Pediatric Pneumococcal Carriage Stephanie M. Thomas, MSPH Monica M. - - PowerPoint PPT Presentation

Pediatric Pneumococcal Carriage

Stephanie M. Thomas, MSPH Monica M. Farley, MD Shabnam Jain, MD

Methods

• NP swabs collected from children 6-59 months of age during

ED visits for any reason from

– –

–

Pre-PCV13: January - August 2009 Post-PCVE: July 2010 - June 2017

• Pediatric flock swabs stored in STGG transport media at
• 80oC and processed in the Georgia EIP Lab

Serotype by Quellung and antimicrobial susceptibility testing by BMD— at CDC

• Survey and immunization records reviewed
• Comparison to invasive pneumococcal disease (IPD)

Results

• Pre-PCV13

– – – – – – 451 children enrolled 139/451 (31%) colonized with S. pneumoniae 22% PCV13 serotypes (most 19A)

• Post-PCV13

4,765 children enrolled 1,447/4,765 (30.4%) colonized with S. pneumoniae Serotype trends on following slides

Demographic and Risk Factors Associated with Pneumococcal Carriage in Post-PCV13

• Mean age for carriers is 25 months; non-carriers is 28 months
• Carriage higher among children with respiratory infection (p<0.001),
• titis media (p=0.03), child in daycare (p<0.001), child with siblings in

household (p=0.03), and black race (p=0.04)

• Overall carriage similar whether up-to-date (30.1%) or not (29.4%)
• Up-to-date for PCV13 had lower PCV13 ST carriage rate (1.8 vs. 5.7

per 100 study population, p<0.001).

• By late 2012, most children (>90%) were up-to-date for PCV13 vaccine

10 20 30 40 50 60 70 80 90 100 1 2 3 4 5 6 7 8 9 Percent of study population up to date with PCV13 Rate of PCV13 Carriage (per 100 study population)

Rate of PCV13 Carriage and percent up to date by age with PCV13 vaccination

• ver 6 month study periods, July2010-June2017

PCV13 Carriage Rate Percent up to date

19A 003 19F 06A 06C 23A/B 33F 22F 11A 12F 17F 09N 07C 10A NT OTHER 15A 35B 21 15B/C

• 6
• 5
• 4
• 3
• 2
• 1

1 2 3 4

Rate Difference

PCV13 NON-PCV13

Differences in Rates of Pneumococcal Carriage Serotypes January-August 2009 vs. July 2010-June 2017

+ vaccine-related serotype

36 32 2 1 1 10 21 14 6 1 16 26 14 7 3 1 8 8 7 1 3 10 7 3 3 10 5 5 1 7 1 3 3 4 1 1 2 1 2 3 4 5 6 7 8 9 PCV13ST 19A 3 19F 6A 6C+ Carriage Rate per 100 Study Population

Serotype 6C and PCV13 Serotype Carriage After the Introduction of PCV13 by year

2010 2011 2012 2013 2014 2015 2016 2017

88 18 11 12 11 6 2 170 30 32 10 20 5 11 217 29 35 21 21 19 17 197 37 45 16 27 6 15 214 50 31 24 31 17 11 187 27 28 15 21 18 18 166 32 19 14 21 14 15 83 18 15 5 8 3 8

5 10 15 20 25 30 35 NON-PCV13ST 15B/C 35B 11A 23A/B 15A 21 Carriage Rate per 100 Study Population

Non-PCV13 Serotype Carriage After the Introduction of PCV13 by year

2010 2011 2012 2013 2014 2015 2016 2017

19F (3) 11% 003 (1) 3% 23F (1) 3% 19A (2) 7% 23A/B (2) 7% 35B (3) 11% 15B/C (3) 11% 021 (1) 3% 15A (3) 11% OTHER (9) 32%

Pediatric (6-59 mos) IPD Serotype Distribution January 2016-April 2017 n=28

Other (n) 038 (3) 034 (1) 10A (1) 12F (1) 22F (1) 33F (1) 35F (1) 19F (3) 1% 003 (3) 1% 19A (1) 0.5% 06C (6) 3% 23A/B (26) 11% 35B (30) 12% 11A (18) 8% 15 B/C (45) 19% 021 (18) 8% 15A (16) 7% NT ( 13) 6% 07C (9) 4% OTHER (45) 19%

Pediatric (6-59 mos) Carriage Serotype Distribution January 2016- April 2017 n=233

Others (n) 35F (7) 16F (6) 33F (6) 034 (5) 17F (4) 10A (3) 22F (3) 031 (3) 09N (3) 038 (2) 034 (1) 09L (1) 28A (1)

Pediatric (6-59 mos) Pneumococcal Carriage, Atlanta Conclusions

• Overall, pneumococcal NP carriage stable at ~30%
• Significant reductions in carriage of serotype 19A and to

lesser extent 6C after introduction of PCV13

• Low level carriage of 19F, 003, 19A, and 6C carriage persists
• No single non-vaccine serotype has emerged as a dominant

carriage serotype

• IPD generally mirrors NP carriage with some exceptions

(11A, 7C, 6C, NT carriage with no IPD)

Thank you