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Leach AJ. What does microbiology have to do with the Hearing for Learning Initiative (HfLI)? MICROBIOLOGY AUSTRALIA 2022. [DOI: 10.1071/ma22035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Where would we be without microbiology in tackling the high prevalence of otitis media (OM; middle ear infection) and disabling hearing loss that disadvantage Australian First Nations children living in remote communities? Understanding the microbiology of OM in this population has been critical in directing innovative clinical trials research and developing appropriate evidence-based practice guidelines. While these processes are critical to reducing disadvantage associated with OM and disabling hearing loss, a remaining seemingly insurmountable gap has remained, threatening progress in improving the lives of children with ear and hearing problems. That gap is created by the crisis in primary health care workforce in remote communities. Short stay health professionals and fly-in fly-out specialist services are under-resourced to manage the complex needs of the community, including prevention and treatment of otitis media and hearing loss rehabilitation. Hence the rationale for the Hearing for Learning Initiative – a workforce enhancement model to improve sustainability, cultural appropriateness, and effectiveness of evidence-based ear and hearing health care for young children in remote settings. This paper summarises the role of microbiology in the pathway to the Hearing for Learning Initiative.
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Beissbarth J, Smith-Vaughan HC, Cheng AC, Morris PS, Leach AJ. BIGDATA: A Protocol to Create and Extend a 25-Year Clinical Trial and Observational Data Asset to Address Key Knowledge Gaps in Otitis Media and Hearing Loss in Australian Aboriginal and Non-Aboriginal Children. Front Pediatr 2022; 10:804373. [PMID: 35498792 PMCID: PMC9047683 DOI: 10.3389/fped.2022.804373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/18/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Otitis media (OM) is a common childhood illness, often resolving without intervention and acute and long-term complications are rare. However, Australian Aboriginal and Torres Strait Islander infants and children experience a high burden of OM and are at high risk of complications (tympanic membrane perforation and chronic infections). Bacterial OM is commonly associated with Streptococcus pneumoniae, non-typeable Haemophilus influenzae, and Moraxella catarrhalis. BIGDATA is a data asset combining over 25 years of microbiology and OM surveillance research from the Ear Health Research Program at Menzies School of Health Research (Northern Territory, Australia), including 11 randomized controlled trials, four cohort studies, eight surveys in over 30 remote communities (including data from Western Australia), and five surveys of urban childcare centers including Aboriginal and Torres Strait Islander and non-Indigenous children. Outcome measures include clinical examinations (focusing on OM), antibiotic prescriptions, pneumococcal vaccination, modifiable risk factors such as smoking and household crowding, and nasopharyngeal and ear discharge microbiology including antimicrobial resistance testing. METHODS AND ANALYSIS The initial series of projects are planned to address the following key knowledge gaps: (i) otitis media prevalence and severity over pre pneumococcal conjugate vaccines (PCVs) and three eras of increasing PCV valency; (ii) impact of increasing valency PCVs on nasopharyngeal carriage dynamics of pneumococcal serotypes, and antimicrobial resistance; (iii) impact of increasing valency PCVs on nasopharyngeal carriage dynamics and antimicrobial resistance of other otopathogens; and (iv) serotype specific differences between children with acute OM and OM with effusion or without OM. These data will be utilized to identify research gaps, providing evidence-based prioritization for ongoing research. ETHICS AND DISSEMINATION Data asset creation and priority analyses were approved by the Human Research Ethics Committee of Northern Territory Department of Health and Menzies School of Health Research (EC00153, 18-3281), the Child and Adolescent Health Service Human Research Ethics Committee and Western Australian Aboriginal Health Ethics Committee. Dissemination will be through peer review publication and conference presentations.
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Affiliation(s)
- Jemima Beissbarth
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | | | - Allen C Cheng
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Melbourne, VIC, Australia
| | - Peter S Morris
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.,Royal Darwin Hospital, Darwin, NT, Australia
| | - Amanda J Leach
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
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Beissbarth J, Wilson N, Arrowsmith B, Binks MJ, Oguoma VM, Lawrence K, Llewellyn A, Mulholland EK, Santosham M, Morris PS, Smith-Vaughan HC, Cheng AC, Leach AJ. Nasopharyngeal carriage of otitis media pathogens in infants receiving 10-valent non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV10), 13-valent pneumococcal conjugate vaccine (PCV13) or a mixed primary schedule of both vaccines: A randomised controlled trial. Vaccine 2021; 39:2264-2273. [PMID: 33766422 DOI: 10.1016/j.vaccine.2021.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 03/04/2021] [Accepted: 03/06/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Aboriginal children in Northern Australia have a high burden of otitis media, driven by early and persistent nasopharyngeal carriage of otopathogens, including non-typeable Haemophilus influenzae (NTHi) and Streptococcus pneumoniae (Spn). In this context, does a combined mixed primary series of Synflorix and Prevenar13 provide better protection against nasopharyngeal carriage of NTHi and Spn serotypes 3, 6A and 19A than either vaccine alone? METHODS Aboriginal infants (n = 425) were randomised to receive Synflorix™ (S, PHiD-CV10) or Prevenar13™ (P, PCV13) at 2, 4 and 6 months (_SSS or _PPP, respectively), or a 4-dose early mixed primary series of PHiD-CV10 at 1, 2 and 4 months and PCV13 at 6 months of age (SSSP). Nasopharyngeal swabs were collected at 1, 2, 4, 6 and 7 months of age. Swabs of ear discharge were collected from tympanic membrane perforations. FINDINGS At the primary endpoint at 7 months of age, the proportion of nasopharyngeal (Np) swabs positive for PCV13-only serotypes 3, 6A, or 19A was 0%, 0.8%, and 1.5% in the _PPP, _SSS, and SSSP groups respectively, and NTHi 55%, 52%, and 52% respectively, and no statistically significant vaccine group differences in other otopathogens at any age. The most common serotypes (in order) were 16F, 11A, 10A, 7B, 15A, 6C, 35B, 23B, 13, and 15B, accounting for 65% of carriage. Ear discharge swabs (n = 108) were culture positive for NTHi (52%), S. aureus (32%), and pneumococcus (20%). CONCLUSIONS Aboriginal infants experience nasopharyngeal colonisation and tympanic membrane perforations associated with NTHi, non-PCV13 pneumococcal serotypes and S. aureus in the first months of life. Nasopharyngeal carriage of pneumococcus or NTHi was not significantly reduced in the early 4-dose combined SSSP group compared to standard _PPP or _SSS schedules at any time point. Current pneumococcal conjugate vaccine formulations do not offer protection from early onset NTHi and pneumococcal colonisation in this high-risk population.
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Affiliation(s)
- J Beissbarth
- Child Health Division, Menzies School of Heath Research, Charles Darwin University, PO Box 41096, Casuarina, Northern Territory, Australia.
| | - N Wilson
- Child Health Division, Menzies School of Heath Research, Charles Darwin University, PO Box 41096, Casuarina, Northern Territory, Australia
| | - B Arrowsmith
- Child Health Division, Menzies School of Heath Research, Charles Darwin University, PO Box 41096, Casuarina, Northern Territory, Australia.
| | - M J Binks
- Child Health Division, Menzies School of Heath Research, Charles Darwin University, PO Box 41096, Casuarina, Northern Territory, Australia.
| | - V M Oguoma
- Health Research Institute, University of Canberra, Canberra, ACT, Australia.
| | - K Lawrence
- Child Health Division, Menzies School of Heath Research, Charles Darwin University, PO Box 41096, Casuarina, Northern Territory, Australia.
| | - A Llewellyn
- Child Health Division, Menzies School of Heath Research, Charles Darwin University, PO Box 41096, Casuarina, Northern Territory, Australia.
| | - E K Mulholland
- Murdoch Children's Research Institute, Department of Paediatrics, University of Melbourne, Australia; London School of Hygiene and Tropical Medicine, UK.
| | - M Santosham
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
| | - P S Morris
- Child Health Division, Menzies School of Heath Research, Charles Darwin University, PO Box 41096, Casuarina, Northern Territory, Australia; Department of Paediatrics, Royal Darwin Hospital, Darwin, Australia.
| | - H C Smith-Vaughan
- Child Health Division, Menzies School of Heath Research, Charles Darwin University, PO Box 41096, Casuarina, Northern Territory, Australia.
| | - A C Cheng
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia; Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Victoria, Australia.
| | - A J Leach
- Child Health Division, Menzies School of Heath Research, Charles Darwin University, PO Box 41096, Casuarina, Northern Territory, Australia.
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Douglas NM, Hennessy JN, Currie BJ, Baird RW. Trends in Bacteremia Over 2 Decades in the Top End of the Northern Territory of Australia. Open Forum Infect Dis 2020; 7:ofaa472. [PMID: 33204758 PMCID: PMC7651056 DOI: 10.1093/ofid/ofaa472] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/01/2020] [Indexed: 11/14/2022] Open
Abstract
Background Information on the local distribution of bloodstream pathogens helps to guide empiric antibiotic selection and can generate hypotheses regarding the effectiveness of infection prevention practices. We assessed trends in bacterial blood culture isolates at Royal Darwin Hospital (RDH) in the Northern Territory of Australia between 1999 and 2019. Methods Species identification was extracted for all blood cultures first registered at RDH. Thirteen organisms were selected for focused analysis. Trends were examined graphically and using univariable linear regression. Results Between 1999 and 2019, 189 577 blood cultures from 65 276 patients were processed at RDH. Overall, 6.72% (12 747/189 577) of blood cultures contained a bacterial pathogen. Staphylococcus aureus was the most common cause of bacteremia during the first decade, with an estimated incidence of 96.6 episodes per 100 000 person-years (py; 95% CI, 72.2-121/100 000 py) in 1999. Since 2009, S. aureus bacteremia has declined markedly, whereas there has been an inexorable rise in Escherichia coli bacteremia (30.1 to 74.7/100 000 py between 1999 and 2019; P < .001), particularly in older adults. Since 2017, E. coli has been more common than S. aureus. Rates of Streptococcus pneumoniae bacteremia have reduced dramatically in children, while Burkholderia pseudomallei remained the fourth most common bloodstream isolate overall. Conclusions The incidence of S. aureus bacteremia, though high by international standards, is declining at RDH, possibly in part due to a sustained focus on both community and hospital infection prevention practices. Gram-negative bacteremia, particularly due to E. coli, is becoming more common, and the trend will likely continue given our aging population.
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Affiliation(s)
- Nicholas M Douglas
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Territory Pathology, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Jann N Hennessy
- Territory Pathology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Bart J Currie
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Rob W Baird
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Territory Pathology, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Department of Infectious Diseases, Royal Darwin Hospital, Darwin, Northern Territory, Australia
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Binks MJ, Beissbarth J, Oguoma VM, Pizzutto SJ, Leach AJ, Smith-Vaughan HC, McHugh L, Andrews RM, Webby R, Morris PS, Chang AB. Acute lower respiratory infections in Indigenous infants in Australia's Northern Territory across three eras of pneumococcal conjugate vaccine use (2006-15): a population-based cohort study. THE LANCET CHILD & ADOLESCENT HEALTH 2020; 4:425-434. [PMID: 32450122 DOI: 10.1016/s2352-4642(20)30090-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 03/06/2020] [Accepted: 03/13/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The burden of acute lower respiratory infection (ALRI) in Indigenous children of Australia's Northern Territory is among the highest globally. No published data exists on the effect of pneumococcal conjugate vaccine (PCV) introduction on ALRIs in this population beyond 2005. The aim of this study was to describe the rates of ALRI admissions to hospital in Indigenous infants in the Northern Territory from 2006 to 2015, across three periods of different PCV use. We hypothesised that broader valency PCVs would be more effective against hospitalisations for pneumonia. METHODS We did a retrospective population-based cohort study of Indigenous infants born in the Northern Territory followed up until age 12 months. Data were from administrative hospital and perinatal datasets. International classification of diseases codes (tenth revision, Australian modification; ICD-10AM) were used to identify respiratory hospitalisations of interest: all-cause ALRI, all-cause pneumonia, bacterial pneumonia, viral pneumonia, influenza-like illness (ILI), respiratory syncytial virus ALRI (RSV-ALRI), and pneumococcal ALRI. Incidence rates were compared between PCV eras (7-valent PCV [PCV7], 2006-09; 10-valent PCV [PCV10], 2009-11; and 13-valent PCV [PCV13], 2011-15) using interrupted time trend analysis and negative binomial regression. FINDINGS For children born between Jan 1, 2006, and Dec 31, 2015, 4138 ALRI episodes (31% of all hospitalisations) occurred among 2888 (20%) of the 14 594 infants. The overall ALRI hospitalisation rate was 29·7 episodes per 100 child-years. Prominent risk factors associated with ALRI hospitalisation were living in a remote community or the Central desert region, being born preterm or with low birthweight. ALRI rates were lowest in the PCV13 era, in association with a significant reduction in bacterial pneumonia hospitalisations in the PCV13 era compared with the PCV10 (incidence rate ratio 0·68, 95% CI 0·57-0·81) and PCV7 (0·70, 0·60-0·81) eras. In contrast, RSV-ALRI rates were 4·9 episodes per 100 child-years in each era. INTERPRETATION A 30% reduction in bacterial-coded pneumonia hospitalisations in the Northern Territory during the era of PCV13 immunisation supports its ongoing use in the region. Despite the reduction, one in five Indigenous infants born in the region continue to be hospitalised with an ALRI in their first year of life. Future gains require multifaceted environmental and biomedical approaches. FUNDING National Health and Medical Research Council of Australia.
