The distribution of pneumococcal serotypes in Brazil was analyzed by age group and clinical diagnosis, using data obtained during 20 years of national surveillance. Serotypes 1 and 5 remained among the main serotypes in all age groups, increasing in frequency with age. Serotype 14 was prevalent among children, whereas serotypes 3 and 4 were most prevalent among the adult population. The potential impact of the 7- and 9-valent conjugate vaccines on children up to age 5 years with severe pneumococcal diseases was 58.2% and 73%, respectively; the highest coverage of the 7-valent vaccine for pneumonia was achieved for children aged 7 months to 2 years (70%), whereas, for meningitis, it was observed for children aged 7 months to 5 years (58.6%). The use of conjugate vaccine may be of potential benefit by reducing the childhood sequelae and mortality of pneumococcal infection in Brazil.

We observed direct and indirect PCV10 protection against IPD caused by VT and a shift in the distribution of serotypes 5 years after the introduction of PCV10. Continued IPD surveillance is needed to evaluate the sustainability of the high prevalence of serotypes 3, 6C, and 19A, which were not included in PCV10.

Data on the prevalence of pneumooccal nasopharyngeal carriage and its risk factors among adolescents are scarce. The aim of this study was to provide such information. A cross-sectional, population-based prospective study was conducted. Participants were 1013 adolescents (age range 10-19 years) randomly recruited in 22 public schools. Those schools were randomly chosen among 307 public schools from 11 Sanitary Districts of Salvador, Brazil. Nasopharyngeal samples were assessed by standard procedures to recover and identify Streptococcus pneumoniae. Data on potential risk factors were gathered by confidential interview based on a standardized questionnaire. Pneumococci were recovered from 8.2 % [83/1013, 95 % confidence interval (CI) 6.6-10.0]. By stepwise logistic regression, pneumococcal colonization was independently associated with younger age [odds ratio (OR) 0.85, 95 % CI 0.77-0.94, P50.001], being male (OR 1.78, 95 % CI 1.11-2.85, P50.02), exposure to passive smoke in the household (OR 1.76, 95 % CI 1.10-2.79, P50.02), having an upper respiratory infection during recruitment (OR 2.67, 95 % CI 1.67-4.28, P,0.001) and having a history involving an episode of acute asthma during the last year (OR 2.89, 95 % CI 1.18-7.08, P50.03). The estimated probability of pneumococcal colonization decreased with age (x 2 for trend58.52, P50.003). These findings provide tools for increasing the use of prevention strategies for pneumococcal diseases, such as pneumococcal vaccination among asthmatic patients and public health measures to stop smoking. INTRODUCTIONThe incidence of invasive pneumococcal disease is highest among children and the elderly (CDC, 1997). However, respiratory infections are an important cause of morbidity and mortality among adolescents (Benguigui, 1992). Among children, Streptococcus pneumoniae is a major causative agent of such infections (Heiskanen-Kosma et al., 1998). The nasopharynx is known to be the main ecological reservoir of S. pneumoniae, from where it can give rise to disease after extending to other areas of the respiratory tract or penetrating normally sterile body fluids (Austrian, 1986). Although nasopharyngeal isolates are not useful for predicting the causative agent of invasive disease in individuals, they reflect epidemiological aspects of pneumococcal disease in the community (Brueggemann et al., 2003).Studies conducted over the last decades have gradually revealed the connection between pneumococcal carriage, and mucosal and invasive infections caused by the (Inostroza et al., 1998). Thus, we estimated that 900 participants would be sufficient to detect a prevalence and the respective 95 % confidence interval (CI) of nasopharyngeal colonization ranging from 8-12 % (point prevalence510 %, 2 % error). We assumed a 12 % refusal to participate, so the sample size was established as 1000 participants. Demographic, clinical and epidemiological data were collected by a standardized questionnaire.Bacteriological data. Two trained biochemists collected nasopharyngeal specimens by rotat...

In March 2010, Brazil introduced the 10-valent pneumococcal conjugate vaccine (PCV10) in the routine infant immunization program using a 4-dose schedule and catch-up for children <23months. We investigated PCV10 effect on nasopharyngeal carriage with vaccine-type Streptococcus pneumoniae (Spn) and non-typeable Haemophilus influenzae (NTHi) among children in São Paulo city. Cross-sectional surveys were conducted in 2010 (baseline) and 2013 (post-PCV10). Healthy PCV-naïve children aged 12-23months were recruited from primary health centers during immunization campaigns. Nasopharyngeal swabs were collected and tested for Hi; for Spn, all baseline and a stratified random sample of 400 post-PCV10 swabs were tested. We compared vaccine-type Spn and NTHi carriage prevalence pre-/post-PCV10, and used logistic regression to estimate PCV10 effectiveness (1-adjusted odds ratio×100%). Overall 501 children were included in the baseline and 1167 in the post-PCV10 survey (including 400 tested for Spn). Spn was detected in 40.3% of children at baseline and 48.8% post-PCV10; PCV10 serotypes were found in 19.8% and 1.8% respectively, representing a decline of 90.9% (p<0.0001). Carriage of vaccine-related serotypes increased (10.8-21.0%, p<0.0001), driven primarily by a rise in serotype 6C (1.8-11.2%, p<0.0001); carriage of serotypes 6A and 19A did not significantly change. PCV10 effectiveness (4 doses) against vaccine-type carriage was 97.3% (95% confidence interval 88.7-99.3). NTHi prevalence increased from 26.0% (130/501) to 43.6% (509/1167, p<0.0001); PCV10 vaccination seemed significantly associated with NTHi carriage, even after adjusting for other known risk factors. Carriage with PCV10 serotypes among toddlers declined dramatically following PCV10 introduction in São Paulo, Brazil. No protection of PCV10 against NTHi was observed. Our findings contribute to a growing body of evidence of PCV10 impact on vaccine-type carriage and highlight the importance of PCV10 as a tool to reduce the burden of pneumococcal disease in Brazil and globally.

A comprehensive investigation of invasive Streptococcus pneumoniae was carried out in Brazil as part of the programme of the national epidemiological surveillance system. The investigation provided data on the trends of resistance to antimicrobial agents. A total of 6470 isolates of S. pneumoniae collected in the country from 1993 to 2004 were tested. During this period of time, the number of penicillin-resistant strains rose from 10?2 to 27?9 %. The proportions of intermediate and high-level resistant strains in 1993, which were 9?1 and 1?1 %, respectively, rose to 22?0 and 5?9 % in 2004. Geometric mean MICs for penicillin increased after the year 2000, to 0?19 mg ml "1 in 2004; most of these isolates were from patients with pneumonia and from children under 5 years old, and belonged to serotype 14. There was a significant increase in the number of isolates belonging to serotypes included in the 7-valent conjugate vaccine from children under 5 years old: from 48?6 % in 1993 to 69?6 % in 2004, mainly related to an increase in the frequency of serotype 14 isolates. From 2000 to 2004, meningitis isolates showed higher resistance rates to cefotaxime (2?6 %) compared to non-meningitis isolates (0?7 %); percentages of isolates resistant to trimethoprim-sulfamethoxazole, tetracycline, erythromycin, chloramphenicol and rifampicin were 65, 14?6, 6?2, 1?3 and 0?7 %, respectively. No levoflaxin resistance was observed. Multidrug resistance was identified in 4?6 % of isolates, of which 3?8 % were resistant to three classes, 0?7 % to four classes and 0?1 % to five classes of antimicrobial agent. The study provides valuable information that may support empirical antimicrobial therapy for severe S. pneumoniae infections in Brazil, and emphasizes the need for conjugate pneumococcal vaccination.