Invasiveness potential of pneumococcal serotypes in children after introduction of PCV13 in Blantyre, Malawi
Abstract Introduction The introduction of PCV13 to the Malawi infant immunization schedule in 2011 has been associated with reduced disease from Streptococcus pneumoniae. Improved understanding of serotypes with high invasive potential can guide future vaccination interventions. We aimed to estimate...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
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BMC
2023-01-01
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| Series: | BMC Infectious Diseases |
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| Online Access: | https://doi.org/10.1186/s12879-023-08022-4 |
| _version_ | 1828051888935796736 |
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| author | Amir Kirolos Todd D. Swarthout Andrew A. Mataya Farouck Bonomali Comfort Brown Jacquline Msefula Naor Bar-Zeev Pui-Ying Iroh Tam Maaike Alaerts Sithembile Bilima Robert S. Heyderman Neil French |
| author_facet | Amir Kirolos Todd D. Swarthout Andrew A. Mataya Farouck Bonomali Comfort Brown Jacquline Msefula Naor Bar-Zeev Pui-Ying Iroh Tam Maaike Alaerts Sithembile Bilima Robert S. Heyderman Neil French |
| author_sort | Amir Kirolos |
| collection | DOAJ |
| description | Abstract Introduction The introduction of PCV13 to the Malawi infant immunization schedule in 2011 has been associated with reduced disease from Streptococcus pneumoniae. Improved understanding of serotypes with high invasive potential can guide future vaccination interventions. We aimed to estimate pneumococcal serotypes associated with acute respiratory infection (ARI) and invasive pneumococcal disease (IPD) in hospitalized children in Blantyre, Malawi. Methods We analysed data from healthy children under 5 years in the community in Blantyre and children admitted to Queen Elizabeth Central Hospital with ARI between 2015 and 2018. Nasopharyngeal swabs from children were tested for S. pneumoniae and serotyped by latex agglutination if positive. We analysed culture-positive blood and cerebrospinal fluid samples from admitted children between 2012 and 2018 to identify cases of IPD after the introduction of PCV13. We calculated the age-adjusted odds ratio (OR) of carriage for S. pneumoniae vaccine serotypes (VT) comparing those with ARI to healthy children. We also calculated age-adjusted ORs comparing serotypes causing IPD to carriage in the community with OR > 1 indicating high invasive potential. Results Serotypes 5 (OR 24.73 [95% CI 7.90–78.56] p < 0.001), 1 (OR 23.38 [95% CI 9.75–56.06] p < 0.001), and 6B (OR 4.73 [95% CI 1.66–11.64] p = 0.001) had high invasive potential. Serotype 6B was no longer significant (OR 1.34 [95% CI 0.07–6.87] p = 0.777) in a sensitivity analysis accounting for year of recruitment. The prevalence of S. pneumoniae carriage in the community was 72.6% [95% CI 71.3–74.0] (3078/4238) and 23.4% (719/3078) of positive community samples were VT. The carriage prevalence in those hospitalised with ARI was 45.5% [95% CI 42.1–48.9] (389/855) and 43.8% of hospital attendees reported antibiotic use prior to admission. We did not identify significant associations with carriage of any serotypes in those with ARI. Conclusions Pneumococcal serotypes 5 and 1 are associated with high invasive potential. Despite high community pneumococcal carriage, pre-hospital antibiotic usage likely reduces pneumococcal detection among children admitted in this setting and further research is needed to investigate serotypes associated with ARI. Data from this study can guide future preventative vaccination strategies in Malawi. |
| first_indexed | 2024-04-10T19:45:11Z |
| format | Article |
| id | doaj.art-63167f6b39844ccaba2eed1a4eeaad19 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-04-10T19:45:11Z |