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Affiliation(s)
- Michael J Binks
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
| | - Jemima Beissbarth
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Victor M Oguoma
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Susan J Pizzutto
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Amanda J Leach
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Heidi C Smith-Vaughan
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Lisa McHugh
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Ross M Andrews
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Rosalind Webby
- Centre for Disease Control, Department of Health, Darwin, NT, Australia
| | - Peter S Morris
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Department of Paediatrics, Royal Darwin Hospital, Darwin, NT, Australia
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Centre for Children's Health Research, Queensland University of Technology, Brisbane, QLD, Australia
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Risk Factors for Carriage of Antibiotic-resistant Bacteria in Healthy Children in the Community: A Systematic Review. Pediatr Infect Dis J 2020; 39:397-405. [PMID: 32301919 DOI: 10.1097/inf.0000000000002532] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In addition to health care settings, antibiotic resistance has also been increasing in the community. Healthy children represent an important potential reservoir of antibiotic-resistant (AR) bacteria. However, strategies to reduce the spread of AR bacteria often fail to specifically address the factors that promote the carriage of AR bacteria in this population.The objective of this review was to Identify risk factors for carriage of AR bacteria by healthy children. METHODS We did a systematic search of MEDLINE, Embase and PubMed for studies in developed (OECD) countries that assessed risk factors for carriage of AR bacteria in healthy children in the community. We excluded studies done before 1998 and studies of AR Streptococcus pneumoniae carriage in the absence of pneumococcal conjugate vaccination. RESULTS Of 1234 studies identified, 30 were eligible for inclusion. These studies assessed the impact of 49 risk factors on AR strains of S. pneumoniae, Haemophilus influenzae, Staphylococcus aureus, Streptococcus pyogenes and Escherichia coli. The majority of these risk factors were assessed in 2 or fewer studies per bacteria. Recent antibiotic consumption was associated with carriage of resistant respiratory bacteria (S. pneumoniae, H. influenzae); however, it was not consistently associated with carriage of AR bacteria in skin or stool (S. aureus and E. coli). For AR S. aureus, transmission within households appeared to have a greater impact than individual antibiotic use. CONCLUSIONS The factors that promote carriage of AR bacteria by healthy children differed between bacterial species. To reduce reservoirs of AR bacteria in the community, it is essential for intervention strategies to target the specific risk factors for different bacteria.
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Beissbarth J, Smith-Vaughan HC, Harris TM, Binks MJ, Leach AJ. Use of the 10-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine (PHiD-CV10) in an Australian Indigenous paediatric population does not alter the prevalence of nontypeable Haemophilus influenzae without the protein D gene. Vaccine 2019; 37:4089-4093. [PMID: 31164306 DOI: 10.1016/j.vaccine.2019.05.079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 05/03/2019] [Accepted: 05/26/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nontypeable Haemophilus influenzae (NTHi) is one of the main respiratory pathogens associated with otitis media and lung infections in Australian Indigenous children. PHiD-CV10, the 10-valent pneumococcal conjugate vaccine containing H. influenzae protein D was used in the Northern Territory infant vaccination schedule for two years from October 2009. METHODS NTHi isolates from nasopharyngeal and ear discharge samples collected before, during and after the PHiD-CV10 era were screened for the hpd gene by PCR. Target amplicon sequence, extracted from available genomic sequence data, was analysed to identify variability in this region. RESULTS There was no statistically significant difference in the proportion of hpd#3-PCR negative isolates from each era; overall 7% and 6% of nasopharyngeal and ear discharge isolates were negative, respectively. The nucleotide sequence data supported the hpd-PCR findings; truncations of the hpd gene precluding amplification and presumably expression of protein D were observed in approximately 7% of available genomes. CONCLUSIONS In the Northern Territory of Australia, a population at high risk of NTHi-associated infection, PHiD-CV10 use did not select for hpd-PCR negative isolates.
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Affiliation(s)
- Jemima Beissbarth
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
| | | | - Tegan Maree Harris
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Michael John Binks
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Amanda Jane Leach
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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Hare KM, Seib KL, Chang AB, Harris TM, Spargo JC, Smith-Vaughan HC. Antimicrobial susceptibility and impact of macrolide antibiotics on Moraxella catarrhalis in the upper and lower airways of children with chronic endobronchial suppuration. J Med Microbiol 2019; 68:1140-1147. [PMID: 31274402 DOI: 10.1099/jmm.0.001033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Moraxella catarrhalis is an important but insufficiently studied respiratory pathogen. AIM To determine antibiotic susceptibility and impact of recent antibiotics on M. catarrhalis from children with chronic endobronchial suppuration. METHODOLOGY We cultured nasopharyngeal (NP) swabs and bronchoalveolar lavage (BAL) fluids collected from children who were prospectively enrolled in studies of chronic cough and had flexible bronchoscopy performed. Recent β-lactam or macrolide antibiotic use was recorded. M. catarrhalis isolates stored at -80 °C were re-cultured and susceptibility determined to a range of antibiotics including the macrolide antibiotic erythromycin. RESULTS Data from concurrently collected NP and BAL specimens were available from 547 children (median age 2.4 years) enrolled from 2007 to 2016. M. catarrhalis NP carriage was detected in 149 (27 %) children and lower airway infection (≥104 c.f.u. ml-1 BAL) in 67 (12 %) children. In total, 91 % of 222 M. catarrhalis isolates were β-lactamase producers, and non-susceptibility was high to benzylpenicillin (98 %), cefaclor (39 %) and cotrimoxazole (38 %). Overall, >97 % isolates were susceptible to cefuroxime, chloramphenicol, erythromycin and tetracycline; three isolates were erythromycin-resistant (MIC >0.5 mg l-1). Recent macrolide antibiotics (n=152 children, 28 %) were associated with significantly reduced M. catarrhalis carriage and lower airway infection episodes compared to children who did not receive macrolides; odds ratios 0.19 (95 % CI 0.10-0.35) and 0.15 (0.04-0.41), respectively. CONCLUSION Despite the frequent use of macrolides, few macrolide-resistant isolates were detected. This suggests a fitness cost associated with macrolide resistance in M. catarrhalis. Macrolide antibiotics remain an effective choice for treating M. catarrhalis lower airway infection in children with chronic endobronchial suppuration.
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Affiliation(s)
- Kim M Hare
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory 0811, Australia
| | - Kate L Seib
- Institute for Glycomics, Griffith University, Gold Coast, Queensland 4222, Australia
| | - Anne B Chang
- Department of Respiratory Medicine, Queensland Children's Hospital, Brisbane, Queensland 4101, Australia.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland 4001, Australia.,Child Health Division, Menzies School of Health Research, Darwin, Northern Territory 0811, Australia
| | - Tegan M Harris
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory 0811, Australia
| | - Jessie C Spargo
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory 0811, Australia
| | - Heidi C Smith-Vaughan
- Child Health Division, Menzies School of Health Research, Darwin, Northern Territory 0811, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland 4222, Australia
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Blood‒Brain Barrier Pathology and CNS Outcomes in Streptococcus pneumoniae Meningitis. Int J Mol Sci 2018; 19:ijms19113555. [PMID: 30423890 PMCID: PMC6275034 DOI: 10.3390/ijms19113555] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 11/05/2018] [Accepted: 11/09/2018] [Indexed: 12/20/2022] Open
Abstract
Streptococcus pneumoniae is a major meningitis-causing pathogen globally, bringing about significant morbidity and mortality, as well as long-term neurological sequelae in almost half of the survivors. Subsequent to nasopharyngeal colonisation and systemic invasion, translocation across the blood‒brain barrier (BBB) by S. pneumoniae is a crucial early step in the pathogenesis of meningitis. The BBB, which normally protects the central nervous system (CNS) from deleterious molecules within the circulation, becomes dysfunctional in S. pneumoniae invasion due to the effects of pneumococcal toxins and a heightened host inflammatory environment of cytokines, chemokines and reactive oxygen species intracranially. The bacteria‒host interplay within the CNS likely determines not only the degree of BBB pathological changes, but also host survival and the extent of neurological damage. This review explores the relationship between S. pneumoniae bacteria and the host inflammatory response, with an emphasis on the BBB and its roles in CNS protection, as well as both the acute and long-term pathogenesis of meningitis.
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Smith-Vaughan HC, Binks MJ, Beissbarth J, Chang AB, McCallum GB, Mackay IM, Morris PS, Marsh RL, Torzillo PJ, Wurzel DF, Grimwood K, Nosworthy E, Gaydon JE, Leach AJ, MacHunter B, Chatfield MD, Sloots TP, Cheng AC. Bacteria and viruses in the nasopharynx immediately prior to onset of acute lower respiratory infections in Indigenous Australian children. Eur J Clin Microbiol Infect Dis 2018; 37:1785-1794. [PMID: 29959609 PMCID: PMC7088242 DOI: 10.1007/s10096-018-3314-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/21/2018] [Indexed: 12/16/2022]
Abstract
Acute lower respiratory infection (ALRI) is a major cause of hospitalization for Indigenous children in remote regions of Australia. The associated microbiology remains unclear. Our aim was to determine whether the microbes present in the nasopharynx before an ALRI were associated with its onset. A retrospective case-control/crossover study among Indigenous children aged up to 2 years. ALRI cases identified by medical note review were eligible where nasopharyngeal swabs were available: (1) 0–21 days before ALRI onset (case); (2) 90–180 days before ALRI onset (same child controls); and (3) from time and age-matched children without ALRI (different child controls). PCR assays determined the presence and/or load of selected respiratory pathogens. Among 104 children (182 recorded ALRI episodes), 120 case-same child control and 170 case-different child control swab pairs were identified. Human adenoviruses (HAdV) were more prevalent in cases compared to same child controls (18 vs 7%; OR = 3.08, 95% CI 1.22–7.76, p = 0.017), but this association was not significant in cases versus different child controls (15 vs 10%; OR = 1.93, 95% CI 0.97–3.87 (p = 0.063). No other microbes were more prevalent in cases compared to controls. Streptococcus pneumoniae (74%), Haemophilus influenzae (75%) and Moraxella catarrhalis (88%) were commonly identified across all swabs. In a pediatric population with a high detection rate of nasopharyngeal microbes, HAdV was the only pathogen detected in the period before illness presentation that was significantly associated with ALRI onset. Detection of other potential ALRI pathogens was similar between cases and controls.
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Affiliation(s)
- Heidi C Smith-Vaughan
- Menzies School of Health Research, Charles Darwin University, Building 58, Royal Darwin Hospital, Rocklands Drive, Darwin, Northern Territory, 0810, Australia. .,School of Medicine, Griffith University, Gold Coast, 4222, Australia.
| | - Michael J Binks
- Menzies School of Health Research, Charles Darwin University, Building 58, Royal Darwin Hospital, Rocklands Drive, Darwin, Northern Territory, 0810, Australia
| | - Jemima Beissbarth
- Menzies School of Health Research, Charles Darwin University, Building 58, Royal Darwin Hospital, Rocklands Drive, Darwin, Northern Territory, 0810, Australia
| | - Anne B Chang
- Menzies School of Health Research, Charles Darwin University, Building 58, Royal Darwin Hospital, Rocklands Drive, Darwin, Northern Territory, 0810, Australia.,Lady Cilento Children's Hospital, Queensland University of Technology, Brisbane, 4101, Australia
| | - Gabrielle B McCallum
- Menzies School of Health Research, Charles Darwin University, Building 58, Royal Darwin Hospital, Rocklands Drive, Darwin, Northern Territory, 0810, Australia
| | - Ian M Mackay
- Faculty of Medicine, Child Health Research Centre, The University of Queensland, Brisbane, 4101, Australia.,Department of Health, Public and Environmental Health Virology Laboratory, Forensic and Scientific Services, Archerfield, 4108, Australia
| | - Peter S Morris
- Menzies School of Health Research, Charles Darwin University, Building 58, Royal Darwin Hospital, Rocklands Drive, Darwin, Northern Territory, 0810, Australia.,Royal Darwin Hospital, Darwin, 0810, Australia
| | - Robyn L Marsh
- Menzies School of Health Research, Charles Darwin University, Building 58, Royal Darwin Hospital, Rocklands Drive, Darwin, Northern Territory, 0810, Australia
| | | | - Danielle F Wurzel
- Murdoch Childrens Research Institute, The Royal Children's Hospital, Melbourne, 3052, Australia
| | - Keith Grimwood
- School of Medicine, Griffith University, Gold Coast, 4222, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, 4222, Australia.,Departments of Infectious Disease and Paediatrics, Gold Coast Health, Gold Coast, 4215, Australia
| | - Elizabeth Nosworthy
- Menzies School of Health Research, Charles Darwin University, Building 58, Royal Darwin Hospital, Rocklands Drive, Darwin, Northern Territory, 0810, Australia
| | - Jane E Gaydon
- QIMR Berghofer Medical Research Institute, Brisbane, 4006, Australia
| | - Amanda J Leach
- Menzies School of Health Research, Charles Darwin University, Building 58, Royal Darwin Hospital, Rocklands Drive, Darwin, Northern Territory, 0810, Australia
| | - Barbara MacHunter
- Menzies School of Health Research, Charles Darwin University, Building 58, Royal Darwin Hospital, Rocklands Drive, Darwin, Northern Territory, 0810, Australia
| | - Mark D Chatfield
- Menzies School of Health Research, Charles Darwin University, Building 58, Royal Darwin Hospital, Rocklands Drive, Darwin, Northern Territory, 0810, Australia.,QIMR Berghofer Medical Research Institute, Brisbane, 4006, Australia
| | - Theo P Sloots
- UQ Centre for Child Health Research, The University of Queensland, Brisbane, 4101, Australia
| | - Allen C Cheng
- Department of Infectious Diseases, Alfred Health, Melbourne, 3004, Australia. .,School of Public Health and Preventive Medicine, Monash University, Melbourne, 3800, Australia.
