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. 2008 Feb;14(2):275-81.
doi: 10.3201/eid1402.070807.

Streptococcus pneumoniae serotype 19A in children, South Korea

Eun Hwa Choi  1 , So Hee Kim, Byung Wook Eun, Sun Jung Kim, Nam Hee Kim, Jina Lee, Hoan Jong Lee
Affiliations

Streptococcus pneumoniae serotype 19A in children, South Korea

Eun Hwa Choi et al. Emerg Infect Dis. 2008 Feb.

Abstract

Despite the concern of replacement disease, notably by serotype 19A after 7-valent conjugate vaccine (PCV7) use, serotype 19A was increasingly recognized in Korean children before the introduction of PCV7. To understand the dynamics of serogroup 19 prevalence from 1991-2006, we serotyped 538 pediatric pneumococcal isolates. Serogroup 19 isolates (n = 126) were characterized by antimicrobial drug susceptibility, presence of mefA/ermB, and multilocus sequence typing. Overall, the proportion of serotype 19A isolates increased but serotype 19F decreased. Among children <5 years of age, the proportion of serotype 19A isolates in invasive pneumococcal disease increased from 0% in 1991-1994 to 8%-10% in 1995-2000, reached 26% in 2001-2003, and remained at 20% in 2004-2006 when vaccine coverage did not exceed 25% (p = 0.005 for trend). This study demonstrates that the expansion of multidrug-resistant ST320 was responsible for the increase in serotype 19A before PCV7 use.

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Figures

Figure 1
Figure 1
Distribution of serotypes with regard to 7-valent conjugate vaccine (PCV7) among 538 isolates encountered during five 3-year periods from 1991 through 2006, South Korea. A) Invasive isolates. B) Noninvasive isolates.
Figure 2
Figure 2
Distribution of serotypes with regard to 7-valent conjugate vaccine (PCV7) among 107 pneumococci isolated from children <5 years of age with an invasive pneumococcal infection (IPD) during five 3- or 4-year periods from 1991 through 2006, South Korea. *The observed increase in the proportion of 19A (p = 0.005) and decrease in the proportion of 19F (p = 0.008) among invasive isolates were statistically significant.
Figure 3
Figure 3
Relationship of 126 strains of serogroup 19 by eBURST analysis. ST271 (blue circle) is the predicted primary founder and ST236 (yellow circle) was assigned to a subgroup founder. Numbers on the diagram correspond to sequence types (STs). The size of each circle correlates with the number of isolates of that ST. *Newly identified ST in this study.
Figure 4
Figure 4
Distributions of sequence types (STs) of serotypes 19A and 19F during five 3-or 4-year periods from 1991 through 2006, South Korea. A) Invasive isolates. B) Noninvasive isolates. *Indicates 11 different STs that contained 1 isolate of serotype 19F.
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