Serotype distribution and antimicrobial susceptibility pattern in children≤5years with invasive pneumococcal disease in India - A systematic review.

Streptococcus pneumoniae is a leading cause of childhood diseases that result in significant morbidity and mortality in India. Commercially licensed and available pneumococcal conjugate vaccines (PCVs) include ten (PCV-10) and 13 (PCV-13) pneumococcal serotypes. Vaccines with other serotype combinations are under development. Reviewing and reporting trends and distribution of pneumococcal serotypes causing invasive pneumococcal disease in India will be useful for policy making as PCV is being introduced into India's universal immunization program. We conducted a systematic literature review of hospital based observational studies (both peer reviewed and gray literature published in English) from India available from January 1990 to December 2016. Studies that documented data on the prevalence of serotype distribution and the antimicrobial resistance pattern of S. pneumoniae in children≤5years of age were included. We screened a total number of 116 studies, of which 109 studies were excluded. Final analysis included seven studies. The most frequent pneumococcal serotypes causing invasive disease among children≤5years were 14, 1, 19F, 6B, 5, 6A, 9V and 23F. Serotype 14 and 19A were represented in most of the geographical regions studied in the reviewed articles. Currently available PCV formulations included 67.3-78.4% of all serotypes contributing to IPD among Indian children≤5years. Pneumococcal resistance to trimethoprim/sulfamethoxazole, erythromycin, penicillin, chloramphenicol, levofloxacin and cefotaxime was seen in 81%, 37%, 10%, 8%, 6% and 4% of all pneumococcal isolates respectively, while vancomycin resistance was not reported. The present review demonstrates that up to 78.4% of reported invasive pneumococcal disease in children≤5years in India are currently caused by serotypes that are included in the available licensed PCVs. However, sentinel surveillance must be continued in representative parts of the country to assess the changing trends in distribution of pneumococcal serotypes and their implication for vaccine selection and rollout in India.

Singh J ，Sundaresan S ，Manoharan A ，Shet A ... -  《-》

Impact of pneumococcal conjugate vaccines on burden of invasive pneumococcal disease and serotype distribution of Streptococcus pneumoniae isolates: an overview from Kuwait.

Diseases caused by Streptococcus pneumoniae are a major worldwide public health problem. The seven-valent pneumococcal conjugate vaccine (PCV7) was introduced in Kuwait in August 2006 and the 13-valent vaccine, PCV13, in August 2010, for children aged <2 years, with catch-up programs for those from 2 to 5 years. The objective of this study was to evaluate the impact of vaccination on vaccine and non-vaccine serotype distribution in invasive and noninvasive S. pneumoniae isolates obtained in Kuwait from August 2006 through December 2011, as compared with previously published data. The susceptibility of all the isolates to penicillin was also evaluated. The study included all cases of noninvasive and invasive pneumococcal diseases (IPD) in children and adults among all age groups during this period. All isolates were serotyped using the Quellung reaction antisera and their susceptibility to penicillin was determined using the E test method. A total of 395 pneumococcal isolates were included in the study. After vaccine introduction, 23% of isolates were from children ≤5 years of age and 49% of cases in this age group were invasive, while 46% of isolates were from adults >50 years of age and 27% of cases in this age group were invasive. Two of 13 cerebrospinal fluid isolates and only one of 266 respiratory isolates obtained were penicillin resistant. For the post-vaccine period, the predominant serotypes in children ≤5 years were 19F, 19A, 6A, 8 and 15B for invasive isolates and 19F and 23F for noninvasive isolates and the predominant serotypes in adults >50 years of age were 14, 3, 1, 19F and 8 for invasive isolates and 19F, 23F, 6B, 14 and 19A for noninvasive isolates. Among children <2 years of age, coverage with PCV7, PCV10, and PCV13 was 34.6%, 38.5% and 61.5%, respectively, in the period post-vaccine introduction. Among children 2-5 years of age, corresponding coverage rates were 42.1%, 47.4% and 63.1%, respectively. A similar trend was noticed in adults, with coverage rates in the 51- to 65-years age group of 45.8%, 62.5% and 70.8% respectively. Compared with previously published findings, from the period prior to vaccine introduction, this represented an increased incidence in some non-PCV7 serotypes that are included in PCV13 (serotypes 1, 6A, and 3). In conclusion, with the emergence of new pneumococcal serotypes, broader vaccine coverage will aid in the prevention of IPD in children.

Mokaddas E ，Albert MJ 《-》

Antibiotic resistance and serotype distribution of invasive pneumococcal diseases before and after introduction of pneumococcal conjugate vaccine in the Kingdom of Saudi Arabia (KSA).

Streptococcus pneumoniae is one of the most common bacterial causes of morbidity and mortality worldwide, causing life threatening infections such as meningitis, pneumonia and febrile bacteremia, particular among young children. The severity and frequency of S. pneumoniae infection and emergence of drug-resistant isolates have highlighted the need for prevention of invasive pneumococcal disease (IPD) as the best method for controlling disease; to better achieve this, more information is needed about serotype distribution and patterns of antibiotic resistance in children in the Kingdom of Saudi Arabia (KSA). Cases of pneumococcal infections in children aged <5 years, recorded in hospitals throughout KSA from 2005 to 2010 were reviewed for serotyping and for antibiotic susceptibility. This covers the time period just before limited introduction of 7-valent pneumococcal conjugate vaccine (PCV7) in 2006, to its introduction into the national immunization program in 2008, until right after a switch to PCV13 in 2010. Case definition required isolation of S. pneumoniae from blood, cerebrospinal fluid, or any sterile biological fluid. Isolates from 311 eligible cases were collected from different regions across KSA, 250 from blood and 61 from cerebrospinal fluid. The most frequently isolated IPD serotypes were 23F, 19F, 6B, 5 and 1. Over the course of the study, there was significant rise of serotype 19A (covered by PCV13 but not PCV7), which accounted for 20% of isolates of IPD in Western and 5% in Central regions in the last 2 years in KSA. There was a notable decrease in serotype 18C over this period, one of the PCV7 serotypes. Serotype coverage for PCV7, PCV10, PCV13 in children <5 years was 53%, 80%, and 91%, respectively across the Kingdom from 2005 to 2010. A total of 66% of IPD isolates were penicillin-resistant, and 62% were erythromycin-resistant. Continued surveillance is critical to measure the emerging of new serotypes and antibiotic resistance strain, and the potential impact of new PCVs. PCV13, recently introduced into the national immunization schedule in place of PCV7, provides the widest coverage among all IPD serotypes across KSA.

Shibl AM ，Memish ZA ，Al-Kattan KM 《-》

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.

Lee JK ，Yun KW ，Choi EH ，Kim SJ ，Lee SY ，Lee HJ ... -  《-》

Changing trends in serotype distribution and antimicrobial susceptibility of Streptococcus pneumoniae causing invasive diseases in Central Thailand, 2009-2012.

Phongsamart W ，Srifeungfung S ，Chatsuwan T ，Nunthapisud P ，Treerauthaweeraphong V ，Rungnobhakhun P ，Sricharoenchai S ，Chokephaibulkit K ... -  《-》