title: Temporal changes in nasopharyngeal carriage of Streptococcus pneumoniae serotype 1 genotypes in healthy Gambians before and after the 7-valent pneumococcal conjugate vaccine.
abstract: Streptococcus pneumoniae serotype 1 is one of the leading causes of invasive pneumococcal disease. However, this invasive serotype is hardly found in nasopharyngeal asymptomatic carriage and therefore large epidemiological studies are needed to assess the dynamics of serotype 1 infection. Within the context of a large cluster randomized trial conducted in rural Gambia to assess the impact of PCV-7 vaccination on nasopharyngeal carriage, we present an ancillary analysis describing the prevalence of nasopharyngeal carriage of pneumococcal serotype 1 and temporal changes of its more frequent genotypes. Nasopharyngeal swabs (NPS) were collected before PCV-7 vaccination (December 2003-May 2004) and up to 30 months after PCV-7 vaccination. The post-vaccination time was divided in three periods to ensure an equal distribution of the number of samples: (1) July 2006-March 2007, (2) April 2007-March 2008 and (3) April 2008-Feb 2009. S. pneumoniae serotype 1 were genotyped by MLST. Serotype 1 was recovered from 87 (0.71%) of 12,319 NPS samples collected. In the pre-vaccination period, prevalence of serotype 1 was 0.47% in both study arms. In the post-vaccination periods, prevalence in the fully vaccinated villages ranged between 0.08% in period 1 and 0.165% in period 2, while prevalence in partly vaccinated villages was between 0.17% in period 3 and 1.34% in period 2. Overall, four different genotypes were obtained, with ST3081 the most prevalent (60.71%), followed by ST618 (29.76%). ST3081 was found only in post-vaccination period 2 and 3, while ST618 had disappeared in post-vaccination period 3. Distribution of these major genotypes was similar in both study arms. Emergence of ST3081 and concomitant disappearance of ST618 may suggest a change in the molecular epidemiology of pneumococcal serotype 1 in this region. This change is not likely to be associated with the introduction of PCV-7 which lacks serotype 1, as it was observed simultaneously in both study arms. Future population-based epidemiological studies will provide further evidence of substantive changes in the pneumococcal serotype 1 epidemiology and the likely mechanisms.
authors.affiliation: Vaccinology Theme, Medical Research Council Unit , Banjul , The Gambia ; Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine , London , United Kingdom.
authors.forename: Chinelo
authors.initials: C
authors.lastname: Ebruke
authors.affiliation: Vaccinology Theme, Medical Research Council Unit , Banjul , The Gambia.
authors.forename: Anna
authors.initials: A
authors.lastname: Roca
authors.affiliation: Vaccinology Theme, Medical Research Council Unit , Banjul , The Gambia.
authors.forename: Uzochukwu
authors.initials: U
authors.lastname: Egere
authors.affiliation: Vaccinology Theme, Medical Research Council Unit , Banjul , The Gambia.
authors.forename: Ousainou
authors.initials: O
authors.lastname: Darboe
authors.affiliation: Centre for International Health, School of Medicine, University of Otago , New Zealand.
authors.forename: Philip C
authors.initials: PC
authors.lastname: Hill
authors.affiliation: Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine , London , United Kingdom.
authors.forename: Brian
authors.initials: B
authors.lastname: Greenwood
authors.affiliation: Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine , London , United Kingdom.
authors.forename: Brendan W
authors.initials: BW
authors.lastname: Wren
authors.affiliation: Vaccinology Theme, Medical Research Council Unit , Banjul , The Gambia ; GlaxoSmithKline Biologicals Wavre , Belgium.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Adegbola
authors.affiliation: Vaccinology Theme, Medical Research Council Unit , Banjul , The Gambia ; Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine , London , United Kingdom ; Microbiology and Infection Unit, Warwick Medical School, University of Warwick , Coventry , United Kingdom.
authors.forename: Martin
authors.initials: M
authors.lastname: Antonio
keywords: 7-valent pneumococcal conjugate vaccine; Gambia; Invasive pneumococcal disease; Molecular epidemiology; Multilocus Sequence Typing; Nasopharyngeal Swab; Nasopharyngeal carriage; ST217 hyper virulent clonal complex; Sequence type; Streptococcus pneumoniae serotype 1