1887

Abstract

A 10-year invasive pneumococcal disease (IPD) enhanced surveillance project in the Oxfordshire region of the UK between 1996 and 2005 identified a total of 2691 isolates from all ages that provided a comprehensive description of pneumococcal epidemiology. All isolates were serotyped and those from children under 5 years of age were genotyped and a matched case–control study using adults hospitalized between 1995 and 2000 was performed to estimate the effectiveness of the pneumococcal polysaccharide vaccine in the local population. Fifty-one serotypes were isolated, with different age distributions. The overall incidence of IPD was 9.2 cases per 100 000 population per annum [95 % confidence interval (CI), 8.6–9.9] and that of meningitis was 0.7 per 100 000 population per annum (95 % CI 0.5–0.9). After adjusting for age, serotype 1 was found to be less likely to be associated with meningitis versus other IPD, compared with the most common serotype 14, whereas serotype 12F was more likely to cause meningitis than other IPD. There were significant temporal changes in IPD incidence of four serotypes, with decreases in serotypes 1, 12F and 14 and increases in serotype 8. A possible novel variant (from serotype 6A to 6B) was found using multilocus sequence typing analysis. From the matched case–control study of adults, the pneumococcal polysaccharide vaccine effectiveness was estimated to be 43 % (2–68 %), which did not change significantly after adjustment for pre-existing co-morbidities. The data provide a baseline against which the impact of the pneumococcal conjugate vaccine introduced in the UK in 2006 could be measured.

Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.47690-0
2008-04-01
2019-10-14
Loading full text...

Full text loading...

/deliver/fulltext/jmm/57/4/480.html?itemId=/content/journal/jmm/10.1099/jmm.0.47690-0&mimeType=html&fmt=ahah

