effects from true vaccine effects. While PCV7 did not affect overall pneumococcal carriage rate, VT7 strains, many of which were antibiotic resistant decreased and were replaced by non-VT13 strains, which were mostly not antibiotic resistant, resulting in a net decrease in antibiotic resistance.
AB - Background: The Palestinian-Israeli Collaborative Research (PICR) cross-conflict setting provided a unique opportunity to study overall and indirect effects of pneumococcal conjugate vaccine (PCV7), in two closely related Palestinian populations governed by two distinct health authorities with distinct vaccination policies. Here, PCV7 effects on pneumococcal carriage, serotype distribution and antibiotic resistance are reported. Methods: Annual cross-sectional surveys of pneumococcal carriage were performed during 2009-2011 among Palestinian children (≤5 years) (a) under Palestinian-Authority (PA) health policy (Ramallah, Nablus and Bethlehem), where PCV7 was unlicensed (b) under Israeli health policy (East-Jerusalem (EJ)) where PCV7 was rapidly implemented from July 2009. Clinical data were collected, pneumococci identified and characterized for antibiotic susceptibilities and serotype. Analyses included multivariate logistic models with an interaction term for PCV7-effect. Results: Altogether, 2755 children from PA (n= 1772) and EJ (n= 983) were enrolled, of which ~30% were pneumococcal carriers. While overall carriage was not affected by vaccination policy, carriage of vaccine-type (VT7) strains decreased from 52% to 22% (p< 0.001) in EJ, where PCV was implemented, but not in PA. This was accompanied by an increase in non-VT13 strains from 34% to 65% (p< 0.001) in EJ, but not in PA. Furthermore, within two years post-PCV7 introduction, proportion of multi-drug resistant strains, which was initially 23% in both populations, decreased significantly in EJ, to 10%, while simultaneously it increased in PA to 33% (p< 0.001). Similar trends were observed for resistance to most antibiotic groups. The proportion of resistant isolates among non-VT13 strains did not change during the study period. Conclusions: The unique study design distinguishes secular and seasonal effects from true vaccine effects. While PCV7 did not affect overall pneumococcal carriage rate, VT7 strains, many of which were antibiotic resistant decreased and were replaced by non-VT13 strains, which were mostly not antibiotic resistant, resulting in a net decrease in antibiotic resistance.
KW - Antibiotic resistance
KW - PCV7 effects
KW - Pneumococcal carriage
KW - Population-based study
UR - http://www.scopus.com/inward/record.url?scp=84922930117&partnerID=8YFLogxK
U2 - 10.1016/j.vaccine.2015.01.003
DO - 10.1016/j.vaccine.2015.01.003
M3 - Article
C2 - 25593104
AN - SCOPUS:84922930117
SN - 0264-410X
VL - 33
SP - 1021
EP - 1026
JO - Vaccine
JF - Vaccine
IS - 8
ER -
