Pre- and post-conjugate vaccine epidemiology of pneumococcal serotype 6C invasive disease and carriage within Navajo and White Mountain Apache communities

Eugene V. Millar, Fabiana C. Pimenta, Alexis Roundtree, Delois Jackson, Maria Da Gloria Carvalho, Mindy J. Perilla, Raymond Reid, Mathuram Santosham, Cynthia G. Whitney, Bernard W. Beall, Katherine L O'Brien

Research output: Contribution to journalArticle

Abstract

Background. A second-generation 13-valent pneumococcal conjugate vaccine, PCV13, was recently licensed. Although PCV13 includes serotype 6A, the usefulness of that antigen may be limited by the emergence of a new serotype, 6C, which was identified among isolates initially characterized (Quellung reaction) as serotype 6A. The epidemiology of serotype 6C prior to and after 7-valent PCV (PCV7) introduction is incompletely understood. Methods. We analyzed conventionally serotyped 6A (CS6A) pneumococci from invasive disease case patients of all ages and carriage isolates from children and adults obtained in population-based studies among Navajo and White Mountain Apache communities during 1994-2009. Samples were tested by triplex polymerase chain reaction to resolve serotypes 6C and 6A. Results. A total of 74 invasive CS6A episodes occurred. All were retyped by polymerase chain reaction; 40 (54.1%) were serotype 6C. The mean annual incidence of serotype 6C invasive disease was 0.3 (95% confidence interval, 0.03-0.9), 0.7 (95% confidence interval, 0.2-1.3), and 1.5 (95% confidence interval, 1.0-2.1) cases per 100,000 population in the years prior to the PCV7 efficacy trial, during the time the PCV7 trial was conducted, and following PCV7 introduction and routine use, respectively (P = .01). In the routine vaccination era, 76% of invasive CS6As were serotype 6C; nearly all cases occurred in adults. The proportion of serotype 6C among CS6A carriage isolates increased from 42% to 61% to 94% in the prevaccine, early vaccine, and routine vaccination eras, respectively. Conclusion. In the PCV7 routine use era, virtually all serogroup 6 invasive pneumococcal disease and carriage strains among Navajo and White Mountain Apache communities are 6C. Monitoring and evaluation of this and other emerging serotypes among invasive disease and carriage isolates is warranted.

Original languageEnglish (US)
Pages (from-to)1258-1265
Number of pages8
JournalClinical Infectious Diseases
Volume51
Issue number11
DOIs
StatePublished - Dec 1 2010

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Conjugate Vaccines
Epidemiology
Confidence Intervals
Vaccination
Serogroup
Multiplex Polymerase Chain Reaction
Streptococcus pneumoniae
Population
Vaccines

ASJC Scopus subject areas

  • Infectious Diseases
  • Microbiology (medical)

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Pre- and post-conjugate vaccine epidemiology of pneumococcal serotype 6C invasive disease and carriage within Navajo and White Mountain Apache communities. / Millar, Eugene V.; Pimenta, Fabiana C.; Roundtree, Alexis; Jackson, Delois; Carvalho, Maria Da Gloria; Perilla, Mindy J.; Reid, Raymond; Santosham, Mathuram; Whitney, Cynthia G.; Beall, Bernard W.; O'Brien, Katherine L.

In: Clinical Infectious Diseases, Vol. 51, No. 11, 01.12.2010, p. 1258-1265.

Research output: Contribution to journalArticle

Millar, Eugene V. ; Pimenta, Fabiana C. ; Roundtree, Alexis ; Jackson, Delois ; Carvalho, Maria Da Gloria ; Perilla, Mindy J. ; Reid, Raymond ; Santosham, Mathuram ; Whitney, Cynthia G. ; Beall, Bernard W. ; O'Brien, Katherine L. / Pre- and post-conjugate vaccine epidemiology of pneumococcal serotype 6C invasive disease and carriage within Navajo and White Mountain Apache communities. In: Clinical Infectious Diseases. 2010 ; Vol. 51, No. 11. pp. 1258-1265.
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title = "Pre- and post-conjugate vaccine epidemiology of pneumococcal serotype 6C invasive disease and carriage within Navajo and White Mountain Apache communities",
abstract = "Background. A second-generation 13-valent pneumococcal conjugate vaccine, PCV13, was recently licensed. Although PCV13 includes serotype 6A, the usefulness of that antigen may be limited by the emergence of a new serotype, 6C, which was identified among isolates initially characterized (Quellung reaction) as serotype 6A. The epidemiology of serotype 6C prior to and after 7-valent PCV (PCV7) introduction is incompletely understood. Methods. We analyzed conventionally serotyped 6A (CS6A) pneumococci from invasive disease case patients of all ages and carriage isolates from children and adults obtained in population-based studies among Navajo and White Mountain Apache communities during 1994-2009. Samples were tested by triplex polymerase chain reaction to resolve serotypes 6C and 6A. Results. A total of 74 invasive CS6A episodes occurred. All were retyped by polymerase chain reaction; 40 (54.1{\%}) were serotype 6C. The mean annual incidence of serotype 6C invasive disease was 0.3 (95{\%} confidence interval, 0.03-0.9), 0.7 (95{\%} confidence interval, 0.2-1.3), and 1.5 (95{\%} confidence interval, 1.0-2.1) cases per 100,000 population in the years prior to the PCV7 efficacy trial, during the time the PCV7 trial was conducted, and following PCV7 introduction and routine use, respectively (P = .01). In the routine vaccination era, 76{\%} of invasive CS6As were serotype 6C; nearly all cases occurred in adults. The proportion of serotype 6C among CS6A carriage isolates increased from 42{\%} to 61{\%} to 94{\%} in the prevaccine, early vaccine, and routine vaccination eras, respectively. Conclusion. In the PCV7 routine use era, virtually all serogroup 6 invasive pneumococcal disease and carriage strains among Navajo and White Mountain Apache communities are 6C. Monitoring and evaluation of this and other emerging serotypes among invasive disease and carriage isolates is warranted.",
author = "Millar, {Eugene V.} and Pimenta, {Fabiana C.} and Alexis Roundtree and Delois Jackson and Carvalho, {Maria Da Gloria} and Perilla, {Mindy J.} and Raymond Reid and Mathuram Santosham and Whitney, {Cynthia G.} and Beall, {Bernard W.} and O'Brien, {Katherine L}",
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T1 - Pre- and post-conjugate vaccine epidemiology of pneumococcal serotype 6C invasive disease and carriage within Navajo and White Mountain Apache communities