| publishDate | 2023-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-63167f6b39844ccaba2eed1a4eeaad192023-01-29T12:05:19ZengBMCBMC Infectious Diseases1471-23342023-01-012311710.1186/s12879-023-08022-4Invasiveness potential of pneumococcal serotypes in children after introduction of PCV13 in Blantyre, MalawiAmir Kirolos0Todd D. Swarthout1Andrew A. Mataya2Farouck Bonomali3Comfort Brown4Jacquline Msefula5Naor Bar-Zeev6Pui-Ying Iroh Tam7Maaike Alaerts8Sithembile Bilima9Robert S. Heyderman10Neil French11Department of Women’s and Children’s Health, Faculty of Health and Life Sciences, Institute of Life Course and Medical Sciences, University of LiverpoolMalawi-Liverpool-Wellcome Research ProgrammeMalawi-Liverpool-Wellcome Research ProgrammeMalawi-Liverpool-Wellcome Research ProgrammeMalawi-Liverpool-Wellcome Research ProgrammeMalawi-Liverpool-Wellcome Research ProgrammeInternational Vaccine Access Center, Johns Hopkins Bloomberg School of Public HealthMalawi-Liverpool-Wellcome Research ProgrammeCardiogenetics Research Group, Center of Medical Genetics, University of Antwerp and Antwerp University HospitalMalawi-Liverpool-Wellcome Research ProgrammeNIHR Mucosal Pathogens Research Unit, Division of Infection and Immunity, Research Department of Infection, University College LondonInstitute of Infection, Veterinary and Ecological Sciences, University of LiverpoolAbstract Introduction The introduction of PCV13 to the Malawi infant immunization schedule in 2011 has been associated with reduced disease from Streptococcus pneumoniae. Improved understanding of serotypes with high invasive potential can guide future vaccination interventions. We aimed to estimate pneumococcal serotypes associated with acute respiratory infection (ARI) and invasive pneumococcal disease (IPD) in hospitalized children in Blantyre, Malawi. Methods We analysed data from healthy children under 5 years in the community in Blantyre and children admitted to Queen Elizabeth Central Hospital with ARI between 2015 and 2018. Nasopharyngeal swabs from children were tested for S. pneumoniae and serotyped by latex agglutination if positive. We analysed culture-positive blood and cerebrospinal fluid samples from admitted children between 2012 and 2018 to identify cases of IPD after the introduction of PCV13. We calculated the age-adjusted odds ratio (OR) of carriage for S. pneumoniae vaccine serotypes (VT) comparing those with ARI to healthy children. We also calculated age-adjusted ORs comparing serotypes causing IPD to carriage in the community with OR > 1 indicating high invasive potential. Results Serotypes 5 (OR 24.73 [95% CI 7.90–78.56] p < 0.001), 1 (OR 23.38 [95% CI 9.75–56.06] p < 0.001), and 6B (OR 4.73 [95% CI 1.66–11.64] p = 0.001) had high invasive potential. Serotype 6B was no longer significant (OR 1.34 [95% CI 0.07–6.87] p = 0.777) in a sensitivity analysis accounting for year of recruitment. The prevalence of S. pneumoniae carriage in the community was 72.6% [95% CI 71.3–74.0] (3078/4238) and 23.4% (719/3078) of positive community samples were VT. The carriage prevalence in those hospitalised with ARI was 45.5% [95% CI 42.1–48.9] (389/855) and 43.8% of hospital attendees reported antibiotic use prior to admission. We did not identify significant associations with carriage of any serotypes in those with ARI. Conclusions Pneumococcal serotypes 5 and 1 are associated with high invasive potential. Despite high community pneumococcal carriage, pre-hospital antibiotic usage likely reduces pneumococcal detection among children admitted in this setting and further research is needed to investigate serotypes associated with ARI. Data from this study can guide future preventative vaccination strategies in Malawi.https://doi.org/10.1186/s12879-023-08022-4PneumococcusInvasive Pneumococcal DiseaseAcute Respiratory Infection |
| spellingShingle | Amir Kirolos Todd D. Swarthout Andrew A. Mataya Farouck Bonomali Comfort Brown Jacquline Msefula Naor Bar-Zeev Pui-Ying Iroh Tam Maaike Alaerts Sithembile Bilima Robert S. Heyderman Neil French Invasiveness potential of pneumococcal serotypes in children after introduction of PCV13 in Blantyre, Malawi BMC Infectious Diseases Pneumococcus Invasive Pneumococcal Disease Acute Respiratory Infection |
| title | Invasiveness potential of pneumococcal serotypes in children after introduction of PCV13 in Blantyre, Malawi |
| title_full | Invasiveness potential of pneumococcal serotypes in children after introduction of PCV13 in Blantyre, Malawi |
| title_fullStr | Invasiveness potential of pneumococcal serotypes in children after introduction of PCV13 in Blantyre, Malawi |
| title_full_unstemmed | Invasiveness potential of pneumococcal serotypes in children after introduction of PCV13 in Blantyre, Malawi |
| title_short | Invasiveness potential of pneumococcal serotypes in children after introduction of PCV13 in Blantyre, Malawi |
| title_sort | invasiveness potential of pneumococcal serotypes in children after introduction of pcv13 in blantyre malawi |
| topic | Pneumococcus Invasive Pneumococcal Disease Acute Respiratory Infection |
| url | https://doi.org/10.1186/s12879-023-08022-4 |
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