Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Aug 31:11:1238502.
doi: 10.3389/fpubh.2023.1238502. eCollection 2023.

Impact of the progressive uptake of pneumococcal conjugate vaccines on the epidemiology and antimicrobial resistance of invasive pneumococcal disease in Gipuzkoa, northern Spain, 1998-2022

Ayla Manzanal  1   2 , Diego Vicente  1   2   3 , Marta Alonso  1   3 , Nekane Azkue  1 , Maria Ercibengoa  3 , José María Marimón  1   3
Affiliations

Impact of the progressive uptake of pneumococcal conjugate vaccines on the epidemiology and antimicrobial resistance of invasive pneumococcal disease in Gipuzkoa, northern Spain, 1998-2022

Ayla Manzanal et al. Front Public Health. .

Abstract

Objectives: To analyze the impact of pneumococcal conjugate vaccines (PCVs) on the incidence of invasive pneumococcal diseases (IPDs) and pneumococcal antibiotic resistance in Gipuzkoa, northern Spain for a 25 years period.

Methods: All cases of IPD confirmed by culture between 1998 and 2022 in a population of around 427,416 people were included. Pneumococci were serotyped and antimicrobial susceptibility was assessed by the EUCAST guidelines.

Results: Overall, 1,516 S. pneumoniae isolates were collected. Annual IPD incidence rates (per 100,000 people) declined from 19.9 in 1998-2001 to 11.5 in 2017-19 (42.2% reduction), especially in vaccinated children (from 46.7 to 24.9) and non-vaccinated older adult individuals (from 48.0 to 23.6). After PCV13 introduction, the decrease in the incidence of infections caused by PCV13 serotypes was balanced by the increase in the incidence of non-PCV13 serotypes. In the pandemic year of 2020, IPD incidence was the lowest: 2.81. The annual incidence rates of penicillin-resistant isolates also decreased, from 4.91 in 1998-2001 to 1.49 in 2017-19 and 0.70 in 2020. Since 2017, serotypes 14, 19A, and 11A have been the most common penicillin-resistant types. The incidence of erythromycin-resistant strains declined, from 3.65 to 1.73 and 0.70 in the same years.

Conclusion: PCV use was associated with declines in the incidence of IPD and the spread of non-vaccine serotypes, that balanced the beneficial effect off PCV13, some of them showing high rates of antibiotic resistance.

Keywords: SARS-CoV-2 preventive measures; invasive pneumococcal disease; non-vaccine serotypes; pneumococcal antibiotic resistance; pneumococcal conjugate vaccines.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Trend in the annual incidence (cases per 100,000 population) of IPD in Gipuzkoa, northern Spain (1998–2020). *PCV13-AS: PCV13 additional serotypes (serotypes 1, 3, 5, 6A, 7F, and 19A).
Figure 2
Figure 2
Annual incidence (cases per 100,000 population/year) of IPD by age group in Gipuzkoa, northern Spain (1998–2021).
Figure 3
Figure 3
Changes in the incidence (cases per 100,000 population/year) of IPD serotypes over time by age group: (A) PCV7 serotypes; (B) PCV13 additional serotypes; (C) PCV13 serotypes; (D) NVTs (non-PCV13 serotypes).
Figure 3
Figure 3
Changes in the incidence (cases per 100,000 population/year) of IPD serotypes over time by age group: (A) PCV7 serotypes; (B) PCV13 additional serotypes; (C) PCV13 serotypes; (D) NVTs (non-PCV13 serotypes).
Figure 4
Figure 4
Time distribution of antibiotic resistance rates (bars) and incidence (line) of resistant isolates causing IPD in Gipuzkoa, northern Spain, 1998–2021: (A) Penicillin resistance; (B) Cefotaxime resistance; (C) Erythromycin resistance; (D) Multidrug resistance (MDR, i.e., resistance to both penicillin and erythromycin). *PCV13 as: PCV13 additional serotypes (serotypes 1, 3, 5, 6A, 7F, and 19A).
Figure 4
Figure 4
Time distribution of antibiotic resistance rates (bars) and incidence (line) of resistant isolates causing IPD in Gipuzkoa, northern Spain, 1998–2021: (A) Penicillin resistance; (B) Cefotaxime resistance; (C) Erythromycin resistance; (D) Multidrug resistance (MDR, i.e., resistance to both penicillin and erythromycin). *PCV13 as: PCV13 additional serotypes (serotypes 1, 3, 5, 6A, 7F, and 19A).
See this image and copyright information in PMC

References

    1. Black S, Shinefield H, Fireman B, Lewis E, Ray P, Hansen JR, et al. . Efficacy, safety and immunogenicity of heptavalent pneumococcal conjugate vaccine in children. Northern California Kaiser Permanente vaccine study center group. Pediatr Infect Dis J. (2000) 19:187–95. doi: 10.1097/00006454-200003000-00003, PMID: - DOI - PubMed
    1. Kyaw MH, Lynfield R, Schaffner W, Craig AS, Hadler J, Reingold A, et al. . Effect of introduction of the pneumococcal conjugate vaccine on drug-resistant Streptococcus pneumoniae. N Engl J Med. (2006) 354:1455–63. doi: 10.1056/NEJMoa051642 - DOI - PubMed
    1. Palmu AA, Jokinen J, Borys D, Nieminen H, Ruokokoski E, Siira L, et al. . Effectiveness of the ten-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine (PHiD-CV10) against invasive pneumococcal disease: a cluster randomised trial. Lancet. (2013) 381:214–22. doi: 10.1016/S0140-6736(12)61854-6, PMID: - DOI - PubMed
    1. Yeh SH, Gurtman A, Hurley DC, Block SL, Schwartz RH, Patterson S, et al. . Immunogenicity and safety of 13-valent pneumococcal conjugate vaccine in infants and toddlers. Pediatrics. (2010) 126:e493–505. doi: 10.1542/peds.2009-3027 - DOI - PubMed
    1. Lo SW, Gladstone RA, van Tonder AJ, Lees JA, du Plessis M, Benisty R, et al. . Pneumococcal lineages associated with serotype replacement and antibiotic resistance in childhood invasive pneumococcal disease in the post-PCV13 era: an international whole-genome sequencing study. Lancet Infect Dis. (2019) 19:759–69. doi: 10.1016/S1473-3099(19)30297-X, PMID: - DOI - PMC - PubMed