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Published on: February 23, 2014
Changes in composition of respiratory bacteria colonizing pneumococcal conjugate vaccinated children, 2006-2023
Frank N Salamone1, Andrew Cox1, Ravinder Kaur1
1Center for Infectious Diseases and Immunology, Rochester General Hospital Research Institute, Rochester, NY 14621, USA.
Insights
The 13-valent pneumococcal conjugate vaccine (PCV13) changed Streptococcus pneumoniae serotypes but not overall colonization rates in children. Nasopharyngeal bacteria in healthy children and uncomplicated acute otitis media (AOM) differed from complex AOM.
Area of Science:
- Pediatric infectious diseases
- Vaccinology
- Microbiology
Background:
- The 13-valent pneumococcal conjugate vaccine (PCV13) was introduced to reduce pneumococcal disease burden.
- Understanding nasopharyngeal colonization patterns is crucial for vaccine impact assessment.
- The relationship between colonization and acute otitis media (AOM) requires ongoing investigation.
Purpose of the Study:
- To evaluate the impact of PCV13 introduction on nasopharyngeal colonization patterns in children.
- To examine the association between nasopharyngeal colonization and acute otitis media (AOM) development.
- To analyze changes in respiratory pathogen distribution following PCV13 implementation.
Main Methods:
- Prospective cohort study of 1537 children aged 6-36 months across PCV7, early-PCV13, and late-PCV13 eras.
- Nasopharyngeal cultures collected during healthy visits and AOM episodes.
- Paired tympanocentesis performed when indicated; analysis of pathogen distribution and serotype changes.
Main Results:
- PCV13 introduction led to serotype replacement in Streptococcus pneumoniae but stable overall colonization rates.
- Haemophilus influenzae rates remained constant, while Moraxella catarrhalis increased.
- Nasopharyngeal pathogen distribution differed significantly between healthy/uncomplicated AOM and complex AOM cases.
- Nasopharyngeal culture was a poor predictor of middle ear fluid isolates.
Conclusions:
- PCV13 effectively replaced targeted serotypes but did not reduce overall pneumococcal nasopharyngeal carriage.
- Distinct respiratory pathogen profiles exist for uncomplicated versus complex AOM.
- Changes in nasopharyngeal colonization patterns post-PCV13 have implications for AOM epidemiology.
Abstract:
We hypothesized that the introduction of 13-valent pneumococcal conjugate vaccine (PCV13) would alter patterns of nasopharyngeal colonization and their relationship to acute otitis media (AOM) in children. We prospectively followed 1537 children from age 6-36 months across three periods: 2006-2009 (PCV7 era), 2010-2014 (early-PCV13 era), and 2015-2023 (late-PCV13 era), collecting nasopharyngeal cultures at healthy and AOM visits, with paired tympanocentesis when appropriate. Colonized children had more frequent daycare attendance and less breastfeeding. Children with no AOM differed from those with uncomplicated AOM (uAOM) by less colonization with respiratory pathogens. Complex AOM (cAOM) nasopharyngeal samples exhibited a higher frequency of Haemophilus influenzae, and vaccine serotype Streptococcus pneumoniae, compared to no AOM and uAOM children. Serotype distribution of S. pneumoniae changed, with replacement of PCV13 serotypes. Streptococcus pneumoniae nasopharyngeal isolation rates remained stable despite serotype replacement. Haemophilus influenzae isolation rates remained constant and Moraxella catarrhalis increased. Nasopharyngeal culture was a poor predictor of middle ear fluid culture. Respiratory bacterial pathogen distribution in healthy children and those with uAOM were similar and both were distinct from cAOM, with significant vaccine-driven serotype replacement occurring without reducing overall pneumococcal colonization.
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