Impact of the Pneumococcal Heptavalent Conjugated Vaccine on Streptococcus pneumoniae Nasopharyngeal Carriage and Antimicrobial Susceptibility in Children 2-5-Year-Old in Beijing, China
Streptococcus pneumoniae is a primary cause of illness and death among
children younger than 5 years in China. The heptavalent pneumococcal conjugate
vaccine (PCV7) was the only conjugated vaccine (PCV) available in
China from 2008 to 2013. This randomized, controlled, open-label study
conducted at 46 Beijing clinics involved 3281 healthy 2-5-year-old Chinese
children, randomized 1:1 to receive one dose of the S. pneumoniae heptavalent conjugated vaccine (PCV7) (n = 1643) or Haemophilus influenzae type b
conjugate vaccine (Hib) (n = 1638). The main objective of this study was to
investigate the impact of PCV7 against that of Hib vaccination in the nasopharyngeal S. pneumoniae colonization in healthy Chinese children. Nasopharyngeal
(NP) samples for culture, serotyping and antimicrobial susceptibility
testing were collected before vaccination and at Day 60 and 180 post-vaccination.
A total 3281 children were enrolled in the study. Demographic characteristics
were similar among both study groups: 1641 children received PCV7. Before
immunization, S. pneumoniae was isolated in 338 and 360 children in the
PCV7 (144 PCV7 isolates) and Hib groups (145 PCV7 isolates), respectively.
At Day 180, PCV7 vaccination was more effective than Hib vaccination in reduction
NP carriage (20.2% [P = 0.052]) and new acquisition (19.0% [P =
0.066]). When reductions in NP carriage and new acquisition of PCV7 VT
plus 6A was analyzed, reduction in the PCV7 vaccinated group achieved statistical
significance (P = 0.034 and P = 0.042 versus Hib, respectively). NP carriage
of NVT increased in both groups (P = 0.305 between study groups at Day 180).
PCV7 decreased NP carriage of non-susceptible VT to amoxicillin (P = 0.000), ceftriaxone (P = 0.047) and MDR (P = 0.024) versus Hib. PCV7 vaccination in
Chinese children 2 to 5 years of age was more effective than vaccination with
Hib in the reduction of S. pneumoniae nasopharyngeal carriage, new acquisition
and non-susceptible isolates.
References
[1]
Hu, S., Shi, Q., Chen, C.I., Caldwell, R, Wang, B., Du, L.X., He, J.J. and Roberts, C.S. (2014) Estimated Public Health Impact of Nationwide Vaccination of Infants with 7-Valent Pneumococcal Conjugate Vaccine (PCV7) in China. International Journal of Infectious Diseases, 26, 116-122. https://doi.org/10.1016/j.ijid.2014.04.012
[2]
WHO Publication (2012) Pneumococcal Vaccines WHO Position Paper. Weekly Epidemiological Record, 87, 129-144.
[3]
Rudan, I., O’Brien, K.L., Nair, H., Liu, L., Theodoratou, E., Qazi, S., Lukšic, I., Fischer Walker, C.L., Black, R.E., Campbell, H. and Child Health Epidemiology Reference Group (CHERG) (2013) Epidemiology and Etiology of Childhood Pneumonia in 2010: Estimates of Incidence, Severe Morbidity, Mortality, Underlying Risk Factors and Causative Pathogens for 192 countries. Journal of Global Health, 3, 010401.
[4]
Le Polain, D.W.O., Flasche, S., Prieto-Merino, D., Goldblatt, D. and Edmunds, W.J. (2015) The Efficacy and Duration of Protection of Pneumococcal Conjugate Vaccines against Nasopharyngeal Carriage: A Meta-regression Model. Pediatric Infectious Disease Journal, 34, 858-864. https://doi.org/10.1097/INF.0000000000000717
[5]
Lakshman, R., Murdoch, C., Race, G., Burkinshaw, R., Shaw, L. and Finn A. (2003) Pneumococcal Nasopharyngeal Carriage in Children Following Heptavalent Pneumococcal Conjugate Vaccination in Infancy. Archives of Disease in Childhood, 88, 211-214. https://doi.org/10.1136/adc.88.3.211
[6]
Gray, B.M., Turner, M.E. and Dillon Jr., H.C. (1982) Epidemiologic Studies of Streptococcus pneumoniae In Infants. The effects of Season and Age on Pneumococcal Acquisition and Carriage in the First 24 Months of Life. American Journal of Epidemiology, 116, 692-703. https://doi.org/10.1093/oxfordjournals.aje.a113452
[7]
Garcia-Rodriguez, J.A. and Fresnadillo Martinez, M.J. (2002) Dynamics of Nasopharyngeal Colonization by Potential Respiratory Pathogens. Journal of Antimicrobial Chemotherapy, 50, 59-73. https://doi.org/10.1093/jac/dkf506
[8]
Fleming-Dutra, K.E., Conklin, L., Loo, J.D., Knoll, M.D., Park, D.E., Kirk, J., Goldblatt, D., Whitney, C.G. and O’Brien, K.L. (2014) Systematic Review of the Effect of Pneumococcal Conjugate Vaccine Dosing Schedules on Vaccine-Type Nasopharyngeal Carriage. Pediatric Infectious Disease Journal, 33, 152-160.
