. 2022 Feb 11;40(7):1054-1060.

doi: 10.1016/j.vaccine.2021.10.046. Epub 2022 Jan 5.

International links between Streptococcus pneumoniae vaccine serotype 4 sequence type (ST) 801 in Northern European shipyard outbreaks of invasive pneumococcal disease

R A Gladstone¹, L Siira², O B Brynildsrud³, D F Vestrheim³, P Turner⁴, S C Clarke⁵, S Srifuengfung⁶, R Ford⁷, D Lehmann⁸, E Egorova⁹, E Voropaeva⁹, G Haraldsson¹⁰, K G Kristinsson¹⁰, L McGee¹¹, R F Breiman¹², S D Bentley¹³, C L Sheppard¹⁴, N K Fry¹⁵, J Corander¹, M Toropainen², A Steens³; Global Pneumococcal Sequencing Consortium

Collaborators, Affiliations

Collaborators

Global Pneumococcal Sequencing Consortium:
Patrick E Akpaka¹⁶, Krow Ampofo¹⁷, Martin Antonio¹⁸, Veeraraghavan Balaji¹⁹, Bernard W Beall¹¹, Houria Belabbès²⁰, Rachel Benisty²¹, Godfrey Bigogo²², Abdullah W Brooks²³, Philip E Carter²⁴, Jennifer E Cornick²⁵, Alejandra Corso²⁶, Maria Cristina de Cunto Brandileone²⁷, Samanta Cristine Grassi Almeida²⁷, Nicholas J Croucher²⁸, Ron Dagan²¹, Alexander Davydov²⁹, Idrissa Diawara³⁰, Sanjay Doiphode³¹, Mignon du Plessis³², Naima Elmdaghri³³, Özgen Köseoglu Eser³⁴, Dean B Everett³⁵, Diego Faccone²⁶, Paula Gagetti²⁶, Noga Givon-Lavi²¹, Md Hasanuzzaman³⁶, Paulina A Hawkins³⁷, Waleria Hryniewicz³⁸, Kristina G Hulten³⁹, Margaret Ip⁴⁰, Aurelie Kapusta⁴¹, Rama Kandasamy⁴², Tamara Kastrin⁴³, Jeremy Keenan⁴⁴, Keith P Klugman³⁷, Brenda Kwambana-Adams⁴⁵, Pierra Y Law⁴⁶, John A Lees²⁸, Pak Leung Ho⁴⁶, Yuan Li¹¹, Stephanie W Lo¹³, Theresa J Ochoa⁴⁷, Shabir A Madhi⁴⁸, Benjamin J Metcalf¹¹, Jennifer Moïsi⁴⁹, Helio Mucavele Fundação Manhiça⁵⁰, Kedibone M Ndlangisa³², Michele Nurse-Lucas¹⁶, Susan A Nzenze⁴⁸, Stephen K Obaro⁵¹, Metka Paragi⁵², Andrew J Pollard⁴², K L Ravikumar⁵³, Ewa Sadowy⁵⁴, Samir K Saha³⁶, Eric Sampane-Donkor⁵⁵, Shamala Devi Sekaran⁵⁶, Sadia Shakoor⁵⁷, Shrijana Shrestha⁵⁸, Betuel Sigauque⁵⁹, Anna Skoczynska⁶⁰, Kwan Soo Ko⁶¹, Peggy-Estelle Tientcheu⁶², Leonid Titov⁶³, Yulia Urban⁹, Jennifer Verani¹¹, Andries J van Tonder⁶⁴, Anne von Gottberg³², Nicole Wolter³²

