Document Type

Journal Article

Publication Title

Pneumonia

Publisher

BioMed Central Ltd

School

School of Medical and Health Sciences

RAS ID

25285

Funders

WA Department of Health through the Collaboration for Applied Research and Evaluation (CARE)

National Health and Medical Research Council (NHMRC) of Australia

Grant Number

NHMRC Number : 545232

Comments

Collins, D. A., Hoskins, A., Snelling, T., Senasinghe, K., Bowman, J., Stemberger, N. A., ... & Lehmann, D. (2017). Predictors of pneumococcal carriage and the effect of the 13-valent pneumococcal conjugate vaccination in the Western Australian Aboriginal population. Pneumonia, 9(1), 14.

https://doi.org/10.1186/s41479-017-0038-x

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 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 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 childrenold, 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.

DOI

10.1186/s41479-017-0038-x

Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

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