title: Epidemiology of serotype 19A isolates from invasive pneumococcal disease in German children.
abstract: BACKGROUND
  This study presents an analysis of 159 serotype 19A isolates from IPD in children before and after the general recommendation for childhood pneumococcal conjugate vaccination in Germany in July 2006. Vaccination formulations used were PCV7, PCV10 (from April 2009) and PCV13 (from Dec. 2009, replacing PCV7).
  
  
  METHODS
  Isolates from invasive pneumococcal disease in children were serotyped using the Quellung reaction, tested for antibiotic susceptibility and analysed for their multi locus sequence type.
  
  
  RESULTS
  In an analysis of 3328 isolates from invasive pneumococcal disease (IPD) in children that were sent to the German National Reference Center for Streptococci between July 1997 and June 2011, we show that the proportion of 19A isolates ranged between 1.7 and 4.2% in the period 1997 to 2006. After the recommendation for pneumococcal conjugate childhood vaccination, which was issued in July 2006, the proportion of 19A isolates increased significantly to 15.0% in 2010/11. Eight clonal complexes (CC) and groups accounted for 77.2% and 65.3% of all serotype 19A isolates before and after vaccination, respectively. While three CCs and several STs were not detected after vaccine introduction, four CCs and several STs first appeared after vaccination, including three ST320 isolates that could be traced to recent imports from the US, UK and India. The proportion of penicillin-nonsusceptible and of multidrug-resistant 19A isolates moderately increased after vaccine introduction. A significant increase in the use of cephalosporins and azithromycin was noted post-vaccination (p=0.00001 and p=0.0013 respectively).
  
  
  CONCLUSIONS
  The prevalence of serotype 19A in Germany has increased significantly between July 2007 and June 2011. Possible reasons for this are the introduction of pneumococcal conjugate vaccination, increased use of cephalosporins and azithromycin, import of multidrug-resistant isolates and increased reporting.
authors: Institute for Medical Microbiology, National Reference Center for Streptococci, Department of Medical Microbiology, University Hospital (RWTH), Pauwelsstr, 30, Aachen, 52074, Germany. mlinden@ukaachen.de
authors: Mark
authors: M
authors: van der Linden
authors: Ralf René
authors: RR
authors: Reinert
authors: Winfried V
authors: WV
authors: Kern
authors: Matthias
authors: M
authors: Imöhl
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D002648:Child; D002675:Child, Preschool; D024901:Drug Resistance, Multiple, Bacterial; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008826:Microbial Sensitivity Tests; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000517:prevention & control; D022242:Pneumococcal Vaccines / Q000276:immunology; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification* / Q000187:drug effects / Q000235:genetics / Q000276:immunology; D018074:Vaccines, Conjugate / Q000276:immunology
chemical_list: D000900:Anti-Bacterial Agents; D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate
references: Pediatr Infect Dis J. 2009 Feb;28(2):118-22
references: 19116604
references: Microbiology (Reading). 1998 Nov;144 ( Pt 11):3049-3060
references: 9846740
references: J Clin Microbiol. 2010 Jan;48(1):101-8
references: 19864476
references: Vaccine. 2009 Jun 24;27(31):4136-41
references: 19406190
references: N Engl J Med. 2003 May 1;348(18):1737-46
references: 12724479
references: J Infect Dis. 2005 Dec 1;192(11):1988-95
references: 16267772
references: Klin Padiatr. 2010 Mar;222(2):92-7
references: 20146163
references: Emerg Infect Dis. 2008 Feb;14(2):275-81
references: 18258121
references: J Infect Dis. 2011 May 15;203(10):1360-8
references: 21398395
references: Antimicrob Agents Chemother. 2008 Sep;52(9):3216-20
references: 18573928
references: Pediatrics. 2010 Mar;125(3):429-36
references: 20176669
references: BMC Genomics. 2009 Dec 30;10:642
references: 20042094
references: Vaccine. 2010 Jun 11;28(26):4249-59
references: 20416266
references: Vaccine. 2012 Aug 31;30(40):5880-5
references: 22771186
references: Pediatr Infect Dis J. 2011 Apr;30(4):302-8
references: 21085049
references: J Clin Microbiol. 2009 Mar;47(3):837-40
references: 19109482
references: JAMA. 2010 Sep 8;304(10):1099-106
references: 20823436
references: Clin Infect Dis. 2009 Feb 1;48(3):e23-33
references: 19115971
references: J Clin Microbiol. 2009 Apr;47(4):1012-20
references: 19225097
references: J Infect Dis. 2009 Mar 15;199(6):776-85
references: 19434927
references: J Infect Dis. 2008 Apr 1;197(7):1016-27
references: 18419539
references: JAMA. 2007 Apr 25;297(16):1784-92
references: 17456820
references: Wkly Epidemiol Rec. 2007 Mar 23;82(12):93-104
references: 17380597