Rebecca Ford, Papua New Guinea

Pneumococcal carriage rates in Papua New Guinean (PNG) children are among the highest globally. One aim of the multi-site PneuCAPTIVE study is to determine the impact of PCV13 (introduced in 2014) on nasopharyngeal carriage in PNG.

Methods

Nasopharyngeal (NP) swabs and blood were collected from children aged <5 years with moderate or severe pneumonia, and/or suspected meningitis at Eastern Highlands Provincial Hospital or outpatient clinics in Goroka (2016-2018). Pneumococci were identified and quantified by lytA qPCR, and serotyped by microarray. IPD was identified by standard blood culture.

Results

PCV13 coverage was 62%. 1043 were enrolled: 90% had pneumococcal carriage, with median density of 6.59 log₁₀ genome equivalents (GE)/ml (IQR 6.00-7.11). Serotype data were available on 914 cases: 37% were PCV13-types; and 55% had multiple pneumococcal-type carriage. 74 different serotypes and genetic lineages of acapsular pneumococci were identified, the most common being acapsular lineage NT2>19A>15B/C>16F>14. PCV13-type carriage was 28% in vaccinated children vs 46% in unvaccinated children. IPD was confirmed in 7 cases (vaccinated – serotype 1; unvaccinated – serotypes 2, 6B, 15F, 19A, 23A, 29): 4/7 carried the homologous serotype.

Conclusions

There is some evidence of PCV13 being effective against PCV13-types but the high diversity of serotypes in PNG warrants extended valency vaccines.

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Author Of 9 Presentations

Conference Calendar

DETERMINING THE PNEUMOCOCCAL CONJUGATE VACCINE COVERAGE REQUIRED FOR INDIRECT PROTECTION IN LAOS, MONGOLIA AND PAPUA NEW GUINEA (ID 851)

Session Name

Population Sciences - Epidemiology, Economics, and Mathematical Modelling

Presenter

Jocelyn Chan,

Authors

ANTIMICROBIAL SUSCEPTIBILITY OF PNEUMOCOCCAL CARRIAGE ISOLATES AMONG PAPUA NEW GUINEAN CHILDREN VACCINATED WITH 10-VALENT OR 13-VALENT PNEUMOCOCCAL CONJUGATE VACCINES (PCVS) (ID 388)

Session Name

Vaccines - Impact of Vaccine programs and Serotype Replacement

Presenter

Tilda Orami, Papua New Guinea

Authors

PNEUMOCOCCAL CONJUGATE VACCINE IS EFFECTIVENESS AGAINST HYPOXIC PNEUMONIA IN LAOS, MONGOLIA AND PAPUA NEW GUINEA: A NOVEL CASE-CONTROL VARIANT STUDY (ID 852)

Session Name

Vaccines - Impact of Vaccine programs and Serotype Replacement

Presenter

Fiona M. Russell, Australia

Authors

Abstract

Abstract

Background

We describe a novel approach to determine PCV13 effectiveness (VE) against hypoxic pneumonia in children admitted with pneumonia in Lao PDR (Laos), Mongolia and Papua New Guinea (PNG).

Methods

A 3-5 year prospective hospital-based observational study of children <59 months admitted with pneumonia was undertaken. Pneumonia was defined using the 2013 WHO definition. Hypoxia was defined as an oxygen saturation <90% in room air or requiring oxygen supplementation during hospitalisation. PCV13 status was determined by written record. VE was calculated using logistic regression comparing the odds of hypoxia between vaccinated and undervaccinated pneumonia cases. To handle potential confounders a propensity score (PS) analysis using inverse probability of treatment weighting (IPW) was used. In Laos, multiple imputation (MI) analysis was undertaken for missing data.

Results

The VE against hypoxic pneumonia were: in Laos, unadjusted 23% (95% CI: -9, 46%; p=0·14), PS adjusted IPW 37% (6, 57%; p=0·02), MI adjusted 35% (7, 55%; p=0·02); in Mongolia, unadjusted 33% (26, 40%; p<0.001), PS adjusted IPW 33% (16, 47%; p<0.001); and in PNG, unadjusted 6% (-15, 24%; p=0.532), PS adjusted IPW 36% (17, 51%; p=0.001).

