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. 2014 Mar;3(1):23-32.
doi: 10.1093/jpids/pit057. Epub 2013 Oct 3.

Impact of 13-Valent Pneumococcal Conjugate Vaccination on Streptococcus pneumoniae Carriage in Young Children in Massachusetts

Grace M Lee  1 , Ken Kleinman  2 , Stephen I Pelton  3 , William Hanage  4 , Susan S Huang  5 , Matthew Lakoma  2 , Maya Dutta-Linn  2 , Nicholas J Croucher  4 , Abbie Stevenson  4 , Jonathan A Finkelstein  6
Affiliations

Impact of 13-Valent Pneumococcal Conjugate Vaccination on Streptococcus pneumoniae Carriage in Young Children in Massachusetts

Grace M Lee et al. J Pediatric Infect Dis Soc. 2014 Mar.

Abstract

Background: In April 2010, a 13-valent pneumococcal conjugate vaccine (PCV13) replaced PCV7 for use in the United States. We evaluated rates of pneumococcal colonization, by serotype and antibiotic resistance, in Massachusetts communities where serial cross-sectional surveillance has been conducted for the past decade.

Methods: Nasopharyngeal swabs were obtained from children 0 to <7 years of age and seen by primary care providers for well child or acute illness visits in 2001, 2004, 2007, 2009, and 2011. Pneumococcal isolates were serotyped by Quellung reaction and classified as PCV7 serotypes (4, 6B, 9V, 14, 18C, 19F, 23F), additional PCV13 serotypes (1, 3, 5, 6A, 7F, 19A), or non-PCV13 serotypes. Changes in colonization and impact of PCV13 were assessed using generalized linear mixed models, adjusting for known risk factors and accounting for clustering by community.

Results: Introduction of PCV13 did not affect the rate of overall pneumococcal colonization (31% in 2011). Colonization with non-PCV13 serotypes increased between 2001 and 2011 for all children (odds ratio [OR] per year, 1.12; 95% confidence interval [CI], 1.10, 1.15; P < .0001). 19A remained the second most common serotype in 2011, although a decline from 2009 was observed. Penicillin (7%), erythromycin (28%), ceftriaxone (10%), and clindamycin (10%) nonsusceptibility were commonly identified, concentrated among a small number of serotypes (including 19A, 35B, 15B/C, and 15A). Among healthy children 6-23 months old, colonization with PCV13 serotypes was lower among recipients of PCV13 vaccine (adjusted OR, 0.30; 95% CI, 0.11, 0.78). This effect was not observed in 6- to 23-month-old children with a concomitant respiratory tract infection (adjusted OR 1.36; 95% CI, 0.66, 2.77) or children 2 to <7 years old (adjusted OR, 1.17; 95% CI, 0.58, 2.34).

Conclusions: 13-Valent pneumococcal conjugate vaccine reduced the prevalence of colonization with PCV13 serotypes among children 6-23 months old, but its efficacy was not shown among older children.

Keywords: Streptococcus pneumoniae; colonization; pneumococcal conjugate vaccine.

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Figures

Figure 1.
Figure 1.
Proportion of children up-to-date (UTD) for PCV13 or PCV7 by age group in 2011.
Figure 2.
Figure 2.
Pneumococcal colonization by vaccine serotype among (A) all swabbed children, (B) children 6–23 months, and (C) children 2 to <7 years of age, 2001–2011.
Figure 3.
Figure 3.
Pneumococcal colonization by (A) PCV7 and additional PCV13 serotypes, and (B) 10 most common non-PCV13 vaccine serotypes among Massachusetts children, 2001–2011.
Figure 4.
Figure 4.
Proportion of antibiotic-resistant pneumococcal isolates, 2001–2011.
Figure 5.
Figure 5.
Frequency of 19A isolates identified as ST199, ST320, ST695, and other STs, 2001–2011.
See this image and copyright information in PMC

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