Affiliations

¹ Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway; Parasites and Microbes, Wellcome Sanger Institute, Cambridge, UK.
² Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland.
³ Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.
⁴ Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia.
⁵ Faculty of Medicine and Institute of Life Sciences, University of Southampton, UK; NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Trust, Southampton, United Kingdom; Global Health Research Institute, University of Southampton, Southampton, United Kingdom; School of Postgraduate Studies, International Medical University, Kuala Lumpur, Malaysia; Centre for Translational Research, IMU Institute for Research, Development and Innovation (IRDI), Kuala Lumpur, Malaysia.
⁶ Faculty of Pharmacy, Siam University, Bangkok, Thailand.
⁷ Papua New Guinea Institute of Medical Research, PO Box 60, Goroka 441, Eastern Highlands Province, Papua New Guinea.
⁸ Telethon Kids Institute, the University of Western Australia, Perth, WA, Australia.
⁹ G.N. Gabrichevsky Research Institute for Epidemiology and Microbiology, Moscow, Russia.
¹⁰ Department of Clinical Microbiology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland and Faculty of Medicine, University of Iceland.
¹¹ Centers for Disease Control and Prevention, Atlanta, USA.
¹² Emory Global Health Institute, Atlanta, USA; Rollins School Public Health, Emory University, USA.
¹³ Parasites and Microbes, Wellcome Sanger Institute, Cambridge, UK.
¹⁴ Vaccine Preventable Bacteria Section, Public Health England - National Infection Service, London, United Kingdom.
¹⁵ Vaccine Preventable Bacteria Section, Public Health England - National Infection Service, London, United Kingdom; Immunisation and Countermeasures Division, Public Health England - National Infection Service, London, United Kingdom.
¹⁶ Department of Paraclinical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago.
¹⁷ Division of Pediatric Infectious Diseases, Department of Pediatrics, School of Medicine, University of Utah, 295 Chipeta Way, PO BOX 581289, Salt Lake City, UT, 84108, USA.
¹⁸ WHO Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at The London School of Hygiene & Tropical Medicine, Fajara, The Gambia.
¹⁹ Christian Medical College, Vellore, India.
²⁰ Ibn Rochd university-hospital center-Casablanca.
²¹ The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
²² Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
²³ International Centre for Diarrheal Diseases Research, Dhaka, Bangladesh.
²⁴ Institute of Environmental Science and Research Limited, Kenepuru Science Centre, Porirua, Zealand.
²⁵ Malawi-Liverpool-Wellcome-Trust, Malawi.
²⁶ Instituto Nacional de Enfermedades Infecciosas, Argentina.
²⁷ Center of Bacteriology, Adolfo Lutz Institute, São Paulo, Brazil.
²⁸ Faculty of Medicine, School of Public Health, Imperial College London, UK.
²⁹ Belarusian State Medical University, Minsk, Belarus, The Republican Research and Practical Center for Epidemiology and Microbiology, Minsk, Belarus.
³⁰ Faculty of Sciences and Techniques of Health, Mohammed VI University of Health Sciences (UM6SS).
³¹ Hamad Medical Corporation, Doha, Qatar.
³² Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, SouthAfrica.
³³ Laboratoire of Microbiology, Faculty of Medicine and Pharmacy & Ibn Rochd University Hospital Center, Casablanca, Morocco.
³⁴ Hacettepe University Faculty of Medicine, Department of Medical Microbiology, 06100, Ankara, Turkey.
³⁵ Queens Research Institute, University of Edinburgh, UK.
³⁶ Child Health Research Foundation, Dhaka, Bangladesh.
³⁷ Rollins School Public Health, Emory University, USA.
³⁸ National Medicines Institute, Division of Clinical Microbiology and Infection Prevention, Warsaw, Poland.
³⁹ Department of Pediatrics, Baylor College of Medicine, Houston TX.
⁴⁰ Dept of Microbiology, Chinese Univ of Hong Kong.
⁴¹ Department of Human Genetics, University of Utah, 15 North 2030 East, Salt Lake City, UT 84112.
⁴² Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, UK.
⁴³ Department of Medical Microbiology, Institute of Public Health of the Republic of Slovenia, Grabloviceva 44, 1000 Ljubljana, Slovenia.
⁴⁴ Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, United States of America.
⁴⁵ Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland; NIHR Global Health Research Unit on Mucosal Pathogens, Division of Infection and Immunity, University College London, London, UK.
⁴⁶ Department of Microbiology and Carol Yu Centre for Infection, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
⁴⁷ Instituto de Medicina Tropical, Universidad Peruana Cayetano Heredia, Lima, Peru.
⁴⁸ Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, SouthAfrica; Dept. of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, South Africa.
⁴⁹ Agence de Médecine Préventive, Paris, France.
⁵⁰ Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Moçambique.
⁵¹ University of Nebraska Medical Center, Omaha, USA.
⁵² National Laboratory of Health, Environment and Food, Centre for Medical Microbiology, Department for Public Health Microbiology, Grablovičeva 44, 1000, Ljubljana, Slovenia.
⁵³ Central Research Laboratory, Department of Microbiology, Kempegowda Institute of Medical Sciences Hospital & Research Center, Bangalore, India.
⁵⁴ Department of Molecular Microbiology, National Medicines Institute, 00-725 Warsaw, Poland.
⁵⁵ Department of Medical Microbiology, School of Biomedical and Allied Health Sciences University of Ghana, Accra, Ghana.
⁵⁶ Faculty of Medical & Health Sciences, UCSI University, Malaysia.
⁵⁷ Department of Pathology and Laboratory Medicine and Department of Paediatrics and Child Health, The Aga Khan University, Karachi 74800, Pakistan.
⁵⁸ Patan Academy of Health Sciences, Kathmandu, Nepal.
⁵⁹ Fundação Manhiça / Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique; Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique.
⁶⁰ National Reference Centre for Bacterial Meningitis, Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland.
⁶¹ Department of Molecular Cell Biology, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Suwon, South Korea.
⁶² Vaccines and Immunity Theme, MRC Unit, The Gambia.
⁶³ The Republican Research and Practical Center for Epidemiology and Microbiology, Minsk, Belarus.
⁶⁴ Department of Veterinary Medicine, University of Cambridge, Cambridge, UK.