https://doi.org/10.1097/INF.0000000000000083
[9]
Goldblatt, D., Ramakrishnan, M. and O’Brien, K. (2013) Using the Impact of Pneumococcal Vaccines on Nasopharyngeal Carriage to Aid Licensing and Vaccine Implementation; A PneumoCarr Meeting Report March 27-28, 2012, Geneva. Vaccine, 32, 146-152. https://doi.org/10.1016/j.vaccine.2013.06.040
[10]
Auranen, K., Rinta-Kokko, H., Goldblatt, D., Nohynek, H., O’Brien, K.L., Satzke, C., Simell, B., Tanskanen, A. and Käyhty, H. (2013) Colonisation Endpoints in Streptococcus pneumoniae Vaccine Trials. Vaccine, 32, 153-158.
https://doi.org/10.1016/j.vaccine.2013.08.061
[11]
Fitzwater, S.P., Chandran, A., Santosham, M. and Johnson, H.L. (2012) The Worldwide Impact of the Seven-Valent Pneumococcal Conjugate Vaccine. The Pediatric Infectious Disease Journal, 31, 501-508.
https://doi.org/10.1097/INF.0b013e31824de9f6
[12]
Grijalva, C.G., Nuorti, J.P., Arbogast, P.G., Martin, S.W., Edwards, K.M. and Griffin, M.R. (2007) Decline in Pneumonia Admissions after Routine Childhood Immunisation with Pneumococcal Conjugate Vaccine in the USA: A Time-Series Analysis. The Lancet, 369, 1179-1186.
[13]
Caldwell, R., Roberts, C.S., An, Z., Chen, C.I. and Wang, B. (2015) The Health and Economic Impact of Vaccination with 7-Valent Pneumococcal Vaccine (PCV7) during an Annual Influenza Epidemic and Influenza Pandemic in China. BMC Infectious Diseases, 15, 284. https://doi.org/10.1186/s12879-015-1021-x
[14]
Dagan, R., Juergens, C., Trammel, J., Patterson, S., Greenberg, D., Givon-Lavi, N., Porat, N., Gurtman, A., Gruber, W.C. and Scott, D.A. (2015) Efficacy of 13-Valent Pneumococcal Conjugate Vaccine (PCV13) versus That of 7-Valent PCV (PCV7) against Nasopharyngeal Colonization of Antibiotic-Nonsusceptible Streptococcus pneumoniae. The Journal of Infectious Diseases, 211, 1144-1153.
https://doi.org/10.1093/infdis/jiu576
[15]
Cohen, R., Levy, C., de La Rocque, F., Gelbert, N., Wollner, A., Fritzell, B., Bonnet, E., Tetelboum, R. and Varon, E. (2006) Impact of Pneumococcal Conjugate Vaccine and of Reduction of Antibiotic Use on Nasopharyngeal Carriage of Nonsusceptible Pneumococci in Children with Acute Otitis Media. The Pediatric Infectious Disease Journal, 25, 1001-1007. https://doi.org/10.1097/01.inf.0000243163.85163.a8
[16]
Shouval, D.S., Greenberg, D., Givon-Lavi, N., Porat, N. and Dagan, R. (2006) Site-Specific Disease Potential of Individual Streptococcus pneumoniae Serotypes in Pediatric Invasive Disease, Acute Otitis Media and Acute Conjunctivitis. The Pediatric Infectious Disease Journal, 25, 602-607.
https://doi.org/10.1097/01.inf.0000220231.79968.f6
[17]
Wroe, P.C., Lee, G.M., Finkelstein, J.A., Pelton, S.I., Hanage, W.P., Lipsitch, M., Stevenson, A.E., Rifas-Shiman, S.L., Kleinman, K., Dutta-Linn, M.M., Hinrichsen, V.L., Lakoma, M. and Huang, S.S. (2012) Pneumococcal Carriage and Antibiotic Resistance in Young Children before 13-Valent Conjugate Vaccine. The Pediatric Infectious Disease Journal, 31, 249-254.
https://doi.org/10.1097/INF.0b013e31824214ac
[18]
Techasaensiri, C., Messina, A.F., Katz, K., Ahmad, N., Huang, R. and McCracken, G.H. (2010) Epidemiology and Evolution of Invasive Pneumococcal Disease Caused by Multidrug Resistant Serotypes of 19A in the 8 Years after Implementation of Pneumococcal Conjugate Vaccine Immunization in Dallas, Texas. The Pediatric Infectious Disease Journal, 29, 294-300.
