1887

Abstract

Invasive pneumococcal disease (IPD) in the elderly is an important public health issue due to the increased proportion of this population in many countries including Brazil. We aimed to characterise pneumococci isolates in adults >50 years with IPD, following the introduction of the 10-valent pneumococcal conjugate vaccine (PCV10) as part of the National Childhood Immunisation Program for children ≤2 years in March 2010.

Between 2013 and 2015, pneumococcal isolates were collected and serotypes were determined using multiplex PCR and/or Quellung reaction. Antimicrobial susceptibility was defined by E-test (bioMérieux); genetic diversity was determined using Multiple-Locus Variable Number Tandem Repeat Analysis (MLVA) and, in selected isolates, Multi Locus Sequence Typing (MLST) was performed.

Among 102 pneumococcal isolates, the most frequent serotypes were 19A, 13 of 102 (12.7 %) and 22F, 10 of 102 (9.8 %). Ninety-eight isolates were tested for antimicrobial susceptibility. Intermediate resistance to penicillin was present in 2/98 (2.0 %), ceftriaxone in 7/98 (7.1 %) and meropenem in 7/95 (7.4 %) of the isolates (non-meningitis breakpoint: 4 µg ml/2 µg ml/0.5 µg ml, respectively). Resistance to penicillin (meningitis breakpoint ≥0.12 µg ml) was observed in 31/98 (31.6 %) of the isolates. Genetic analysis presented two relevant clonal groups, belonging to non-PCV10 serotypes: 19A (ST320, linked to non-susceptibility) and 22F (ST6403).

Our data suggest a predominance of non-PCV10 serotypes among IPD in the elderly population in circulating strains ca. 3 to 5 years after the introduction of PCV10 in Brazil.

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2018-05-01
2024-03-29
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References

