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Abstract
BackgroundIn mid 2010, the 7-valent pneumococcal conjugate vaccine (PCV7) was replaced by the 13-valent conjugate vaccine (PCV13) for childhood immunization in Italy. Our objective in this study was to obtain a snapshot of pneumococcal carriage frequency, colonizing serotypes, and antibiotic resistance in healthy children in two Italian cities one year after PCV13 was introduced.MethodsNasopharyngeal swabs were obtained from 571 children aged 0-5 years from November 2011-April 2012. Pneumococcal isolates were serotyped and tested for antimicrobial susceptibility. Penicillin and/or erythromycin non-susceptible isolates were analyzed by Multi Locus Sequence Typing (MLST).ResultsAmong the children examined, 81.2% had received at least one dose of PCV7 or PCV13 and 74.9% had completed the recommended vaccination schedule for their age. Among the latter, 57.3% of children had received PCV7, 27.1% PCV13, and 15.6% a combination of the two vaccines. The overall carriage rate was 32.9%, with children aged 6-35 months the most prone to pneumococcal colonization (6-23 months OR: 3.75; 95% CI: 2.19-6.43 and 24-35 months OR: 3.15, 95%CI: 2.36-4.22). A total of 184 pneumococcal isolates were serotyped and divided into PCV7 (5.4%), PCV13 (18.0%), and non-PCV13 (82.0%) serotypes. Serotypes 6C, 24F, and 19A were the most prevalent (10.3%, 8.6%, and 8.1%, respectively). The proportion of penicillin non-susceptible (MIC >0.6 mg/L) isolates was 30.9%, while 42.3% were erythromycin resistant. Non-PCV13 serotypes accounted for 75.4% and 70.8% of the penicillin and erythromycin non-susceptible isolates, respectively.ConclusionsOur results revealed low rates of PCV7 and PCV13 serotypes in Italian children, potentially due to the effects of vaccination. As the use of PCV13 continues, its potential impact on vaccine serotypes such as 19A and cross-reactive serotypes such as 6C will be assessed, with this study providing a baseline for further analysis of surveillance isolates.
Highlights
Streptococcus pneumoniae is an important human pathogen causing a broad spectrum of infections, ranging from upper and lower respiratory tract infections to invasive pneumococcal diseases (IPD), such as meningitis and sepsis
The only difference observed between the children populations of the two cities with regard to demographic characteristics was a higher presence of young siblings in Milan, which was borderline significant (p= 0.051)
According to the Italian schedule [16], children vaccinated with a combination of vaccines receive 2 or 3 doses of PCV7 followed by 1 dose of PCV13 (48/62 children, 77.4%) or 1 or 2 doses of PCV7 followed by 2 doses of PCV13 (14/62 children, 22.6%)
Summary
Streptococcus pneumoniae (pneumococcus) is an important human pathogen causing a broad spectrum of infections, ranging from upper and lower respiratory tract infections (otitis, sinusitis, and pneumonia) to invasive pneumococcal diseases (IPD), such as meningitis and sepsis. Children under 5 years of age and elderly people represent high-risk groups for serious pneumococcal infections. The widespread use of PCV7 led to an overall decrease in IPD due to vaccine serotypes in vaccinated children as well as non-vaccinated persons of all ages [5,6]. Our objective in this study was to obtain a snapshot of pneumococcal carriage frequency, colonizing serotypes, and antibiotic resistance in healthy children in two Italian cities one year after PCV13 was introduced. Results: Among the children examined, 81.2% had received at least one dose of PCV7 or PCV13 and 74.9% had completed the recommended vaccination schedule for their age. Non-PCV13 serotypes accounted for 75.4% and 70.8% of the penicillin and erythromycin non-susceptible isolates, respectively. As the use of PCV13 continues, its potential impact on vaccine serotypes such as 19A and cross-reactive serotypes such as 6C will be assessed, with this study providing a baseline for further analysis of surveillance isolates
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