[19]
Carvalho Mda, G., Pimenta, F.C., Gertz, R.E., Joshi, H.H., Trujillo, A.A., Keys, L.E., Findley, J., Moura, I.S., Park, I.H., Hollingshead, S.K., Pilishvili, T., Whitney, C.G., Nahm, M.H., Beall, B.W. and Active Bacterial Core Surveillance Team (2009) PCR-Based Quantitation and Clonal Diversity of the Current Prevalent Invasive Serogroup 6 Pneumococcal Serotype, 6C, in the United States in 1999 and 2006 to 2007. Journal of Clinical Microbiology, 47, 554-559.
https://doi.org/10.1128/JCM.01919-08
[20]
Sharma, D., Baughman, W., Holst, A., Thomas, S., Jackson, D., da Gloria Carvalho, M., Beall, B., Satola, S., Jerris, R., Jain, S., Farley, M.M. and Nuorti, J.P. (2013) Pneumococcal Carriage and Invasive Disease in Children before Introduction of the 13-Valent Conjugate Vaccine: Comparison with the Era before 7-Valent Conjugate Vaccine. The Pediatric Infectious Disease Journal, 32, e45-e53.
https://doi.org/10.1097/INF.0b013e3182788fdd
[21]
Wei, S.H., Chiang, C.S., Chen, C.L. and Chiu, C.H. (2015) Pneumococcal Disease and Use of Pneumococcal Vaccines in Taiwan. Clinical and Experimental Vaccine Research, 4, 121-129. https://doi.org/10.7774/cevr.2015.4.2.121
[22]
Lyu, S., Yao, K.H., Dong, F., Xu, B.P., Liu, G., Wang, Q., Shi, W., Tong, J.J., Shen, K.L. and Yang, Y.H. (2016) Vaccine Serotypes of Streptococcus pneumoniae with High-Level Antibiotic Resistance Isolated More Frequently Seven Years after the Licensure of PCV7 in Beijing. The Pediatric Infectious Disease Journal, 35, 316-321.
https://doi.org/10.1097/INF.0000000000001000
[23]
Daana, M., Rahav, G., Hamdan, A., Thalji, A., Jaar, F., Abdeen, Z., Jaber, H., Goral, A., Huppert, A., Raz, M., Regev-Yochay, G. and PICR Study Group (2015) Measuring the Effects of Pneumococcal Conjugate Vaccine (PCV7) on Streptococcus pneumoniae Carriage and Antibiotic Resistance: The Palestinian-Israeli Collaborative Research (PICR). Vaccine, 33, 1021-1026.
[24]
Ho, P.L., Chiu, S.S., Chan, M.Y., Ang, I., Chow, K.H. and Lau, Y.L. (2011) Changes in Nasopharyngeal Carriage and Serotype Distribution of Antibiotic-Resistant Streptococcus pneumoniae before and after the Introduction of 7-Valent Pneumococcal Conjugate Vaccine in Hong Kong. Diagnostic Microbiology and Infectious Disease, 71, 327-334.
[25]
Rivera-Olivero, I.A., Del Nogal, B., Fuentes, M., Cortez, R., Bogaert, D., Hermans, P.W. and Waard, J.H. (2014) Immunogenicity of a 7-Valent Pneumococcal Conjugate Vaccine (PCV7) and Impact on Carriage in Venezuelan Children at Risk of Invasive Pneumococcal Diseases. Vaccine, 32, 4006-4011.
[26]
Zhang, W., Shen, X., Wang, Y., Chen, Y., Huang, M., Zeng, Q., Fan, M., Bergman, U. and Yang, Y. (2008) Outpatient Antibiotic Use and Assessment of Antibiotic Guidelines in Chinese Children’s Hospitals. European Journal of Clinical Pharmacology, 64, 821-828. https://doi.org/10.1007/s00228-008-0489-3
[27]
Kaplan, S.L., Barson, W.J., Lin, P.L., Romero, J.R., Bradley, J.S., Tan, T.Q., Hoffman, J.A., Givner, L.B. and Mason, E.O. (2013) Early Trends for Invasive Pneumococcal Infections in Children after the Introduction of the 13-Valent Pneumococcal Conjugate Vaccine. The Pediatric Infectious Disease Journal, 32, 203-207.
https://doi.org/10.1097/INF.0b013e318275614b
[28]
Singleton, R., Wenger, J., Klejka, J.A., Bulkow, L.R., Thompson, A., Sarkozy, D., Emini, E.A., Gruber, W.C. and Scott, D.A. (2013) The 13-Valent Pneumococcal Conjugate Vaccine for Invasive Pneumococcal Disease in Alaska Native Children: Results of a Clinical Trial. The Pediatric Infectious Disease Journal, 32, 257-263.
[29]
Hu, Y., Luo, S., Tang, X., Lou, L., Chen, Y. and Guo, J. (2015) Comparative Assessment of Immunization Coverage of Migrant Children between National Immunization Program Vaccines and Non-National Immunization Program Vaccines in East China. Human Vaccines & Immunotherapeutics, 11, 761-768.
https://doi.org/10.1080/21645515.2015.1012015