References

  1. Akduman, D., Ehret, J. M. & Judson, F. N. ( 2006; ). Comparison of secular trends in pneumococcal serotypes causing invasive disease in Denver, Colorado (1971–2004) and serotype coverage by marketed pneumococcal vaccines. Clin Microbiol Infect 12, 1141–1143.[CrossRef]
    [Google Scholar]
  2. Beall, B., McEllistrem, M., Gertz, R., Wedel, S., Boxrud, D., Gonzalez, A., Medina, M., Pai, R., Thompson, T. & other authors ( 2006; ). Pre- and postvaccination clonal compositions of invasive pneumococcal serotypes for isolates collected in the United States in 1999, 2001 and 2002. J Clin Microbiol 44, 999–1017.[CrossRef]
    [Google Scholar]
  3. Beekmann, S. E., Heilmann, K. P., Richter, S. S., Garcia-de-Lomas, J. & Doern, G. V., The GRASP Study Group ( 2005; ). Antimicrobial resistance in Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and Group A β-haemolytic streptococci in 2002-2003 results of the multinational GRASP Surveillance Program. Int J Antimicrob Agents 25, 148–156.[CrossRef]
    [Google Scholar]
  4. Birtles, A., McCarthy, N., Sheppard, C. L., Rutter, H., Guiver, M., Haworth, E. & George, R. C. ( 2005; ). Multilocus sequence typing directly on DNA from clinical samples and a cultured isolate to investigate linked fatal pneumococcal disease in residents of a shelter for homeless men. J Clin Microbiol 43, 2004–2008.[CrossRef]
    [Google Scholar]
  5. Black, S., Shinefield, H., Fireman, B., Lewis, E., Ray, P., Hansen, J., Elvin, L., Ensor, K., Hacknell, J. & other authors ( 2000; ). Efficacy, safety and immunogenicity of heptavalent pneumococcal conjugate vaccine in children. Pediatr Infect Dis J 19, 187–195.[CrossRef]
    [Google Scholar]
  6. Brueggemann, A. & Spratt, B. ( 2003; ). Geographic distribution and clonal diversity of Streptococcus pneumoniae serotype 1 isolates. J Clin Microbiol 41, 4966–4970.[CrossRef]
    [Google Scholar]
  7. Brueggemann, A., Griffiths, D., Meats, E., Peto, T., Crook, D. & Spratt, B. ( 2003; ). Clonal relationships between invasive and carriage Streptococcus pneumoniae and serotype- and clone-specific differences in invasive disease potential. J Infect Dis 187, 1424–1432.[CrossRef]
    [Google Scholar]
  8. Byington, C., Samore, M., Stoddard, G., Barlow, S., Daly, J., Korgenski, K., Firth, S., Glover, D., Jensen, J. & other authors ( 2005; ). Temporal trends of invasive disease due to Streptococcus pneumoniae among children in the Intermountain West: emergence of nonvaccine serogroups. Clin Infect Dis 41, 21–29.[CrossRef]
    [Google Scholar]
  9. CDC ( 2005; ). Outbreak of invasive pneumococcal disease – Alaska, 2003–2004. MMWR Morb Mortal Wkly Rep 54, 72–75.
    [Google Scholar]
  10. Conaty, S., Watson, L., Dinnes, J. & Waugh, N. ( 2004; ). The effectiveness of pneumococcal polysaccharide vaccines in adults: a systematic review of observational studies and comparison with results from randomised controlled trials. Vaccine 22, 3214–3224.[CrossRef]
    [Google Scholar]
  11. Cutts, F., Zaman, S., Enwere, G., Jaffar, S., Levine, O., Okoko, J., Oluwalana, C., Vaughan, A., Obaro, S. & other authors ( 2005; ). Efficacy of nine-valent pneumococcal conjugate vaccine against pneumonia and invasive pneumococcal disease in The Gambia: randomised, double-blind, placebo-controlled trial. Lancet 365, 1139–1146.[CrossRef]
    [Google Scholar]
  12. Dagan, R., Gradstein, S., Belmaker, I., Porat, N., Siton, Y., Weber, G., Janco, J. & Yagupsky, P. ( 2000; ). An outbreak of Streptococcus pneumoniae serotype 1 in a closed community in southern Israel. Clin Infect Dis 30, 319–321.[CrossRef]
    [Google Scholar]
  13. Dagan, R., Givon-Lavi, N., Zamir, O. & Fraser, D. ( 2003; ). Effect of a nonavalent conjugate vaccine on carriage of antibiotic-resistant Streptococcus pneumoniae in day-care centers. Pediatr Infect Dis J 22, 532–540.
    [Google Scholar]
  14. Dear, K., Andrews, R., Holden, J. & Tatham, D. ( 2003; ). Vaccines for preventing pneumococcal infection in adults (Review). Cochrane Database Syst Rev 4, CD000422
    [Google Scholar]
  15. Dept Health ( 2006; ). Immunisation against Infectious Disease – “The Green Book”, Chapter 25: pneumococcal.
