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. 2021 Sep 1;224(12 Suppl 2):S237-S247.
doi: 10.1093/infdis/jiab172.

Impact of 13-Valent Pneumococcal Conjugate Vaccine on Nasopharyngeal Carriage Rates of Streptococcus pneumoniae in a Rural Community in the Dominican Republic

Maria G Dunn  1 , Fernanda C Lessa  2 , Jacqueline Sánchez  3 , Ramona Cordero  4 , Jesús Feris-Iglesias  3 , Doraliza Cedano  3 , Maria da Glória Carvalho  2 , Josefina Fernández  3 , Kristen A Feemster  1
Affiliations

Impact of 13-Valent Pneumococcal Conjugate Vaccine on Nasopharyngeal Carriage Rates of Streptococcus pneumoniae in a Rural Community in the Dominican Republic

Maria G Dunn et al. J Infect Dis. .

Abstract

Background: Invasive pneumococcal disease (IPD) leads to thousands of pediatric deaths annually. Pneumococcal colonization precedes IPD. In 2013, the Dominican Republic introduced the 13-valent pneumococcal conjugate vaccine (PCV13) into its routine infant immunization program, with doses at ages 2, 4, and 12 months. Prevalence of pneumococcal nasopharyngeal colonization was evaluated post-PCV13 introduction.

Methods: A prospective cohort study of 125 children aged 2-35 months was conducted in a rural Dominican Republic community November 2016 through July 2017. Nasopharyngeal swabs and clinical and vaccination data were collected at enrollment and 4-6 months later. Serotypes included in PCV13 were defined as vaccine-type. Colonization rates and serotype distribution were compared at baseline and follow-up, and the association between colonization and vaccination status among the entire cohort was evaluated at each time point.

Results: Of 125 children enrolled, 118 (94%) completed follow-up. Overall and vaccine-type pneumococcal colonization rates were 62% and 25%, respectively, at baseline and 60% and 28% at follow-up. Among children age-eligible for 3 doses, 50% and 51% were fully vaccinated at baseline and follow-up, respectively. At baseline assessment, children up-to-date for age for PCV13 were less likely to be colonized with vaccine-type pneumococci than children not up-to-date, and the same was found for fully vaccinated children (3 doses) compared to those not fully vaccinated (odds ratios [ORs], 0.38 [95% confidence interval {CI}, .18-.79], and 0.14 [95% CI, .04-.45], respectively). The same associations were not found at follow-up assessment.

Conclusions: Three years post -PCV13 introduction, vaccine-type colonization rates remained high. Low vaccination coverage for 3 PCV13 doses may have contributed. The protective effect of PCV13 on vaccine-type carriage suggests an increase in PCV13 coverage could lead to substantial declines in pneumococcal vaccine-type carriage.

Keywords: Caribbean; nasopharyngeal colonization; pediatric; pneumococcal conjugate vaccine.

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Figures

Figure 1.
Figure 1.
Vaccine-type serotype distribution. *Represents all vaccine-type serotypes isolated. For co-colonized subjects, serotypes were counted individually.
Figure 2.
Figure 2.
Non-vaccine-type serotype distribution. Abbreviation: NT, nontypeable.
Figure 3.
Figure 3.
Serotype distribution in co-colonized subjects. Abbreviation: NT, nontypeable.
Figure 4.
Figure 4.
Change in 13-valent pneumococcal conjugate vaccine colonization status according to change in vaccination status.
See this image and copyright information in PMC

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