  1. Vieira AC, Gomes MC, Rolo Filho M, Eudes Filho J, Bello EJM et al. Streptococcus pneumoniae: estudo das cepas isoladas de liquor. J Pediatr 2007; 83:71–78 [View Article]
    [Google Scholar]
  2. Nuorti JP, Cynthia GW. Prevention of pneumococcal disease among infants and children: use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2010; 59:1–18
    [Google Scholar]
  3. Simell B, Auranen K, Käyhty H, Goldblatt D, Dagan R. et al. The fundamental link between pneumococcal carriage and disease. Expert Rev Vaccines 2012; 11:841–855 [View Article][PubMed]
    [Google Scholar]
  4. Minayo MCS. O envelhecimento da população brasileira e os desafios para o setor saúde. Cad Saúde Pública 2012; 28:208–210 [View Article]
    [Google Scholar]
  5. Brasil Projeção da População do Brasil para o sexo e idade para o período 2000/2060 Instituto Brasileiro de Geografia e Estatística, Brasília, DF: 2013
    [Google Scholar]
  6. Kalache A, Veras RP, Ramos LR. O envelhecimento da população mundial: um desafio novo. Rev Saúde Pública 1987; 21:200–210 [View Article]
    [Google Scholar]
  7. Lima-Costa MF, Veras R. Saúde pública e envelhecimento. Cad Saúde Pública 2003; 19:700–701 [View Article]
    [Google Scholar]
  8. Saad PM. Envelhecimento populacional: demandas e possibilidades na área de saúde. Séries Demográficas 2016; 3:153–166
    [Google Scholar]
  9. Whitney CG, Farley MM, Hadler J, Harrison LH, Bennett NM. et al. Decline in invasive pneumococcal disease after the introduction of protein-polysaccharide conjugate vaccine. N Engl J Med 2003; 348:1737–1746 [View Article][PubMed]
    [Google Scholar]
  10. Centers for Disease Control and Prevention (CDC) Invasive pneumococcal disease in young children before licensure of 13-valent pneumococcal conjugate vaccine – United States, 2007. MMWR 2010; 59:253–257[PubMed]
    [Google Scholar]
  11. Lee MR, Chen CM, Chuang TY, Huang YT, Hsueh PR. Capsular serotypes and antimicrobial susceptibilities of Streptococcus pneumoniae causing invasive pneumococcal disease from 2009–2012 with an emphasis on serotype 19A in bacteraemic pneumonia and empyema and β-lactam resistance. Int J Antimicrob Agents 2013; 42:395–402 [View Article][PubMed]
    [Google Scholar]
  12. Kim SH, Song JH, Chung DR, Thamlikitkul V, Yang Y. et al. Changing trends in antimicrobial resistance and serotypes of Streptococcus pneumoniae isolates in Asian countries: an Asian Network for Surveillance of Resistant Pathogens (ANSORP) study. Antimicrob Agents Chemother 2012; 56:1418–1426 [View Article][PubMed]
    [Google Scholar]
  13. Weil-Olivier C, van der Linden M, de Schutter I, Dagan R, Mantovani L. Prevention of pneumococcal diseases in the post-seven valent vaccine era: a European perspective. BMC Infect Dis 2012; 12:12.1:1 [View Article][PubMed]
    [Google Scholar]
  14. Mott M. Emergence of serotype 19A after PCV10 associated with a ST 320 in adult population, in Porto Alegre, BRAZIL. Dissertação de Mestrado Universidade Federal de Ciências da Saúde de Porto Alegre, Brasil;
    [Google Scholar]
  15. Departamento de vigilância epidemiológica, Secretária de Vigilância em Saúde, Ministério da Saúde 2010; Informe técnico da vacina pneumocócica 10-valente (conjugada) no calendário básico de vacinação da criança. Brasília. www.sgc.goias.gov.br/upload/links/arq_723_infotec.pdf Accessed 12-12-2017
  16. Ministério da Saúde 2018; Calendário Básico vacinação da Criança. Brazil. http://portalms.saude.gov.br/acoes-e-programas/vacinacao/calendario-nacional-de-vacinacao Access 07-03-2018
  17. Hausdorff WP, Bryant J, Paradiso PR, Siber GR. Which pneumococcal serogroups cause the most invasive disease: implications for conjugate vaccine formulation and use, part I. Clin Infect Dis 2000; 30:100–121 [View Article][PubMed]
    [Google Scholar]
  18. dos Santos SR, Passadore LF, Takagi EH, Fujii CM, Yoshioka CR et al. Serotype distribution of Streptococcus pneumoniae isolated from patients with invasive pneumococcal disease in Brazil before and after ten-pneumococcal conjugate vaccine implementation. Vaccine 2013; 31:6150–6154 [View Article][PubMed]