  16. Enright, M. & Spratt, B. ( 1998; ). A multilocus sequence typing scheme for Streptococcus pneumoniae: identification of clones associated with serious invasive disease. Microbiology 144, 3049–3060.[CrossRef]
    [Google Scholar]
  17. Fedson, D. S. & Liss, C. ( 2004; ). Precise answers to the wrong question: prospective clinical trials and the meta-analyses of pneumococcal vaccine in elderly and high-risk adults. Vaccine 22, 927–946.[CrossRef]
    [Google Scholar]
  18. Feikin, D. & Klugman, K. ( 2002; ). Historical changes in pneumococcal serogroup distribution: implications for the era of pneumococcal conjugate vaccines. Clin Infect Dis 35, 547–555.[CrossRef]
    [Google Scholar]
  19. George, R. & Melegaro, A. ( 2001; ). Invasive pneumococcal infection: England and Wales, 1999. CDR Weekly 11, 6–12.
    [Google Scholar]
  20. Gratten, M., Morey, F., Dixon, J., Manning, K., Torzillo, P., Matters, R., Erlich, J., Hanna, J., Asche, V. & Riley, I. ( 1993; ). An outbreak of serotype 1 Streptococcus pneumoniae infection in central Australia. Med J Aust 158, 340–342.
    [Google Scholar]
  21. Hanage, W., Huang, S., Lipsitch, M., Bishop, C., Godoy, D., Pelton, S., Goldstein, R., Huot, H. & Finkelstein, J. ( 2007; ). Diversity and antibiotic resistance among nonvaccine serotypes of Streptococcus pneumoniae carriage isolates in the post-heptavalent conjugate vaccine era. J Infect Dis 195, 347–352.[CrossRef]
    [Google Scholar]
  22. Hausdorff, W., Bryant, J., Paradiso, P. & Siber, G. ( 2000a; ). Which pneumococcal serogroups cause the most invasive disease: implications for conjugate vaccine formulation and use, Part 1. Clin Infect Dis 30, 100–121.[CrossRef]
    [Google Scholar]
  23. Hausdorff, W., Bryant, J., Kloek, C., Paradiso, P. & Siber, G. ( 2000b; ). The contribution of specific pneumococcal serogroups to different disease manisfestations: implications for conjugate vaccine formulation and use, Part II. Clin Infect Dis 30, 122–140.[CrossRef]
    [Google Scholar]
  24. Henriques Normark, B., Kalin, M., Ortqvist, A., Akerlund, T., Liljequist, B. O., Hedlund, J., Svenson, S. B., Zhou, J., Spratt, B. G. & other authors ( 2001; ). Dynamics of penicillin-susceptible clones in invasive pneumococcal disease. J Infect Dis 184, 861–869.[CrossRef]
    [Google Scholar]
  25. Hoge, C. W., Reichler, M. R., Dominguez, E. A., Bremer, J. C., Mastro, T. D., Hendricks, K. A., Musher, D. M., Elliott, J. A., Facklam, R. R. & Breiman, R. F. ( 1994; ). An epidemic of pneumococcal disease in an over crowded, inadequately ventilated jail. N Engl J Med 331, 643–648.[CrossRef]
    [Google Scholar]
  26. HPA ( 2003; ). Invasive pneumococcal infection, England and Wales:2000. CDR Weekly 13 (21).
    [Google Scholar]
  27. Huang, S. S., Platt, R., Rifas-Shiman, S. L., Pelton, S. I., Goldmann, D. & Finkelstein, J. A. ( 2005; ). Post-PCV7 changes in colonizing pneumococcal serotypes in 16 Massachusetts communities, 2001 and 2004. Pediatrics 116, e408–e413.[CrossRef]
    [Google Scholar]
  28. Ihekweazu, C. A., Dance, D. A., Pebody, R., George, R. C., Smith, M. D., Waight, P., Christensen, H., Cartwright, K. A. & Stuart, J. M. ( 2007; ). Trends in incidence of pneumococcal disease before introduction of conjugate vaccine: South West England, 1996–2005. Epidemiol Infect
    [Google Scholar]
  29. Jefferies, J. M., Johnson, C. H., Kirkham, L. A., Cowan, G. J., Ross, K. S., Smith, A., Clarke, S. C., Brueggemann, A. B., George, R. C. & other authors ( 2007; ). Presence of nonhemolytic pneumolysin in serotypes of Streptococcus pneumoniae associated with disease outbreaks. J Infect Dis 196, 936–944.[CrossRef]
    [Google Scholar]
  30. Kirkham, L., Jefferies, J., Kerr, A., Jing, Y., Clarke, S., Smith, A. & Mitchell, T. ( 2006; ). Identification of invasive serotype 1 streptococcal isolates that express nonhemolytic pneumolysin. J Clin Microbiol 44, 151–159.[CrossRef]
    [Google Scholar]
  31. Klugman, K. P., Madhi, S. A., Huebner, R. E., Kohberger, R., Mbelle, N. & Pierce, N., Vaccine Trialists Group ( 2003; ). A trial of a 9-valent pneumococcal conjugate vaccine in children with and those without HIV infection. N Engl J Med 349, 1341–1348.[CrossRef]
    [Google Scholar]