PMID: 34996643
PMCID: PMC8820377
DOI: 10.1016/j.vaccine.2021.10.046

International links between Streptococcus pneumoniae vaccine serotype 4 sequence type (ST) 801 in Northern European shipyard outbreaks of invasive pneumococcal disease

R A Gladstone et al. Vaccine. 2022.

. 2022 Feb 11;40(7):1054-1060.

doi: 10.1016/j.vaccine.2021.10.046. Epub 2022 Jan 5.

Authors

Collaborators

Global Pneumococcal Sequencing Consortium:
Patrick E Akpaka¹⁶, Krow Ampofo¹⁷, Martin Antonio¹⁸, Veeraraghavan Balaji¹⁹, Bernard W Beall¹¹, Houria Belabbès²⁰, Rachel Benisty²¹, Godfrey Bigogo²², Abdullah W Brooks²³, Philip E Carter²⁴, Jennifer E Cornick²⁵, Alejandra Corso²⁶, Maria Cristina de Cunto Brandileone²⁷, Samanta Cristine Grassi Almeida²⁷, Nicholas J Croucher²⁸, Ron Dagan²¹, Alexander Davydov²⁹, Idrissa Diawara³⁰, Sanjay Doiphode³¹, Mignon du Plessis³², Naima Elmdaghri³³, Özgen Köseoglu Eser³⁴, Dean B Everett³⁵, Diego Faccone²⁶, Paula Gagetti²⁶, Noga Givon-Lavi²¹, Md Hasanuzzaman³⁶, Paulina A Hawkins³⁷, Waleria Hryniewicz³⁸, Kristina G Hulten³⁹, Margaret Ip⁴⁰, Aurelie Kapusta⁴¹, Rama Kandasamy⁴², Tamara Kastrin⁴³, Jeremy Keenan⁴⁴, Keith P Klugman³⁷, Brenda Kwambana-Adams⁴⁵, Pierra Y Law⁴⁶, John A Lees²⁸, Pak Leung Ho⁴⁶, Yuan Li¹¹, Stephanie W Lo¹³, Theresa J Ochoa⁴⁷, Shabir A Madhi⁴⁸, Benjamin J Metcalf¹¹, Jennifer Moïsi⁴⁹, Helio Mucavele Fundação Manhiça⁵⁰, Kedibone M Ndlangisa³², Michele Nurse-Lucas¹⁶, Susan A Nzenze⁴⁸, Stephen K Obaro⁵¹, Metka Paragi⁵², Andrew J Pollard⁴², K L Ravikumar⁵³, Ewa Sadowy⁵⁴, Samir K Saha³⁶, Eric Sampane-Donkor⁵⁵, Shamala Devi Sekaran⁵⁶, Sadia Shakoor⁵⁷, Shrijana Shrestha⁵⁸, Betuel Sigauque⁵⁹, Anna Skoczynska⁶⁰, Kwan Soo Ko⁶¹, Peggy-Estelle Tientcheu⁶², Leonid Titov⁶³, Yulia Urban⁹, Jennifer Verani¹¹, Andries J van Tonder⁶⁴, Anne von Gottberg³², Nicole Wolter³²

Affiliations

¹ Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway; Parasites and Microbes, Wellcome Sanger Institute, Cambridge, UK.
² Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland.
³ Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.
⁴ Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia.
⁵ Faculty of Medicine and Institute of Life Sciences, University of Southampton, UK; NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Trust, Southampton, United Kingdom; Global Health Research Institute, University of Southampton, Southampton, United Kingdom; School of Postgraduate Studies, International Medical University, Kuala Lumpur, Malaysia; Centre for Translational Research, IMU Institute for Research, Development and Innovation (IRDI), Kuala Lumpur, Malaysia.
⁶ Faculty of Pharmacy, Siam University, Bangkok, Thailand.
⁷ Papua New Guinea Institute of Medical Research, PO Box 60, Goroka 441, Eastern Highlands Province, Papua New Guinea.
⁸ Telethon Kids Institute, the University of Western Australia, Perth, WA, Australia.
⁹ G.N. Gabrichevsky Research Institute for Epidemiology and Microbiology, Moscow, Russia.
¹⁰ Department of Clinical Microbiology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland and Faculty of Medicine, University of Iceland.
¹¹ Centers for Disease Control and Prevention, Atlanta, USA.
¹² Emory Global Health Institute, Atlanta, USA; Rollins School Public Health, Emory University, USA.
¹³ Parasites and Microbes, Wellcome Sanger Institute, Cambridge, UK.
¹⁴ Vaccine Preventable Bacteria Section, Public Health England - National Infection Service, London, United Kingdom.
¹⁵ Vaccine Preventable Bacteria Section, Public Health England - National Infection Service, London, United Kingdom; Immunisation and Countermeasures Division, Public Health England - National Infection Service, London, United Kingdom.
¹⁶ Department of Paraclinical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago.
¹⁷ Division of Pediatric Infectious Diseases, Department of Pediatrics, School of Medicine, University of Utah, 295 Chipeta Way, PO BOX 581289, Salt Lake City, UT, 84108, USA.
¹⁸ WHO Collaborating Centre for New Vaccines Surveillance, Medical Research Council Unit The Gambia at The London School of Hygiene & Tropical Medicine, Fajara, The Gambia.
¹⁹ Christian Medical College, Vellore, India.
²⁰ Ibn Rochd university-hospital center-Casablanca.
²¹ The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
²² Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
²³ International Centre for Diarrheal Diseases Research, Dhaka, Bangladesh.
²⁴ Institute of Environmental Science and Research Limited, Kenepuru Science Centre, Porirua, Zealand.
²⁵ Malawi-Liverpool-Wellcome-Trust, Malawi.
²⁶ Instituto Nacional de Enfermedades Infecciosas, Argentina.
²⁷ Center of Bacteriology, Adolfo Lutz Institute, São Paulo, Brazil.
²⁸ Faculty of Medicine, School of Public Health, Imperial College London, UK.
²⁹ Belarusian State Medical University, Minsk, Belarus, The Republican Research and Practical Center for Epidemiology and Microbiology, Minsk, Belarus.
³⁰ Faculty of Sciences and Techniques of Health, Mohammed VI University of Health Sciences (UM6SS).
³¹ Hamad Medical Corporation, Doha, Qatar.
³² Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, SouthAfrica.
³³ Laboratoire of Microbiology, Faculty of Medicine and Pharmacy & Ibn Rochd University Hospital Center, Casablanca, Morocco.
³⁴ Hacettepe University Faculty of Medicine, Department of Medical Microbiology, 06100, Ankara, Turkey.
³⁵ Queens Research Institute, University of Edinburgh, UK.
³⁶ Child Health Research Foundation, Dhaka, Bangladesh.
³⁷ Rollins School Public Health, Emory University, USA.
³⁸ National Medicines Institute, Division of Clinical Microbiology and Infection Prevention, Warsaw, Poland.
³⁹ Department of Pediatrics, Baylor College of Medicine, Houston TX.
⁴⁰ Dept of Microbiology, Chinese Univ of Hong Kong.
⁴¹ Department of Human Genetics, University of Utah, 15 North 2030 East, Salt Lake City, UT 84112.
⁴² Oxford Vaccine Group, Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, Oxford, UK.
⁴³ Department of Medical Microbiology, Institute of Public Health of the Republic of Slovenia, Grabloviceva 44, 1000 Ljubljana, Slovenia.
⁴⁴ Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, United States of America.
⁴⁵ Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland; NIHR Global Health Research Unit on Mucosal Pathogens, Division of Infection and Immunity, University College London, London, UK.
⁴⁶ Department of Microbiology and Carol Yu Centre for Infection, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
⁴⁷ Instituto de Medicina Tropical, Universidad Peruana Cayetano Heredia, Lima, Peru.
⁴⁸ Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, SouthAfrica; Dept. of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, South Africa.
⁴⁹ Agence de Médecine Préventive, Paris, France.
⁵⁰ Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Moçambique.
⁵¹ University of Nebraska Medical Center, Omaha, USA.
⁵² National Laboratory of Health, Environment and Food, Centre for Medical Microbiology, Department for Public Health Microbiology, Grablovičeva 44, 1000, Ljubljana, Slovenia.
⁵³ Central Research Laboratory, Department of Microbiology, Kempegowda Institute of Medical Sciences Hospital & Research Center, Bangalore, India.
⁵⁴ Department of Molecular Microbiology, National Medicines Institute, 00-725 Warsaw, Poland.
⁵⁵ Department of Medical Microbiology, School of Biomedical and Allied Health Sciences University of Ghana, Accra, Ghana.
⁵⁶ Faculty of Medical & Health Sciences, UCSI University, Malaysia.
⁵⁷ Department of Pathology and Laboratory Medicine and Department of Paediatrics and Child Health, The Aga Khan University, Karachi 74800, Pakistan.
⁵⁸ Patan Academy of Health Sciences, Kathmandu, Nepal.
⁵⁹ Fundação Manhiça / Centro de Investigação em Saúde da Manhiça (CISM), Maputo, Mozambique; Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique.
⁶⁰ National Reference Centre for Bacterial Meningitis, Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland.
⁶¹ Department of Molecular Cell Biology, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Suwon, South Korea.
⁶² Vaccines and Immunity Theme, MRC Unit, The Gambia.
⁶³ The Republican Research and Practical Center for Epidemiology and Microbiology, Minsk, Belarus.
⁶⁴ Department of Veterinary Medicine, University of Cambridge, Cambridge, UK.

