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Evolution of pneumococcal serotype 19A in children in Bangladesh: insights from genomic analysis

Arif Mohammad Tanmoy1, Esha Kazi1, Naito Kanon1

  • 1Child Health Research Foundation, Dhaka, Bangladesh.

BMC Microbiology
|November 25, 2025
PubMed

Insights

Invasive pneumococcal disease (IPD) caused by Streptococcus pneumoniae serotype 19A did not increase in Bangladeshi children after PCV10 vaccine introduction. Continuous genomic surveillance is crucial due to evolving local 19A strains and increasing macrolide resistance.

Area of Science:

  • Microbiology
  • Genomics
  • Epidemiology

Background:

  • Invasive pneumococcal disease (IPD) caused by Streptococcus pneumoniae is a significant global health threat, especially for children.
  • Serotype 19A is noted for multidrug resistance (MDR) and increased incidence post-vaccine introduction in many regions.
  • Bangladesh introduced the 10-valent pneumococcal conjugate vaccine (PCV10) in 2015, anticipating a low burden of serotype 19A.

Purpose of the Study:

  • To investigate the hospital incidence of serotype 19A in children under five years old in Bangladesh before and after PCV10 introduction.
  • To conduct a comprehensive genomic analysis of serotype 19A isolates to understand population structure, antimicrobial resistance, and evolutionary dynamics.
  • To assess the impact of PCV10 introduction on the prevalence of specific 19A lineages and their resistance patterns.

Main Methods:

  • Longitudinal IPD surveillance data from 2004 to 2023 were analyzed for hospital incidence trends of serotype 19A.
  • Whole-genome sequencing was performed on 153 serotype 19A isolates from various sample types (IPD, otitis media, carriage, urine).
  • Phylogenetic and Bayesian Evolutionary Analysis Sampling Trees (BEAST) analyses were employed to determine population structure, global pneumococcal sequence clusters (GPSCs), sequence types (STs), and antimicrobial resistance genes, comparing them with global 19A genomes.

Main Results:

  • No increase in hospital IPD incidence due to serotype 19A was observed post-PCV10 introduction.
  • The multidrug-resistant 19A-ST320 lineage (GPSC1) was notably absent in Bangladesh.
  • A new dominant lineage, ST12888 (GPSC84) carrying the 19A subtype-I (19A-I) capsular locus, emerged and increased from 15% to 70% post-PCV10 introduction.
  • Increasing macrolide resistance was detected within the 19A-I/GPSC84 lineage, with estimated origins between 2007 and 2011.

Conclusions:

  • The study supports Bangladesh's decision to implement PCV10 based on pre-vaccination serotype burden data.
  • The emergence and rapid spread of the 19A-I/GPSC84 lineage highlight the dynamic nature of pneumococcal populations.
  • Continuous epidemiological and genomic surveillance is essential for monitoring vaccine effectiveness and adapting public health strategies against evolving Streptococcus pneumoniae strains.
Abstract

Keywords:
BangladeshEvolutionGenomicsInvasive pneumococcal diseasePCV10Serotype 19AStreptococcus pneumoniae

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