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. 2017 Nov;140(5):e20170001.
doi: 10.1542/peds.2017-0001. Epub 2017 Oct 4.

Immunization, Antibiotic Use, and Pneumococcal Colonization Over a 15-Year Period

Grace M Lee  1   2 , Ken Kleinman  3 , Stephen Pelton  4 , Marc Lipsitch  5 , Susan S Huang  6 , Matt Lakoma  7 , Maya Dutta-Linn  7 , Melisa Rett  7 , William P Hanage  5 , Jonathan A Finkelstein  7   8
Affiliations

Immunization, Antibiotic Use, and Pneumococcal Colonization Over a 15-Year Period

Grace M Lee et al. Pediatrics. 2017 Nov.

Abstract

Background: Rates of invasive pneumococcal disease have declined since widespread introduction of pneumococcal conjugate vaccines (PCVs) in the United States. We evaluated the impact of immunization status and recent antibiotic use on an individual child's risk of colonization.

Methods: This study extends previously reported data from children <7 years of age seen for well child or acute care visits in Massachusetts communities. Nasopharyngeal swabs were collected during 6 surveillance seasons from 2000 to 2014. Parent surveys and medical record reviews confirmed immunization status and recent antibiotic use. We estimated the proportions of children colonized with PCV7-included, additional PCV13-included, and non-PCV13 serotypes. Risk factors for colonization with additional PCV13-included and non-PCV13 serotypes were assessed by using generalized linear mixed models adjusted for clustering by community.

Results: Among 6537 children, 19A emerged as the predominant serotype in 2004, with substantial reductions in 2014. Among non-PCV serotypes, 15B/C, 35B, 23B, 11A, and 23A were most common in 2014. We observed greater odds for both additional PCV13 and non-PCV13 colonization in younger children, those with more child care exposure, and those with a concomitant respiratory tract infection. Adjusted odds for additional PCV13 colonization was lower (odds ratio 0.48 [95% confidence interval 0.31-0.75]) among children up-to-date for PCV13 vaccines. Recent antibiotic use was associated with higher odds of additional PCV13 colonization but substantially lower odds of non-PCV13 colonization.

Conclusions: Despite the success of pneumococcal vaccines in reducing colonization and disease due to targeted serotypes, ongoing community-based surveillance will be critical to evaluate the impact of interventions on pneumococcal colonization and disease.

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Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: Dr Lipsitch has received consulting fees from Pfizer, Antigen Discovery, and Affinivax and has received research funding through his institution from Pfizer and PATH Vaccine Solutions. Dr Hanage has received consulting fees from Antigen Discovery. Ms Huang conducts clinical studies in which participating hospitals and nursing homes receive contributed products from Sage Products, Molnlycke, 3M, Clorox, and Xttrium. Dr Kleinman conducts trials in which participating hospitals and nursing homes receive contributed products from Sage Products and Clorox. Dr Pelton received honorarium for participation in scientific advisory boards from Pfizer, GlaxoSmithKline, Sequiris, and Merck as well as research funding to Boston University Medical Campus from Pfizer and Merck; the other authors have indicated they have no potential conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Pneumococcal colonization by vaccine serotype in selected Massachusetts communities from 2001 to 2014. PCV7 was recommended for use in 2000 and PCV13 was recommended to replace PCV7 in 2010.
FIGURE 2
FIGURE 2
Pneumococcal colonization by serotype from 2001 to 2014 for (A) PCV7 and additional PCV13 serotypes, and (B) non-PCV13 serotypes. The scale represents the proportion of children swabbed that were colonized with each serotype.
FIGURE 3
FIGURE 3
Antibiotic nonsusceptibility of pneumococcal isolates from 2001 to 2014. I, indicates intermediate susceptibility; R, indicates isolates are resistant.
See this image and copyright information in PMC

Comment in

References

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