Distribution of Streptococcus Pneumoniae Serotypes in Nasopharyngeal Carriage and in Invasive Pneumococcal Disease in Sao Paulo, Brazil

BackgroundPneumococcal conjugate vaccines (PCVs) are in the process of implementation in Latin America. Experience in developed countries has shown that they reduce the incidence of invasive and non-invasive disease. However, there is evidence that the introduction of PCVs in universal mass vaccination programs, combined with inappropriate and extensive use of antibiotics, could be associated to changes in non-PCV serotypes, including serotype 19A. We conducted a systematic review to determine the distribution of serotype 19A, burden of pneumococcal disease and antibiotic resistance in the region.MethodsWe performed a systematic review of serotype 19A data from observational and randomized clinical studies in the region, conducted between 1990 and 2010, for children under 6 years. Pooled prevalence estimates from surveillance activities with confidence intervals were calculated.ResultsWe included 100 studies in 22 countries and extracted data from 63. These data reported 19733 serotyped invasive pneumococcal isolates, 3.8% of which were serotype 19A. Serotype 19A isolates were responsible for 2.4% acute otitis media episodes, and accounted for 4.1% and 4.4% of 4,380 nasopharyngeal isolates from healthy children and in hospital-based/sick children, respectively. This serotype was stable over the twenty years of surveillance in the region. A total of 53.7% Spn19A isolates from meningitis cases and only 14% from non meningitis were resistant to penicillin.ConclusionsBefore widespread PCV implementation in this region, serotype 19A was responsible for a relatively small number of pneumococcal disease cases. With increased use of PCVs and a greater number of serotypes included, monitoring S. pneumoniae serotype distribution will be essential for understanding the epidemiology of pneumococcal disease.

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“…For sick children, the overall prevalence for 4 countries was 2.7%, ranging from 1.6% in Venezuela to 11.1% in Brazil [48,54,57-60] (Figure 3d).…”

Section: Resultsmentioning

confidence: 99%

Streptococcus pneumoniae serotype 19A in Latin America and the Caribbean: a systematic review and meta-analysis, 1990–2010

et al. 2012

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“…Although the combinations 6A/6B, 22F/22A, 11A/11D and 6C/6D were not resolved by the PCR assay, based on known carriage serotype frequencies obtained in Brazil by conventional culture (Laval et al, 2006;Berezin et al, 2007;Franco et al, 2010), the occurrence of 6D, 22A and 11D isolates was considered unlikely. In comparison, 20 serotypes were detected using the Quellung reaction on recovered isolates.…”

Section: Resultsmentioning

confidence: 99%

Molecular epidemiological investigation to determine the source of a fatal case of serotype 22F pneumococcal meningitis

Lamaro‐Cardoso

Lemos

Carvalho

et al. 2012

Journal of Medical Microbiology

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A child's death due to pneumococcal meningitis after contracting the disease in an after-school programme prompted an investigation to assess nasopharyngeal (NP) carriage among her contacts. The serotype of the meningitis case isolate was determined, together with the serotypes of the NP specimens of contacts, comprising the case patient's brother, the case patient's afterschool programme contacts and the brother's day-care centre (DCC) contacts. NP swabs from 155 children and 69 adults were obtained. Real-time PCR and conventional multiplex PCR (CM-PCR) assays were used to detect pneumococcal carriage and determine serotypes. Brothenriched culture of NP specimens followed by pneumococcal isolation and Quellung-based serotyping were also performed. DNA extracts prepared from cerebrospinal fluid of the index case and from the NP strain isolated from the brother and from one attendee of the brother's DCC were subjected to genotyping. Pneumococcal carriage assessed by real-time PCR and culture was 49.6 and 36.6 %, respectively (P,0.05). Twenty-three serotypes were detected using CM-PCR, with serotypes 6A/6B, 14, 19F, 6C/6D, 22F/22A, 23F and 11A/11D being the most frequent. All eight serotype 22F/22A NP specimens recovered were from children attending the brother's DCC. The meningitis case isolate and the NP carriage isolate from the patient's brother were both serotype 22F and shared the same new multilocus sequence type (ST6403) with the attendee of the brother's DCC. CM-PCR proved to be useful for assessing carriage serotype distribution in a setting of high-risk pneumococcal transmission. The causal serotype appeared to be linked to the brother of the case patient and attendees of his DCC.

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“…As vacinas pneumocócicas têm como um dos grandes objetivos a prevenção da pneumonia da comunidade, sendo protetora para a maior parte dos sorotipos relacionados à doença 2,3 .…”

unclassified

Pneumococcal vaccines and pneumonias

Berezin¹

2012

J Pediatr (Rio J)

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Distribution of Streptococcus Pneumoniae Serotypes in Nasopharyngeal Carriage and in Invasive Pneumococcal Disease in Sao Paulo, Brazil

Cited by 17 publications

References 10 publications

Streptococcus pneumoniae serotype 19A in Latin America and the Caribbean: a systematic review and meta-analysis, 1990–2010

Streptococcus pneumoniae serotype 19A in Latin America and the Caribbean: a systematic review and meta-analysis, 1990–2010

Molecular epidemiological investigation to determine the source of a fatal case of serotype 22F pneumococcal meningitis

Pneumococcal vaccines and pneumonias

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