title: Noninvasive pneumococcal clones associated with antimicrobial nonsusceptibility isolated from children in the era of conjugate vaccines.
abstract: Carriage and noninvasive pneumococcal isolates frequently have a higher prevalence of antimicrobial nonsusceptibility than invasive isolates. From 2009 to 2014, we determined the associated clones in 169 pediatric noninvasive nonsusceptible pneumococci from a total of 506 isolates collected after 7- and 13-valent conjugate vaccine introduction (PCV7/13) to the Irish childhood immunization schedule in 2008 and 2010, respectively. We compared our results to those from 25 noninvasive pediatric pneumococcal isolates collected in 2007, the year before introduction of conjugate vaccines. In 2007, England(14)-9 and Spain(9V)-3 accounted for 12% and 32% of nonsusceptible clones, respectively, but in 2009 to 2014, their prevalence fell to 0% and 2.4%. Furthermore, there was a significant decline in Spain(6B)-2 and its variants from 2009 to 2014 (P = 0.0024). Fluctuations occurred in clonal complex 320 associated with serotype 19A. The prevalence of Sweden(15A)-25 and its variants and ST558 (a single-locus variant of Utah(35B)-24) associated with nonvaccine serotypes (NVT) 15A and 35B increased from 0% and 8% in 2007 to 19% and 16% in 2013 to 2014, respectively. Pilus locus 1 (PI-1) is associated with the spread of some nonsusceptible pneumococcal clones. PI-1 was more frequently associated with PCV7/13 serotypes than NVT (P = 0.0020). Our data highlight the value of surveillance of noninvasive pneumococci following conjugate vaccine introduction. Importantly, emerging clones associated with NVT may limit the effectiveness of PCV7/13 in reducing the high rate of nonsusceptibility among pediatric noninvasive pneumococci, with implications for empirical treatment strategies.
authors.affiliation: Epidemiology and Molecular Biology Unit and Irish Meningococcal and Meningitis Reference Laboratory, Temple Street Children's University Hospital, Dublin, Ireland Department of Clinical Microbiology, RCSI Education and Research Centre, Beaumont Hospital, Dublin, Ireland martha.mcelligott@cuh.ie.
authors.forename: Martha
authors.initials: M
authors.lastname: McElligott
authors.affiliation: Epidemiology and Molecular Biology Unit and Irish Meningococcal and Meningitis Reference Laboratory, Temple Street Children's University Hospital, Dublin, Ireland Department of Clinical Microbiology, RCSI Education and Research Centre, Beaumont Hospital, Dublin, Ireland.
authors.forename: Imelda
authors.initials: I
authors.lastname: Vickers
authors.affiliation: Epidemiology and Molecular Biology Unit and Irish Meningococcal and Meningitis Reference Laboratory, Temple Street Children's University Hospital, Dublin, Ireland.
authors.forename: Mary
authors.initials: M
authors.lastname: Meehan
authors.affiliation: Epidemiology and Molecular Biology Unit and Irish Meningococcal and Meningitis Reference Laboratory, Temple Street Children's University Hospital, Dublin, Ireland Department of Clinical Microbiology, RCSI Education and Research Centre, Beaumont Hospital, Dublin, Ireland.
authors.forename: Mary
authors.initials: M
authors.lastname: Cafferkey
authors.affiliation: Epidemiology and Molecular Biology Unit and Irish Meningococcal and Meningitis Reference Laboratory, Temple Street Children's University Hospital, Dublin, Ireland Health Protection Surveillance Centre, Dublin, Ireland.
authors.forename: Robert
authors.initials: R
authors.lastname: Cunney
authors.affiliation: Department of Clinical Microbiology, RCSI Education and Research Centre, Beaumont Hospital, Dublin, Ireland Department of Microbiology, Beaumont Hospital, Dublin, Ireland.
authors.forename: Hilary
authors.initials: H
authors.lastname: Humphreys
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D006801:Humans; D011008:Pneumococcal Infections / Q000188:drug therapy / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000627:therapeutic use*; D065288:Serogroup; D018074:Vaccines, Conjugate / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate