Epidemiology of serotype 19A isolates from invasive pneumococcal disease in German children

BMC Infectious Diseases

Matthias Imöhl¹  Winfried V Kern²  Ralf René Reinert¹  Mark van der Linden¹ 

[1] Institute for Medical Microbiology, National Reference Center for Streptococci, Department of Medical Microbiology, University Hospital (RWTH), Pauwelsstr. 30, Aachen, 52074, Germany;Division of Infectious Diseases, Department of Medicine, Albert-Ludwigs-University, Freiburg, Germany

关键词: Germany;    Serotype 19A;    Streptococcus pneumoniae;   

Others  :  1158437
DOI  :  10.1186/1471-2334-13-70

 received in 2012-09-25, accepted in 2013-01-31,  发布年份 2013

【 摘 要 】

Background

This study presents an analysis of 159 serotype 19A isolates from IPD in children before and after the general recommendation for childhood pneumococcal conjugate vaccination in Germany in July 2006. Vaccination formulations used were PCV7, PCV10 (from April 2009) and PCV13 (from Dec. 2009, replacing PCV7).

Methods

Isolates from invasive pneumococcal disease in children were serotyped using the Quellung reaction, tested for antibiotic susceptibility and analysed for their multi locus sequence type.

Results

In an analysis of 3328 isolates from invasive pneumococcal disease (IPD) in children that were sent to the German National Reference Center for Streptococci between July 1997 and June 2011, we show that the proportion of 19A isolates ranged between 1.7 and 4.2% in the period 1997 to 2006. After the recommendation for pneumococcal conjugate childhood vaccination, which was issued in July 2006, the proportion of 19A isolates increased significantly to 15.0% in 2010/11. Eight clonal complexes (CC) and groups accounted for 77.2% and 65.3% of all serotype 19A isolates before and after vaccination, respectively. While three CCs and several STs were not detected after vaccine introduction, four CCs and several STs first appeared after vaccination, including three ST320 isolates that could be traced to recent imports from the US, UK and India. The proportion of penicillin-nonsusceptible and of multidrug-resistant 19A isolates moderately increased after vaccine introduction. A significant increase in the use of cephalosporins and azithromycin was noted post-vaccination (p=0.00001 and p=0.0013 respectively).

Conclusions

The prevalence of serotype 19A in Germany has increased significantly between July 2007 and June 2011. Possible reasons for this are the introduction of pneumococcal conjugate vaccination, increased use of cephalosporins and azithromycin, import of multidrug-resistant isolates and increased reporting.

【 授权许可】

   
2013 van der Linden et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Pneumococcal conjugate vaccine for childhood immunization--WHO position paper Wkly Epidemiol Rec 2007, 82(12):93-104.
• [2]Whitney CG, Farley MM, Hadler J, Harrison LH, Bennett NM, Lynfield R, Reingold A, Cieslak PR, Pilishvili T, Jackson D, et al.: Decline in invasive pneumococcal disease after the introduction of protein-polysaccharide conjugate vaccine. N Engl J Med 2003, 348(18):1737-1746.
• [3]Kaplan SL, Barson WJ, Lin PL, Stovall SH, Bradley JS, Tan TQ, Hoffman JA, Givner LB, Mason EO Jr: Serotype 19A Is the most common serotype causing invasive pneumococcal infections in children. Pediatrics 2010, 125(3):429-436.
• [4]Moore MR, Gertz RE Jr, Woodbury RL, Barkocy-Gallagher GA, Schaffner W, Lexau C, Gershman K, Reingold A, Farley M, Harrison LH, et al.: Population snapshot of emergent Streptococcus pneumoniae serotype 19A in the United States, 2005. J Infect Dis 2008, 197(7):1016-1027.
• [5]Pai R, Moore MR, Pilishvili T, Gertz RE, Whitney CG, Beall B: Postvaccine genetic structure of Streptococcus pneumoniae serotype 19A from children in the United States. J Infect Dis 2005, 192(11):1988-1995.
• [6]Beall BW, Gertz RE, Hulkower RL, Whitney CG, Moore MR, Brueggemann AB: Shifting genetic structure of invasive serotype 19A pneumococci in the United States. J Infect Dis 2011, 203(10):1360-1368.
• [7]Choi EH, Kim SH, Eun BW, Kim SJ, Kim NH, Lee J, Lee HJ: Streptococcus pneumoniae Serotype 19A in children, South Korea. Emerg Infect Dis 2008, 14(2):275-281.
• [8]Dagan R, Givon-Lavi N, Leibovitz E, Greenberg D, Porat N: Introduction and proliferation of multidrug-resistant Streptococcus pneumoniae serotype 19A clones that cause acute otitis media in an unvaccinated population. J Infect Dis 2009, 199(6):776-785.
• [9]Reinert R, Jacobs MR, Kaplan SL: Pneumococcal disease caused by serotype 19A: review of the literature and implications for future vaccine development. Vaccine 2010, 28(26):4249-4259.
• [10]Fenoll A, Granizo JJ, Aguilar L, Gimenez MJ, Aragoneses-Fenoll L, Hanquet G, Casal J, Tarrago D: Temporal trends of invasive Streptococcus pneumoniae serotypes and antimicrobial resistance patterns in Spain from 1979 to 2007. J Clin Microbiol 2009, 47(4):1012-1020.
• [11]Amrine-Madsen H, Van Eldere J, Mera RM, Miller LA, Poupard JA, Thomas ES, Halsey WS, Becker JA, O’Hara FP: Temporal and spatial distribution of clonal complexes of Streptococcus pneumoniae isolates resistant to multiple classes of antibiotics in Belgium, 1997 to 2004. Antimicrob Agents Chemother 2008, 52(9):3216-3220.
• [12]Mahjoub-Messai F, Doit C, Koeck JL, Billard T, Evrard B, Bidet P, Hubans C, Raymond J, Levy C, Cohen R, et al.: Population snapshot of streptococcus pneumoniae serotype 19A isolates before and after introduction of seven-valent pneumococcal vaccination for French children. J Clin Microbiol 2009, 47(3):837-840.
• [13]Rückinger S, von Kries R, Siedler A, van der Linden M: Association of serotype of Streptococcus pneumoniae with risk of severe and fatal outcome. Pediatr Infect Dis J 2009, 28(2):118-122.
• [14]Gobel U, Heinrich B, Krauth KA, Steingruber HJ, von Kries R: Process and outcome quality of the German paediatric surveillance unit (ESPED). Klin Padiatr 2010, 222(2):92-97.
• [15]Rückinger S, van der Linden M, Reinert RR, von Kries R, Burckhardt F, Siedler A: Reduction in the incidence of invasive pneumococcal disease after general vaccination with 7-valent pneumococcal conjugate vaccine in Germany. Vaccine 2009, 27(31):4136-4141.
• [16]van der Linden M, Weiss S, Falkenhorst G, Siedler A, Imohl M, von Kries R: Four years of universal pneumococcal conjugate infant vaccination in Germany: Impact on incidence of invasive pneumococcal disease and serotype distribution in children. Vaccine 2012, 30(40):5880-5885.
• [17]Institute CLS: Performance standards for antimicrobial susceptibility testing; eighteenth informational supplement. PA: Wayne; 2008.
• [18]Clinical Laboratory Standards Institute: Performance standards for antimicrobial susceptibility testing; Twenty-first Informational Supplement M100-S21. Wayne, PA: CLSI; 2011.
• [19]Enright MC, Spratt BG: A multilocus sequence typing scheme for Streptococcus pneumoniae identification of clones associated with serious invasive disease. Microbiology 1998, 144:3049-3060.
• [20]Institute CLS: Performance standards for antimicrobial susceptibility testing; sixteenth informational supplement. PA: Wayne; 2006.
• [21]van der Linden M, von Kries R, Imöhl M, Rückinger S, Reinert R: Increased disease awareness after onset of a national immunization program with 7-valent pneumococcal conjugate vaccine. In Poster presented at 7th International Symposium on Pneumococci & Pneumococcal Diseases ISPPD. Tel Aviv, Israel; 2010.
• [22]Rückinger SSA, von Kries R, Reinert RR, Imöhl M, van der Linden M: Further incidence trends of invasive pneumococcal disease more than 2 years after introduction of 7-valent pneumococcal conjugate vaccination in Germany. In Poster presented at 28th Annual Meeting of the European Society for Paediatric Infectious Diseases (ESPID). Nice, France; 2010.
• [23]Singleton RJ, Hennessy TW, Bulkow LR, Hammitt LL, Zulz T, Hurlburt DA, Butler JC, Rudolph K, Parkinson A: Invasive pneumococcal disease caused by nonvaccine serotypes among alaska native children with high levels of 7-valent pneumococcal conjugate vaccine coverage. JAMA 2007, 297(16):1784-1792.
• [24]Richter SS, Heilmann KP, Dohrn CL, Riahi F, Beekmann SE, Doern GV: Changing epidemiology of antimicrobial-resistant Streptococcus pneumoniae in the United States, 2004–2005. Clin Infect Dis 2009, 48(3):e23-33.
• [25]Pillai DR, Shahinas D, Buzina A, Pollock RA, Lau R, Khairnar K, Wong A, Farrell DJ, Green K, McGeer A, et al.: Genome-wide dissection of globally emergent multi-drug resistant serotype 19A Streptococcus pneumoniae. BMC Genomics 2009, 10:642. BioMed Central Full Text
• [26]Hanage WP, Bishop CJ, Huang SS, Stevenson AE, Pelton SI, Lipsitch M, Finkelstein JA: Carried pneumococci in Massachusetts children: the contribution of clonal expansion and serotype switching. Pediatr Infect Dis J 2011, 30(4):302-308.
• [27]Aguiar SI, Pinto FR, Nunes S, Serrano I, Melo-Cristino J, Sa-Leao R, Ramirez M, de Lencastre H: Denmark14-230 clone as an increasing cause of pneumococcal infection in Portugal within a background of diverse serotype 19A lineages. J Clin Microbiol 2010, 48(1):101-108.
• [28]van Gils EJ, Veenhoven RH, Hak E, Rodenburg GD, Keijzers WC, Bogaert D, Trzcinski K, Bruin JP, van Alphen L, van der Ende A, et al.: Pneumococcal conjugate vaccination and nasopharyngeal acquisition of pneumococcal serotype 19A strains. JAMA 2010, 304(10):1099-1106.