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Reduction of antimicrobial resistant pneumococci seven years after introduction of pneumococcal vaccine in Iceland

Reduction of antimicrobial resistant pneumococci seven years after introduction of pneumococcal vaccine in Iceland


Title: Reduction of antimicrobial resistant pneumococci seven years after introduction of pneumococcal vaccine in Iceland
Author: Hjálmarsdóttir, Martha Ásdís   orcid.org/0000-0002-9764-9943
Haraldsson, Gunnsteinn Ægir
Quirk, Sigríður Júlía   orcid.org/0000-0002-8254-9720
Haraldsson, Ásgeir
Erlendsdóttir, Helga
Kristinsson, Karl Gústaf
Date: 2020
Language: English
Scope:
University/Institute: Landspitali - The National University Hospital of Iceland
Department: Faculty of Medicine
Clinical Laboratory Services, Diagnostics and Blood Bank
Women's and Childrens's Services
Series: PLoS ONE; 15(3)
ISSN: 1932-6203
DOI: https://doi.org/10.1371/journal.pone.0230332
Subject: Sýklalyfjaónæmi; Bóluefni; Biochemistry, Genetics and Molecular Biology (all); Agricultural and Biological Sciences (all); Multidisciplinary
URI: https://hdl.handle.net/20.500.11815/3358

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Citation:

Hjálmarsdóttir , M Á , Haraldsson , G Æ , Quirk , S J , Haraldsson , Á , Erlendsdóttir , H & Kristinsson , K G 2020 , ' Reduction of antimicrobial resistant pneumococci seven years after introduction of pneumococcal vaccine in Iceland ' , PLoS ONE , vol. 15 , no. 3 , e0230332 . https://doi.org/10.1371/journal.pone.0230332

Abstract:

Background Penicillin non-susceptible (PNSP) and multi-resistant pneumococci have been prevalent in Iceland since early nineties, mainly causing problems in treatment of acute otitis media. The 10-valent protein conjugated pneumococcal vaccine (PHiD-CV) was introduced into the childhood vaccination program in 2011. The aim of the study was to investigate the changes in antimicrobial susceptibility and serotype distribution of penicillin non-susceptible pneumococci (PNSP) in Iceland 2011-2017. Methods and findings All pneumococcal isolates identified at the Landspítali University Hospital in 2011-2017, excluding isolates from the nasopharynx and throat were studied. Susceptibility testing was done according to the EUCAST guidelines using disk diffusion with chloramphenicol, erythromycin, clindamycin, tetracycline, trimethoprim/sulfamethoxazole and oxacillin for PNSP screening. Penicillin and ceftriaxone minimum inhibitory concentrations (MIC) were measured for oxacillin resistant isolates using the E-test. Serotyping was done using latex agglutination and/or multiplex PCR. The total number of pneumococcal isolates that met the study criteria was 1,706, of which 516 (30.2%) were PNSP, and declining with time. PNSP isolates of PHiD-CV vaccine serotypes (VT) were 362/516 (70.2%) declining with time, 132/ 143 (92.3%) in 2011 and 17/54 (31.5%) in 2017. PNSP were most commonly of serotype 19F, 317/516 isolates declining with time, 124/143 in 2011 and 15/54 in 2017. Their number decreased in all age groups, but mainly in the youngest children. PNSP isolates of non PHiD-CV vaccine serotypes (NVT) were 154/516, increasing with time, 11/14, in 2011 and 37/54 in 2017. The most common emerging NVTs in 2011 and 2017 were 6C, 1/143 and 10/ 54 respectively. Conclusions PNSP of VTs have virtually disappeared from children with pneumococcal diseases after the initiation of pneumococcal vaccination in Iceland and a clear herd effect was observed. This was mainly driven by a decrease of PNSP isolates belonging to a serotype 19F multiresistant lineage. However, emerging multi-resistant NVT isolates are of concern.

Description:

Funding: This work is an investigator-initiated study that was supported by grants from: - The Landspítali University Hospital Research Fund (MÁH) https://www.landspitali.is - GlaxoSmithKline Biologicals SA (KGK, HE, ÁH), https://www.gsk.com The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: This work is an investigator-initiated study that was supported by grants from: - The Landspítali University Hospital Research Fund (MÁH) https://www.landspitali.is - GlaxoSmithKline Biologicals SA https://www.gsk.com The authors declare that this does not alter our adherence to PLOS ONE policies on sharing data and materials. Neither GlaxoSmithKline Biologicals SA, nor Landspítali University Hospital Research Fund had any role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Publisher Copyright: Copyright: © 2020 Hjálmarsdóttir et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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