Adult invasive pneumococcal disease between 2003 and 2006 in North-Rhine Westphalia, Germany: serotype distribution before recommendation for general pneumococcal conjugate vaccination for children <2 years of age

Abstract

A laboratory-based surveillance study of adult invasive pneumococcal disease was conducted in North-Rhine Westphalia, Germany's most populous federal state, with approximately 18 million inhabitants. Invasive isolates (n = 519) were obtained between 2003 and 2006, before the general recommendation for vaccination of German children <2 years with the pneumococcal conjugate vaccine was issued at the end of July 2006. Penicillin G resistance was observed in 5% of meningitis cases. In the non-meningitis group, only intermediately resistant strains were detected (0.4%). Intermediate resistance to cefotaxime occurred both in meningitis cases (1.7%) and non-meningitis cases (0.4%). Non-susceptibility rates (intermediate resistance and resistance) were 16.2% for macrolides, 10.9% for trimethoprim-sulphamethoxazole, 5.0% for tetracycline, 3.9% for clindamycin, and 0.4% for levofloxacin. All isolates were susceptible to amoxycillin (non-meningitis) and telithromycin. The leading serotypes were serotypes 14 (14.3%), 7F (9.4%), 3 (9.2%), 4 (8.7%) and 1 (8.1%). Serotype coverage for the seven-valent conjugate vaccine was 43.9%. For the ten-valent and 13-valent vaccines (in development), the coverages were 61.8% and 76.7%, respectively. The 23-valent polysaccharide vaccine had a coverage of 91.1%.

Association of Serotypes of Streptococcus pneumoniae with Age in Invasive Pneumococcal Disease

“…Overall, the most frequent serotypes were 14, 23F, 1, 6B, and 7F (in descending order), which is similar to the most frequent serotypes published in reports of other studies conducted over the same period in Germany (11,12). They deviate in part from older German data (17,20), but they are generally in line with the results reported from other countries (3,5,6,8,22,27).…”

The paradox in pneumococcal serotypes: highly invasive does not mean highly lethal

“…Surveillance systems (e.g. USActive Bacterial Core Surveillance Study [6], German Pneumococcus Surveillance Study [7]) rely on invasive isolates, because here the causality between pathogen and disease is easy to establish. However, in pneumococcal pneumonia, a positive blood culture only can be obtained in a minority of patients (,10%) [8].…”

Serotypes of Streptococcus pneumoniae Isolates from Children with Invasive Pneumococcal Disease in Turkey: Baseline Evaluation of the Introduction of the Pneumococcal Conjugate Vaccine Nationwide

“…Therefore, surveillance of pneumococcal diseases on the basis of serotypes is essential, not only to learn about the current serotype pattern but also to observe the effectiveness of PCVs by following possible serotype changes in the population after vaccine introduction. In several studies, regional and temporal variations in serotype distribution were reported after PCV usage (6,7,(10)(11)(12). In this study, we aimed to identify serotypes of pneumococcal strains causing IPD in children in Turkey during the time period when PCV7 was newly included in the country's NIP.…”