Invasive pneumococcal infections in Vellore, India: clinical characteristics and distribution of serotypes

BMC Infectious Diseases

Rune Andersson²  Ranjith Jayaraman¹  Rosemol Vargheese¹  James John¹  Erik Backhaus³  Veeraraghavan Balaji¹  Camilla Elisson²  Viktor Molander² 

[1] Department of Microbiology, Christian Medical College, CMC & H, Ida Scudder Road Vellore-4, Vellore, India;Institute of Biomedicine, Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, Guldhedsgatan 10 A, P.O. Box 7193, 40234, Gothenburg, Sweden;Department of Infectious Diseases, Skaraborg Regional Hospital, S-541 85, Skövde, Sweden

关键词: Serotype;    India;    Pneumococcal vaccine;    Vaccination;    Pneumococcus;    Invasive pneumococcal disease;   

Others  :  1145436
DOI  :  10.1186/1471-2334-13-532

 received in 2013-05-29, accepted in 2013-11-07,  发布年份 2013

【 摘 要 】

Background

Streptococcus pneumoniae infection is a serious problem worldwide and the case fatality rate remains high. The aim of this study was to analyze the distribution of pneumococcal serotypes causing invasive pneumococcal disease (IPD), to survey the potential coverage of present and future vaccines, and to investigate differences between serotypes and groups of serotypes with regard to manifestation, case fatality rate, age, and other risk factors.

Methods

Isolates from 244 consecutive patients with IPD were collected at the Christian Medical College, Vellore, India between January 2007 and June 2011, and clinical data were obtained retrospectively. Clinical characteristics were analyzed both for individual serotypes and for those grouped as “invasive”, “pediatric”, or “vaccine” serotypes.

Results

The serotype coverage for the pneumococcal conjugated vaccines (PCV) PCV7, PCV10, PCV13, PCV15, and pneumococcal polysaccharide vaccine (PPV) PPV23 was 29%, 53%, 64%, 66%, and 73%, respectively. The proportion of IPD caused by vaccine types was lower than pre-vaccination studies from other parts of the world. In adults, serotype 1 was mainly isolated from previously healthy patients without risk factors for IPD. This serotype caused more pneumonia and less meningitis than other serotypes, as was also noted for the “invasive” serotypes (1, 5, and 7 F).

Conclusions

The most common pneumococcal serotypes in this study behaved in similar ways to those in countries where the PCV has been introduced. Also, the most common serotypes in this study are included in the new PCVs. Therefore, a national program of childhood immunization with PCV10/13 in India is likely to be successful.

