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Nasopharyngeal S. pneumoniae carriage and density in Belgian infants after 9 years of pneumococcal conjugate vaccine programme

(2018) VACCINE. 36(1). p.15-22
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Abstract
Background: In Belgium, the infant pneumococcal conjugate vaccine (PCV) programme changed from PCV7 (2007-2011) to PCV13 (2011-2015) and to PCV10 (2015-2016). A 3-year nasopharyngeal carriage study was initiated during the programme switch in 2016. Main objective of the year 1 assessment was to obtain a baseline measurement of pneumococcal carriage prevalence, carriage density, serotype distribution and antibiotic resistance. Materials/methods: Two infant populations aged 6-30 months and without use of antibiotics in the seven days prior to sampling were approached: (1) attending one of 85 randomly selected day-care centres (DCC); (2) presenting with AOM at study-trained general practitioners and paediatricians. Demographic and clinical characteristics were documented and a single nasopharyngeal swab was taken. S. pneumoniae were cultured, screened for antibiotic resistance and serotyped, and quantitative Taqman real-time PCR (qRT-PCR) targeting LytA was performed. Results: Culture-based (DCC: 462/760; 60.8%- AOM: 27/39; 69.2%) and LytA-based (DCC: 603/753; 80.1% - AOM: 32/39; 82.1%) carriage prevalence was high. Average pneumococcal DNA load in LytA-positive day-care samples was 6.5 x 10(6) copies/mu l (95%Cl = 3.9-9.2 x 10(6), median = 3.5 x 10(5)); DNA load was positively associated with signs of common cold and negatively with previous antibiotic use. Culture based frequency of 13 pneumococcal vaccine (PCV) serotypes was 5.4% in DCC and 7.7% in AOM, with 19F and 14 being most frequent, and frequencies below 0.5% for serotypes 3, 6A, 19A in both populations. Predominant non-PCV serotypes were 23B and 23A in day-care and 11A in infants with AOM. In day-care, resistance to penicillin was rare (<0.5%) and absent against levofloxacin; 32.7% and 16.9% isolates were cotrimoxazole- and erythromycin-resistant respectively. Conclusion: Four years after PCV13 introduction in the vaccination programme, PCV13 serotype carriage was rare in infants throughout Belgium and penicillin resistance was rare. Continued surveillance in the context of a PCV programme switch is necessary.
Keywords
S. pneumoniae, Nasopharyngeal carriage, Day-care, Otitis media, Infants, ACUTE OTITIS-MEDIA, ATTENDING DAY-CARE, STREPTOCOCCUS-PNEUMONIAE, HAEMOPHILUS-INFLUENZAE, ANTIBIOTIC-RESISTANCE, SEROTYPE DISTRIBUTION, CHILDREN, DISEASE, PATHOGENS, BACTERIAL

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Chicago
Wouters, Ine, Liesbet Van Heirstraeten, Stefanie Desmet, Stéphanie Blaizot, Jan Verhaegen, Herman Goossens, Pierre Van Damme, et al. 2018. “Nasopharyngeal  S. Pneumoniae Carriage and Density in Belgian Infants After 9 Years of Pneumococcal Conjugate Vaccine Programme.” Vaccine 36 (1): 15–22.
APA
Wouters, I., Van Heirstraeten, L., Desmet, S., Blaizot, S., Verhaegen, J., Goossens, H., Van Damme, P., et al. (2018). Nasopharyngeal  S. pneumoniae carriage and density in Belgian infants after 9 years of pneumococcal conjugate vaccine programme. VACCINE, 36(1), 15–22.
Vancouver
1.
Wouters I, Van Heirstraeten L, Desmet S, Blaizot S, Verhaegen J, Goossens H, et al. Nasopharyngeal  S. pneumoniae carriage and density in Belgian infants after 9 years of pneumococcal conjugate vaccine programme. VACCINE. 2018;36(1):15–22.
MLA
Wouters, Ine, Liesbet Van Heirstraeten, Stefanie Desmet, et al. “Nasopharyngeal  S. Pneumoniae Carriage and Density in Belgian Infants After 9 Years of Pneumococcal Conjugate Vaccine Programme.” VACCINE 36.1 (2018): 15–22. Print.
@article{8547548,
  abstract     = {Background: In Belgium, the infant pneumococcal conjugate vaccine (PCV) programme changed from PCV7 (2007-2011) to PCV13 (2011-2015) and to PCV10 (2015-2016). A 3-year nasopharyngeal carriage study was initiated during the programme switch in 2016. Main objective of the year 1 assessment was to obtain a baseline measurement of pneumococcal carriage prevalence, carriage density, serotype distribution and antibiotic resistance. 
Materials/methods: Two infant populations aged 6-30 months and without use of antibiotics in the seven days prior to sampling were approached: (1) attending one of 85 randomly selected day-care centres (DCC); (2) presenting with AOM at study-trained general practitioners and paediatricians. Demographic and clinical characteristics were documented and a single nasopharyngeal swab was taken. S. pneumoniae were cultured, screened for antibiotic resistance and serotyped, and quantitative Taqman real-time PCR (qRT-PCR) targeting LytA was performed. 
Results: Culture-based (DCC: 462/760; 60.8\%- AOM: 27/39; 69.2\%) and LytA-based (DCC: 603/753; 80.1\% - AOM: 32/39; 82.1\%) carriage prevalence was high. Average pneumococcal DNA load in LytA-positive day-care samples was 6.5 x 10(6) copies/mu l (95\%Cl = 3.9-9.2 x 10(6), median = 3.5 x 10(5)); DNA load was positively associated with signs of common cold and negatively with previous antibiotic use. Culture based frequency of 13 pneumococcal vaccine (PCV) serotypes was 5.4\% in DCC and 7.7\% in AOM, with 19F and 14 being most frequent, and frequencies below 0.5\% for serotypes 3, 6A, 19A in both populations. Predominant non-PCV serotypes were 23B and 23A in day-care and 11A in infants with AOM. In day-care, resistance to penicillin was rare ({\textlangle}0.5\%) and absent against levofloxacin; 32.7\% and 16.9\% isolates were cotrimoxazole- and erythromycin-resistant respectively. 
Conclusion: Four years after PCV13 introduction in the vaccination programme, PCV13 serotype carriage was rare in infants throughout Belgium and penicillin resistance was rare. Continued surveillance in the context of a PCV programme switch is necessary.},
  author       = {Wouters, Ine and Van Heirstraeten, Liesbet and Desmet, Stefanie and Blaizot, St{\'e}phanie and Verhaegen, Jan and Goossens, Herman and Van Damme, Pierre and Malhotra-Kumar, Surbhi and Theeten, Heidi and NPcarriage study group, the and Van Herck, Koen},
  issn         = {0264-410X},
  journal      = {VACCINE},
  language     = {eng},
  number       = {1},
  pages        = {15--22},
  title        = {Nasopharyngeal  S. pneumoniae  carriage and density in Belgian infants after 9\unmatched{202f}years of pneumococcal conjugate vaccine programme},
  url          = {http://dx.doi.org/10.1016/j.vaccine.2017.11.052},
  volume       = {36},
  year         = {2018},
}

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