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. 2015 Apr 21;33(17):2015-21.
doi: 10.1016/j.vaccine.2015.03.012. Epub 2015 Mar 14.

Five winters of pneumococcal serotype replacement in UK carriage following PCV introduction

Rebecca A Gladstone  1 , Johanna M Jefferies  2 , Anna S Tocheva  1 , Kate R Beard  1 , David Garley  1 , Wei Wei Chong  1 , Stephen D Bentley  3 , Saul N Faust  4 , Stuart C Clarke  5
Affiliations

Five winters of pneumococcal serotype replacement in UK carriage following PCV introduction

Rebecca A Gladstone et al. Vaccine. .

Abstract

The seven-valent pneumococcal conjugate vaccine (PCV7) was added to the UK national immunisation programme in September 2006. PCV13 replaced PCV7 in April 2010. As carriage precedes disease cases this study collected carried pneumococci from children each winter from 2006/7 to 2010/11 over PCV introduction. Conventional microbiology and whole genome sequencing were utilised to characterise pneumococcal strains. Overall prevalence of pneumococcal carriage remained stable. Vaccine serotypes (VT) decreased (p<0.0001) with concomitant increases in non-vaccine serotypes (NVT). In winter 2010/11 only one isolate of PCV7 VT was observed (6B). PCV13 unique VTs decreased between winters immediately preceding and following PCV13 introduction (p=0.04). Significant decreases for VTs 6B, 19F, 23F (PCV7) and 6A (PCV13) and increases for NVT 21, 23B, 33F and 35F were detected. The serotype replacement was accompanied by parallel changes in genotype prevalence for associated sequence types with clonal expansion contributing to replacement. By winter 2010/11, serotype coverage of PCV7 and PCV13 was 1% and 11% respectively. VT replacement was observed for PCV7 and PCV13 serotypes. Conjugate vaccine design and use requires continuous monitoring and revision.

Keywords: Next generation sequencing; Pneumococcal vaccines; Serotype replacement; Streptococcus pneumoniae; Whole genome.

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Figures

Fig. 1
Fig. 1
Carriage rate and temporal prevalence of PCV VT and NVT. Dashed black horizontal lines denote the time period between which the significant change was observed. Dashed grey vertical lines denote vaccine introductions with respect to sampling time points
Fig. 2
Fig. 2
Temporal prevalence of PCV7 serotypes. *Significant decrease observed between base-line winter 2006/7 and final study winter 2010/11
Fig. 3
Fig. 3
Temporal prevalence of serotypes unique to PCV13. *Significant decrease observed between base-line winter 2006/7 and final study winter 2010/11
Fig. 4
Fig. 4
Temporal prevalence for the top 10 NVT in final winter 2010/11. * Significant increase between base-line winter 2006/7 and final study winter 2010/11. # Significant increase within study not observable between base-line winter 2006/7 and final study winter 2010/11
Fig. 5
Fig. 5
Temporal prevalence of STs associated with changes in serotype prevalence between winter 2006/7 and winter 2010/11. *Significant change between base-line winter 2006/7 and final study winter 2010/11. # Significant change within study observable between winter 2007/8 and final study winter 2010/11
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