【 授权许可】

   
2013 Molander et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Bravo LC: Overview of the disease burden of invasive pneumococcal disease in Asia. Vaccine 2009, 27:7282-7291.
• [2]Sjostrom K, Spindler C, Ortqvist A, Kalin M, Sandgren A, Kuhlmann-Berenzon S, Henriques-Normark B: Clonal and capsular types decide whether pneumococci will act as a primary or opportunistic pathogen. Clin Infect Dis 2006, 42:451-459.
• [3]Brachman PS, Abrutyn E: Bacterial infections of humans: epidemiology and control. New York: Springer Science + Business Media; 2009.
• [4]Alanee SR, McGee L, Jackson D, Chiou CC, Feldman C, Morris AJ, Ortqvist A, Rello J, Luna CM, Baddour LM, Ip M, Yu VL, Klugman KP: Association of serotypes of Streptococcus pneumoniae with disease severity and outcome in adults: an international study. Clin Infect Dis 2007, 45:46-51.
• [5]Jansen AG, Rodenburg GD, van der Ende A, van Alphen L, Veenhoven RH, Spanjaard L, Sanders EA, Hak E: Invasive pneumococcal disease among adults: associations among serotypes, disease characteristics, and outcome. Clin Infect Dis 2009, 49:e23-e29.
• [6]Trollfors B, Berg S, Backhaus E, Andersson R, Bossen Konradsen H: Invasive, paediatric, vaccine strains of Streptococcus pneumoniae: are there differences in clinical characteristics? Scand J Infect Dis 2009, 41:84-87.
• [7]Berg S, Trollfors B, Persson E, Backhaus E, Larsson P, Ek E, Claesson BE, Jonsson L, Radberg G, Johansson S, Ripa T, Kaltoft MS, Konradsen HB: Serotypes of Streptococcus pneumoniae isolated from blood and cerebrospinal fluid related to vaccine serotypes and to clinical characteristics. Scand J Infect Dis 2006, 38:427-432.
• [8]Skinner JM, Indrawati L, Cannon J, Blue J, Winters M, Macnair J, Pujar N, Manger W, Zhang Y, Antonello J, Shiver J, Caulfield M, Heinrichs JH: Pre-clinical evaluation of a 15-valent pneumococcal conjugate vaccine (PCV15-CRM197) in an infant-rhesus monkey immunogenicity model. Vaccine 2011, 29:8870-8876.
• [9]Myint TT, Madhava H, Balmer P, Christopoulou D, Attal S, Menegas D, Sprenger R, Bonnet E: The impact of 7-valent pneumococcal conjugate vaccine on invasive pneumococcal disease: a literature review. Adv Ther 2013, 30:127-151.
• [10]Munoz-Almagro C, Esteva C, de Sevilla MF, Selva L, Gene A, Pallares R: Emergence of invasive pneumococcal disease caused by multidrug-resistant serotype 19A among children in Barcelona. J Infect 2009, 59:75-82.
• [11]Lalitha MK, Pai R, John TJ, Thomas K, Jesudason MV, Brahmadathan KN, Sridharan G, Steinhoff MC: Serotyping of Streptococcus pneumoniae by agglutination assays: a cost-effective technique for developing countries. Bull World Health Organ 1996, 74:387-390.
• [12]Pai R, Gertz RE, Beall B: Sequential multiplex PCR approach for determining capsular serotypes of Streptococcus pneumoniae isolates. J Clin Microbiol 2006, 44:124-131.
• [13]CLSI: Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically; Approved Standard—Eighth Edition CLSI document M07-A8. Wayne, PA: Clinical and Laboratory Standards Institute; 2009.
• [14]CLSI: Performance Standards for Antimicrobial Susceptibility Testing; Twenty-First Informational Supplement. CLSI document M100-S21. Wayne, PA: Clinical and Laboratory Standards Institute; 2011.
• [15]O’Brien KL, Wolfson LJ, Watt JP, Henkle E, Deloria-Knoll M, McCall N, Lee E, Mulholland K, Levine OS, Cherian T: Burden of disease caused by Streptococcus pneumoniae in children younger than 5 years: global estimates. Lancet 2009, 374:893-902.
• [16]Prospective multicentre hospital surveillance of Streptococcus pneumoniae disease in India: Invasive Bacterial Infection Surveillance (IBIS) Group, International Clinical Epidemiology Network (INCLEN). Lancet 1999, 353:1216-1221.
• [17]John TJ, Pai R, Lalitha MK, Jesudason MV, Brahmadathan KN, Sridharan G, Steinhoff MC: Prevalence of pneumococcal serotypes in invasive diseases in southern India. Indian J Med Res 1996, 104:205-207.
