Understanding the Evolution of Antibiotic-nonsusceptible Pneumococcal Nasopharyngeal Colonization following Pneumococcal Conjugate Vaccine Implementation in Young Children

Dana Danino, Noga Givon-Lavi, Shalom Ben-Shimol, David Greenberg, Ron Dagan

Research output: Contribution to journalArticlepeer-review

19 Scopus citations

Abstract

Background: Four main processes determine pneumococcal conjugate vaccine (PCV) antibiotic-nonsusceptible Streptococcus pneumoniae (ANSP) carriage: reduction of PCV serotypes, increase of non-PCV serotypes, potential overall reduction in carriage, and within-serotype nonsusceptibility resulting from continuous antibiotic pressure. The post-PCV implementation dynamics of these components were examined in young children from 2 distinct ethnic populations: Jewish and Bedouin. Methods: We performed ongoing, prospective, population-based, active surveillance initiated at the time of 7- and 13-valent PCVs (PCV7; PCV13) implementation. Nasopharyngeal cultures for S. pneumoniae were obtained daily from children aged <5 years who visited the only pediatric emergency room in the district during a 6-year period (2009 to 2015). Results: Of 8446 nasopharyngeal samples, 48.3% were positive (42.0% and 52.8% for Jewish and Bedouin children, respectively; P <. 001). Nonsusceptibility was significantly more frequent among PCV serotypes than among non-PCV serotypes and among Bedouin children than among Jewish children. PCV serotype carriage declined by 80%, while that of non-PCV serotypes increased by 140%. The overall (all serotypes) pneumococcal carriage significantly declined (33% and 11% in Bedouin and Jewish children, respectively). Among non-PCV isolates, the proportion of ANSP significantly increased with time in both populations. As a summation of all 4 processes, ANSP carriage significantly decreased among both Bedouin and Jewish children. Conclusions: PCV impact on ANSP nasopharyngeal carriage is a dynamic, multicomponent process, highly dependent on antibiotic consumption in the community, which may result in a continuous increase in antibiotic resistance in the replacing serotypes.

Original languageEnglish
Pages (from-to)648-656
Number of pages9
JournalClinical Infectious Diseases
Volume69
Issue number4
DOIs
StatePublished - 15 Aug 2019

Keywords

  • PCV
  • antibiotic-nonsusceptible pneumococcus
  • children
  • colonization
  • pneumococcal conjugate vaccine

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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