Susann Skovbjerg, Sweden
Sahlgrenska University Hospital Dep of Clinical MicrobiologyPresenter of 1 Presentation
SEROTYPE DISTRIBUTION AND CLINICAL PICTURE OF INVASIVE PNEUMOCOCCAL DISEASE IN THE POST- CONJUGATE VACCINE ERA OF SOUTHWESTERN SWEDEN (ID 573)
Abstract
Background
The pneumococcal conjugate vaccines (PCVs) were introduced in southwestern Sweden in 2009. Here we assessed associations between pneumococcal serotype distribution, age, predisposing factors, clinical manifestations and case-fatality-rate in patients with invasive pneumococcal disease (IPD).
Methods
Data from 1,278 patients with 1,304 episodes of IPD between January 2009 and December 2015 in southwestern Sweden, were collected from medical records. Pneumococcal isolates were serotyped by gel diffusion and/or Quellung reactions at the Public Health Agency, Sweden.
Results
Except for serotype 3, the prevalence of PCV13 serotypes decreased from 76 % in 2009 to 25 % in 2015, while non-PCV13 serotypes increased, mainly among the elderly and in patients with predisposing factors. Non-PCV13 serotypes were associated with bacteremia with unknown focus, and PCV13 serotypes with invasive pneumonia. Serotype 3 and 4 were associated with intensive care unit admission, whilst serotype 1 and 7F caused IPD among healthier and younger patients. The case-fatality rate was lower for 7F caused IPD (4%) than for all other serotypes (13%).
Conclusions
Non-PCV13 serotypes now dominate among IPD cases in southwestern Sweden, and more often caused disease in patients with predisposing factors as compared to PCV13 types. Serotype 3 is still prevalent and often cause severe IPD.
Author Of 2 Presentations
SEROTYPE DISTRIBUTION AND CLINICAL PICTURE OF INVASIVE PNEUMOCOCCAL DISEASE IN THE POST- CONJUGATE VACCINE ERA OF SOUTHWESTERN SWEDEN (ID 573)
Abstract
Background
The pneumococcal conjugate vaccines (PCVs) were introduced in southwestern Sweden in 2009. Here we assessed associations between pneumococcal serotype distribution, age, predisposing factors, clinical manifestations and case-fatality-rate in patients with invasive pneumococcal disease (IPD).
Methods
Data from 1,278 patients with 1,304 episodes of IPD between January 2009 and December 2015 in southwestern Sweden, were collected from medical records. Pneumococcal isolates were serotyped by gel diffusion and/or Quellung reactions at the Public Health Agency, Sweden.
Results
Except for serotype 3, the prevalence of PCV13 serotypes decreased from 76 % in 2009 to 25 % in 2015, while non-PCV13 serotypes increased, mainly among the elderly and in patients with predisposing factors. Non-PCV13 serotypes were associated with bacteremia with unknown focus, and PCV13 serotypes with invasive pneumonia. Serotype 3 and 4 were associated with intensive care unit admission, whilst serotype 1 and 7F caused IPD among healthier and younger patients. The case-fatality rate was lower for 7F caused IPD (4%) than for all other serotypes (13%).
Conclusions
Non-PCV13 serotypes now dominate among IPD cases in southwestern Sweden, and more often caused disease in patients with predisposing factors as compared to PCV13 types. Serotype 3 is still prevalent and often cause severe IPD.
ASSOCIATION BETWEEN PNEUMOCOCCAL CARRIAGE AND ANTIMICROBIAL ACTIVITY IN URINE OF MALAWIAN CHILDREN HOSPITALIZED WITH ACUTE RESPIRATORY INFECTION (ID 445)
Abstract
Background
Following the 2011 introduction of PCV13 in Malawi, 77% of healthy children carry pneumococci in the nasopharynx, while 41% of children hospitalized for acute respiratory infection (ARI) are colonized. We assessed if there is an association between pneumococcal carriage and pre-hospital antibiotic exposure.
Methods
Participants included 69 children aged 1-4 years admitted to Queen Elizabeth Central Hospital, Blantyre, Malawi 2016-2019 due to ARI. Information on pre-hospital antibiotics was collected from parents and/or the child´s health passport. Antimicrobial activity was detected by a urine bioassay. Pneumococci were isolated from a nasopharyngeal sample and tested for antibiotic susceptibility.
Results
Among the 40/69 (58%) samples showing antibiotic activity, 6 (8.7%) were from children with no report of pre-hospital antibiotics. Pneumococci was isolated from 55% of children with urine antimicrobial activity, while carriage was 74% in children with no activity. No difference in pneumococcal penicillin susceptibility was found between children with or without urine antimicrobial activity.
Conclusions
The urine bioassay is a useful tool for assessment of antibiotic exposure in resource limited settings, since patient´s reported history may not be reliable. Pre-hospital antibiotics may explain lower pneumococcal carriage prevalence among those hospitalized compared to healthy. However, pre-hospital antibiotics have not selected for penicillin resistance.