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11
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Mohammadzadeh M, Pourakbari B, Mahmoudi S, Keshtkar A, Habibi-Anbouhi M, Mamishi S. Efficacy of whole-cell pneumococcal vaccine in mice: A systematic review and meta-analysis. Microb Pathog 2018; 122:122-129. [PMID: 29908308 DOI: 10.1016/j.micpath.2018.06.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 01/14/2018] [Accepted: 06/13/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND Despite the fact that pneumococcal conjugate vaccines (PCVs) have significantly reduced the rate of invasive pneumococcal diseases through the use of vaccine serotypes, infection with Streptococcus pneumoniae remains a major public health hazard. Serotype-independent vaccines that are economically viable species of common protein antigens such as whole-cell vaccines (WCVs) are needed. Considering the ongoing debate about the effectiveness of WCVs, a systematic literature review and meta-analysis was carried out to determine the efficacy of WCVs against colonization in mice. MATERIAL AND METHODS A systematic review was undertaken of published studies on the protection (colonized/uncolonized) of whole cell pneumococcal vaccine in mice. The search terms used were "whole cell vaccine" and "Streptococcus pneumoniae" in PubMed, Google Scholar, Embase, Web of Science and Scopus engines. Data was extracted from original publications and a meta-analysis was performed on studies divided into sub-groups by the number of inoculations, type of sample, type of adjuvant, time of sampling, design of study and quality of study. RESULTS Ten eligible articles published from 2000 to 2016 were included in this review. The meta-analysis was performed on eight out of 10 studies and demonstrated that the estimated pooled risk ratios (RRs) for comparison of colonization between the vaccinated and unvaccinated mice for outcomes 1 and 2 were 0.18 and 0.24, respectively. Lower RRs were observed in sub-groups that were inoculated with vaccines three times, those using cholera toxin (CT) adjuvants and those obtained as tracheal specimens from the mice. CONCLUSIONS The best protocol for use of a WCV is its application with CT adjuvant administered intranasally in three inoculations at doses of 10⁸ CFU. Further studies performed under similar conditions to obtain accurate results on the effectiveness of this vaccine are recommended.
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Affiliation(s)
- Mona Mohammadzadeh
- Pediatric Infectious Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Babak Pourakbari
- Pediatric Infectious Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Shima Mahmoudi
- Pediatric Infectious Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Abbas Keshtkar
- Department of Health Sciences Education Development, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | | | - Setareh Mamishi
- Pediatric Infectious Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Pediatric Infectious Disease, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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12
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Collins DA, Hoskins A, Snelling T, Senasinghe K, Bowman J, Stemberger NA, Leach AJ, Lehmann D. Predictors of pneumococcal carriage and the effect of the 13-valent pneumococcal conjugate vaccination in the Western Australian Aboriginal population. Pneumonia (Nathan) 2017; 9:14. [PMID: 29021946 PMCID: PMC5611608 DOI: 10.1186/s41479-017-0038-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 08/15/2017] [Indexed: 11/30/2022] Open
Abstract
Background The 7-valent pneumococcal conjugate vaccine (PCV7) was introduced to prevent invasive pneumococcal disease (IPD) in Western Australian (WA) Aboriginal people in 2001. PCV13 replaced PCV7 in July 2011, covering six additional pneumococcal serotypes; however, IPD rates remained high in Aboriginal people in WA. Upper respiratory tract pneumococcal carriage can precede IPD, and PCVs alter serotype distribution. Methods To assess the impact of PCV13 introduction, identify emerging serotypes, and assess risk factors for carriage, nasopharyngeal swabs and information on demographic characteristics, health, medication and living conditions from Aboriginal children and adults across WA from August 2008 to November 2014 were collected. Bacteria were cultured using selective media and pneumococcal isolates were serotyped by Quellung reaction. Risk factors were analysed by multivariable logistic regression. Results One thousand five hundred swabs pre- and 1385 swabs post-PCV13 introduction were collected. Pneumococcal carriage was detected in 66.8% of children <5 years old and 53.2% of 5–14 year-olds post-PCV13, compared with pre-PCV13 prevalence of 72.2% and 49.4%, respectively. The prevalence of PCV13-non-PCV7 serotypes decreased in children <5 years old from 13.5% pre-PCV13 to 5.8% post-PCV13 (p < 0.01), and from 8.4% to 6.1% in children 5–14 years old (p > 0.05). The most common serotypes post-PCV13 were 11A (prevalence 4.0%), 15B (3.5%), 16F (3.5%), and 19F (3.2%). Risk of detection of pneumococcal carriage increased until age 12 months (odds ratio [OR] 4.19, 95% confidence interval [CI] 2.39–7.33), with nasal discharge (OR 2.49 [95% CI 2.00–3.09]), residence in a remote community (OR 2.21 [95% CI 1.67–2.92]) and household crowding (OR 1.36 [95% CI 1.11–1.67]). Recent antibiotic use was negatively associated with pneumococcal carriage (OR 0.48 [95% CI 0.33–0.69]). Complete resistance to penicillin was present among isolates of serotypes 19A (6.0%), 19F (2.3%) and non-serotypeable isolates (1.9%). Serotype 23F and newly emerged serotype 7B isolates showed high rates of resistance to cotrimoxazole, erythromycin and tetracycline (86.9%, 86.9%, 82.0%, respectively for 23F, 100.0%, 100.0% and 93.3% for 7B). Conclusion Since PCV13 replaced PCV7, carriage of PCV13-non-PCV7 serotypes decreased significantly among children <5 years old, those most likely to have received PCV13, and to a lesser extent in older people. Known risk factors for carriage including crowding and young age remain in the Aboriginal population.
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Affiliation(s)
- Deirdre A Collins
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA Australia.,Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA Australia
| | - Anke Hoskins
- Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA Australia
| | - Thomas Snelling
- Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA Australia
| | - Kalpani Senasinghe
- Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA Australia
| | - Jacinta Bowman
- Division of Microbiology & Infectious Diseases, PathWest Laboratory Medicine WA, Perth, WA Australia
| | - Natalie A Stemberger
- Division of Microbiology & Infectious Diseases, PathWest Laboratory Medicine WA, Perth, WA Australia
| | - Amanda J Leach
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory Australia
| | - Deborah Lehmann
- Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA Australia
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13
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TIGR4 strain causes more severe disease than WU2 strain in a mouse model of Streptococcus pneumoniae meningitis: a common pathogenic role for interferon-γ. Microbes Infect 2017; 19:413-421. [PMID: 28438705 DOI: 10.1016/j.micinf.2017.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 04/05/2017] [Accepted: 04/05/2017] [Indexed: 01/08/2023]
Abstract
Streptococcus pneumoniae (S. pneumoniae) meningitis causes debilitating neurological symptoms and acute fatalities in patients, and long-term neurological sequelae in some survivors. Current vaccines do not protect against all 94 known S. pneumoniae capsular serotypes, many of which are capable of causing pneumococcal meningitis (PM). We here compare the pathogenic outcomes of two clinically virulent isolates of S. pneumoniae, serotype 3 strain WU2 and serotype 4 strain TIGR4, in a murine model of PM. At an identical infectious dosage of 103 CFU administered via the intracerebroventricular route, significantly greater mortality, interleukin (IL)1β and IL6 production, and blood-brain barrier dysfunction occurred in TIGR4-induced PM compared to PM caused by WU2. Higher bacterial counts in the cerebrospinal fluid and nitrite/nitrate in serum were observed 40 h post inoculation with TIGR4 compared to mice infected with WU2. Similar to our previous findings in WU2 PM, interferon-γ was an essential driver of the pathogenesis of TIGR4 PM, suggesting that this cytokine may be a common pathogenic agent across a range of pneumococcal meningitides and, thus, a potential therapeutic target for intervention.
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14
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Hare KM, Smith-Vaughan HC, Chang AB, Pizzutto S, Petsky HL, McCallum GB, Leach AJ. Propensity of pneumococcal carriage serotypes to infect the lower airways of children with chronic endobronchial infections. Vaccine 2017; 35:747-756. [PMID: 28062125 DOI: 10.1016/j.vaccine.2016.12.059] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 12/05/2016] [Accepted: 12/22/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Chronic endobronchial infections in children are responsible for a high disease burden. Streptococcus pneumoniae is frequently isolated; however, few publications have described serotypes associated with non-invasive lower airway infection. METHODS Paired nasopharyngeal (NP) swabs and bronchoalveolar lavage (BAL) fluids were collected from children undergoing bronchoscopy for chronic cough. NP swabs were also collected from asymptomatic children in otitis media surveillance studies (controls). Specimens were processed and lower airway infection defined (⩾104 colony forming units/mL BAL) as previously described. Serotype-specific odds ratios (ORs) were calculated (as described for invasive pneumococcal disease) to indicate propensity for infection. RESULTS From 2007-2015, paired specimens were processed from 435 children with protracted bacterial bronchitis (PBB), chronic suppurative lung disease (CSLD) or bronchiectasis. S. pneumoniae lower airway infection was detected in 95 children: 27% with PBB and 20% with CSLD/bronchiectasis. Most (91%) children were vaccinated with ⩾2 doses of 7-valent, 10-valent or 13-valent pneumococcal conjugate vaccine. Paired NP and BAL serotype distributions were very similar; prevalent serotypes (>10 isolates) were 19A (9%), 19F, 6C, 35B, 15B, 16F, 15A, 15C, 23A, 23F and 11A. For 21 serotypes found in both NP and BAL specimens, ORs for infection were low; range 0.46 (serotype 23B) to 2.15 (serotype 6A). In the 2008-2013 surveillance studies, NP swabs were collected from 1565 asymptomatic children; 74% were pneumococcal carriers. For 21 of 22 serotypes found in both control NP swabs and BAL specimens, ORs for infection were similarly low; range 0.33 (serotype 23B) to 3.29 (serotype 22F); none was significantly different from 1. The exception was serotype 7B with OR 8.84 (95% CI 1.46, 38.1). CONCLUSIONS Most NP carriage serotypes have a similar propensity to cause lower airway infection in children with suppurative lung diseases. Further development of pneumococcal vaccines is needed to prevent non-invasive disease caused by commonly carried serotypes.
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Affiliation(s)
- Kim M Hare
- Child Health Division, Menzies School of Health Research, PO Box 41096, Casuarina, NT 0811, Australia.
| | - Heidi C Smith-Vaughan
- Child Health Division, Menzies School of Health Research, PO Box 41096, Casuarina, NT 0811, Australia
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, PO Box 41096, Casuarina, NT 0811, Australia; Queensland Children's Health Service and Queensland University of Technology, Graham Street, South Brisbane, QLD 4101, Australia
| | - Susan Pizzutto
- Child Health Division, Menzies School of Health Research, PO Box 41096, Casuarina, NT 0811, Australia
| | - Helen L Petsky
- Queensland Children's Health Service and Queensland University of Technology, Graham Street, South Brisbane, QLD 4101, Australia
| | - Gabrielle B McCallum
- Child Health Division, Menzies School of Health Research, PO Box 41096, Casuarina, NT 0811, Australia
| | - Amanda J Leach
- Child Health Division, Menzies School of Health Research, PO Box 41096, Casuarina, NT 0811, Australia
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15
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Dunne EM, Carville K, Riley TV, Bowman J, Leach AJ, Cripps AW, Murphy D, Jacoby P, Lehmann D. Aboriginal and non-Aboriginal children in Western Australia carry different serotypes of pneumococci with different antimicrobial susceptibility profiles. Pneumonia (Nathan) 2016; 8:15. [PMID: 28702294 PMCID: PMC5471808 DOI: 10.1186/s41479-016-0015-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 08/18/2016] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Carriage of Streptococcus pneumoniae is considered a precursor to pneumococcal diseases including pneumonia. As part of the Kalgoorlie Otitis Media Research Project, we characterised pneumococci isolated from the nasopharynx of Western Australian Aboriginal and non-Aboriginal children. METHODS Between 1999 and 2005, 100 Aboriginal and 180 non-Aboriginal children were followed from birth to two years, with nasopharyngeal aspirates collected at ages 1-3 and 6-8 weeks, then at 4, 6, 12, 18 and 24 months. Introduction of 7-valent pneumococcal conjugate vaccine (7vPCV) in 2001 enabled evaluation of its impact on carriage in study participants according to vaccines doses received. Pneumococcal serotyping was performed by Quellung and antimicrobial susceptibility by disk diffusion and Etest®. Molecular epidemiology of pneumococcal isolates was investigated by pulse-field gel electrophoresis and multilocus sequence typing. RESULTS Overall, the prevalence of 7vPCV serotypes was similar for Aboriginal and non-Aboriginal children (19 % vs. 16 %), but the prevalence of non-vaccine serotypes was higher in Aboriginal children (22 % vs. 7 %). A multi-resistant 6B clone (ST90) was found only in non-Aboriginal children. Aboriginal children who received three doses of 7vPCV had lower odds of carrying 7vPCV serotypes (odds ratio [OR] 0.19, 95 % CI 0.08-0.44) and higher odds of carrying non-vaccine serotypes (OR 2.37, 95 % CI 1.13-4.99) than unvaccinated Aboriginal children; this finding was not observed in non-Aboriginal children. CONCLUSIONS This unique study shows important differences in pneumococcal serotypes, genotypes, and antimicrobial susceptibility between Aboriginal and non-Aboriginal children living in the same geographic area before widespread 7vPCV use, and highlights the need for ongoing post-vaccination surveillance in outback Australia.
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Affiliation(s)
- Eileen M. Dunne
- Pneumococcal Research, Murdoch Childrens Research Institute, Parkville, VIC Australia
| | - Kylie Carville
- Victorian Infectious Disease Reference Laboratory at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC Australia
| | - Thomas V. Riley
- Microbiology & Immunology, School of Pathology & Laboratory Medicine, The University of Western Australia, Crawley, WA Australia
- Department of Microbiology, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Nedlands, WA Australia
| | - Jacinta Bowman
- Department of Microbiology, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Nedlands, WA Australia
| | - Amanda J. Leach
- Child Health Division, Menzies School of Health Research, Darwin, NT Australia
| | - Allan W. Cripps
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Southport, QLD Australia
| | - Denise Murphy
- Public Health Bacteriology Laboratory, Centre for Public Health Sciences, Coopers Plains, QLD Australia
| | - Peter Jacoby
- Telethon Kids Institute, The University of Western Australia, Subiaco, WA Australia
| | - Deborah Lehmann
- Telethon Kids Institute, The University of Western Australia, Subiaco, WA Australia
| | - the Kalgoorlie Otitis Media Research Project Team
- Pneumococcal Research, Murdoch Childrens Research Institute, Parkville, VIC Australia
- Victorian Infectious Disease Reference Laboratory at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC Australia
- Microbiology & Immunology, School of Pathology & Laboratory Medicine, The University of Western Australia, Crawley, WA Australia
- Department of Microbiology, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Nedlands, WA Australia
- Child Health Division, Menzies School of Health Research, Darwin, NT Australia
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Southport, QLD Australia
- Public Health Bacteriology Laboratory, Centre for Public Health Sciences, Coopers Plains, QLD Australia
- Telethon Kids Institute, The University of Western Australia, Subiaco, WA Australia
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16
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Otczyk DC, Cripps AW. Vaccination for the control of childhood bacterial pneumonia - Haemophilus influenzae type b and pneumococcal vaccines. Pneumonia (Nathan) 2016; 2:2-15. [PMID: 31463182 PMCID: PMC6707409 DOI: 10.15172/pneu.2013.2/229] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 10/25/2012] [Accepted: 02/14/2013] [Indexed: 12/31/2022] Open
Abstract
Pneumonia in childhood is endemic in large parts of the world and in particular, in developing countries, as well as in many indigenous communities within developed nations. Haemophilus influenzae type b and Streptococcus pneumoniae conjugate vaccines are currently available against the leading bacterial causes of pneumonia. The use of the vaccines in both industrialised and developing countries have shown a dramatic reduction in the burden of pneumonia and invasive disease in children. However, the greatest threat facing pneumococcal conjugate vaccine effectiveness is serotype replacement. The current vaccines provide serotype-specific, antibody-mediated protection against only a few of the 90+ capsule serotypes. Therefore, there has been a focus in recent years to rapidly advance technologies that will result in broader disease coverage and more affordable vaccines that can be used in developing countries. The next generation of pneumococcal vaccines have advanced to clinical trials.
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Affiliation(s)
- Diana C. Otczyk
- School of Medicine, Griffith Health Institute, Griffith University, Gold Coast Campus, Queensland, 4222 Australia
| | - Allan W. Cripps
- School of Medicine, Griffith Health Institute, Griffith University, Gold Coast Campus, Queensland, 4222 Australia
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17
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Leach AJ, Wigger C, Beissbarth J, Woltring D, Andrews R, Chatfield MD, Smith-Vaughan H, Morris PS. General health, otitis media, nasopharyngeal carriage and middle ear microbiology in Northern Territory Aboriginal children vaccinated during consecutive periods of 10-valent or 13-valent pneumococcal conjugate vaccines. Int J Pediatr Otorhinolaryngol 2016; 86:224-32. [PMID: 27260611 DOI: 10.1016/j.ijporl.2016.05.011] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/05/2016] [Accepted: 05/08/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study aims to monitor the prevalence of suppurative otitis media in remote Indigenous communities after introduction of 13-valent pneumococcal conjugate vaccine (PCV13) in October 2011. We previously reported a decline in suppurative OM following replacement of PCV7 by 10-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine (PHiD-CV10) in October 2009. METHODS We continued regular surveillance in remote Indigenous communities between February 2010 and August 2013. This analysis reports the general health, otitis media (OM), nasopharyngeal (NP) carriage and middle ear microbiology in children less than 36 months of age who received a primary course of at least two doses of PHiD-CV10 or PCV13, and not more than one dose of another pneumococcal vaccine. RESULTS Mean ages of 511 PHiD-CV10- and 140 PCV13-vaccinated children were 19 and 13 months, respectively. Most children received 3-dose non-mixed PCV schedules. At the time of assessment, general health was poor and prevalence of risk factors was high in both groups: overall, around 14% of children had scabies, 20% had impetigo, 59% had runny nose and 39% had cough. Average household size was 8 persons, and 60% of the mothers smoked. Bilaterally normal middle ears were detected in 10% and 7%, respectively. OM with effusion (OME), almost all bilateral, was diagnosed in 52% and 50%, any suppurative OM (acute OM or any tympanic membrane perforation [TMP]) in 37% and 41%, and TMP in 14% and 12%, respectively. Children in the PCV13 group had significantly less NP carriage of combined Streptococcus pneumoniae (Spn) and non-typeable Haemophilus influenzae (NTHi) (62% versus 51%) but significantly more polymicrobial (Spn and NTHi) middle ear cultures (12% versus 43%), and significantly less Staphylococcus aureus-positive middle ears (40% versus 7%). Although NP carriage of pneumococcal serotype 19A was low in the PCV13 group, serotypes 19F and 23F persist. CONCLUSIONS The general health, particularly ear health, of little children in remote Australian Indigenous communities remains in crisis. In particular, transition to PCV13 did not show substantial further improvement in ear health. Possible vaccine-related differences in microbiology, including potential beneficial effects of PHiD-CV10 on NTHi infection, need to be further evaluated in randomised trials.
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Affiliation(s)
- Amanda J Leach
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
| | - Christine Wigger
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Jemima Beissbarth
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Donna Woltring
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Ross Andrews
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Mark D Chatfield
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Heidi Smith-Vaughan
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Peter S Morris
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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18
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Jayasinghe S, Chiu C, Menzies R, Lehmann D, Cook H, Giele C, Krause V, McIntyre P. Evaluation of impact of 23 valent pneumococcal polysaccharide vaccine following 7 valent pneumococcal conjugate vaccine in Australian Indigenous children. Vaccine 2015; 33:6666-74. [PMID: 26519550 DOI: 10.1016/j.vaccine.2015.10.089] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 10/06/2015] [Accepted: 10/19/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND High incidence and serotype diversity of invasive pneumococcal disease (IPD) in Indigenous children in remote Australia led to rapid introduction of 7-valent conjugate pneumococcal vaccine (7vPCV) at 2, 4 and 6 months in 2001, followed by 23-valent polysaccharide pneumococcal vaccine (23vPPV) in the second year of life. All other Australian children were offered 3 doses of 7vPCV without a booster from 2005. This study evaluated the impact of the unique pneumococcal vaccine schedule of 7vPCV followed by the 23vPPV booster among Indigenous Australian children. METHODS Changes in IPD incidence derived from population-based passive laboratory surveillance in Indigenous children <5 years eligible for 23vPPV were compared to non-Indigenous eligible for 7vPCV only from the pre-vaccine introduction period (Indigenous 1994-2000; non-Indigenous 2002-2004) to the post-vaccine period (2008-2010 in both groups) using incidence rate ratios (IRRs) stratified by age into serotype groupings of vaccine (7v and 13vPCV and 23vPPV) and non-vaccine types. Vaccine coverage was assessed from the Australian Childhood Immunisation Register. RESULTS At baseline, total IPD incidence per 100,000 was 216 (n=230) in Indigenous versus 55 (n=1993) in non-Indigenous children. In 2008-2010, IRRs for 7vPCV type IPD were 0.03 in both groups, but for 23v-non7v type IPD 1.2 (95% CI 0.8-1.8) in Indigenous versus 3.1 (95% CI 2.5-3.7) in non-Indigenous, difference driven primarily by serotype 19A IPD (IRR 0.6 in Indigenous versus 4.3 in non-Indigenous). For non-7vPCV type IPD overall, IRR was significantly higher in those age-eligible for 23vPPV booster compared to those younger, but in both age groups was lower than for non-Indigenous children. CONCLUSION These ecologic data suggest a possible "serotype replacement sparing" effect of 23vPPV following 7vPCV priming, especially for serotype 19A with supportive evidence from other immunogenicity and carriage studies. Applicability post 10vPCV or 13v PCV priming in similar settings would depend on local serotype distribution of IPD.
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Affiliation(s)
- Sanjay Jayasinghe
- National Centre for Immunisation Research and Surveillance for Vaccine Preventable Diseases, Westmead, Australia; Discipline of Paediatrics and Child Health, University of Sydney, Sydney, Australia.
| | - Clayton Chiu
- National Centre for Immunisation Research and Surveillance for Vaccine Preventable Diseases, Westmead, Australia; Discipline of Paediatrics and Child Health, University of Sydney, Sydney, Australia
| | - Rob Menzies
- National Centre for Immunisation Research and Surveillance for Vaccine Preventable Diseases, Westmead, Australia; School of Public Health and Community Medicine, University of New South Wales, Australia
| | - Deborah Lehmann
- Telethon Kids Institute, the University of Western Australia, Perth, Western Australia, Australia
| | - Heather Cook
- Centre for Disease Control, Department of Health, Northern Territory, Australia
| | - Carolien Giele
- Communicable Disease Control Directorate, Department of Health, Western Australia, Australia
| | - Vicki Krause
- Centre for Disease Control, Department of Health, Northern Territory, Australia
| | - Peter McIntyre
- National Centre for Immunisation Research and Surveillance for Vaccine Preventable Diseases, Westmead, Australia; Discipline of Paediatrics and Child Health, University of Sydney, Sydney, Australia; School of Public Health, University of Sydney, Sydney, Australia
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19
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Leach AJ, Wigger C, Hare K, Hampton V, Beissbarth J, Andrews R, Chatfield M, Smith-Vaughan H, Morris PS. Reduced middle ear infection with non-typeable Haemophilus influenzae, but not Streptococcus pneumoniae, after transition to 10-valent pneumococcal non-typeable H. influenzae protein D conjugate vaccine. BMC Pediatr 2015; 15:162. [PMID: 26482232 PMCID: PMC4615539 DOI: 10.1186/s12887-015-0483-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 10/09/2015] [Indexed: 04/25/2023] Open
Abstract
Background In October 2009, 7-valent pneumococcal conjugate vaccine (PCV7: PrevenarTM Pfizer) was replaced in the Northern Territory childhood vaccination schedule by 10-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine (PHiD-CV10; Synflorix™ GlaxoSmithKline Vaccines). This analysis aims to determine whether the reduced prevalence of suppurative otitis media measured in the PHiD-CV10 era was associated with changes in nasopharyngeal (NP) carriage and middle ear discharge (ED) microbiology in vaccinated Indigenous children. Methods Swabs of the NP and ED were collected in remote Indigenous communities between September 2008 and December 2012. Swabs were cultured using standardised methods for otitis media pathogens. Children less than 3 years of age and having received a primary course of 2 or more doses of one PCV formulation and not more than one dose of another PCV formulation were included in the primary analysis; children with non-mixed single formulation PCV schedules were also compared. Results NP swabs were obtained from 421 of 444 (95 %) children in the PCV7 group and 443 of 451 (98 %) children in the PHiD-CV10 group. Non-mixed PCV schedules were received by 333 (79 %) and 315 (71 %) children, respectively. Pneumococcal (Spn) NP carriage was 76 % and 82 %, and non-typeable Haemophilus influenzae (NTHi) carriage was 68 % and 73 %, respectively. ED was obtained from 60 children (85 perforations) in the PCV7 group and from 47 children (59 perforations) in the PHiD-CV10 group. Data from bilateral perforations were combined. Spn was cultured from 25 % and 18 %, respectively, and NTHi was cultured from 61 % and 34 % respectively (p = 0.008). Conclusions The observed reduction in the prevalence of suppurative OM in this population was not associated with reduced NP carriage of OM pathogens. The prevalence of NTHi-infected ED was lower in PHiD-CV10 vaccinated children compared to PCV7 vaccinated children. Changes in clinical severity may be explained by the action of PHiD-CV10 on NTHi infection in the middle ear. Randomised controlled trials are needed to answer this question. Electronic supplementary material The online version of this article (doi:10.1186/s12887-015-0483-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Amanda Jane Leach
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
| | - Christine Wigger
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
| | - Kim Hare
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
| | - Vanya Hampton
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
| | - Jemima Beissbarth
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
| | - Ross Andrews
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
| | - Mark Chatfield
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
| | - Heidi Smith-Vaughan
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
| | - Peter Stanley Morris
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia. .,Royal Darwin Hospital, Darwin, Northern Territory, Australia.
