Streptococcus pneumoniae Serotypes 9 and 14 Circulating in Brazil over a 23-Year Period Prior to Introduction of the 10-Valent Pneumococcal Conjugate Vaccine: Role of International Clones in the Evolution of Antimicrobial Resistance and Description of a Novel Genotype

ABSTRACTAntimicrobial-resistant pneumococcal strains have been detected worldwide since the 1960s. In Brazil, the first penicillin-nonsusceptible pneumococci (PNSP) were reported in the 1980s, and their emergence and dissemination have been mainly attributed to serogroup 9 and serotype 14 strains, especially those highly related to recognized international clones. In the present study, antimicrobial susceptibility testing and multilocus sequence typing were performed on 315 pneumococcal isolates belonging to serogroup 9 (n= 99) or serotype 14 (n= 216), recovered from patients or asymptomatic carriers between 1988 and 2011 in Brazil, in order to trace changes in antimicrobial resistance and genotypes prior to the full introduction of the pneumococcal conjugate vaccine in the country. Over the 23-year study period, the PNSP levels increased, and four clonal complexes (CC156, CC66, CC15, and CC5401) have played important roles in the evolution and dissemination of pneumococcal isolates belonging to serogroup 9 and serotype 14, as well as in the emergence of antimicrobial resistance, in the pre-pneumococcal-vaccination era. The earliest PNSP strains detected in this study belonged to serotype 9N/ST66 and were single locus variants of the international clone Tennessee14-18 ST67 (CC66). The first serotype 14 PNSP isolates were identified in 1990 and were related to the England14-9 ST9 (CC15) clone. Serotype 14 PNSP variants of the Spain9V-3 ST156 clone with elevated penicillin MICs and nonsusceptibility to other beta-lactams were detected in 1995 and showed an increasing trend over the years. The results also indicated that introduction of ST156 in our region was preceded by the emergence of trimethoprim-sulfamethoxazole resistance and by the dissemination of ST162. In addition to the presence of successful international clones, a novel regional serotype 14 genotype (CC5401) has emerged in 1996.

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Impact of the Pneumococcal Conjugate Vaccine on Serotype Distribution and Antimicrobial Resistance of Invasive Streptococcus pneumoniae Isolates in Dallas, TX, Children From 1999 Through 2005

The Pediatric Infectious Disease Journal ◽

10.1097/inf.0b013e31805cdbeb ◽

2007 ◽

Vol 26 (6) ◽

pp. 461-467 ◽

Cited By ~ 119

Author(s):

Allison F. Messina ◽

Kathy Katz-Gaynor ◽

Theresa Barton ◽

Naveed Ahmad ◽

Faryal Ghaffar ◽

...

Keyword(s):

Streptococcus Pneumoniae ◽

Antimicrobial Resistance ◽

Conjugate Vaccine ◽

Pneumococcal Conjugate Vaccine ◽

Serotype Distribution

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Serotypic distribution and antimicrobial resistance of Streptococcus pneumoniae in Chinese children under 5 years after the introduction of the 13-valent conjugate pneumococcal vaccine: protocol for a scoping review

F1000Research ◽

10.12688/f1000research.22660.1 ◽

2020 ◽

Vol 9 ◽

pp. 221

Author(s):

Xu Han ◽

Niurka Molina Águila ◽

Haiyang Yu ◽

C. Nivaldo Linares Pérez ◽

C. María Eugenia Toledo Romaní

Keyword(s):

Streptococcus Pneumoniae ◽

Antimicrobial Resistance ◽

Conjugate Vaccine ◽

Scoping Review ◽

Pneumococcal Conjugate Vaccine ◽

World Health ◽

Immunization Programs ◽

China National Knowledge Infrastructure ◽

Surveillance Network ◽

The Impact

The World Health Organization (WHO) recommends that pneumococcal conjugate vaccines (PCVs) be included in immunization programs worldwide. In China, the 7-valent pneumococcal conjugate vaccine (PREVNAR 7®) was authorized in 2008 but was not included in the national immunization programs. In 2016, PREVNAR 13®, a 13-valent pneumococcal conjugate vaccine (PCV13), was licensed for optional use in China. We will conduct a scoping review of the distribution of serotypes and antimicrobial resistance of Streptococcus pneumoniae in children aged under 5 years in China since the introduction of PCV13. We will obtain data from PubMed, the China National Knowledge Infrastructure (CNKI), and Wanfang Med Online. We will also review epidemiological data from WHO and the China Antimicrobial Surveillance Network (CHINET). Our analysis will include the condition of interest, the intervention, and the geographical region. All types of studies will be eligible for inclusion in the study database if they meet the inclusion criteria. This scoping review is intended to outline how S. pneumoniae serotypes are distributed, and it will map their antimicrobial resistance in children aged under 5 years in China. The results of this study will provide useful information on the impact of PCV13 in China.

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Changes in serotype prevalence and antimicrobial resistance among invasive Streptococcus pneumoniae isolates in Korea, 1996–2008

Journal of Medical Microbiology ◽

10.1099/jmm.0.058164-0 ◽

2013 ◽

Vol 62 (8) ◽

pp. 1204-1210 ◽

Cited By ~ 19

Author(s):

Sungkyoung Lee ◽

Songmee Bae ◽

Kwang-Jun Lee ◽

Jae-Yon Yu ◽

Yeonho Kang

Keyword(s):

Streptococcus Pneumoniae ◽

Antimicrobial Resistance ◽

High Resistance ◽

Age Groups ◽

Pneumococcal Vaccination ◽

Multidrug Resistant ◽

Increasing Trend ◽

Resistance Rates ◽

Child Vaccination ◽

Over Time

We investigated changes in serotypes and antimicrobial susceptibilities among 386 isolates of invasive Streptococcus pneumoniae collected from numerous hospitals in Korea from 1996 to 2008. Serotypes 19F (9.8 %), 23F (8.3 %), 19A (7.8 %), 6A (7.5 %), 3 (7.3 %), 9V (6.5 %), 6B (6.2 %), 14 (4.9 %), 1 (3.9 %), 11A (3.9 %) and 4 (3.1 %) represented 69.2 % of all isolates. While the overall proportion of PCV7 serotypes was stable over time, we observed modest decreases in children <5 years old and in adults ≥65 years old between 1996–1999 and 2007–2008. An increased prevalence of non-PCV7 serotypes in these age groups was primarily attributable to an increase in serotypes 3, 6A and 19A. Most invasive S. pneumoniae isolates showed high resistance rates to erythromycin (74.9 %), tetracycline (71.1 %) and clindamycin (61.7 %). Between 1996–2003 and 2004–2008, non-susceptibility rates to cefotaxime and multi-drugs (three or more classes) in PCV7 serotypes showed a declining trend, while in non-PCV7 serotypes there was an increasing trend. Non-PCV7 serotypes 6A and 19A, which mostly exhibited multidrug-resistant phenotypes (69.0 % and 76.7 % respectively), increased between 1996–2003 and 2004–2008. Although PCV7 was introduced in Korea in November 2003, pneumococcal vaccination has not been included in the national child vaccination programme. Our results provide details of serotype occurrence that will be useful when adoption of universal pneumococcal vaccination in Korea is being considered.

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