Streptococcus pneumoniae nasopharyngeal colonisation in children aged under six years with acute respiratory tract infection in Lithuania, February 2012 to March 2013

Usonis, Vytautas; Stacevičienė, Indrė; Petraitienė, Sigita; Vaičiūnienė, Daiva; Alasevicius, Tomas; Kirslienė, Jūratė

doi:10.2807/1560-7917.es2015.20.13.21079

Cited by 7 publications

(10 citation statements)

References 34 publications

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“…This study was undertaken to evaluate the circulation of SPn serotypes among children under 6 years of age with acute RTI in Lithuania before the introduction of universal pneumococcal vaccination in the country in October 2014 [ 19 ]. This paper is an extension to the other results of our study which were published separately [ 20 ].…”

Section: Introductionmentioning

confidence: 61%

The influence of Streptococcus pneumoniae nasopharyngeal colonization on the clinical outcome of the respiratory tract infections in preschool children

et al. 2015

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BackgroundStreptococcus pneumoniae (SPn) is an important pathogen causing a variety of clinical manifestations. The effects of SPn nasopharyngeal colonization on respiratory tract infections are poorly studied. We evaluated the association of SPn colonization with features of respiratory tract infections.MethodsChildren under the age of 6 years who visited a primary care physician because of respiratory tract infections were enrolled in the study. History was taken, children were clinically assessed by the physician, and nasopharyngeal swabs were obtained and cultured for SPn. Positive samples were serotyped. Associations of SPn colonization with clinical signs and symptoms, recovery duration, absence from day care centre, frequencies of specific diagnoses, and treatment with antimicrobials were evaluated.ResultsIn total 900 children were enrolled. The prevalence of SPn colonization was 40.8 % (n = 367). There were minor differences between male and female subjects (199 of 492, 40.4 % vs 168 of 408, 41.2 %, p = 0.825). Children with and without siblings had similar colonization rates (145 of 334, 43.4 % vs 219 of 562, 39.0 %, p = 0.187). Clinical signs and symptoms were not associated with SPn colonization. Children colonized with SPn had longer recovery duration compared to non-colonized children (114 of 367, 31.1 % vs 98 of 533, 18.4 %, p < 0.001) and were longer absent from day care (270 of 608, 44.4 % vs 94 of 284, 33.1 %, p = 0.001). Pneumonia, sinusitis, and acute otitis media were more frequently diagnosed in children colonized with SPn. Children attending day care centres had significantly higher prevalence of SPn colonization (270 of 367, 44.4 % vs 338 of 533, 33.1 %, p = 0.001). Children with pneumonia, sinusitis and acute otitis media were more frequently treated with antimicrobials than children with other diagnoses.ConclusionsSPn nasopharyngeal colonization has a negative impact on the course of respiratory tract infection, likely because of SPn being the cause of the disease or a complicating factor. It is also associated with and may be responsible for higher frequencies of bronchitis, pneumonia, acute otitis media, sinusitis and the need of antimicrobial treatment.

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Section: Introductionmentioning

confidence: 61%

The influence of Streptococcus pneumoniae nasopharyngeal colonization on the clinical outcome of the respiratory tract infections in preschool children

et al. 2015

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“…The enrolled children comprised 408 girls and 492 boys under six years of age with acute RTI. The distribution of enrolled children by sex and age was similar in all the cities, with the exception of Alytus, which may be due to a very small number of study participants in this city ( n = 18) [ 16 ].…”

Section: Resultsmentioning

confidence: 99%

“…A total of 367 SPn strains (one per patient) were isolated from the 900 samples collected, giving a colonisation rate of 40.8 %. A detailed analysis of SPn colonisation and serotype distribution in relation to various factors were published separately [ 16 , 17 ].…”

Section: Resultsmentioning

confidence: 99%

“…Results of this study might be the background for further investigations on the impact of PCV vaccination on the distribution of resistant SPn serotypes in Lithuania, including the widely discussed phenomenon of replacement in circulating resistant SPn serotypes due to vaccination [ 15 ]. SPn colonisation rate, serotype distribution and the influence on the clinical outcome were published separately [ 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

