Nasopharyngeal carriage of Streptococcus pneumoniae in Taiwan before and after the introduction of a conjugate vaccine

Chen Yen Kuo, Kao Pin Hwang, Yu Chia Hsieh, Chi Hui Cheng, Fang Liang Huang, Yea Huei Shen, Yhu Chering Huang, Cheng Hsun Chiu, Po Yen Chen, Tzou Yien Lin

Research output: Contribution to journalArticle

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Abstract

Background: The heptavalent pneumococcal conjugate vaccine was introduced in Taiwan in October 2005. To evaluate the effect of the vaccination, we conducted an active, prospective, large-scale, long-term, and multicenter study to assess the prevalence of nasopharyngeal Streptococcus pneumoniae carriage in Taiwanese children. Methods: This study was performed at three tertiary teaching hospitals in northern, central, and southern Taiwan. Questionnaires provided demographic, family/household, and medical history data. Pneumococcal isolates were tested for their susceptibility to various antimicrobial agents and serotypes. In addition, influenza virus and Staphylococcus aureus were recovered from nasopharyngeal and nasal swabs, respectively. Results: Between July 2005 and July 2008, 857 pneumococcal strains were recovered from a total of 6057 children aged >2 months to 5 years (carriage rate, 14.1%). Carriage rates differed geographically and varied with subject age. In a multivariate analysis, having at least one sibling, attendance at day-care centers, a history of otitis media, and history of upper respiratory tract infection in the previous 2 weeks were each associated with a higher risk of pneumococcal colonization of the nasopharynx. Staphylococcus aureus nasal colonization was inversely associated with nasopharyngeal carriage of pneumococcus (p= 0.000; odds ratio [OR]: 0.48; 95% CI: 0.39-0.58). Daycare attendance was the only risk factor for carriage of penicillin non-susceptible S. pneumoniae (OR: 2.37; 95% CI: 1.22-4.88). Although vaccination rates rose from 2005 to 2008, no concomitant decrease in S. pneumoniae carriage occurred. The rate of penicillin resistance among S. pneumoniae isolates was 92.8% (using the meningitis criteria). The prevalence of cefotaxime resistance (21.6%) was higher than that of penicillin (6.9%; non-meningitis criteria). Slightly more than half (57.4%) of the isolates belonged to strains covered by the heptavalent pneumococcal conjugate vaccine when both vaccine and vaccine-related serotypes were included. Conclusions: Although vaccination rates rose from 2005 to 2008, no concomitant decrease occurred in S. pneumoniae carriage. Interaction between S. aureus and S. pneumoniae may influence vaccination efficacy. These findings provide baseline data to further compare pneumococcal carriage rates and antibiotic resistance patterns in Taiwanese children as vaccination rates continue to increase.

Original languageEnglish
Pages (from-to)5171-5177
Number of pages7
JournalVaccine
Volume29
Issue number32
DOIs
Publication statusPublished - Jul 18 2011
Externally publishedYes

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Conjugate Vaccines
Streptococcus pneumoniae
Taiwan
vaccines
Vaccination
vaccination
penicillins
Staphylococcus aureus
Nose
Penicillins
odds ratio
serotypes
Medical History Taking
Rosa
Vaccines
Odds Ratio
day care centers
Staphylococcal Pneumonia
Penicillin Resistance
nasopharynx

Keywords

  • Carriage
  • Streptococcus pneumoniae
  • Vaccine

ASJC Scopus subject areas

  • Immunology and Microbiology(all)
  • Infectious Diseases
  • Public Health, Environmental and Occupational Health
  • veterinary(all)
  • Molecular Medicine

Cite this

Nasopharyngeal carriage of Streptococcus pneumoniae in Taiwan before and after the introduction of a conjugate vaccine. / Kuo, Chen Yen; Hwang, Kao Pin; Hsieh, Yu Chia; Cheng, Chi Hui; Huang, Fang Liang; Shen, Yea Huei; Huang, Yhu Chering; Chiu, Cheng Hsun; Chen, Po Yen; Lin, Tzou Yien.

In: Vaccine, Vol. 29, No. 32, 18.07.2011, p. 5171-5177.

Research output: Contribution to journalArticle

Kuo, CY, Hwang, KP, Hsieh, YC, Cheng, CH, Huang, FL, Shen, YH, Huang, YC, Chiu, CH, Chen, PY & Lin, TY 2011, 'Nasopharyngeal carriage of Streptococcus pneumoniae in Taiwan before and after the introduction of a conjugate vaccine', Vaccine, vol. 29, no. 32, pp. 5171-5177. https://doi.org/10.1016/j.vaccine.2011.05.034
Kuo, Chen Yen ; Hwang, Kao Pin ; Hsieh, Yu Chia ; Cheng, Chi Hui ; Huang, Fang Liang ; Shen, Yea Huei ; Huang, Yhu Chering ; Chiu, Cheng Hsun ; Chen, Po Yen ; Lin, Tzou Yien. / Nasopharyngeal carriage of Streptococcus pneumoniae in Taiwan before and after the introduction of a conjugate vaccine. In: Vaccine. 2011 ; Vol. 29, No. 32. pp. 5171-5177.
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AU - Huang, Fang Liang

AU - Shen, Yea Huei

AU - Huang, Yhu Chering

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AU - Lin, Tzou Yien

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N2 - Background: The heptavalent pneumococcal conjugate vaccine was introduced in Taiwan in October 2005. To evaluate the effect of the vaccination, we conducted an active, prospective, large-scale, long-term, and multicenter study to assess the prevalence of nasopharyngeal Streptococcus pneumoniae carriage in Taiwanese children. Methods: This study was performed at three tertiary teaching hospitals in northern, central, and southern Taiwan. Questionnaires provided demographic, family/household, and medical history data. Pneumococcal isolates were tested for their susceptibility to various antimicrobial agents and serotypes. In addition, influenza virus and Staphylococcus aureus were recovered from nasopharyngeal and nasal swabs, respectively. Results: Between July 2005 and July 2008, 857 pneumococcal strains were recovered from a total of 6057 children aged >2 months to 5 years (carriage rate, 14.1%). Carriage rates differed geographically and varied with subject age. In a multivariate analysis, having at least one sibling, attendance at day-care centers, a history of otitis media, and history of upper respiratory tract infection in the previous 2 weeks were each associated with a higher risk of pneumococcal colonization of the nasopharynx. Staphylococcus aureus nasal colonization was inversely associated with nasopharyngeal carriage of pneumococcus (p= 0.000; odds ratio [OR]: 0.48; 95% CI: 0.39-0.58). Daycare attendance was the only risk factor for carriage of penicillin non-susceptible S. pneumoniae (OR: 2.37; 95% CI: 1.22-4.88). Although vaccination rates rose from 2005 to 2008, no concomitant decrease in S. pneumoniae carriage occurred. The rate of penicillin resistance among S. pneumoniae isolates was 92.8% (using the meningitis criteria). The prevalence of cefotaxime resistance (21.6%) was higher than that of penicillin (6.9%; non-meningitis criteria). Slightly more than half (57.4%) of the isolates belonged to strains covered by the heptavalent pneumococcal conjugate vaccine when both vaccine and vaccine-related serotypes were included. Conclusions: Although vaccination rates rose from 2005 to 2008, no concomitant decrease occurred in S. pneumoniae carriage. Interaction between S. aureus and S. pneumoniae may influence vaccination efficacy. These findings provide baseline data to further compare pneumococcal carriage rates and antibiotic resistance patterns in Taiwanese children as vaccination rates continue to increase.

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