Conclusions

Our novel approach shows that PCV13 is effective against hypoxic pneumonia. PCV13 will contribute to reducing child mortality.

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HIGH PNEUMOCOCCAL CARRIAGE RATES WITH DIVERSE SEROTYPES IN PAPUA NEW GUINEANCHILDRENWITH PNEUMONIA IN A RANDOMIZED TRIAL OF 10-VALENT AND 13-VALENT PNEUMOCOCCAL CONJUGATE VACCINES (ID 430)

Session Name

Vaccines - Impact of Vaccine programs and Serotype Replacement

Presenter

Mition J. Yoannes, Papua New Guinea

Authors

EMERGENCE OF A COTRIMOXAZOLE RESISTANT SEROTYPE 16F LINEAGE IN AN INTENSIVELY VACCINATED AFRICAN BIRTH COHORT: THE DRAKENSTEIN CHILD HEALTH STUDY (ID 930)

Session Name

Basic Sciences - Conventional and Molecular Microbiology

Presenter

Gillian Ndhlovu, South Africa

Authors

HIGH RATES OF MULTIPLE NASOPHARYNGEAL PNEUMOCOCCAL CARRIAGE IN CHILDREN WITH PNEUMONIA IN PAPUA NEW GUINEA FOLLOWING PNEUMOCOCCAL CONJUGATE VACCINE INTRODUCTION (ID 731)

Session Name

Vaccines - Impact of Vaccine programs and Serotype Replacement

Presenter

Rebecca Ford, Papua New Guinea

Authors

Abstract

Abstract

Background

Methods

Results

Conclusions

There is some evidence of PCV13 being effective against PCV13-types but the high diversity of serotypes in PNG warrants extended valency vaccines.

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PNEUMOCOCCAL CARRIAGE IN CHILDREN WITH PNEUMONIA IN THREE ASIAN COUNTRIES FOLLOWING VACCINE INTRODUCTION (ID 1082)

Session Name

Vaccines - Impact of Vaccine programs and Serotype Replacement

Presenter

Catherine Satzke, Australia

Authors

A DYNAMIC MODEL TO DETERMINE FACTORS REQUIRED FOR ELIMINATION OF VACCINE-TYPE CARRIAGE FOLLOWING PNEUMOCOCCAL CONJUGATE VACCINE INTRODUCTION IN THE ASIA-PACIFIC (ID 850)

Session Name

Population Sciences - Epidemiology, Economics, and Mathematical Modelling

Presenter

Jocelyn Chan,

Authors

GLOBAL GENOMIC EPIDEMIOLOGY OF PNEUMOCOCCAL SEROTYPE 2 ISOLATED DURING 1989 TO 2019 (ID 1084)

Session Name

Basic Sciences - Genomics and Transmission

Presenter

Roly Malaker, Bangladesh

Authors

Abstract

Abstract

Background

Serotype 2 was a major cause of pneumococcal pneumonia about 100 years ago and then disappeared. Recently, serotype 2 re-emerged in many countries, including Bangladesh and associated with meningitis. This study aims to understand genomic and epidemiological characteristics of newly emerged serotype 2 strains.

Methods

Whole-genome sequencing was performed on 146 isolates (invasive= 125, carriage= 8 and other= 5, unknown= 8) collected between 1989 and 2017. Data were analyzed for comparative genomics, antimicrobial resistance and molecular typing.

Results

Isolates were from 16 countries, mostly in Asia (n=93), Africa (n=23) and Oceania (n=26). Bangladesh (n=66) and Papua New Guinea (n=26) contributed 63% of the isolates. Among the known clinical conditions, 80% (91/113) were from meningitis. All isolates belonged to GPSC96 lineage and descended from two predominant sequence types: ST74 found in Asia and Africa, and ST1504 found in Papua New Guinea and Israel. Almost all isolates were sensitive to all antibiotics. No significant genetic differences were detected between invasive and carriage isolates.

Conclusions

Our findings don’t explain why the recent increase in serotype 2 occurred but exclude an outbreak or emergence of an antimicrobial-resistant strain as the cause. These isolates have unusually high propensity to be invasive, mostly causing meningitis.

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