Ten-year surveillance of invasive Streptococcus pneumoniae isolates in central Turkey prior to the introduction of a conjugate vaccine

Abstract

Introduction: The aim of this study was to characterize the serotypes and antimicrobial susceptibility patterns of invasive Streptococcus pneumoniae isolates in central Turkey. Methodology: A total of 332 invasive S. pneumoniae isolates were identified, serotyped and tested for antimicrobial susceptibility by routine microbiological methods. Results: The most common serogroups/serotypes were 1, 19, 3, 18, 6, 14, and 7 in rank order. Serogroup/serotype coverage of the 23-valent polysaccharide vaccine, and the 7-, 10-, and 13-valent conjugate vaccines were 96%, 44%, 78.6%, 96.4%, respectively. Overall, 20 (6%) of the isolates were resistant to penicillin, 1 (0.3%) to cefotaxime, 20 (6%) to erythromycin, 13 (4%) to cloramphenicol, and 120 (36%) to trimethoprim-sulfamethoxasole. Among cerebrospinal fluid (CSF) isolates, 20 (18.5%) were resistant to penicillin (26.3% and 11.5%, respectively, of child and adult meningitis cases; p≥0.05). Conclusions: Although the seven-valent conjugate vaccine is expected to protect less than half of children younger than three years of age, of the incorporation of this vaccine into the routine immunization program of Turkey is advised to continue. However, the 13-valent conjugate vaccine, including serotypes 1, 3, 5, and 7, has the most potential prevent the highest burden of invasive pneumococcal diseases in this age group.

Invasive Pneumococcal Disease in Two Non-Vaccinated Pediatric Cases: Pleural Empyema and Bacteremia

“…Perçin ve arkadaşlarının 15 S.pneumoniae serotip 1, sıklıkla lober pnömoni ve parapnömonik ampiyemli olgulardan izole edilen invazif bir suştur 1,7 . Ayrıca serotip 5, 7F (7A), 19A ve 3 ile birlikte KPA-7 ile aşılı popülasyonlarda da TKP'de en sık izole edilen serotiptir7.…”

“…Uygun antibiyotik kullanımı, direnç gelişimini azaltabileceğinden, hastalardan izole edilen bütün suşların antibiyotiklere duyarlılık düzeyinin saptanarak antibiyograma göre tedavi verilmesi önerilmektedir. Penisiline dirençli pnömokok suşları, başka bir β-laktam grubundan olan ve penisilin ile aynı yoldan etki eden 3. kuşak sefalosporinlere karşı da yine benzer yolla direnç geliştirebil-mektedir 15 . Çoklu ilaç direncinin görülmesi, pnömokok enfeksiyonlarında optimum tedavi seçeneğinde belirsizliğe neden olmaktadır.…”

Development of a protein antigen based pneumococcal vaccine utilizing a polyanhydride nanoparticle delivery platform

“…Russell et al (70) found that a minimum of two vaccinations before the age of 12 months, plus a PPSV23 booster at 18 months, was required for noticeable protection from S. pneumoniae to occur. While the PCV vaccines can be given at the same time as other infant immunizations, patient compliance in maintaining clinic visits can become difficult, even more so in developing countries (64). This multiple immunization schedule also requires a lot of vaccine product to be purchased, and this can quickly become expensive.…”

“…Unless these emerging capsule types are included in the current polysaccharide vaccines, no serotype-specific immune memory can be developed. Countries and regions of the world also vary in which S. pneumoniae serotypes are most prevalent in their reported cases of pneumonia and IPD (48,64). In these areas of the world, even if a full 3 dose PCV vaccination schedule is administered, the reduction in disease-causing strains may be 30-40 % less than in American clinical use (42).…”

“…Streptococcus pneumoniae is the primary cause of bacterial pneumonia worldwide with over 90 serotypes that have been identified(1,11,64). The capsule polysaccharide based 23-valent PPSV23 and 7-valent PCV vaccines have shown beneficial results due to worldwide use (59) but obstacles remain, especially in the limited number of serotypes targeted within the vaccines and the use of poorly immunogenic polysaccharide antigen to which the most at risk populations cannot mount good immune responses against without a multiple dose vaccine regimen(55,70,75).…”