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Leach AJ, Wigger C, Andrews R, Chatfield M, Smith-Vaughan H, Morris PS. Otitis media in children vaccinated during consecutive 7-valent or 10-valent pneumococcal conjugate vaccination schedules. BMC Pediatr 2014; 14:200. [PMID: 25109288 PMCID: PMC4149294 DOI: 10.1186/1471-2431-14-200] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 07/29/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2001 when 7-valent pneumococcal conjugate vaccine (PCV7) was introduced, almost all (90%) young Australian Indigenous children living in remote communities had some form of otitis media (OM), including 24% with tympanic membrane perforation (TMP). In late 2009, the Northern Territory childhood vaccination schedule replaced PCV7 with 10-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine (PHiD-CV10). METHODS We conducted regular surveillance of all forms of OM in children in remote Indigenous communities between September 2008 and December 2012. This analysis compares children less than 36 months of age who received a primary course of at least two doses of PCV7 or PHiD-CV10, and not more than one dose of another pneumococcal vaccine. RESULTS Mean ages of 444 PCV7- and 451 PHiD-CV10-vaccinated children were 20 and 18 months, respectively. Bilaterally normal middle ears were detected in 7% and 9% respectively. OM with effusion was diagnosed in 41% and 51% (Risk Difference 10% [95% Confidence Interval 3 to 17] p = 0.002), any suppurative OM (acute OM or any TMP) in 51% versus 39% (RD -12% [95% CI -19 to -5] p = 0.0004], and TMP in 17% versus 14% (RD -3% [95% CI -8 to 2] p = 0.2), respectively. Multivariate analyses described a similar independent negative association between suppurative OM and PHiD-CV10 compared to PCV7 (Odds Ratio = 0.6 [95% CI 0.4 to 0.8] p = 0.001). Additional children in the household were a risk factor for OM (OR = 2.4 [95% CI 2 to 4] p = 0.001 for the third additional child), and older age and male gender were associated with less disease. Other measured risk factors were non-significant. Similar clinical results were found for children who had received non-mixed PCV schedules. CONCLUSIONS Otitis media remains a significant health and social issue for Australian Indigenous children despite PCV vaccination. Around 90% of young children have some form of OM. Children vaccinated in with PHiD-CV10 had less suppurative OM than children vaccinated with PCV7. Ongoing surveillance during the PCV13 era, and trials of early intervention including earlier and mixed vaccine schedules are warranted.
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Affiliation(s)
- Amanda Jane Leach
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
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21
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Gonçalves VM, Dias WO, Campos IB, Liberman C, Sbrogio-Almeida ME, Silva EP, Cardoso CP, Alderson M, Robertson G, Maisonneuve JF, Tate A, Anderson P, Malley R, Fratelli F, Leite LC. Development of a whole cell pneumococcal vaccine: BPL inactivation, cGMP production, and stability. Vaccine 2014; 32:1113-20. [DOI: 10.1016/j.vaccine.2013.10.091] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 10/15/2013] [Accepted: 10/25/2013] [Indexed: 10/25/2022]
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Collins DA, Hoskins A, Bowman J, Jones J, Stemberger NA, Richmond PC, Leach AJ, Lehmann D. High nasopharyngeal carriage of non-vaccine serotypes in Western Australian aboriginal people following 10 years of pneumococcal conjugate vaccination. PLoS One 2013; 8:e82280. [PMID: 24349245 PMCID: PMC3857785 DOI: 10.1371/journal.pone.0082280] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 10/22/2013] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Invasive pneumococcal disease (IPD) continues to occur at high rates among Australian Aboriginal people. The seven-valent pneumococcal conjugate vaccine (7vPCV) was given in a 2-4-6-month schedule from 2001, with a 23-valent pneumococcal polysaccharide vaccine (23vPPV) booster at 18 months, and replaced with 13vPCV in July 2011. Since carriage surveillance can supplement IPD surveillance, we have monitored pneumococcal carriage in western Australia (WA) since 2008 to assess the impact of the 10-year 7vPCV program. METHODS We collected 1,500 nasopharyngeal specimens from Aboriginal people living in varied regions of WA from August 2008 until June 2011. Specimens were cultured on selective media. Pneumococcal isolates were serotyped by the quellung reaction. RESULTS Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis were carried by 71.9%, 63.2% and 63.3% respectively of children <5 years of age, and 34.6%, 22.4% and 27.2% of people ≥5 years. Of 43 pneumococcal serotypes identified, the most common were 19A, 16F and 6C in children <5 years, and 15B, 34 and 22F in older people. 7vPCV serotypes accounted for 14.5% of all serotypeable isolates, 13vPCV for 32.4% and 23vPPV for 49.9%, with little variation across all age groups. Serotypes 1 and 12F were rarely identified, despite causing recent IPD outbreaks in WA. Complete penicillin resistance (MIC ≥2µg/ml) was found in 1.6% of serotype 19A (5.2%), 19F (4.9%) and 16F (3.2%) isolates and reduced penicillin susceptibility (MIC ≥0.125µg/ml) in 24.9% of isolates, particularly 19F (92.7%), 19A (41.3%), 16F (29.0%). Multi-resistance to cotrimoxazole, tetracycline and erythromycin was found in 83.0% of 23F isolates. Among non-serotypeable isolates 76.0% had reduced susceptibility and 4.0% showed complete resistance to penicillin. CONCLUSIONS Ten years after introduction of 7vPCV for Aboriginal Australian children, 7vPCV serotypes account for a small proportion of carried pneumococci. A large proportion of circulating serotypes are not covered by any currently licensed vaccine.
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Affiliation(s)
- Deirdre A. Collins
- Telethon Institute for Child Health Research, Centre for Child Health Research, the University of Western Australia, Perth, Western Australia, Australia
- * E-mail:
| | - Anke Hoskins
- Telethon Institute for Child Health Research, Centre for Child Health Research, the University of Western Australia, Perth, Western Australia, Australia
| | - Jacinta Bowman
- Division of Microbiology & Infectious Diseases, PathWest Laboratory Medicine WA, Perth, Western Australia, Australia
| | - Jade Jones
- Division of Microbiology & Infectious Diseases, PathWest Laboratory Medicine WA, Perth, Western Australia, Australia
| | - Natalie A. Stemberger
- Division of Microbiology & Infectious Diseases, PathWest Laboratory Medicine WA, Perth, Western Australia, Australia
- Microbiology & Immunology, School of Pathology and Laboratory Medicine, the University of Western Australia, Perth, Western Australia, Australia
| | - Peter C. Richmond
- School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
| | - Amanda J. Leach
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Deborah Lehmann
- Telethon Institute for Child Health Research, Centre for Child Health Research, the University of Western Australia, Perth, Western Australia, Australia
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Prevalence and molecular characterisation of Streptococcus pneumoniae serotype 6C in Queensland, Australia. Diagn Microbiol Infect Dis 2013; 78:307-12. [PMID: 24369995 DOI: 10.1016/j.diagmicrobio.2013.11.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 11/13/2013] [Accepted: 11/16/2013] [Indexed: 12/13/2022]
Abstract
Streptococcus pneumoniae serotype 6C was first identified in 2007, although retrospective studies have since identified serotype 6C among stored isolates dating back to 1962. We investigated the incidence and genetic diversity of serotype 6C strains isolated from Queensland patients between 2001 and 2011. Isolates were identified by Quellung reaction and antimicrobial susceptibility testing was performed. The incidence of serotype 6C among serogroup 6 Queensland invasive pneumococcal disease increased from 6.8% (2001-2004) to 39% (2005-2010) of serogroup 6 isolates (P = 0). Genetic diversity of Queensland 6C isolates was high, with molecular analysis identifying 19 sequence types by multi-locus sequence typing, and 35 types by multi-locus variable-number tandem repeat analysis.
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Tellería-Orriols JJ, García-Salido A, Varillas D, Serrano-González A, Casado-Flores J. TLR2-TLR4/CD14 polymorphisms and predisposition to severe invasive infections by Neisseria meningitidis and Streptococcus pneumoniae. Med Intensiva 2013; 38:356-62. [PMID: 24144680 DOI: 10.1016/j.medin.2013.08.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 07/09/2013] [Accepted: 08/01/2013] [Indexed: 12/19/2022]
Abstract
PURPOSE Streptococcus pneumoniae and Neisseria meningitidis are major causes of severe invasive bacterial infections in some individuals. Apparently the genetic is a major susceptibility determinant to these infectious diseases. We study if the functional polymorphisms within genes of the innate immune system (TLR2-TLR4 and CD14) are related to the predisposition to severe invasive infections caused by S. pneumoniae and N. meningitidis. MATERIAL AND METHODS Prospective descriptive study. Sixty-six Caucasian healthy children and 173 consecutive Caucasian children with invasive bacterial infections by N. meningitidis (n=59) and S. pneumoniae (n=114) were enrolled between January 1, 2008 and December 31, 2010. All blood samples were genotyped with description of the coding polymorphisms in p.R753Q of TLR2 gene and p.D299G of TLR4 gene as well as the promotor polymorphism c.-159C>T of the CD14 gene. RESULTS Compared to the controls the p.753Q allele of TLR2 and the allele c.-159T of CD14 were more frequent in patients with S. pneumoniae (p<0.0001 and p=0.0167) and meningococcal infections (p=0.0003 and p=0.0276 respectively). CONCLUSIONS Genetical variations in the innate immune system by polymorphisms in the TLR2 and CD14, could be related with an increases susceptibility to severe invasive infections by S. pneumoniae and N. meningitidis.
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Affiliation(s)
| | - A García-Salido
- Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
| | - D Varillas
- Medicine Faculty, University of Valladolid, Valladolid, Spain
| | - A Serrano-González
- Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - J Casado-Flores
- Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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Long-term azithromycin for Indigenous children with non-cystic-fibrosis bronchiectasis or chronic suppurative lung disease (Bronchiectasis Intervention Study): a multicentre, double-blind, randomised controlled trial. THE LANCET RESPIRATORY MEDICINE 2013; 1:610-620. [DOI: 10.1016/s2213-2600(13)70185-1] [Citation(s) in RCA: 129] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Lai JYR, Cook H, Yip TW, Berthelsen J, Gourley S, Krause V, Smith H, Leach AJ, Smith-Vaughan H. Surveillance of pneumococcal serotype 1 carriage during an outbreak of serotype 1 invasive pneumococcal disease in central Australia 2010-2012. BMC Infect Dis 2013; 13:409. [PMID: 24138669 PMCID: PMC3766201 DOI: 10.1186/1471-2334-13-409] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Accepted: 08/15/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND An outbreak of serotype 1 invasive pneumococcal disease (IPD) occurred in Central Australia from October 2010 to the latter part of 2012. Surveillance of serotype 1 carriage was conducted to determine epidemiological features of asymptomatic carriage that could potentially be driving the outbreak. METHODS 130 patients and accompanying persons presenting at Alice Springs Hospital Emergency Department consented to nasopharyngeal swab (NPS) collection. NPS were processed by standard methods, including culture, pneumococcal lytA quantitative real-time PCR, serotype 1-specific real-time PCR and multi-locus sequence typing (MLST). RESULTS Pneumococcal carriage was detected in 16% of participants. Carriage was highest in the under 10 year olds from remote communities surrounding Alice Springs (75%). Four NPS were positive for serotype 1 DNA by PCR; 3 were also culture-positive for serotype 1 pneumococci. Serotype 1 isolates had atypical colony morphology on primary culture. All serotype 1 carriers were healthy children 5 to 8 years of age from remote communities. By MLST, serotype 1 isolates were ST306, as were IPD isolates associated with this outbreak. CONCLUSIONS During an outbreak of serotype 1 ST306 IPD, carriage of the outbreak strain was detected in 3% NPS collected. All carriers were healthy children 5 to 8 years of age.