AU - Millar, Eugene V.

AU - Pimenta, Fabiana C.

AU - Roundtree, Alexis

AU - Jackson, Delois

AU - Carvalho, Maria Da Gloria

AU - Perilla, Mindy J.

AU - Reid, Raymond

AU - Santosham, Mathuram

AU - Whitney, Cynthia G.

AU - Beall, Bernard W.

AU - O'Brien, Katherine L

PY - 2010/12/1

Y1 - 2010/12/1

N2 - Background. A second-generation 13-valent pneumococcal conjugate vaccine, PCV13, was recently licensed. Although PCV13 includes serotype 6A, the usefulness of that antigen may be limited by the emergence of a new serotype, 6C, which was identified among isolates initially characterized (Quellung reaction) as serotype 6A. The epidemiology of serotype 6C prior to and after 7-valent PCV (PCV7) introduction is incompletely understood. Methods. We analyzed conventionally serotyped 6A (CS6A) pneumococci from invasive disease case patients of all ages and carriage isolates from children and adults obtained in population-based studies among Navajo and White Mountain Apache communities during 1994-2009. Samples were tested by triplex polymerase chain reaction to resolve serotypes 6C and 6A. Results. A total of 74 invasive CS6A episodes occurred. All were retyped by polymerase chain reaction; 40 (54.1%) were serotype 6C. The mean annual incidence of serotype 6C invasive disease was 0.3 (95% confidence interval, 0.03-0.9), 0.7 (95% confidence interval, 0.2-1.3), and 1.5 (95% confidence interval, 1.0-2.1) cases per 100,000 population in the years prior to the PCV7 efficacy trial, during the time the PCV7 trial was conducted, and following PCV7 introduction and routine use, respectively (P = .01). In the routine vaccination era, 76% of invasive CS6As were serotype 6C; nearly all cases occurred in adults. The proportion of serotype 6C among CS6A carriage isolates increased from 42% to 61% to 94% in the prevaccine, early vaccine, and routine vaccination eras, respectively. Conclusion. In the PCV7 routine use era, virtually all serogroup 6 invasive pneumococcal disease and carriage strains among Navajo and White Mountain Apache communities are 6C. Monitoring and evaluation of this and other emerging serotypes among invasive disease and carriage isolates is warranted.

AB - Background. A second-generation 13-valent pneumococcal conjugate vaccine, PCV13, was recently licensed. Although PCV13 includes serotype 6A, the usefulness of that antigen may be limited by the emergence of a new serotype, 6C, which was identified among isolates initially characterized (Quellung reaction) as serotype 6A. The epidemiology of serotype 6C prior to and after 7-valent PCV (PCV7) introduction is incompletely understood. Methods. We analyzed conventionally serotyped 6A (CS6A) pneumococci from invasive disease case patients of all ages and carriage isolates from children and adults obtained in population-based studies among Navajo and White Mountain Apache communities during 1994-2009. Samples were tested by triplex polymerase chain reaction to resolve serotypes 6C and 6A. Results. A total of 74 invasive CS6A episodes occurred. All were retyped by polymerase chain reaction; 40 (54.1%) were serotype 6C. The mean annual incidence of serotype 6C invasive disease was 0.3 (95% confidence interval, 0.03-0.9), 0.7 (95% confidence interval, 0.2-1.3), and 1.5 (95% confidence interval, 1.0-2.1) cases per 100,000 population in the years prior to the PCV7 efficacy trial, during the time the PCV7 trial was conducted, and following PCV7 introduction and routine use, respectively (P = .01). In the routine vaccination era, 76% of invasive CS6As were serotype 6C; nearly all cases occurred in adults. The proportion of serotype 6C among CS6A carriage isolates increased from 42% to 61% to 94% in the prevaccine, early vaccine, and routine vaccination eras, respectively. Conclusion. In the PCV7 routine use era, virtually all serogroup 6 invasive pneumococcal disease and carriage strains among Navajo and White Mountain Apache communities are 6C. Monitoring and evaluation of this and other emerging serotypes among invasive disease and carriage isolates is warranted.

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