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Antibiotic resistance of Streptococcus pneumoniae, isolated from nasopharynx of preschool children with acute respiratory tract infection in Lithuania

et al. 2016

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BackgroundIncreasing pneumococcal resistance to commonly used antibiotics and multidrug resistance is a serious public health concern. Data on distribution of resistant Streptococcus pneumoniae (SPn) strains among children in Lithuania are limited. We evaluated the circulation of SPn serotypes and antimicrobial susceptibility among preschool children in Lithuania before the introduction of universal infant pneumococcal vaccination.MethodsA prospective study was carried out from February 2012 to March 2013 in five cities of Lithuania. A total of 900 children under six years of age who presented to primary care centre or a hospital emergency department with acute respiratory tract infection were enrolled in the study. Nasopharyngeal swabs were obtained and cultured for SPn. Positive samples (n = 367) were serotyped and tested for antimicrobial susceptibility. Associations of pneumococcal non-susceptibility with study site, season, age, sex, attendance of day care centre and treatment with antimicrobials (between one and six months prior the study) were evaluated.ResultsAbout a half (56.7 %) of SPn strains were susceptible to all the antibiotics tested. Pneumococcal non-susceptibility to penicillin, erythromycin, clindamycin and trimethoprim–sulphamethoxazole was 15.8, 21.3, 16.9 and 27.3 %, respectively. None of the tested isolates was resistant to norfloxacin or vancomycin. We found a geographical variation of pneumococcal resistance within the cities of the country. Age, sex, the attendance of day care centre and treatment with antimicrobials prior the study was not significantly associated with a carriage of non-susceptible SPn strains. Among non-susceptible SPn serotypes 67.9 %–82.4 % were present in currently available pneumococcal conjugate vaccines.ConclusionsThe rates of nasopharyngeal SPn susceptibility to penicillin and macrolides are still high among preschool children in Lithuania, however they are lower compared with previous studies. A strict policy with respect to antibiotic prescription together with widespread use of vaccination could potentially reduce the carriage rate of antibiotic-resistant pneumococci in our country.

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“…The increase in carriage of serotypes 6C and 19A has also been observed in other countries after PCV7 implementation [27,29,34] but no details on shifts in the mean age of carriage were provided. Nonetheless, it is known that in IPD an age-related serotype distribution exists [35–37] as well as in carriage. In the absence of PCV7, it has been observed that PCV7 serotypes tend to peak in prevalence at 2 years of age and non-PCV7 serotypes at 4 years of age [38].…”

Section: Discussionmentioning

confidence: 99%

Periodic cycles of pneumococcal serotypes carried by children before and after 7-valent pneumococcal conjugate vaccine

Paulo

Sá-Leão

2017

PLoS ONE

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BackgroundPeriodic cycles in the serotype-specific incidence of invasive pneumococcal disease have been described but less is known in carriage.MethodsWe analyzed serotype carriage prevalence among children 0–6 years old over a 15-year period that included pre-PCV7 data and a decade of PCV7 use. Mixed generalized additive models were used to study periodic cycles and how PCV7 impacted on them.ResultsPneumococcal carriage data of 7,463 children were analyzed. Periodic cycles ranging from 3 to 6 years were observed for PCV7-serotypes (VT) 14, 19F and 23F and for non-PCV7 types (NVT) 3, 6A, 6C, 11A, and NT. An indirect impact of PCV7 on periodic cycles of NVT was observed and could be translated in three ways: (i) a higher amplitude in the PCV7 period (serotypes 3 and 11A), (ii) sustained increase in the prevalence of carriage (serotypes 6C, 19A and NT) and (iii) an increase in the inter-epidemic period (serotypes 3, 6A and NT). An increase in the child’s mean age of carriage of VTs 6B, 19F and 23F was observed. Serotypes 3, 6C, 11A and 15A became more frequent in ages previously associated with carriage of VTs.ConclusionsPeriodic cycles among serotypes frequently carried exist and can be modeled. These cycles can be perturbed upon introduction of PCVs and can lead to shifts in the mean age of carriage. Cyclic re-emergence of VTs can occur in settings with non-universal vaccine use. These results should be taken into account when interpreting surveillance data on pneumococcal carriage.

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Streptococcus pneumoniae nasopharyngeal colonisation in children aged under six years with acute respiratory tract infection in Lithuania, February 2012 to March 2013

Cited by 7 publications

References 34 publications

The influence of Streptococcus pneumoniae nasopharyngeal colonization on the clinical outcome of the respiratory tract infections in preschool children

The influence of Streptococcus pneumoniae nasopharyngeal colonization on the clinical outcome of the respiratory tract infections in preschool children

Antibiotic resistance of Streptococcus pneumoniae, isolated from nasopharynx of preschool children with acute respiratory tract infection in Lithuania

Periodic cycles of pneumococcal serotypes carried by children before and after 7-valent pneumococcal conjugate vaccine

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