    [Google Scholar]
  19. Domingues CM, Verani JR, Montenegro Renoiner EI, de Cunto Brandileone MC, Flannery B. et al. Effectiveness of ten-valent pneumococcal conjugate vaccine against invasive pneumococcal disease in Brazil: a matched case-control study. Lancet Respir Med 2014; 2:464–471 [View Article][PubMed]
    [Google Scholar]
  20. Weil-Olivier C, Gaillat J. Can the success of pneumococcal conjugate vaccines for the prevention of pneumococcal diseases in children be extrapolated to adults?. Vaccine 2014; 32:2022–2026 [View Article][PubMed]
    [Google Scholar]
  21. Centers for Disease Control and Prevention (CDC) Licensure of 13-valent pneumococcal conjugate vaccine for adults aged 50 years and older. MMWR 2012; 61:394–395[PubMed]
    [Google Scholar]
  22. Hak E, Grobbee DE, Sanders EA, Verheij TJ, Bolkenbaas M et al. Rationale and design of CAPITA: a RCT of 13-valent conjugated pneumococcal vaccine efficacy among older adults. Neth J Med 2008; 66:378–383[PubMed]
    [Google Scholar]
  23. Fenoll A, Granizo JJ, Aguilar L, Gimenez MJ, Aragoneses-Fenoll L et al. Temporal trends of invasive Streptococcus pneumoniae serotypes and antimicrobial resistance patterns in Spain from 1979 to 2007. J Clin Microbiol 2009; 47:1012–1020 [View Article]
    [Google Scholar]
  24. Spellerberg B, Brandt C. Streptococcus. In: Manual of Clinical Microbiology, 10th ed. American Society of Microbioly; 2011 pp. 383–384
    [Google Scholar]
  25. 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 [View Article][PubMed]
    [Google Scholar]
  26. Dias CA, Teixeira LM, Carvalho MG, Beall B. Sequential multiplex PCR for determining capsular serotypes of pneumococci recovered from Brazilian children. J Med Microbiol 2007; 56:1185–1188 [View Article][PubMed]
    [Google Scholar]
  27. Pinto TC, Souza AR, de Pina SE, Costa NS, Borges Neto AA et al. Phenotypic and molecular characterization of optochin-resistant Streptococcus pneumoniae isolates from Brazil, with description of five novel mutations in the atpC gene. J Clin Microbiol 2013; 51:3242–3249 [View Article][PubMed]
    [Google Scholar]
  28. CLSI Performance Standards for Antimicrobial Susceptibility Testing 25th Information Supplement M100-S25 Wayne, PA: Clinical and Laboratory Standards Institute; 2015
    [Google Scholar]
  29. Koeck JL, Njanpop-Lafourcade BM, Cade S, Varon E, Sangare L et al. Evaluation and selection of tandem repeat loci for Streptococcus pneumoniae MLVA strain typing. BMC Microbiol 2005; 5:66–69 [View Article][PubMed]
    [Google Scholar]
  30. Cunha GR. Diversidade genética de isolados de Streptococcus pneumoniae pertencentes a sorotipos não integrantes da vacina 10-valente. Dissertação de Mestrado Universidade Federal de Ciências da Saúde de Porto Alegre, Brasil; 2014
    [Google Scholar]
  31. Elberse KE, Nunes S, Sá-Leão R, van der Heide HG, Schouls LM. Multiple-locus variable number tandem repeat analysis for Streptococcus pneumoniae: comparison with PFGE and MLST. PLoS One 2011; 6:e19668 [View Article][PubMed]
    [Google Scholar]
  32. Multiple-Locus Variable Number Tandem Repeat Analysis (MLVA) 2011 Available in: www.mlva.eu/index.php www.mlva.eu/recherche.php?type=spneumoniae Accessed 18-12-2017
  33. 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 [View Article][PubMed]
    [Google Scholar]
  34. Multi Locus Sequence Typing (MLST) 2017 Available in: www.mlst.net/ https://pubmlst.org/bigsdb?db=pubmlst_spneumoniae_seqdef Accessed 18-2-2017
  35. Fukusumi M, Chang B, Tanabe Y, Oshima K, Maruyama T et al. Invasive pneumococcal disease among adults in Japan, April 2013 to March 2015: disease characteristics and serotype distribution. BMC Infect Dis 2017; 17:1–7 [View Article]
    [Google Scholar]
  36. Caierão J, Hawkins P, Sant'anna FH, da Cunha GR, D'Azevedo PA et al. Serotypes and genotypes of invasive Streptococcus pneumoniae before and after PCV10 implementation in southern Brazil. PLoS One 2014; 9:e111129 [View Article][PubMed]