  32. Konradsen, H. & Kaltoft, M. ( 2002; ). Invasive pneumococcal infections in Denmark from 1995 to 1999: epidemiology, serotypes and resistance. Clin Diagn Lab Immunol 9, 358–365.
    [Google Scholar]
  33. Lexau, C., Lynfield, R., Danila, R., Pilishvili, T., Facklam, R., Farley, M., Harrison, L., Schaffner, W., Reingold, A. & other authors ( 2005; ). Changing epidemiology of invasive pneumococcal disease among older adults in the era of pediatric pneumococcal conjugate vaccine. JAMA 294, 2043–2051.[CrossRef]
    [Google Scholar]
  34. MacGowan, A. P. & Wise, R. ( 2005; ). Establishing MIC breakpoints and the interpretation of in vitro susceptibility tests. J Antimicrob Chemother 48 (Suppl. 1), 17–28.
    [Google Scholar]
  35. Mavroidi, A., Godoy, D., Aanensen, D. M., Robinson, D. A., Hollingshead, S. K. & Spratt, B. G. ( 2004; ). Evolutionary genetics of the capsular locus of serogroup 6 pneumococci. J Bacteriol 186, 8181–8192.[CrossRef]
    [Google Scholar]
  36. Melegaro, A., Edmunds, W. J., Pebody, R., Miller, E. & George, R. ( 2006; ). The current burden of pneumococcal disease in England and Wales. J Infect 52, 37–48.[CrossRef]
    [Google Scholar]
  37. Musher, D. M., Rueda-Jaimes, A. M., Graviss, E. A. & Rodriguez-Barradas, M. C. ( 2006; ). Effect of pneumococcal vaccination: a comparison of vaccination rates in patients with bacteremic and nonbacteremic pneumococcal pneumonia. Clin Infect Dis 43, 1004–1008.[CrossRef]
    [Google Scholar]
  38. Noakes, K., Pebody, R. G., Gungabissoon, U., Stowe, J. & Miller, E. ( 2006; ). Pneumococcal polysaccharide vaccine uptake in England, 1989-2003, prior to the introduction of a vaccination programme for older adults. J Public Health (Oxf) 28, 242–247.[CrossRef]
    [Google Scholar]
  39. O'Brien, K. L., Moulton, L. H., Reid, R., Weatherholtz, R., Oski, J., Brown, L., Kumar, G., Parkinson, A., Hu, D. & other authors ( 2003; ). Efficacy and safety of seven-valent conjugate pneumococcal vaccine in American Indian children: group randomised trial. Lancet 362, 355–361.[CrossRef]
    [Google Scholar]
  40. Pai, R., Moore, M., Pilishvili, T., Gertz, R., Whitney, C., Beall, B. & Team, A. B. S. ( 2005; ). Postvaccine genetic structure of Streptococcus pneumoniae serotype 19A from children in the United States. J Infect Dis 192, 1988–1995.[CrossRef]
    [Google Scholar]
  41. Sleeman, K. L., Griffiths, D., Shackley, F., Diggle, L., Gupta, S., Maiden, M. C., Moxon, E. R., Crook, D. W. & Peto, T. E. ( 2006; ). Capsular serotype-specific attack rates and duration of carriage of Streptococcus pneumoniae in a population of children. J Infect Dis 194, 682–688.[CrossRef]
    [Google Scholar]
  42. Spratt, B. G., Hanage, W., Li, B., Aanensen, D. & Feil, E. ( 2004; ). Displaying the relatedness among isolates of bacterial species - the eBURST approach. FEMS Microbiol Lett 241, 129–134.[CrossRef]
    [Google Scholar]
  43. Whitney, C. G., Farley, M., Hadler, J., Harrison, L., Bennett, N., Lynfield, R., Reingold, A., Cieslak, P., Pilishvili, T. & other authors ( 2003; ). Decline in invasive pneumococcal disease after the introduction of protein-polysaccharide conjugate vaccine. N Engl J Med 348, 1737–1746.[CrossRef]
    [Google Scholar]
  44. Whitney, C. G., Pilishvili, T., Farley, M. M., Schaffner, W., Craig, A. S., Lynfield, R., Nyquist, A. C., Gershman, K. A., Vazquez, M. & other authors ( 2006; ). Effectiveness of seven-valent pneumococcal conjugate vaccine against invasive pneumococcal disease: a matched case-control study. Lancet 368, 1495–1502.[CrossRef]
    [Google Scholar]
  45. WHO ( 1999; ). Pneumococcal vaccines; WHO position paper. Wkly Epidemiol Rec 74, 117–184.
    [Google Scholar]
  46. WHO ( 2007; ). Pneumococcal conjugate vaccine for childhood immunization – WHO position paper. Wkly Epidemiol Rec 82, 93–104.
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/jmm.0.47690-0
Loading
/content/journal/jmm/10.1099/jmm.0.47690-0
Loading

Data & Media loading...

Serotype-specific frequency over the study period. [PDF](13 KB)

PDF

MLST profiles of isolates from children under 5 years of age. [PDF](22 KB)

PDF
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error