Immunization, Antibiotic Use, and Pneumococcal Colonization Over a 15-Year Period

Lee, Grace M.; Kleinman, Ken; Pelton, Stephen I.; Lipsitch, Marc; Huang, Susan S.; Lakoma, Matt; Dutta-Linn, M. Maya; Rett, Melisa; Hanage, William P.; Finkelstein, Jonathan A.

doi:10.1542/peds.2017-0001

Cited by 38 publications

(32 citation statements)

References 40 publications

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“…with pneumococcal carriage after the introduction of PCV into national immunization schedules have reported age, poverty or proxies of poverty, number of young children living in the household, and symptoms of URTI as positively associated with pneumococcal carriage [41][42][43][44][45]. Previous studies have heterogenous findings regarding exposure to cigarette smoke and recent antibiotic use and their associations with pneumococcal carriage [5,11,[46][47][48][49][50][51][52][53]. We found exposure to household cigarette smoke was a risk factor, but only for PCV10 carriage.…”

Section: Plos Onementioning

confidence: 51%

Factors associated with pneumococcal carriage and density in children and adults in Fiji, using four cross-sectional surveys

et al. 2020

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This study describes predictors of pneumococcal nasopharyngeal carriage and density in Fiji. We used data from four annual (2012-2015) cross-sectional surveys, pre-and postintroduction of ten-valent pneumococcal conjugate vaccine (PCV10) in October 2012. Infants (5-8 weeks), toddlers (12-23 months), children (2-6 years), and their caregivers participated. Pneumococci were detected and quantified using lytA qPCR, with molecular serotyping by microarray. Logistic and quantile regression were used to determine predictors of pneumococcal carriage and density, respectively. There were 8,109 participants. Pneumococcal carriage was negatively associated with years post-PCV10 introduction (global P<0.001), and positively associated with indigenous iTaukei ethnicity (aOR 2.74 [95% CI 2.17-3.45] P<0.001); young age (infant, toddler, and child compared with caregiver participant groups) (global P<0.001); urban residence (aOR 1.45 [95% CI 1.30-2.57] P<0.001); living with �2 children <5 years of age (aOR 1.42 [95% CI 1.27-1.59] P<0.001); low family income (aOR 1.44 [95% CI 1.28-1.62] P<0.001); and upper respiratory tract infection (URTI) symptoms (aOR 1.77 [95% CI 1.57-2.01] P<0.001). Predictors were similar for PCV10 and non-PCV10 carriage, except PCV10 carriage was negatively associated with PCV10 vaccination (0.58 [95% CI 0.41-0.82] P = 0.002) and positively associated with exposure to household cigarette smoke (aOR 1.21 [95% CI 1.02-1.43] P = 0.031), while there was no association between years post-PCV10 introduction and non-PCV10 carriage. Pneumococcal density was positively associated with URTI symptoms (adjusted median difference 0.28 [95% CI 0.16, 0.40] P<0.001) and toddler and child, compared with caregiver, participant groups (global P = 0.008). Predictors were similar for PCV10 and non-PCV10 density, except infant, toddler, and child participant groups were not associated with PCV10 density. PCV10 introduction was associated with reduced the odds of overall and PCV10 pneumococcal carriage in Fiji. However, after adjustment iTaukei ethnicity was positively

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Section: Plos Onementioning

confidence: 51%

Factors associated with pneumococcal carriage and density in children and adults in Fiji, using four cross-sectional surveys

et al. 2020

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“…Eradication of the entire targeted species in an individual through use of a vaccine may be difficult or impossible, because of the limitations of immunity at the mucosal sites where these species live and/or because of antigenic variation (84), which hampers the ability of a vaccine to target a whole species. For example, serotype-specific conjugate vaccination against S. pneumoniae has nearly eliminated targeted serotypes but has left overall carriage levels approximately unchanged (85,86) because of strain replacement. Similarly, development of vaccines against Staphylococcus aureus and members of the hospital-acquired Enterobacteriaceae has been hampered by strain variation.…”

Section: The Microbiome As An Innocent Bystander Protected Bymentioning

confidence: 99%

Microbiome as a tool and a target in the effort to address antimicrobial resistance

Relman

Lipsitch

2018

Proc. Natl. Acad. Sci. U.S.A.

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Reciprocal, intimate relationships between the human microbiome and the host immune system are shaped by past microbial encounters and prepare the host for future ones. Antibiotics and other antimicrobials leave their mark on both the microbiome and host immunity. Antimicrobials alter the structure of the microbiota, expand the host-specific pool of antimicrobial-resistance genes and organisms, degrade the protective effects of the microbiota against invasion by pathogens, and may impair vaccine efficacy. Through these effects on the microbiome they may affect immune responses. Vaccines that exert protective or therapeutic effects against pathogens may reduce the use of antimicrobials, the development and spread of antimicrobial resistance, and the harmful impacts of these drugs on the microbiome. Other strategies involving manipulation of the microbiome to deplete antibiotic-resistant organisms or to enhance immune responses to vaccines may prove valuable in addressing antimicrobial resistance as well. This article describes the intersections of immunity, microbiome and antimicrobial exposure, and the use of vaccines and other alternative strategies for the control and management of antimicrobial resistance.

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“…In this issue of Pediatrics, Lee et al 1 report surveillance data from Massachusetts communities regarding Streptococcus pneumoniae (SPN) colonization during the pneumococcal conjugate vaccine (PCV) era. Nasopharyngeal (NP) colonization is thought to precede SPN disease, so it is a reasonable measure of circulating (and potentially disease-producing) pneumococcal strains.…”

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confidence: 99%

“…Nasopharyngeal (NP) colonization is thought to precede SPN disease, so it is a reasonable measure of circulating (and potentially disease-producing) pneumococcal strains. Three aspects are notable: (1) shifting serotypes of known invasive pneumococcal disease (IPD) producers; (2) risk factors for colonization; and (3) evolving antibiotic resistance.…”

mentioning

confidence: 99%

“…To overcome the phenomenon of serotype replacement, vaccine strategies need to expand beyond serotype specificity by identifying antigens common to all SPN, regardless of serotype. Meanwhile, studies like this one by Lee et al, 1 that monitor pneumococcal seroepidemiology will inform treatment and vaccine strategies. The hope that IPD and antibiotic resistance would disappear after widespread use of PCV vaccines has yet to be realized.…”

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confidence: 99%

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Playing “Whack-a-Mole” With Pneumococcal Serotype Eradication

Swanson

Harrison

2017

Pediatrics

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Immunization, Antibiotic Use, and Pneumococcal Colonization Over a 15-Year Period

Abstract: Despite the success of pneumococcal vaccines in reducing colonization and disease due to targeted serotypes, ongoing community-based surveillance will be critical to evaluate the impact of interventions on pneumococcal colonization and disease.

Cited by 38 publications

References 40 publications

Factors associated with pneumococcal carriage and density in children and adults in Fiji, using four cross-sectional surveys

Factors associated with pneumococcal carriage and density in children and adults in Fiji, using four cross-sectional surveys

Microbiome as a tool and a target in the effort to address antimicrobial resistance

Playing “Whack-a-Mole” With Pneumococcal Serotype Eradication

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