Characterisation of Streptococcus pneumoniae isolates from invasive disease in adults following the introduction of PCV10 in Brazil

Christophe, Bernard Louizette; Mott, Mariana; Cunha, Gabriela da; Caierão, Juliana; Azevedo, Pedro de; Dias, Cícero

doi:10.1099/jmm.0.000717

Cited by 15 publications

(12 citation statements)

References 37 publications

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“…Although emergence of this serotype after PCV7 introduction in certain high-income countries is a well-established fact (Isaacman et al, 2010; Isturiz et al, 2017), serotype 19A emergence after PCV10 introduction in Brazil still seems to be a contradictory issue. While certain studies reveal that occurrence of this serotype has not significantly changed (Medeiros et al, 2017; Neves et al, 2018), others report an increasing rate (Cassiolato et al, 2018; Christophe et al, 2018). We also observed that serotypes 3, 8, 20, and 23A emerged among isolates from IPD cases, whereas serotypes 6C, 35B, and NT isolates were more commonly associated with asymptomatic carriage.…”

Section: Discussionmentioning

confidence: 97%

“…We also observed that serotypes 3, 8, 20, and 23A emerged among isolates from IPD cases, whereas serotypes 6C, 35B, and NT isolates were more commonly associated with asymptomatic carriage. Emergence of serotype 6C in carriage and of serotypes 3 and 8 in IPD after PCV10 implementation in Brazil has been recently described (Medeiros et al, 2017; Christophe et al, 2018; Neves et al, 2018). Of note, all these emerging non-PCV10 serotypes have been circulating in our setting since the 1990s, reinforcing the possibility of serotype replacement phenomenon.…”

Section: Discussionmentioning

confidence: 99%

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Evolution of Penicillin Non-susceptibility Among Streptococcus pneumoniae Isolates Recovered From Asymptomatic Carriage and Invasive Disease Over 25 years in Brazil, 1990–2014

et al. 2019

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Streptococcus pneumoniae is a major cause of community-acquired pneumonia and meningitis, and it is also found as a commensal, colonizing the human upper respiratory tract of a portion of the human population. Its polysaccharide capsule allows the recognition of more than 90 capsular types and represents the target of the currently available pneumococcal conjugate vaccines (PCVs), such as the 10-valent (PCV10) and the 13-valent (PCV13). Penicillin non-susceptible pneumococci (PNSP) have been listed as one of the current major antimicrobial-resistant pathogen threats. In Brazil, the emergence of PNSP was initially detected in the mid 1990s and PCV10 has been part of the National Immunization Program since 2010. Here, we investigated the distribution of capsular types and penicillin susceptibility profiles of 783 pneumococcal strains isolated in Brazil between 1990 and 2014 to assess the evolution of penicillin non-susceptibility among pneumococci associated with asymptomatic carriage and invasive pneumococcal disease (IPD). The most common serotypes among carriage isolates were 19F, 6B, 6C, 23F, and 14. Among IPD isolates, the most frequent types were 14, 3, 6B, 5, 19F, and 4. We detected 21 types exclusively associated with IPD isolates, whereas non-typeable (NT) isolates were only detected in carriage. Nearly half of the isolates belonged to PCV10 serotypes, which remarkably decreased in occurrence (by nearly 50%) after PCV10 introduction (2011–2014), while non-PCV10 serotypes increased. PNSP frequency and levels were much higher among carriage isolates, but PNSP belonging to PCV10 serotypes were more common in IPD. While the occurrence of PNSP has decreased significantly among IPD isolates since 2011, it kept increasing among carriage strains. Such a difference can be attributed to the serotypes that emerged in each clinical source after PCV10 usage. PNSP with multidrug resistance profiles that emerged within carriage isolates comprised mostly serotypes 6C and 35B, as well as NT isolates. In turn, penicillin-susceptible capsular types 3, 20, and 8 have risen among IPD. Overall, our results reinforce the relevance of PNSP surveillance over a long period of time to better understand the dynamics of antimicrobial resistance in response to PCV introduction and may also contribute to improve control measures toward drug-resistant pneumococci.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Evolution of Penicillin Non-susceptibility Among Streptococcus pneumoniae Isolates Recovered From Asymptomatic Carriage and Invasive Disease Over 25 years in Brazil, 1990–2014

et al. 2019

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“…A study conducted in the city of Porto Alegre, Brazil, 3–4 years after PCV10 introduction (2013–2015) among invasive strains from adults ≥50 years identified 10 strains belonging to ST320 among 13 invasive Spn19A strains [28].…”

Section: Discussionmentioning

confidence: 99%

“…The characterization of Spn19A from Brazil has been described only in independent studies, each with a limited number of Spn19A strains isolated [28–30]. In a recent report, using data from Brazilian laboratory-based surveillance, nonvaccine types increased, with Spn19A being the most prevalent cause of IPD after four years of PCV10 use [31].…”