    [Google Scholar]
  37. Mott M, Caierão J, Rosa da Cunha G, Rodrigues Perez LR, Matusiak R et al. Susceptibility profiles and correlation with pneumococcal serotypes soon after implementation of the 10-valent pneumococcal conjugate vaccine in Brazil. Int J Infect Dis 2014; 20:47–51 [View Article][PubMed]
    [Google Scholar]
  38. Brandileone MC, Zanella RC, Almeida SCG, Brandao AP, Ribeiro AF. et al. Effect of 10-valent pneumococcal conjugate vaccine on nasopharyngeal carriage of Streptococcus pneumoniae and Haemophilus influenzae among children in São Paulo, Brazil. Vaccine 2016; 34:5604–5611 [View Article][PubMed]
    [Google Scholar]
  39. Nurhonen M, Cheng AC, Auranen K. Pneumococcal transmission and disease in silico: a microsimulation model of the indirect effects of vaccination. PLoS One 2013; 8:e56079 [View Article][PubMed]
    [Google Scholar]
  40. Neves FPG, Cardoso NT, Snyder RE, Marlow MA, Cardoso CAA et al. Pneumococcal carriage among children after four years of routine 10-valent pneumococcal conjugate vaccine use in Brazil: The emergence of multidrug resistant serotype 6C. Vaccine 2017; 35:2794–2800 [View Article][PubMed]
    [Google Scholar]
  41. Tan TQ. Pediatric invasive pneumococcal disease in the United States in the era of pneumococcal conjugate vaccines. Clin Microbiol Rev 2012; 25:409–419 [View Article][PubMed]
    [Google Scholar]
  42. Croucher NJ, Chewapreecha C, Hanage WP, Harris SR, McGee L et al. Evidence for soft selective sweeps in the evolution of pneumococcal multidrug resistance and vaccine escape. Genome Biol Evol 2014; 6:1589–1602 [View Article][PubMed]
    [Google Scholar]
  43. Cardoso NT, Santos BA, Barbosa AV, Superti SV, Teixeira LM et al. Serotypes, antimicrobial resistance and genotypes of Streptococcus pneumoniae associated with infections in cancer patients in Brazil. Diagn Microbiol Infect Dis 2017; 87:281–285 [View Article][PubMed]
    [Google Scholar]
  44. Corrêa RA, Lundgren FLC, Pereira-Silva JL, Silva RLF, Cardoso AP et al. Diretrizes brasileiras para pneumonia adquirida na comunidade em adultos imunocompetentes - 2009. J Bras Pneumol 2009; 35:574–601 [View Article]
    [Google Scholar]
  45. Hulten KG, Kaplan SL, Lamberth LB, Barson WJ, Romero JR et al. Changes in Streptococcus pneumoniae serotype 19A invasive infections in children from 1993 to 2011. J Clin Microbiol 2013; 51:1294–1297 [View Article][PubMed]
    [Google Scholar]
  46. Hsieh YC, Lin TL, Chang KY, Huang YC, Chen CJ et al. Expansion and evolution of Streptococcus pneumoniae serotype 19A ST320 clone as compared to its ancestral clone, Taiwan19F-14 (ST236). J Infect Dis 2013; 208:203–210 [View Article][PubMed]
    [Google Scholar]
  47. Lamaro-Cardoso J, de Lemos AP, Carvalho MG, Pimenta FC, Roundtree A et al. Molecular epidemiological investigation to determine the source of a fatal case of serotype 22F pneumococcal meningitis. J Med Microbiol 2012; 61:686–692 [View Article][PubMed]
    [Google Scholar]
  48. Demczuk WHB, Martin I, Hoang L, van Caeseele P, Lefebvre B et al. Phylogenetic analysis of emergent Streptococcus pneumoniae serotype 22F causing invasive pneumococcal disease using whole genome sequencing. PLoS One 2017; 12:e0178040 [View Article][PubMed]
    [Google Scholar]
  49. Metcalf BJ, Gertz RE, Gladstone RA, Walker H, Sherwood LK et al. Strain features and distributions in pneumococci from children with invasive disease before and after 13-valent conjugate vaccine implementation in the USA. Clin Microbiol Infect 2016; 22:e9-60.e2960.e9–6060 [View Article][PubMed]
    [Google Scholar]
  50. Pichon B, Ladhani SN, Slack MP, Segonds-Pichon A, Andrews NJ et al. Changes in molecular epidemiology of Streptococcus pneumoniae causing meningitis following introduction of pneumococcal conjugate vaccination in England and Wales. J Clin Microbiol 2013; 51:820–827 [View Article][PubMed]
    [Google Scholar]
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