PMID: 34996643
PMCID: PMC8820377
DOI: 10.1016/j.vaccine.2021.10.046

Abstract

Background: Pneumococcal disease outbreaks of vaccine preventable serotype 4 sequence type (ST)801 in shipyards have been reported in several countries. We aimed to use genomics to establish any international links between them.

Methods: Sequence data from ST801-related outbreak isolates from Norway (n = 17), Finland (n = 11) and Northern Ireland (n = 2) were combined with invasive pneumococcal disease surveillance from the respective countries, and ST801-related genomes from an international collection (n = 41 of > 40,000), totalling 106 genomes. Raw data were mapped and recombination excluded before phylogenetic dating.

Results: Outbreak isolates were relatively diverse, with up to 100 SNPs (single nucleotide polymorphisms) and a common ancestor estimated around the year 2000. However, 19 Norwegian and Finnish isolates were nearly indistinguishable (0-2 SNPs) with the common ancestor dated around 2017.

Conclusion: The total diversity of ST801 within the outbreaks could not be explained by recent transmission alone, suggesting that harsh environmental and associated living conditions reported in the shipyards may facilitate invasion of colonising pneumococci. However, near identical strains in the Norwegian and Finnish outbreaks does suggest that transmission between international shipyards also contributed to those outbreaks. This indicates the need for improved preventative measures in this working population including pneumococcal vaccination.

Keywords: Molecular epidemiology; Outbreak; PCVs; PPV23; Pneumococcal; ST801; Serotype 4; Streptococcus pneumoniae; Whole genome sequencing.

PubMed Disclaimer

Conflict of interest statement

Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: [R.A.G received a PhD stipend from Pfizer 2009–2011. L.S is a co-investigator in an unrelated study, for which THL has received research funding from GlaxoSmithKline Vaccines. S.C.C: acts as principal investigator on studies conducted on behalf of University Hospital Southampton NHS Foundation Trust/University of Southampton that are sponsored by vaccine manufacturers but receives no personal payments from them. S.C.C. has participated in advisory boards for vaccine manufacturers but receives no personal payments for this work. S.C.C. has received financial assistance from vaccine manufacturers to attend conferences. All grants and honoraria are paid into accounts within the respective NHS Trusts or Universities, or to independent charities. N.K.F, C.L.S The Immunisation and Countermeasures Division, Public Health England - National Infection Service, London, UK provides vaccine manufacturers with post-marketing surveillance reports, which the Marketing Authorization Holders are required to submit to the UK Licensing authority in compliance with their Risk Management Strategy. A cost recovery charge is made for these reports. N.K.F and C.S. conduct contract research funded by vaccine manufacturers (including GlaxoSmithKline and Pfizer) on behalf of Public Health England. No personal remuneration is received. M.T reports grants from GlaxoSmithKline and Pfizer to the Finnish Institute for Health and Welfare for unrelated research projects in which she is a co-investigator. All remaining authors report no conflicts of interest.].

Figures

**Fig. 1**
Phylogeny of CC801 and outbreak clade, Fig. 1A) Phylogeny of CC801 n = 73, SNP scale. Green triangle denotes subtree that is expanded in Fig. 1B) Subtree of closely related isolates n = 25, SNP scale. Most recent common ancestor (MRCA) of the cluster containing n = 19 near indistinguishable Norwegian and Finnish isolates (Dark orange triangle). Available in Microreact views https://microreact.org/project/gpsGPSC162/dce8ac7c and https://microreact.org/project/gpsGPSC162/fdf71de9.

See this image and copyright information in PMC

References

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International links between Streptococcus pneumoniae vaccine serotype 4 sequence type (ST) 801 in Northern European shipyard outbreaks of invasive pneumococcal disease

Collaborators

Affiliations

International links between Streptococcus pneumoniae vaccine serotype 4 sequence type (ST) 801 in Northern European shipyard outbreaks of invasive pneumococcal disease

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical