child ildren <5 5 years old ld, , in in Southern Is Israel, - - PowerPoint PPT Presentation

Dyn ynamics of Non-susceptib ible le S. . pneumoniae nasopharyngeal colo lonization in in hospit italized child ildren <5 5 years old ld, , in in Southern Is Israel, , early ly and post PCV's 's im imple lementation

The Pediatric Infectious Disease Unit Soroka University Medical Center Ben-Gurion University Beer-Sheva, Israel

Dana Danino, Noga Givon-Lavi, Shalom Ben-Shimol, David Greenberg, Ron Dagan

Disclosure

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Pneumococcal nasopharyngeal colonization

Port of entry for mucosal and invasive infections Source of transmission Site of potential acquisition of antibiotic resistance Children < 5 years are the main carriers, and thus also the main transmitters

PCVs impact on pneumococcal carriage VT13 Non VT13

(Replacement)

Overall carriage

+/- ?

Within-serotype nonsusceptibility

(Continuous antibiotic pressure)

Methods

• An ongoing, prospective, population-based, active surveillance, one

hospital serving the entire population

• Vaccination program and Vaccine uptake ≥2 doses
• Every working day, 8 children <5 years, visiting the pediatric emergency

room were enrolled, since Nov 2009

• Methodology of nasopharyngeal cultures, microbiology, serotyping and

susceptibility testing were previously described (Dagan et al, JID, 211:1144,

2015, Human Vaccine Immunother, 12(2): 268-276,2016)

PCV7- NIP + catch-up PCV7- private market PCV13- NIP

NIP= national immunization program

Antibiotic non-susceptibility rates between VT13 and non-VT13 carried serotypes prior to the impact of PCVs (07/2009-06/2010)

% of all positive cultures VT13 serotypes (n=318) Non VT13 serotypes (n=261)

S= susceptible, Pen= penicillin, Ery= erythromycin, Clind= clindamycin % % % % % % % % % <0.001 <0.001 <0.001 <0.001 <0.001 <0.001

% of all cultures

Over erall all Pneumococcal car neumococcal carria riage ge

(n= (n=4,166)

PCV PCV7 NIP + catch-up PCV PCV13 13 NIP

Dynamics of pneumococcal carriage, 2009 - 2015

PCV PCV7 private market

% % % % % %

<0.001* <0.001* <0.001*

% Non VT Non VT13 13 ser eroty

• types

pes

(n= (n=2,962) )

VT13 serotypes

(n=1,204)

10 20 30 40 50

Antibiotic non-susceptibility rates: all non-VT13 serotypes (N=2,962)

% of non-VT13 positive cultures

S= susceptible, Pen= penicillin, Ery= erythromycin, Clind= clindamycin * Rate ratio (confidence intervals)

% % % % % %

2009-10 2014-15

1.2 (1.0-1.4)* 1.6 (1.0-2.5)* 2.6 (1.5-4.3)* 2.6 (1.4-5.1)* 1.9 (1.4-2.5)* 2.7 (1.6-4.3)*

Dynamics in Non-susceptibility; 5 most common non-VT13 serotypes

% of Non-VT13 positive cultures % of Non-VT13 positive cultures

2009-10

% Pen= penicillin, Ery= erythromycin, Clind= clindamycin

* =P value <0.05 ; trend in proportion for all years 2009-10 – 2014-15

% % % % % % % % % % % % % % % % % % %

2014-15

15A

(n=178)

% % % % % % % % % % % % % % %

* * * * * * *

11A

(n=160)

23B

(n=202)

15B/C

(n=367)

16F

(n=220)

5 10 15 20 25 30 35

Impact of PCV on overall non-susceptible pneumococcal carriage (N=8,537)

% of all cultures

Pnc= pneumococcal, S= susceptible, Pen= penicillin, Ery= erythromycin, Clind= clindamycin * Rate ratio (confidence intervals)

% % % % % % % %

2009-10 2014-15

0.6 (0.6-0.7)* 0.6 (0.5-0.7)* 0.6 (0.5-0.7)* 0.5 (0.4-0.7)* 0.7 (0.6-0.8)* 0.7 (0.6-0.8)*

Conclusions

• PCVs impact on non-susceptible pneumococcal carriage, is derived from

4 different components:

VT13 Overall carriage Non-VT13 Intra-serotype non-susceptibility

• PCV7/PCV13 introduction to the Israeli national immunization program

reduced non-susceptible pneumococcal carriage from first to sixth year

• Non-responsible overuse of antibiotics is still prevalent and an ongoing

risk for rebound of antibiotic resistance among pneumococci

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