Pneumococcal carriage in children in Ulaanbaatar, Mongolia before and one year after the introduction of the 13-valent pneumococcal conjugate vaccine

Nasopharyngeal carriage of Streptococcus pneumoniae precedes disease, is the source of pneumococcal community spread, and the mechanism for herd protection provided by pneumococcal conjugate vaccines (PCVs). There are few PCV impact studies in low- and middle-income countries, particularly in Asia....

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Vydáno v:	Vaccine Ročník 37; číslo 30; s. 4068 - 4075
Hlavní autoři:	von Mollendorf, Claire, Dunne, Eileen M., La Vincente, Sophie, Ulziibayar, Mukhchuluun, Suuri, Bujinlkham, Luvsantseren, Dashtseren, Narangerel, Dorj, Ortika, Belinda D., Pell, Casey L., Nation, Monica L., Alamrousi, Ahmed, Hinds, Jason, Demberelsuren, Sodbayar, Nguyen, Cattram, Mungun, Tuya, Mulholland, E. Kim, Satzke, Catherine
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	Netherlands Elsevier Ltd 09.07.2019 Elsevier Limited
Témata:	13-valent pneumococcal conjugate vaccine impact Age groups Allergy and Immunology antibiotic resistance Antimicrobial agents Antimicrobial resistance Caregivers Children Clinics Communities community health confidence interval Confidence intervals Conjugates Cross-Sectional Studies Density Deoxyribonucleic acid DNA DNA chips DNA microarrays Drug resistance Ethics Families & family life Female Genes Health facilities Herd immunity Humans Immunization Infant Laboratories Male Mongolia monitoring Nasopharynx - immunology Nasopharynx - microbiology Pneumococcal carriage Pneumococcal Infections - immunology Pneumococcal Infections - microbiology Pneumococcal Infections - prevention & control Pneumococcal Vaccines - therapeutic use Pneumonia Prevalence quantitative polymerase chain reaction Risk Factors Schedules Serotypes Serotyping Streptococcus infections Streptococcus pneumoniae Streptococcus pneumoniae - immunology Streptococcus pneumoniae - pathogenicity surveys vaccination Vaccines Vaccines, Conjugate - therapeutic use Mongolia Herd immunity Mongolia Children Antimicrobial resistance 13-valent pneumococcal conjugate vaccine impact Pneumococcal carriage
ISSN:	0264-410X, 1873-2518, 1873-2518
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Shrnutí:	Nasopharyngeal carriage of Streptococcus pneumoniae precedes disease, is the source of pneumococcal community spread, and the mechanism for herd protection provided by pneumococcal conjugate vaccines (PCVs). There are few PCV impact studies in low- and middle-income countries, particularly in Asia. In 2016, Mongolia introduced the 13-valent PCV (PCV13) in a phased manner using a 2 + 1 schedule, with catch-up. We aimed to assess the impact of PCV13 introduction on nasopharyngeal pneumococcal carriage and density in children in Mongolia. We conducted two cross-sectional carriage surveys (pre- and one year post-PCV) at community health clinics in two districts of the capital city, Ulaanbaatar in both May-July 2015 and 2017. The study analysis included 961 children too young to be vaccinated (5–8 weeks old) and 989 children eligible for vaccination (12–23 months old). Pneumococci were detected by quantitative real-time PCR and molecular serotyping performed using DNA microarray. One year post-PCV introduction, PCV13 serotype carriage reduced by 52% in 12–23 month olds (adjusted prevalence ratio [aPR] 0.48 [95% confidence interval [CI] 0.39–0.59]), with evidence of non-PCV13 serotype replacement (aPR 1.55 [95% CI 1.30–1.85]), compared with the pre-PCV period. In 5–8 week olds, PCV13 serotype carriage reduced by 51% (aPR 0.49 [95% CI 0.33–0.73]) with no significant change in non-PCV13 serotype carriage (aPR 1.10 [95% CI 0.83–1.46]). An increase was observed in both PCV13 and non-PCV13 pneumococcal density post-PCV introduction. Antimicrobial resistance (AMR) genes were common, with 82.3% of samples containing at least one of the 10 AMR genes assessed. This study demonstrates substantive PCV13 impact on pneumococcal carriage one year post-vaccine introduction in Mongolia. The reductions in PCV13 serotype carriage are likely to result in reductions in pneumococcal disease including indirect effects. Increases in non-PCV13 serotypes require further monitoring.
Bibliografie:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23
ISSN:	0264-410X 1873-2518 1873-2518
DOI:	10.1016/j.vaccine.2019.05.078