Serotype distribution of Streptococcus pneumoniae causing invasive disease in children in the post-PCV era: A systematic review and meta-analysis
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Open Access
- 9 May 2017
- journal article
- research article
- Published by Public Library of Science (PLoS) in PLOS ONE
- Vol. 12 (5), e0177113
- https://doi.org/10.1371/journal.pone.0177113
Abstract
Routine immunisation with pneumococcal conjugate vaccines (PCV7/10/13) has reduced invasive pneumococcal disease (IPD) due to vaccine serotypes significantly. However, an increase in disease due to non-vaccine types, or serotype replacement, has been observed. Serotypes’ individual contributions to IPD play a critical role in determining the overall effects of PCVs. This study examines the distribution of pneumococcal serotypes in children to identify leading serotypes associated with IPD post-PCV introduction. A systematic search was performed to identify studies and surveillance reports (published between 2000 and December 2015) of pneumococcal serotypes causing childhood IPD post-PCV introduction. Serotype data were differentiated based on the PCV administered during the study period: PCV7 or higher valent PCVs (PCV10 or PCV13). Meta-analysis was conducted to estimate the proportional contributions of the most frequent serotypes in childhood IPD in each period. We identified 68 studies reporting serotype data among IPD cases in children. We analysed data from 38 studies (14 countries) where PCV7 was administered and 20 (24 countries) where PCV10 or PCV13 have been introduced. Studies reported early and late periods of PCV7 administration (range: 2001∓13). In these settings, serotype 19A was the most predominant cause of childhood IPD, accounting for 21.8% (95%CI 18.6∓25.6) of cases. In countries that have introduced higher valent PCVs, study periods were largely representative of the transition and early years of PCV10 or PCV13. In these studies, the overall serotype-specific contribution of 19A was lower (14.2% 95%CI 11.1∓18.3). Overall, non-PCV13 serotypes contributed to 42.2% (95%CI 36.1∓49.5%) of childhood IPD cases. However, regional differences were noted (57.8% in North America, 71.9% in Europe, 45.9% in Western Pacific, 28.5% in Latin America, 42.7% in one African country, and 9.2% in one Eastern Mediterranean country). Predominant non-PCV13 serotypes overall were 22F, 12F, 33F, 24F, 15C, 15B, 23B, 10A, and 38 (descending order), but their rank order varied by region. Childhood IPD is associated with a wide number of serotypes. In the early years after introduction of higher valent PCVs, non-PCV13 types caused a considerable proportion of childhood IPD. Serotype data, particularly from resource-limited countries with high burden of IPD, are needed to assess the importance of serotypes in different settings. The geographic diversity of pneumococcal serotypes highlights the importance of continued surveillance to guide vaccine design and recommendations.Keywords
Funding Information
- Sanofi (PR1395789)
This publication has 83 references indexed in Scilit:
- Serotype-Specific Changes in Invasive Pneumococcal Disease after Pneumococcal Conjugate Vaccine Introduction: A Pooled Analysis of Multiple Surveillance SitesPLoS Medicine, 2013
- Changes in Streptococcus pneumoniae serotype distribution in invasive disease and nasopharyngeal carriage after the heptavalent pneumococcal conjugate vaccine introduction in Bogotá, ColombiaVaccine, 2013
- Pneumococcal Carriage and Invasive Disease in Children Before Introduction of the 13-valent Conjugate VaccineThe Pediatric Infectious Disease Journal, 2013
- PspA Family Distribution, unlike Capsular Serotype, Remains Unaltered following Introduction of the Heptavalent Pneumococcal Conjugate VaccineClinical and Vaccine Immunology, 2012
- Serotypes of Streptococcus pneumoniae Isolates from Children with Invasive Pneumococcal Disease in Turkey: Baseline Evaluation of the Introduction of the Pneumococcal Conjugate Vaccine NationwideClinical and Vaccine Immunology, 2011
- Serotype replacement in disease after pneumococcal vaccinationThe Lancet, 2011
- Relationship between Serotypes, Age, and Clinical Presentation of Invasive Pneumococcal Disease in Madrid, Spain, after Introduction of the 7-Valent Pneumococcal Conjugate Vaccine into the Vaccination CalendarClinical and Vaccine Immunology, 2011
- Serotype specific invasive capacity and persistent reduction in invasive pneumococcal diseaseVaccine, 2010
- Systematic Evaluation of Serotypes Causing Invasive Pneumococcal Disease among Children Under Five: The Pneumococcal Global Serotype ProjectPLoS Medicine, 2010
- Burden of disease caused by Streptococcus pneumoniae in children younger than 5 years: global estimatesThe Lancet, 2009