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Affiliation(s)
- Jana YR Lai
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Heather Cook
- Department of Health, Centre for Disease Control, Darwin, NT, Australia
| | - Teem-Wing Yip
- Department of Health, Centre for Disease Control, Darwin, NT, Australia
- Flinders University Northern Territory Clinical School, Adelaide, NT, Australia
| | | | - Stephen Gourley
- Flinders University Northern Territory Clinical School, Adelaide, NT, Australia
- Alice Springs Hospital Emergency Department, Alice Springs, NT, Australia
| | - Vicki Krause
- Department of Health, Centre for Disease Control, Darwin, NT, Australia
- Flinders University Northern Territory Clinical School, Adelaide, NT, Australia
| | - Helen Smith
- Forensic & Scientific Services, Queensland Health, Brisbane, QLD, Australia
| | - Amanda J Leach
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Heidi Smith-Vaughan
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
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Hare KM, Singleton RJ, Grimwood K, Valery PC, Cheng AC, Morris PS, Leach AJ, Smith-Vaughan HC, Chatfield M, Redding G, Reasonover AL, McCallum GB, Chikoyak L, McDonald MI, Brown N, Torzillo PJ, Chang AB. Longitudinal nasopharyngeal carriage and antibiotic resistance of respiratory bacteria in indigenous Australian and Alaska native children with bronchiectasis. PLoS One 2013; 8:e70478. [PMID: 23940582 PMCID: PMC3734249 DOI: 10.1371/journal.pone.0070478] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 06/20/2013] [Indexed: 11/19/2022] Open
Abstract
Background Indigenous children in Australia and Alaska have very high rates of chronic suppurative lung disease (CSLD)/bronchiectasis. Antibiotics, including frequent or long-term azithromycin in Australia and short-term beta-lactam therapy in both countries, are often prescribed to treat these patients. In the Bronchiectasis Observational Study we examined over several years the nasopharyngeal carriage and antibiotic resistance of respiratory bacteria in these two PCV7-vaccinated populations. Methods Indigenous children aged 0.5–8.9 years with CSLD/bronchiectasis from remote Australia (n = 79) and Alaska (n = 41) were enrolled in a prospective cohort study during 2004–8. At scheduled study visits until 2010 antibiotic use in the preceding 2-weeks was recorded and nasopharyngeal swabs collected for culture and antimicrobial susceptibility testing. Analysis of respiratory bacterial carriage and antibiotic resistance was by baseline and final swabs, and total swabs by year. Results Streptococcus pneumoniae carriage changed little over time. In contrast, carriage of Haemophilus influenzae declined and Staphylococcus aureus increased (from 0% in 2005–6 to 23% in 2010 in Alaskan children); these changes were associated with increasing age. Moraxella catarrhalis carriage declined significantly in Australian, but not Alaskan, children (from 64% in 2004–6 to 11% in 2010). While beta-lactam antibiotic use was similar in the two cohorts, Australian children received more azithromycin. Macrolide resistance was significantly higher in Australian compared to Alaskan children, while H. influenzae beta-lactam resistance was higher in Alaskan children. Azithromycin use coincided significantly with reduced carriage of S. pneumoniae, H. influenzae and M. catarrhalis, but increased carriage of S. aureus and macrolide-resistant strains of S. pneumoniae and S. aureus (proportion of carriers and all swabs), in a ‘cumulative dose-response’ relationship. Conclusions Over time, similar (possibly age-related) changes in nasopharyngeal bacterial carriage were observed in Australian and Alaskan children with CSLD/bronchiectasis. However, there were also significant frequency-dependent differences in carriage and antibiotic resistance that coincided with azithromycin use.
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Affiliation(s)
- Kim M Hare
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
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Loman NJ, Gladstone RA, Constantinidou C, Tocheva AS, Jefferies JMC, Faust SN, O’Connor L, Chan J, Pallen MJ, Clarke SC. Clonal expansion within pneumococcal serotype 6C after use of seven-valent vaccine. PLoS One 2013; 8:e64731. [PMID: 23724086 PMCID: PMC3665553 DOI: 10.1371/journal.pone.0064731] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 04/17/2013] [Indexed: 12/29/2022] Open
Abstract
Streptococcus pneumoniae causes invasive infections, primarily at the extremes of life. A seven-valent conjugate vaccine (PCV7) is used to protect against invasive pneumococcal disease in children. Within three years of PCV7 introduction, we observed a fourfold increase in serotype 6C carriage, predominantly due to a single clone. We determined the whole-genome sequences of nineteen S. pneumoniae serotype 6C isolates, from both carriage (n = 15) and disease (n = 4) states, to investigate the emergence of serotype 6C in our population, focusing on a single multi-locus sequence type (MLST) clonal complex 395 (CC395). A phylogenetic network was constructed to identify different lineages, followed by analysis of variability in gene sets and sequences. Serotype 6C isolates from this single geographical site fell into four broad phylogenetically distinct lineages. Variation was seen in the 6C capsular locus and in sequences of genes encoding surface proteins. The largest clonal complex was characterised by the presence of lantibiotic synthesis locus. In our population, the 6C capsular locus has been introduced into multiple lineages by independent capsular switching events. However, rapid clonal expansion has occurred within a single MLST clonal complex. Worryingly, plasticity exists within current and potential vaccine-associated loci, a consideration for future vaccine use, target selection and design.
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Affiliation(s)
- Nicholas J. Loman
- Centre for Systems Biology, School of Biosciences, University of Birmingham, Birmingham, United Kingdom
| | - Rebecca A. Gladstone
- Molecular Microbiology Group, Sir Henry Wellcome Laboratories, Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Chrystala Constantinidou
- Division of Microbiology and Infection, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Anna S. Tocheva
- Molecular Microbiology Group, Sir Henry Wellcome Laboratories, Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Johanna M. C. Jefferies
- Molecular Microbiology Group, Sir Henry Wellcome Laboratories, Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Southampton NIHR, Respiratory Biomedical Research Unit, University Hospital Southampton Foundation NHS Trust, Southampton, United Kingdom
| | - Saul N. Faust
- Molecular Microbiology Group, Sir Henry Wellcome Laboratories, Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- NIHR, Wellcome Trust Clinical Research Facility, University Hospital Southampton Foundation NHS Trust, Southampton, United Kingdom
- Southampton NIHR, Respiratory Biomedical Research Unit, University Hospital Southampton Foundation NHS Trust, Southampton, United Kingdom
| | - Leigh O’Connor
- Centre for Systems Biology, School of Biosciences, University of Birmingham, Birmingham, United Kingdom
| | - Jacqueline Chan
- Division of Microbiology and Infection, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Mark J. Pallen
- Division of Microbiology and Infection, Warwick Medical School, University of Warwick, Coventry, United Kingdom
- * E-mail:
| | - Stuart C. Clarke
- Molecular Microbiology Group, Sir Henry Wellcome Laboratories, Academic Unit of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Health Protection Agency, Southampton, United Kingdom
- Southampton NIHR, Respiratory Biomedical Research Unit, University Hospital Southampton Foundation NHS Trust, Southampton, United Kingdom
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Conjugation of polysaccharide 6B from Streptococcus pneumoniae with pneumococcal surface protein A: PspA conformation and its effect on the immune response. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2013; 20:858-66. [PMID: 23554468 DOI: 10.1128/cvi.00754-12] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Despite the substantial beneficial effects of incorporating the 7-valent pneumococcal conjugate vaccine (PCV7) into immunization programs, serotype replacement has been observed after its widespread use. As there are many serotypes currently documented, the use of a conjugate vaccine relying on protective pneumococcal proteins as active carriers is a promising alternative to expand PCV coverage. In this study, capsular polysaccharide serotype 6B (PS6B) and recombinant pneumococcal surface protein A (rPspA), a well-known protective antigen from Streptococcus pneumoniae, were covalently attached by two conjugation methods. The conjugation methodology developed by our laboratory, employing 4-(4,6-dimethoxy-1,3,5-triazin-2-yl)-4-methylmorpholinium chloride (DMT-MM) as an activating agent through carboxamide formation, was compared with reductive amination, a classical methodology. DMT-MM-mediated conjugation was shown to be more efficient in coupling PS6B to rPspA clade 1 (rPspA1): 55.0% of PS6B was in the conjugate fraction, whereas 24% was observed in the conjugate fraction with reductive amination. The influence of the conjugation process on the rPspA1 structure was assessed by circular dichroism. According to our results, both conjugation processes reduced the alpha-helical content of rPspA; reduction was more pronounced when the reaction between the polysaccharide capsule and rPspA1 was promoted between the carboxyl groups than the amine groups (46% and 13%, respectively). Regarding the immune response, both conjugates induced functional anti-rPspA1 and anti-PS6B antibodies. These results suggest that the secondary structure of PspA1, as well as its reactive groups (amine or carboxyl) involved in the linkage to PS6B, may not play an important role in eliciting a protective immune response to the antigens.
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Bacterial respiratory pathogens in children with inherited immune and airway disorders: nasopharyngeal carriage and disease risk. Pediatr Infect Dis J 2013; 32:399-404. [PMID: 23552676 DOI: 10.1097/inf.0b013e31827db77a] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Children with primary immunodeficiencies, sickle cell disease and cystic fibrosis are at risk to develop invasive bacterial infections caused by respiratory tract pathogens, in particular Streptococcus pneumoniae, Haemophilus influenzae and Staphylococcus aureus. This review article evaluates the role of nasopharyngeal colonization by these pathogens in the high prevalence of respiratory and invasive infections in children with inherited disorders affecting the immune system or the respiratory tract. We conclude that respiratory and invasive diseases that occur in children with primary immunodeficiencies or sickle cell disease are probably a result of increased nasopharyngeal colonization rates compared with healthy children. However, when the inherited disorder is characterized by local airway abnormalities such as in cystic fibrosis, enhanced nasopharyngeal colonization does not seem to play a major role in invasive disease risk. As the evidence for the role of nasopharyngeal colonization in disease risk in these specific patient groups partly comes from experimental studies and animal models, longitudinal studies in children are needed. Detailed understanding of the effect of colonization on the development of respiratory and invasive infections in children with primary immunodeficiencies, sickle cell disease or cystic fibrosis provides a justification for the selective introduction of vaccination and prophylactic antibiotic treatment. Recommendations for the use of (preventive) therapeutic strategies in these patient groups taking into account disease-specific immunologic mechanisms underlying colonization and disease are described.
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Hare KM, Leach AJ, Morris PS, Smith-Vaughan H, Torzillo P, Bauert P, Cheng AC, McDonald MI, Brown N, Chang AB, Grimwood K. Impact of recent antibiotics on nasopharyngeal carriage and lower airway infection in Indigenous Australian children with non-cystic fibrosis bronchiectasis. Int J Antimicrob Agents 2012; 40:365-9. [PMID: 22819151 DOI: 10.1016/j.ijantimicag.2012.05.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 05/22/2012] [Accepted: 05/22/2012] [Indexed: 11/16/2022]
Abstract
Indigenous Australian children have increased rates of bronchiectasis. Despite a lack of high-level evidence on effectiveness and antibiotic resistance, these children often receive long-term antibiotics. In this study, we determined the impact of recent macrolide (primarily azithromycin) and β-lactam antibiotic use on nasopharyngeal colonisation, lower airway infection (>10(4) CFU/mL of bronchoalveolar lavage fluid culture) and antibiotic resistance in non-typeable Haemophilus influenzae (NTHi), Streptococcus pneumoniae and Moraxella catarrhalis isolates from 104 Indigenous children with radiographically confirmed bronchiectasis. Recent antibiotic use was associated with significantly reduced nasopharyngeal carriage, especially of S. pneumoniae in 39 children who received macrolides [odds ratio (OR)=0.22, 95% confidence interval (CI) 0.08-0.63] and 26 children who received β-lactams (OR=0.07, 95% CI 0.01-0.32), but had no significant effect on lower airway infection involving any of the three pathogens. Children given macrolides were significantly more likely to carry (OR=4.58, 95% CI 1.14-21.7) and be infected by (OR=8.13, 95% CI 1.47-81.3) azithromycin-resistant S. pneumoniae. Children who received β-lactam antibiotics may be more likely to have lower airway infection with β-lactamase-positive ampicillin-resistant NTHi (OR=4.40, 95% CI 0.85-23.9). The risk of lower airway infection by antibiotic-resistant pathogens in children receiving antibiotics is of concern. Clinical trials to determine the overall benefit of long-term antibiotic therapy are underway.
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Affiliation(s)
- K M Hare
- Child Health Division, Menzies School of Health Research, Charles Darwin University, P.O. Box 41096, Casuarina, Darwin, NT 0811, Australia.
