TY - JOUR
T1 - Impact of private use of the 13-valent pneumococcal conjugate vaccine (PCV13) on pneumococcal carriage among Portuguese children living in urban and rural regions
AU - Félix, Sofia
AU - Handem, Sara
AU - Nunes, Sónia
AU - Paulo, Ana Cristina
AU - Candeias, Catarina
AU - Valente, Carina
AU - Simões, Alexandra S.
AU - Almeida, Sónia T.
AU - Tavares, Débora A.
AU - Brito-Avô, António
AU - de Lencastre, Hermínia
AU - Sá-Leão, Raquel
N1 - Funding Information:
This work was supported by projects PTDC/SAU-ESA/65048/2006 and Pest-OE/EQB/LA0004/2011, from Fundação para a Ciência e a Tecnologia (FCT), Portugal; WI182109 and WI230921 from Pfizer Portugal; LISBOA-01–0145-FEDER (Microbiologia Molecular, Estrutural e Celular, funded by FEDER through COMPETE2020 – Programa Operacional Competitividade e Internacionalização); and LISBOA-01–0145-FEDER-016417 (ONEIDA co-funded by Fundos Europeus Estruturais e de Investimento, Programa Operacional Regional Lisboa 2020 and Fundação para a Ciência e a Tecnologia (FCT)). SF, SH, SN, CV, CC, ASS, DAT and STA were supported by PhD fellowships from FCT PD/BD/105732/2014, PD/BD/128365/2017, SFRH/BD/40706/2007, SFRH/BD/70058/2010, PD/BD/148434/2019, SFRH/BD/27325/2006, SFRH/BD/70147/2010, SFRH/BD/108380/2015. ACP was supported by post-doc fellowship SFRH/BPD/99638/2014 from FCT.
Funding Information:
RSL has received consulting and speaking fees from Pfizer and consulting fees from Merck Sharp & Dome. RSL has received funds for unrestricted research grants from Pfizer, paid directly to her institution. ABA has received consulting and speaking fees from Pfizer. All other authors declare they have no conflicts of interest.
Publisher Copyright:
© 2021 The Authors
PY - 2021/7/22
Y1 - 2021/7/22
N2 - In Portugal, the 13-valent pneumococcal conjugate vaccine (PCV13) was commercially available between 2010 and 2015, following a decade of private use of PCV7. We evaluated changes on serotype distribution and antimicrobial susceptibility of pneumococci carried by children living in two regions of Portugal (one urban and one rural). Three epidemiological periods were defined: pre-PCV13 (2009–2010), early-PCV13 (2011–2012), and late-PCV13 (2015–2016). Nasopharyngeal samples (n = 4,232) were obtained from children 0–6 years old attending day-care centers. Private use of PCVs was very high in both regions (>75%). Pneumococcal carriage remained stable and high over time (62.1%, 62.4% and 61.6% (p = 0.909) in the urban region; and 59.8%, 62.8%, 59.5% (p = 0.543) in the rural region). Carriage of PCV7 serotypes remained low (5.3%, 7.8% and 4.3% in the urban region; and 2.5%, 3.7% and 4.8% in the rural region). Carriage of PCV13 serotypes not targeted by PCV7 decreased in both the urban (16.4%, 7.3%, and 1.6%; p < 0.001) and rural regions (13.2%, 7.8%, and 1.9%; p < 0.001). This decline was mostly attributable to serotype 19A (14.1%, 4.4% and 1.3% in the urban region; and 11.1%, 3.6% and 0.8% in the rural region, both p < 0.001). Serotype 3 declined over time in the urban region (10.1%, 4.4%, 0.8%; p < 0.001) and had no obvious trend in the rural region (4.2%, 6.7%, 2.4%; p = 0.505). Serotype 6C decreased in both regions while serotypes 11D, 15A/B/C, 16F, 21, 22F, 23A/B, 24F, 35F, and NT were the most prevalent in the late-PCV13 period. Intermediate resistance to penicillin and non-susceptibility to erythromycin decreased significantly in both regions (19.5%, 13.3%, and 9.3%; and 25.4%, 25.9%, and 13.4%; both p < 0.001, respectively in the urban region; and 12.4%, 11.1%, and 2.8% (p < 0.001); and 15.3%, 14.7%, and 9.2% (p = 0.037), respectively, in the rural region). In conclusion, private use of PCV13 led to significant changes on the pneumococcal population carried by children in Portugal.
AB - In Portugal, the 13-valent pneumococcal conjugate vaccine (PCV13) was commercially available between 2010 and 2015, following a decade of private use of PCV7. We evaluated changes on serotype distribution and antimicrobial susceptibility of pneumococci carried by children living in two regions of Portugal (one urban and one rural). Three epidemiological periods were defined: pre-PCV13 (2009–2010), early-PCV13 (2011–2012), and late-PCV13 (2015–2016). Nasopharyngeal samples (n = 4,232) were obtained from children 0–6 years old attending day-care centers. Private use of PCVs was very high in both regions (>75%). Pneumococcal carriage remained stable and high over time (62.1%, 62.4% and 61.6% (p = 0.909) in the urban region; and 59.8%, 62.8%, 59.5% (p = 0.543) in the rural region). Carriage of PCV7 serotypes remained low (5.3%, 7.8% and 4.3% in the urban region; and 2.5%, 3.7% and 4.8% in the rural region). Carriage of PCV13 serotypes not targeted by PCV7 decreased in both the urban (16.4%, 7.3%, and 1.6%; p < 0.001) and rural regions (13.2%, 7.8%, and 1.9%; p < 0.001). This decline was mostly attributable to serotype 19A (14.1%, 4.4% and 1.3% in the urban region; and 11.1%, 3.6% and 0.8% in the rural region, both p < 0.001). Serotype 3 declined over time in the urban region (10.1%, 4.4%, 0.8%; p < 0.001) and had no obvious trend in the rural region (4.2%, 6.7%, 2.4%; p = 0.505). Serotype 6C decreased in both regions while serotypes 11D, 15A/B/C, 16F, 21, 22F, 23A/B, 24F, 35F, and NT were the most prevalent in the late-PCV13 period. Intermediate resistance to penicillin and non-susceptibility to erythromycin decreased significantly in both regions (19.5%, 13.3%, and 9.3%; and 25.4%, 25.9%, and 13.4%; both p < 0.001, respectively in the urban region; and 12.4%, 11.1%, and 2.8% (p < 0.001); and 15.3%, 14.7%, and 9.2% (p = 0.037), respectively, in the rural region). In conclusion, private use of PCV13 led to significant changes on the pneumococcal population carried by children in Portugal.
KW - Antibiotic resistance
KW - Carriage
KW - PCV13
KW - Pneumococcal conjugate vaccine
KW - Serotype
KW - Streptococcus pneumoniae
UR - http://www.scopus.com/inward/record.url?scp=85108815362&partnerID=8YFLogxK
U2 - 10.1016/j.vaccine.2021.06.035
DO - 10.1016/j.vaccine.2021.06.035
M3 - Article
C2 - 34183206
AN - SCOPUS:85108815362
SN - 0264-410X
VL - 39
SP - 4524
EP - 4533
JO - Vaccine
JF - Vaccine
IS - 32
ER -