Section: Introductionmentioning

confidence: 99%

Expansion of the multidrug-resistant clonal complex 320 among invasive Streptococcus pneumoniae serotype 19A after the introduction of a ten-valent pneumococcal conjugate vaccine in Brazil

et al. 2018

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BackgroundIn 2010, a ten–valent pneumococcal conjugate vaccine (PCV10) was introduced in the routine infant national immunization program in Brazil. Invasive pneumococcal disease (IPD) caused by serotype 19A (Spn19A) increased after the introduction of PCVs in several countries. We compared the frequency, antimicrobial resistance and molecular patterns of invasive Spn19A strains before and after PCV10 introduction in Brazil using data from the national laboratory-based surveillance.MethodsWe analyzed invasive Spn19A strains isolated from 2005–2009 (pre-PCV10 period), 2011–2015 and 2016–2017 (post-PCV10 periods). Antimicrobial susceptibility was performed for all Spn19A strains, and multilocus sequence typing (MLST) was performed for strains isolated in the age groups <5 years and ≥50 years.ResultsAmong the study period, a total of 9,852 invasive Spn strains were analyzed, and 673 (6.8%) belonged to serotype 19A. Overall, the proportion of Spn19A among the total number of IPD strains increased from 2.8% in 2005–2009 to 7.0% and 16.4% in 2011–2015 and 2016–2017, respectively. The relative increase in Spn19A was observed especially in children <5 years old (2005–2009: 3.2%; 2011–2015: 15.5%; 2016–2017: 31.2%). The percentage of penicillin resistance (MIC 2.0–4.0 μg/mL), erythromycin resistance and multidrug resistance (MDR) increased after PCV10 introduction due to the expansion of the MDR clonal complex CC320 (2005–2009: 8.6%; 2011–2015: 56.1%; 2016–2017: 66.5%).ConclusionWe observed an expansion of MDR-CC320 among invasive Spn19A strains after PCV10 introduction in Brazil, probably related to a combination of factors, such as vaccination and antimicrobial pressure. Continued surveillance of Spn19A strains is necessary to monitor the sustainability of this clonal complex in the Brazilian population.

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“…Initially, 491 articles were selected and identified; 10 were repeated, and 479 were excluded by the analysis of their title and abstract. Lastly, two potential articles 3,8 were included, as they met the guidelines proposed for the present systematic research. Based on the chosen descriptors, the scientific data banks were consulted to extract the information made available in being attended, besides fever and mental changes, as the main clinical manifestations to analyze the occurrence of deaths.…”

Section: Resultsmentioning

confidence: 99%

Meningitis in the Elderly Population in Brazil: Narrative Review

2021

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Background: With advancing age, the physiological changes grow increasingly worse, favoring the severity of possible infections in older adults. People older than 60 years are constantly subject to underlying diseases with associated symptoms, which may be mistaken for those of meningitis. Objective: To present scientific evidence, based on a narrative literature review, of meningitis in the older Brazilian population. Methods: The articles were searched in the SciELO, LILACS, MEDLINE (PubMed), Scopus, BIREME, and Web of Science databases, besides a search for gray literature in Google Scholar. The studies were selected with a combination based on the Medical Subject Headings (MeSH), conducted according to the PRISMA recommendations (2015). The quality of the studies included in the research scored 6 points or more, as assessed with the qualitative grading protocol proposed by Pithon et al. (2015). Results: The predominance of non-10 valent pneumococcal conjugate vaccine (PCV10) serotypes stands out in the invasive pneumococcal disease in the older population in strains circulating three to five years after the PCV10 was introduced in Brazil. A long interval between the onset of symptoms and the diagnosis of the disease indicates a worsened prognosis and increased lethality in the older Brazilian population. Conclusion: Meningitis in the older population is associated with greater diagnostic difficulty, neurologic severity, clinical complications, and increased mortality

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Characterisation of Streptococcus pneumoniae isolates from invasive disease in adults following the introduction of PCV10 in Brazil

Abstract: Our data suggest a predominance of non-PCV10 serotypes among IPD in the elderly population in circulating strains ca. 3 to 5 years after the introduction of PCV10 in Brazil.

Cited by 15 publications

References 37 publications

Evolution of Penicillin Non-susceptibility Among Streptococcus pneumoniae Isolates Recovered From Asymptomatic Carriage and Invasive Disease Over 25 years in Brazil, 1990–2014

Evolution of Penicillin Non-susceptibility Among Streptococcus pneumoniae Isolates Recovered From Asymptomatic Carriage and Invasive Disease Over 25 years in Brazil, 1990–2014

Expansion of the multidrug-resistant clonal complex 320 among invasive Streptococcus pneumoniae serotype 19A after the introduction of a ten-valent pneumococcal conjugate vaccine in Brazil

Meningitis in the Elderly Population in Brazil: Narrative Review

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