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Ercibengoa M, Arostegi N, Marimón JM, Alonso M, Pérez-Trallero E. Dynamics of pneumococcal nasopharyngeal carriage in healthy children attending a day care center in northern Spain. Influence of detection techniques on the results. BMC Infect Dis 2012; 12:69. [PMID: 22440017 PMCID: PMC3383471 DOI: 10.1186/1471-2334-12-69] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Accepted: 03/22/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pneumococcal nasopharyngeal carriage precedes invasive infection and is the source for dissemination of the disease. Differences in sampling methodology, isolation or identification techniques, as well as the period (pre -or post-vaccination) when the study was performed, can influence the reported rates of colonization and the distribution of serotypes carried. OBJECTIVES To evaluate the prevalence and dynamics of pneumococcal nasopharyngeal colonization in healthy children aged 6-34 months attending a day care center with a high level of hygiene and no overcrowding. The study was performed 3-4 years after the 7-valent pneumococcal vaccine was introduced, using multiple methodologies to detect and characterize the isolates. METHODS Over 12 months, 25 children were sampled three times, 53 children twice and 27 children once. Three Streptococcus pneumoniae typing techniques were used: Quellung, Pneumotest-Latex-kit and multiplex-polymerase chain reaction (PCR). The similarity of isolates of the same serotype was established by pulsed field gel electrophoresis (PFGE) and occasionally the multilocus sequence type (ST) was also determined. RESULTS Overall pneumococcal carriage and multiple colonization rates were 89.5% (94/105) and 39%, respectively. Among 218 pneumococci detected, 21 different serotypes and 13 non-typeable isolates were found. The most prevalent serotypes were 19A, 16F and 15B. Serotypes 15B, 19A and 21 were mainly found as single carriage; in contrast serotypes 6B, 11A and 20, as well as infrequent serotypes, were isolated mainly as part of multiple carriage. Most 19A isolates were ST193 but most serotypes showed high genetic heterogeneity. Changes in the pneumococci colonizing each child were frequent and the same serotype detected on two occasions frequently showed a different genotype. By multiplex-PCR, 100% of pneumococci could be detected and 94% could be serotyped versus 80.3% by the Quellung reaction and Pneumotest-Latex in combination (p < 0.001). CONCLUSIONS Rates of S. pneumoniae carriage and multiple colonization were very high. Prevalent serotypes differed from those found in similar studies in the pre-vaccination period. In the same child, clearance of a pneumococcal strain and acquisition of a new one was frequent in a short period of time. The most effective technique for detecting pneumococcal nasopharyngeal carriers was multiplex-PCR.
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Affiliation(s)
- María Ercibengoa
- Microbiology Department, Hospital Universitario Donostia-Instituto Biodonostia, San Sebastián, Spain
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Bauer MJ, Georgousakis MM, Vu T, Henningham A, Hofmann A, Rettel M, Hafner LM, Sriprakash KS, McMillan DJ. Evaluation of novel Streptococcus pyogenes vaccine candidates incorporating multiple conserved sequences from the C-repeat region of the M-protein. Vaccine 2012; 30:2197-205. [DOI: 10.1016/j.vaccine.2011.12.115] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Revised: 12/02/2011] [Accepted: 12/26/2011] [Indexed: 11/26/2022]
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Westerink MJ, Schroeder HW, Nahm MH. Immune Responses to pneumococcal vaccines in children and adults: Rationale for age-specific vaccination. Aging Dis 2012; 3:51-67. [PMID: 22500271 PMCID: PMC3320805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 07/19/2011] [Accepted: 07/19/2011] [Indexed: 05/31/2023] Open
Abstract
Streptococcus pneumoniae is a significant human pathogen and currently available pneumococcal vaccines are designed to elicit anti-capsule antibodies. The 23-valent polysaccharide vaccine has been used in older adults for many years whereas 7-, 10-, and 13-valent pneumococcal conjugate vaccines have only been used commonly for young children in the last decade. In addition to their high protective efficacy among children, the use of conjugate vaccines in young children has had a number of additional effects, including production of a serotype shift and providing new herd immunity to adults. The immunogenicity of both of these types of vaccines can be determined by using an ELISA assay to measure antibody levels or an opsonophagocytosis assay to assess opsonic function. As these assays have improved over time, awareness of the analytical limitations of older studies has grown. While the 23-valent vaccine is effective among young adults, it is less effective among elderly adults. Aging-associated ineffectiveness may be due to aging-dependent changes in the antibody repertoire and/or a reduction in IgM antibody production associated with aging-dependent changes in B cell subpopulations. The immunologic basis of aging-associated immune defects thus remains an active area of research.
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Affiliation(s)
- M.A. Julie Westerink
- University of Toledo, Department of Medicine, Division of Infectious Diseases, Department of Medical Microbiology and Immunology and Department of Pathology, Toledo OH 43614, USA
| | - Harry W. Schroeder
- University of Alabama at Birmingham, Department of Medicine, Division of Immunology and Rheumatology, Birmingham, AL 35294, USA
| | - Moon H. Nahm
- University of Alabama at Birmingham, Department of Pathology, Division of Laboratory Medicine, Birmingham, AL 35294, USA
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Contribution of serotype and genetic background to virulence of serotype 3 and serogroup 11 pneumococcal isolates. Infect Immun 2011; 79:4839-49. [PMID: 21930754 DOI: 10.1128/iai.05663-11] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The capsular serotype has long been associated with the virulence of Streptococcus pneumoniae. Here we present an in-depth study of phenotypic and genetic differences between serotype 3 and serogroup 11 S. pneumoniae clinical isolates from both the general and indigenous populations of Australia. Both serotypes/groups included clonally unrelated strains with differences in well-known polymorphic virulence genes, such as nanA and pspA, as demonstrated by multilocus sequence typing and Western blot analysis. Nonetheless, the serotype 3 strains were consistently and significantly more virulent in mice than the serogroup 11 strains. Despite extensive genomic analysis, noncapsular genes common to one serotype/group but not the other were not identified. Nevertheless, following the conversion of a serotype 11A isolate to serotype 3 and subsequent analysis in an intranasal infection model, it was evident that both capsular and noncapsular factors determine the virulence phenotype in mice. However, it appears that these noncapsular factors vary from strain to strain.
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Two DHH subfamily 1 proteins contribute to pneumococcal virulence and confer protection against pneumococcal disease. Infect Immun 2011; 79:3697-710. [PMID: 21768284 DOI: 10.1128/iai.01383-10] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Streptococcus pneumoniae is an important human bacterial pathogen, causing such infections as pneumonia, meningitis, septicemia, and otitis media. Current capsular polysaccharide-based conjugate vaccines protect against a fraction of the over 90 serotypes known, whereas vaccines based on conserved pneumococcal proteins are considered promising broad-range alternatives. The pneumococcal genome encodes two conserved proteins of an as yet unknown function, SP1298 and SP2205, classified as DHH (Asp-His-His) subfamily 1 proteins. Here we examined their contribution to pneumococcal pathogenesis using single and double knockout mutants in three different strains: D39, TIGR4, and BHN100. Mutants lacking both SP1298 and SP2205 were severely impaired in adherence to human epithelial Detroit 562 cells. Importantly, the attenuated phenotypes were restored upon genetic complementation of the deleted genes. Single and mixed mouse models of colonization, otitis media, pneumonia, and bacteremia showed that bacterial loads in the nasopharynx, middle ears, lungs, and blood of mice infected with the mutants were significantly reduced from those of wild-type-infected mice, with an apparent additive effect upon deletion of both genes. Minor strain-specific phenotypes were observed, i.e., deletion of SP1298 affected host-cell adherence in BHN100 only, and deletion of SP2205 significantly attenuated virulence in lungs and blood in D39 and BHN100 but not TIGR4. Finally, subcutaneous vaccination with a combination of both DHH subfamily 1 proteins conferred protection to nasopharynx, lungs, and blood of mice infected with TIGR4. We conclude that SP1298 and SP2205 play a significant role at several stages of pneumococcal infection, and importantly, these proteins are potential candidates for a multicomponent protein vaccine.
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Jacups SP, Cheng A. The epidemiology of community acquired bacteremic pneumonia, due to Streptococcus pneumoniae, in the Top End of the Northern Territory, Australia--over 22 years. Vaccine 2011; 29:5386-92. [PMID: 21651943 DOI: 10.1016/j.vaccine.2011.05.082] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 05/20/2011] [Accepted: 05/23/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Diseases caused by Streptococcus pneumoniae continue to cause substantial morbidity and mortality throughout the world. Furthermore, detrimental outcomes are more pronounced in some populations--such as those living in third world poverty, and Indigenous people who live in developed nations. METHODS This study describes the epidemiology of blood culture positive S. pneumoniae community-acquired pneumonia (CAP) in the Top End of the Northern Territory of Australia. Demographics, indigenous status, medical risk factors, serotype and outcomes were collected from adults presenting to hospital with blood culture positive S. pneumoniae CAP, from 1987 to 2008. RESULTS We report 205 cases, with a median age of 40 years. The average overall incidence rate ratio was 10.3 for indigenous adults compared with non-indigenous adults. There was no statistical difference between incidence rates pre and post-23-valent pneumococcal polysaccharide vaccine (23vPPV) introduction. Serotypes in presenting cases were predominantly (84.7%) 23vPPV types. The whole-population logistic regression model identified significant adjusted relative risks: 95% CI, for age 45 and older 1.6: 1.1, 2.2, indigenous 5.9: 3.7, 9.5, diabetes 2.3: 1.6, 3.3, excess alcohol 4.8: 2.8, 8.3, smoking 2.7: 1.9, 3.7 with indigenous+excess alcohol 18.5: 17.3, 19.7 as predictive for bacteremic S. pneumoniae CAP presentation. CONCLUSIONS Our results suggest that, the national 23vPPV program appears to be under-utilized. An integrated Public Health approach vigorously targeting indigenous adolescents, before substances such as alcohol and smoking are habitual, together with increased vaccine coverage, will reduce the burden of pneumococcal disease in this population.
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Affiliation(s)
- Susan P Jacups
- School for Environmental Research, Charles Darwin University, Northern Territory, Australia.
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Yao KH, Liu ZJ, Yu JG, Yu SJ, Yuan L, Nahm MH, Yang YH. Type distribution of serogroup 6 Streptococcus pneumoniae and molecular epidemiology of newly identified serotypes 6C and 6D in China. Diagn Microbiol Infect Dis 2011; 70:291-8. [PMID: 21546198 DOI: 10.1016/j.diagmicrobio.2011.03.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Revised: 03/15/2011] [Accepted: 03/20/2011] [Indexed: 11/17/2022]
Abstract
The recently determined serotypes 6C and 6D Streptococcus pneumoniae, as well as subtypes 6B-I and 6B-II, were not reported in China. Among the 171 invasive isolates, 19 were identified as serogroup 6. There were equal distribution (42.1%) of 6B-I and 6B-II, 15.8% of 6A and lack of 6C and 6D. Among 1662 noninvasive isolates, 210 were identified as serogroup 6. The rates of types 6A, 6B-I, 6B-II, 6C, and 6D were 42.4%, 21.0%, 29.1%, 4.8%, and 2.9%, respectively. Subtype 6B-II was more resistant to antibiotics than others. The main sequence types (STs) of serotype 6C and 6D isolates were ST2912 and ST982, respectively. These results suggested that all recognized types of serogroup 6 can be found in China and that subtype 6B-II was more drug resistant. The epidemic STs of serotype 6C and 6D did not show genetic association with the STs spreading in other countries.
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Affiliation(s)
- Kai-Hu Yao
- Beijing Pediatric Research Institute, Beijing Children's Hospital affiliated to Capital Medical University, Beijing 100045, China
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Chavanet P, Atale A, Mahy S, Neuwirth C, Varon E, Dabernat H, Portier H. [Nasopharyngeal carriage, antibiotic susceptibility and serotyping of Streptococcus pneumoniae and Haemophilus influenzae in children attending day care centers]. Med Mal Infect 2011; 41:307-17. [PMID: 21429682 DOI: 10.1016/j.medmal.2011.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Revised: 12/27/2010] [Accepted: 02/07/2011] [Indexed: 11/28/2022]
Abstract
UNLABELLED The aim of this study was to investigate the nasal carriage of Streptococcus pneumoniae (SP) and Haemophilus influenzae (HI) in children. METHODS Nasal samples were swabbed from children 3 months to 3 years of age, between December 2006 and April 2007, in 10 day-care centers in Dijon. RESULTS Three hundred and eighty-five children, 22.7 ± 8.4 months, were included. All were vaccinated against H1 and 92% had received at least one dose of PCV7 vaccine. HI colonization (55%) was associated with young age and concomitant pneumococcal carriage (52.4% vs. 39%). Amoxicillin/clavulanate and cefotaxime resistance rates were 17% and 0.5%. Pneumococcal carriage (48%) was increased in case of prior hospitalization. The rate of PDSP, 50%, was increased in case of recent infection (91% vs. 81%), previous antibiotherapy (64% vs. 41%), and decreased if PCV7 was completed (40.2% vs. 61,8%). There was no resistance to amoxicillin. The erythromycin resistance rate was 50.5%. 15% of the strains were vaccinal serotypes. Thirty-six and 41% of the strains were related and non-related to vaccine serotypes. Twenty-four and 11.6% of the strains were serotypes 19A and 6A respectively. CONCLUSION Over the last 10 years the global antibiotic resistance in children decreased for SP (22.9%) but nasal colonization remained stable due to the increase of some serotypes, such as 19A, most often resistant to antibiotics. The vaccine effectiveness against HI is optimal since no HIb serotypes were detected; resistance to betalactam is currently due equally to enzymatic mechanism and alteration of protein binding penicillin.
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Affiliation(s)
- P Chavanet
- Département d'infectiologie, CHU de Dijon, BP 77908, 21000 Dijon, France.
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The prevalence and characteristics of Streptococcus pneumoniae isolates expressing serotypes 6C and 6D in Hong Kong prior to the introduction of the 7-valent pneumococcal conjugate vaccine. Diagn Microbiol Infect Dis 2011; 68:439-44. [PMID: 20926218 DOI: 10.1016/j.diagmicrobio.2010.07.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Revised: 07/24/2010] [Accepted: 07/26/2010] [Indexed: 11/23/2022]
Abstract
A study was conducted to determine the prevalence of the 2 newly described types, 6C and 6D, among pneumococcal isolates collected in Hong Kong before availability of the 7-valent pneumococcal conjugate vaccine. A total of 154 serogroup 6 isolates obtained from nasopharynx (n = 106), blood (n = 22), respiratory (n = 24), and cerebrospinal fluid (CSF) (n = 2) during 1995 to 2001 were analyzed by polymerase chain reaction typing. Five nasopharyngeal and 2 sputum isolates were found to belong to 6C and 6D, respectively. The isolates were genetically diverse, but one 6C and two 6D isolates exhibited some clonal relationship. Phylogenetic analysis of the wchA-wciN(β)-wciO nucleotide sequences showed that the Hong Kong 6C/6D isolates had 2 allelic profiles, which were more closely related to 6C/6D isolates from Fijian and Korea than were those from Brazil and the United States. However, all of the wciP gene sequences for both Hong Kong and non-Hong Kong isolates clustered together: 6C isolates with the wciP-9 allele and 6D isolates with the wciP-5 allele. In conclusion, the prevalence of the 2 newly described serotypes was low before the era of the pneumococcal conjugate vaccine. Nonetheless, results from the molecular studies indicated that the evolution of the capsular genes have involved complex pathways.
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Satzke C, Ortika BD, Oftadeh S, Russell FM, Robins-Browne RM, Mulholland EK, Gilbert GL. Molecular epidemiology of Streptococcus pneumoniae serogroup 6 isolates from Fijian children, including newly identified serotypes 6C and 6D. J Clin Microbiol 2010; 48:4298-300. [PMID: 20810769 PMCID: PMC3020807 DOI: 10.1128/jcm.00861-10] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Revised: 05/27/2010] [Accepted: 08/23/2010] [Indexed: 11/20/2022] Open
Abstract
Multilocus sequence typing (MLST) was applied to all unique serotype 6C and 6D isolates and a random selection of serotype 6B and 6A isolates from nasopharyngeal swabs from Fijian children enrolled in a recent vaccine trial. The results suggest that Fijian serotype 6D has arisen independently from both serotypes 6A/C and 6B.
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Affiliation(s)
- Catherine Satzke
- Department of Paediatrics, University of Melbourne, Centre for International Child Health, Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, Australia.
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Mackenzie GA, Leach AJ, Carapetis JR, Fisher J, Morris PS. Epidemiology of nasopharyngeal carriage of respiratory bacterial pathogens in children and adults: cross-sectional surveys in a population with high rates of pneumococcal disease. BMC Infect Dis 2010; 10:304. [PMID: 20969800 PMCID: PMC2974682 DOI: 10.1186/1471-2334-10-304] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Accepted: 10/23/2010] [Indexed: 11/10/2022] Open
Abstract
Background To determine the prevalence of carriage of respiratory bacterial pathogens, and the risk factors for and serotype distribution of pneumococcal carriage in an Australian Aboriginal population. Methods Surveys of nasopharyngeal carriage of Streptococcus pneumoniae, non-typeable Haemophilus influenzae, and Moraxella catarrhalis were conducted among adults (≥16 years) and children (2 to 15 years) in four rural communities in 2002 and 2004. Infant seven-valent pneumococcal conjugate vaccine (7PCV) with booster 23-valent pneumococcal polysaccharide vaccine was introduced in 2001. Standard microbiological methods were used. Results At the time of the 2002 survey, 94% of eligible children had received catch-up pneumococcal vaccination. 324 adults (538 examinations) and 218 children (350 examinations) were enrolled. Pneumococcal carriage prevalence was 26% (95% CI, 22-30) among adults and 67% (95% CI, 62-72) among children. Carriage of non-typeable H. influenzae among adults and children was 23% (95% CI, 19-27) and 57% (95% CI, 52-63) respectively and for M. catarrhalis, 17% (95% CI, 14-21) and 74% (95% CI, 69-78) respectively. Adult pneumococcal carriage was associated with increasing age (p = 0.0005 test of trend), concurrent carriage of non-typeable H. influenzae (Odds ratio [OR] 6.74; 95% CI, 4.06-11.2) or M. catarrhalis (OR 3.27; 95% CI, 1.97-5.45), male sex (OR 2.21; 95% CI, 1.31-3.73), rhinorrhoea (OR 1.66; 95% CI, 1.05-2.64), and frequent exposure to outside fires (OR 6.89; 95% CI, 1.87-25.4). Among children, pneumococcal carriage was associated with decreasing age (p < 0.0001 test of trend), and carriage of non-typeable H. influenzae (OR 9.34; 95% CI, 4.71-18.5) or M. catarrhalis (OR 2.67; 95% CI, 1.34-5.33). Excluding an outbreak of serotype 1 in children, the percentages of serotypes included in 7, 10, and 13PCV were 23%, 23%, and 29% (adults) and 22%, 24%, and 40% (2-15 years). Dominance of serotype 16F, and persistent 19F and 6B carriage three years after initiation of 7PCV is noteworthy. Conclusions Population-based carriage of S. pneumoniae, non-typeable H. influenzae, and M. catarrhalis was high in this Australian Aboriginal population. Reducing smoke exposure may reduce pneumococcal carriage. The indirect effects of 10 or 13PCV, above those of 7PCV, among adults in this population may be limited.
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Affiliation(s)
- Grant A Mackenzie
- Child Health Division, Menzies School of Health Research, Darwin, Australia.
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Bratcher PE, Park IH, Oliver MB, Hortal M, Camilli R, Hollingshead SK, Camou T, Nahm MH. Evolution of the capsular gene locus of Streptococcus pneumoniae serogroup 6. MICROBIOLOGY-SGM 2010; 157:189-198. [PMID: 20929956 PMCID: PMC3068628 DOI: 10.1099/mic.0.043901-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Streptococcus pneumoniae expressing serogroup 6 capsules frequently causes pneumococcal infections and the evolutionary origins of the serogroup 6 strains have been extensively studied. However, these studies were performed when serogroup 6 had only two known members (serotypes 6A and 6B) and before the two new members (serotypes 6C and 6D) expressing wciNβ were found. We have therefore reinvestigated the evolutionary origins of serogroup 6 by examining the profiles of the capsule gene loci and the multilocus sequence types (MLSTs) of many serogroup 6 isolates from several continents. We confirmed that there are two classes of cps locus sequences for serogroup 6 isolates. In our study, class 2 cps sequences were limited to a few serotype 6B isolates. Neighbour-joining analysis of cps sequence profiles showed a distinct clade for 6C and moderately distinct clades for class 1 6A and 6B sequences. The serotype 6D cps profile was found within the class 1 6B clade, suggesting that it was created by recombination between 6C and 6B cps loci. Interestingly, all 6C isolates also had a unique wzy allele with a 6 bp deletion. This suggests that serotype switching to 6C involves the transfer of a large (>4 kb) gene segment that includes both the wciNβ allele and the ‘short’ wzy allele. The MLST studies of serotype 6C isolates suggest that the 6C cps locus is incorporated into many different pneumococcal genomic backgrounds but that, interestingly, 6C cps may have preferentially entered strains of the same genomic backgrounds as those of serotype 6A.
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Affiliation(s)
- P E Bratcher
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - I H Park
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - M B Oliver
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - M Hortal
- Maternal and Child Health Department, Ministry of Public Health Montevideo, Uruguay
| | - R Camilli
- Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - S K Hollingshead
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - T Camou
- Maternal and Child Health Department, Ministry of Public Health Montevideo, Uruguay
| | - M H Nahm
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.,Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
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Jacups SP, Morris PS, Leach AJ. Haemophilus influenzae type b carriage in Indigenous children and children attending childcare centers in the Northern Territory, Australia, spanning pre- and post-vaccine eras. Vaccine 2010; 29:3083-8. [PMID: 20875498 DOI: 10.1016/j.vaccine.2010.09.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Revised: 09/07/2010] [Accepted: 09/09/2010] [Indexed: 12/01/2022]
Abstract
UNLABELLED This paper investigates Haemophilus influenzae type b (Hib) carriage in Indigenous children and children attending childcare centres in the Northern Territory of Australia, 1992-2005. More than 10 years after the introduction of the Hib conjugate vaccine, Hib carriage persists in Indigenous children (3.4%, 2003-2005) and children attending childcare centres (0.2%, 2004). This is the first Australian study to examine Hib carriage spanning the pre- and post-vaccination eras. Increasing carriage rates contribute to Hib disease resurgence especially in those with higher disease burdens, such as remote Indigenous Australians, ongoing carriage surveillance provides a sentinel warning system for invasive disease. BACKGROUND Following the introduction of H. influenzae type b (Hib) conjugate vaccine to Australia in 1993 as a three dose (2, 4, 12 month) schedule, the incidence of Hib disease decreased dramatically in children, especially in those aged under 5 years. We investigate Hib carriage in Indigenous children and children attending childcare centres from the Northern Territory (NT) of Australia between 1992 and 2005. We report Hib carriage rates in this well vaccinated population, with previously documented high rates of invasive disease. METHODS Hib carriage was reviewed in nasopharyngeal or nasal swabs collected between 1992 and 2005; from over 2000 children (61% Indigenous) aged 0-6 years enrolled in 7 otitis media or carriage surveillance studies in the NT. RESULTS More than 10 years after the introduction of the Hib conjugate vaccine, Hib carriage persists at low levels, but at a higher rate in Indigenous children (3.4%, 2003-2005) than children attending childcare centres (0.2%, 2004), in the NT of Australia. CONCLUSIONS This is the first Australian study to examine Hib carriage spanning the pre- and post-vaccination eras. Ongoing carriage surveillance provides a sentinel warning system for invasive disease. This notifies public health professionals of potential invasive disease, creating early warning systems for intervention if Australian Indigenous children or children attending childcare centres are to follow current international trends associated with high rates of carriage preceding invasive disease-despite high vaccination rates. Internationally there is growing concern that increasing carriage rates are the driving force behind Hib disease resurgence especially in those with higher disease burdens, such as remote Indigenous Australians. Changes to the vaccination schedule from PRP-OMPC (PedvaxHIB(®)), to PRP-T (2, 4, 6, 12 months) from January 2010-may affect carriage and in time, invasive disease rates. This work is important for national and International comparisons as well as feeding back information to vaccine policy makers of the Hib carriage environment throughout this period.
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Affiliation(s)
- Susan P Jacups
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
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The nonserotypeable pneumococcus: phenotypic dynamics in the era of anticapsular vaccines. J Clin Microbiol 2009; 48:831-5. [PMID: 20042626 DOI: 10.1128/jcm.01701-09] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Nonserotypeable pneumococci (NSP) are commonly carried by Australian Indigenous children in remote communities. The purpose of this study was to characterize carriage isolates of NSP from Indigenous children vaccinated with the seven-valent pneumococcal conjugate vaccine (PCV7) and to use these data to guide decisions on reporting of NSP. A total of 182 NSP were characterized by BOX typing, antibiogram analysis, and multilocus sequence typing (MLST) of common BOX types. NSP positive for the wzg capsule gene were analyzed by a multiplex PCR-based reverse line blot hybridization assay (mPCR/RLB-H) targeting capsule genes to determine the serotype. Among 182 NSP, 49 BOX types were identified. MLST of 10 representative isolates found 7 STs, including ST448 (which accounted for 11% of NSP). Non-penicillin susceptibility was evident in 51% of the isolates. Pneumococcal wzg sequences were detected in only 23 (13%) NSP, including 10 that contained an approximately 1.2-kb insert in the region. mPCR/RLB-H identified serotype 14 wzy sequences in all 10 NSP, and 1 also contained a serotype 3-specific wze sequence. Among the remaining 13 wzg-positive NSP, few belonged to the serotypes represented in PCV7. It appears that most NSP identified in Australian Indigenous children are from a true nonencapsulated lineage. Few NSP represented serotypes in PCV7 that suppress capsular expression. High rates of carriage and penicillin resistance and the occasional presence of capsule genes suggest a role for NSP in the maintenance and survival of capsulated pneumococci. To avoid the inflation of pneumococcal carriage and antibiotic resistance rates, in clinical trials, we recommend separate reporting of rates of capsular strains and NSP and the exclusion of data for NSP from primary analyses.
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