title: Prevention of Antibiotic-Nonsusceptible Invasive Pneumococcal Disease With the 13-Valent Pneumococcal Conjugate Vaccine.
abstract: BACKGROUND
  Antibiotic-nonsusceptible invasive pneumococcal disease (IPD) decreased substantially after the US introduction of the pediatric 7-valent pneumococcal conjugate vaccine (PCV7) in 2000. However, rates of antibiotic-nonsusceptible non-PCV7-type IPD increased during 2004-2009. In 2010, the 13-valent pneumococcal conjugate vaccine (PCV13) replaced PCV7. We assessed the impact of PCV13 on antibiotic-nonsusceptible IPD rates.
  
  
  METHODS
  We defined IPD as pneumococcal isolation from a normally sterile site in a resident from 10 US surveillance sites. Antibiotic-nonsusceptible isolates were those intermediate or resistant to ≥1 antibiotic classes according to 2012 Clinical and Laboratory Standards Institute breakpoints. We examined rates of antibiotic nonsusceptibility and estimated cases prevented between observed cases of antibiotic-nonsusceptible IPD and cases that would have occurred if PCV13 had not been introduced.
  
  
  RESULTS
  From 2009 to 2013, rates of antibiotic-nonsusceptible IPD caused by serotypes included in PCV13 but not in PCV7 decreased from 6.5 to 0.5 per 100 000 in children aged <5 years and from 4.4 to 1.4 per 100 000 in adults aged ≥65 years. During 2010-2013, we estimated that 1636 and 1327 cases of antibiotic-nonsusceptible IPD caused by serotypes included in PCV13 but not PCV7 were prevented among children aged <5 years (-97% difference) and among adults aged ≥65 years (-64% difference), respectively. Although we observed small increases in antibiotic-nonsusceptible IPD caused by non-PCV13 serotypes, no non-PCV13 serotype dominated among antibiotic-nonsusceptible strains.
  
  
  CONCLUSIONS
  After PCV13 introduction, antibiotic-nonsusceptible IPD decreased in multiple age groups. Continued surveillance is needed to monitor trends of nonvaccine serotypes. Pneumococcal conjugate vaccines are important tools in the approach to combat antibiotic resistance.
authors.affiliation: Epidemic Intelligence Service Respiratory Diseases Branch, Centers for Disease Control and Prevention.
authors.forename: Sara
authors.initials: S
authors.lastname: Tomczyk
authors.affiliation: Minnesota Department of Health, St. Paul.
authors.forename: Ruth
authors.initials: R
authors.lastname: Lynfield
authors.affiliation: Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: William
authors.initials: W
authors.lastname: Schaffner
authors.affiliation: University of California School of Public Health, Berkeley.
authors.forename: Arthur
authors.initials: A
authors.lastname: Reingold
authors.affiliation: Colorado Department of Public Health & Environment, Denver.
authors.forename: Lisa
authors.initials: L
authors.lastname: Miller
authors.affiliation: Connecticut Department of Public Health, Hartford.
authors.forename: Susan
authors.initials: S
authors.lastname: Petit
authors.affiliation: Minnesota Department of Health, St. Paul.
authors.forename: Corinne
authors.initials: C
authors.lastname: Holtzman
authors.affiliation: New York State Department of Health, Albany.
authors.forename: Shelley M
authors.initials: SM
authors.lastname: Zansky
authors.affiliation: Oregon Public Health Division, Portland.
authors.forename: Ann
authors.initials: A
authors.lastname: Thomas
authors.affiliation: New Mexico Department of Health, Santa Fe.
authors.forename: Joan
authors.initials: J
authors.lastname: Baumbach
authors.affiliation: John Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Lee H
authors.initials: LH
authors.lastname: Harrison
authors.affiliation: Emory University School of Medicine Veterans Affairs Medical Center, Atlanta, Georgia.
authors.forename: Monica M
authors.initials: MM
authors.lastname: Farley
authors.affiliation: Respiratory Diseases Branch, Centers for Disease Control and Prevention.
authors.forename: Bernard
authors.initials: B
authors.lastname: Beall
authors.affiliation: Respiratory Diseases Branch, Centers for Disease Control and Prevention.
authors.forename: Lesley
authors.initials: L
authors.lastname: McGee
authors.affiliation: Respiratory Diseases Branch, Centers for Disease Control and Prevention.
authors.forename: Ryan
authors.initials: R
authors.lastname: Gierke
authors.affiliation: Respiratory Diseases Branch, Centers for Disease Control and Prevention.
authors.forename: Tracy
authors.initials: T
authors.lastname: Pondo
authors.affiliation: Respiratory Diseases Branch, Centers for Disease Control and Prevention.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000188:drug therapy / Q000276:immunology / Q000517:prevention & control*; D022242:Pneumococcal Vaccines; D065288:Serogroup; D013296:Streptococcus pneumoniae / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: C538862:13-valent pneumococcal vaccine; D000900:Anti-Bacterial Agents; D022242:Pneumococcal Vaccines
keywords: Streptococcus pneumoniae; antibiotic nonsusceptibility; pneumococcal conjugate vaccine; resistance