Predictors of pneumococcal carriage and the effect of the 13-valent pneumococcal conjugate vaccination in the Western Australian Aboriginal population

Deirdre Collins, Anke Hoskins, Thomas Snelling, Kalpani Senasinghe, Jacinta Bowman, Natalie Stemberger, Amanda Leach, Deborah Lehmann

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    Abstract

    Background: The 7-valent pneumococcal conjugate vaccine (PCV7) was introduced to prevent invasive pneumococcaldisease (IPD) in Western Australian (WA) Aboriginal people in 2001. PCV13 replaced PCV7 in July 2011, covering sixadditional pneumococcal serotypes; however, IPD rates remained high in Aboriginal people in WA. Upper respiratorytract pneumococcal carriage can precede IPD, and PCVs alter serotype distribution.
    Methods: To assess the impact of PCV13 introduction, identify emerging serotypes, and assess risk factors for carriage,nasopharyngeal swabs and information on demographic characteristics, health, medication and living conditions fromAboriginal children and adults across WA from August 2008 to November 2014 were collected. Bacteria were culturedusing selective media and pneumococcal isolates were serotyped by Quellung reaction. Risk factors were analysed bymultivariable logistic regression.
    Results: One thousand five hundred swabs pre- and 1385 swabs post-PCV13 introduction were collected. Pneumococcalcarriage was detected in 66.8% of children <5 years old and 53.2% of 5–14 year-olds post-PCV13, compared with pre-PCV13 prevalence of 72.2% and 49.4%, respectively. The prevalence of PCV13-non-PCV7 serotypes decreased inchildren <5 years old from 13.5% pre-PCV13 to 5.8% post-PCV13 (p < 0.01), and from 8.4% to 6.1% in children5–14 years old (p > 0.05). The most common serotypes post-PCV13 were 11A (prevalence 4.0%), 15B (3.5%),16F (3.5%), and 19F (3.2%).Risk of detection of pneumococcal carriage increased until age 12 months (odds ratio [OR] 4.19, 95% confidence interval[CI] 2.39–7.33), with nasal discharge (OR 2.49 [95% CI 2.00–3.09]), residence in a remote community (OR 2.21 [95% CI 1.67–2.92]) and household crowding (OR 1.36 [95% CI 1.11–1.67]). Recent antibiotic use was negatively associated withpneumococcal carriage (OR 0.48 [95% CI 0.33–0.69]). Complete resistance to penicillin was present among isolatesof serotypes 19A (6.0%), 19F (2.3%) and non-serotypeable isolates (1.9%). Serotype 23F and newly emerged serotype 7Bisolates showed high rates of resistance to cotrimoxazole, erythromycin and tetracycline (86.9%, 86.9%, 82.0%, respectivelyfor 23F, 100.0%, 100.0% and 93.3% for 7B).
    Conclusion: Since PCV13 replaced PCV7, carriage of PCV13-non-PCV7 serotypes decreased significantly among children<5 years old, those most likely to have received PCV13, and to a lesser extent in older people. Known risk factors forcarriage including crowding and young age remain in the Aboriginal population.
    Original languageEnglish
    Article number14
    Pages (from-to)1-11
    Number of pages11
    JournalPneumonia
    Volume9
    DOIs
    Publication statusPublished - 2017

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