• [18]Jauneikaite E, Jefferies JM, Hibberd ML, Clarke SC: Prevalence of Streptococcus pneumoniae serotypes causing invasive and non-invasive disease in South East Asia: a review. Vaccine 2012, 30:3503-3514.
• [19]Harboe ZB, Benfield TL, Valentiner-Branth P, Hjuler T, Lambertsen L, Kaltoft M, Krogfelt K, Slotved HC, Christensen JJ, Konradsen HB: Temporal trends in invasive pneumococcal disease and pneumococcal serotypes over 7 decades. Clin Infect Dis 2010, 50:329-337.
• [20]Henriques Normark B, Kalin M, Ortqvist A, Akerlund T, Liljequist BO, Hedlund J, Svenson SB, Zhou J, Spratt BG, Normark S, Kallenius G: Dynamics of penicillin-susceptible clones in invasive pneumococcal disease. J Infect Dis 2001, 184:861-869.
• [21]Pilishvili T, Lexau C, Farley MM, Hadler J, Harrison LH, Bennett NM, Reingold A, Thomas A, Schaffner W, Craig AS, Smith PJ, Beall BW, Whitney CG, Moore MR: Sustained reductions in invasive pneumococcal disease in the era of conjugate vaccine. J Infect Dis 2010, 201:32-41.
• [22]Miller E, Andrews NJ, Waight PA, Slack MP, George RC: Herd immunity and serotype replacement 4 years after seven-valent pneumococcal conjugate vaccination in England and Wales: an observational cohort study. Lancet Infect Dis 2011, 11:760-768.
• [23]Harboe ZB, Thomsen RW, Riis A, Valentiner-Branth P, Christensen JJ, Lambertsen L, Krogfelt KA, Konradsen HB, Benfield TL: Pneumococcal serotypes and mortality following invasive pneumococcal disease: a population-based cohort study. PLoS Med 2009, 6:e1000081.
• [24]Yaro S, Lourd M, Traore Y, Njanpop-Lafourcade BM, Sawadogo A, Sangare L, Hien A, Ouedraogo MS, Sanou O, Parent Du Chatelet I, Koeck JL, Gessner BD: Epidemiological and molecular characteristics of a highly lethal pneumococcal meningitis epidemic in Burkina Faso. Clin Infect Dis 2006, 43:693-700.
• [25]Leimkugel J, Adams Forgor A, Gagneux S, Pfluger V, Flierl C, Awine E, Naegeli M, Dangy JP, Smith T, Hodgson A, Pluschke G: An outbreak of serotype 1 Streptococcus pneumoniae meningitis in northern Ghana with features that are characteristic of Neisseria meningitidis meningitis epidemics. J Infect Dis 2005, 192:192-199.
• [26]Antonio M, Hakeem I, Awine T, Secka O, Sankareh K, Nsekpong D, Lahai G, Akisanya A, Egere U, Enwere G, Zaman SM, Hill PC, Corrah T, Cutts F, Greenwood BM, Adegbola RA: Seasonality and outbreak of a predominant Streptococcus pneumoniae serotype 1 clone from The Gambia: expansion of ST217 hypervirulent clonal complex in West Africa. BMC Microbiol 2008, 8:198. BioMed Central Full Text
• [27]Song JH, Jung SI, Ko KS, Kim NY, Son JS, Chang HH, Ki HK, Oh WS, Suh JY, Peck KR, Lee NY, Yang Y, Lu Q, Chongthaleong A, Chiu CH, Lalitha MK, Perera J, Yee TT, Kumarasinghe G, Jamal F, Kamarulzaman A, Parasakthi N, Van PH, Carlos C, So T, Ng TK, Shibl A: High prevalence of antimicrobial resistance among clinical Streptococcus pneumoniae isolates in Asia (an ANSORP study). Antimicrob Agents Chemother 2004, 48:2101-2107.
• [28]Levine OS, Cherian T: Pneumococcal vaccination for Indian children. Indian Pediatr 2007, 44:491-496.
• [29]Lalwani S, Chatterjee S, Chhatwal J, Verghese VP, Mehta S, Shafi F, Borys D, Moreira M, Schuerman L: Immunogenicity, safety, and reactogenicity of the 10-valent pneumococcal non-typeable Hemophilus influenzae protein D conjugate vaccine (PHiD-CV) when co-administered with the DTPw-HBV/Hib vaccine in Indian infants: a single-blind, randomized, controlled study. Human vaccines & immunotherapeutics 2012, 8:612-622.
• [30]Vanderkooi OG, Scheifele DW, Girgenti D, Halperin SA, Patterson SD, Gruber WC, Emini EA, Scott DA, Kellner JD: Safety and immunogenicity of a 13-valent pneumococcal conjugate vaccine in healthy infants and toddlers given with routine pediatric vaccinations in Canada. Pediatr Infect Dis J 2012, 31:72-77.