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Multicenter Study
. 2023 Dec;55(1):266-275.
doi: 10.1080/07853890.2022.2160877.

Serotype distribution of Streptococcus pneumoniae and pneumococcal vaccine coverage in adults in Turkey between 2015 and 2018

Gulsen Hascelik  1 , Guner Soyletir  2 , Zeynep Gulay  3 , Banu Sancak  1 , Akgun Yaman  4 , Nezahat Gurler  5 , Sabire Sohret Aydemir  6 , Gulcin Bayramoglu  7 , Faruk Aydin  7 , Yesim Cekin  8 , Asuman Birinci  9 , Cuneyt Ozakin  10 , Nezahat Akpolat  11 , Betil Ozhak Baysan  12 , Meral Gultekin  12 , Yasemin Zer  13 , Laser Sanal  14 , Cigdem Arabaci  15 , Yasemin Ay Altintop  16 , Candan Ozturk  17 , Mehmet Ceyhan  18
Affiliations
Multicenter Study

Serotype distribution of Streptococcus pneumoniae and pneumococcal vaccine coverage in adults in Turkey between 2015 and 2018

Gulsen Hascelik et al. Ann Med. 2023 Dec.

Abstract

Objective: To evaluate the serotype distribution and antibiotic resistance in pneumococcal infections in adults and to provide a perspective regarding serotype coverage of both current and future pneumococcal vaccines.

Patients and methods: This passive surveillance study was conducted with the Streptococcus pneumoniae strains isolated from the specimens of patients with pneumonia (materials isolated from bronchoalveolar lavage), bacteraemia, meningitis, pleuritis and peritonitis between 2015 and 2018. Serogrouping and serotyping were performed by latex particle agglutination and by conventional Quellung reaction using commercial type-specific antisera, respectively. The strains were analysed for penicillin, cefotaxime, erythromycin and moxifloxacin susceptibilities by E-test.

Results: In the whole study group (410 samples from adults aged ≥18 years), the most frequent serotypes were 3 (14.1%), 19 F (12%) and 1 (9.3%). The vaccine coverage for PCV13, PCV15, PCV20 and PPV23 was 63.9%, 66.6%, 74.1% and 75.9%, respectively, in all isolates. Penicillin non-susceptibility in invasive pneumococcal disease (IPD) was 70.8% and 57.1% in the patients aged <65 and ≥65 years, respectively. About 21.1% and 4.3% of the patients with and without IPD had cefotaxime resistance. Non-susceptibility to erythromycin and moxifloxacin was 38.2% and 1.2%, respectively.

Conclusions: The results revealed that novel PCV vaccines may provide improved coverage as compared with the currently available vaccine, PCV13. The significant antibiotic resistance rates imply the need to extend the serotype coverage of the vaccines. Continuing the surveillance in pneumococcal diseases is critical to explore the serotype distribution and incidence changes of IPD cases in the population and to inform policy makers to make necessary improvements in the national immunization programmes.Key messagesThis multicentre study demonstrated the most recent serotype distribution and antibiotic resistance in adult population in Turkey.Shifting from PCV13 to novel conjugated vaccines will significantly increase the coverage.Continuing the surveillance in pneumococcal diseases is critical to explore the serotype distribution changes and the incidence of cases with invasive pneumococcal disease in the population.

Keywords: Streptococcus pneumoniae; antibiotic susceptibility; serotype; surveillance; vaccine coverage.

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Conflict of interest statement

Mehmet Ceyhan received consulting fees and research funding from Pfizer Pharmaceuticals, Istanbul, Turkey and all the remaining authors report no conflict of interest.

Figures

Figure 1.
Figure 1.
The map of Turkey that geographically represents the study centres and the included isolates from each centre.
Figure 2.
Figure 2.
Serotypes covered by PCV13, PCV15, PCV20 and PPV23.
Figure 3.
Figure 3.
Changes in antibiotic non-susceptibility in years.
Figure 4.
Figure 4.
Comparison of the coverage of pneumococcal vaccines.
See this image and copyright information in PMC

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