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 -80 o C 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), otitis 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
Rate of PCV13 Carriage and percent up to date by age with PCV13 vaccination over 6 month study periods, July2010-June2017 9 100 90 Percent of study population up to date with PCV13 Rate of PCV13 Carriage (per 100 study population) 8 80 7 70 6 60 5 50 4 40 3 30 2 20 1 10 0 0 PCV13 Carriage Rate Percent up to date
Differences in Rates of Pneumococcal Carriage Serotypes January-August 2009 vs. July 2010-June 2017 4 15B/C 3 2 21 35B 15A 1 NT OTHER 10A 07C 09N 17F Rate Difference 19F 06A 12F 11A 0 003 22F 33F -1 23A/B -2 -3 -4 06C -5 19A -6 NON-PCV13 PCV13
Serotype 6C and PCV13 Serotype Carriage After the Introduction of PCV13 by year 9 36 8 32 7 Carriage Rate per 100 Study Population 6 5 21 4 26 16 3 14 10 14 2 10 10 8 7 6 8 7 7 7 1 5 5 4 2 3 3 2 3 3 3 3 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 PCV13ST 19A 3 19F 6A 6C+ 2010 2011 2012 2013 2014 2015 2016 2017 + vaccine-related serotype
Non-PCV13 Serotype Carriage After the Introduction of PCV13 by year 35 170 30 214 187 197 217 83 166 25 Carriage Rate per 100 Study Population 88 20 15 10 50 45 18 32 30 37 32 15 35 5 31 28 31 27 18 27 29 20 21 24 21 19 18 18 12 21 21 8 8 11 11 19 15 17 16 15 14 14 17 15 11 10 5 11 6 3 5 6 2 0 NON-PCV13ST 15B/C 35B 11A 23A/B 15A 21 2010 2011 2012 2013 2014 2015 2016 2017
Pediatric (6-59 mos) Carriage Serotype Distribution Pediatric (6-59 mos) IPD Serotype Distribution January 2016- April 2017 January 2016-April 2017 n=233 n=28 003 19A 19F 19F (3) (1) (3) (3) 1% 0.5% 11% 003 1% (1) Other (n) Others (n) 3% 06C 038 (3) 35F (7) 23F (6) 034 (1) 16F (6) 23A/B (1) 3% 10A (1) 33F (6) (26) 3% 12F (1) OTHER 034 (5) 11% OTHER 22F (1) 17F (4) (45) (9) 19A 33F (1) 10A (3) 19% 32% (2) 35F (1) 35B 22F (3) 07C (9) 4% 7% (30) 031 (3) 12% 09N (3) NT ( 13) 6% 23A/B 038 (2) (2) 034 (1) 15A 7% 09L (1) 11A 35B (16) 28A (1) (18) 7% 15A (3) 8% (3) 11% 021 021 11% 15B/C (18) 15 B/C (1) (3) 8% (45) 3% 11% 19%
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)
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