Vaccination of Icelandic Children with the 10-Valent Pneumococcal Vaccine Leads to a Significant Herd Effect among Adults in Iceland

• Published in: Journal of clinical microbiology Vol. 57; no. 4
• Main Authors: Quirk, Sigríður J, Haraldsson, Gunnsteinn, Hjálmarsdóttir, Martha Á, van Tonder, Andries J, Hrafnkelsson, Birgir, Bentley, Stephen D, Haraldsson, Ásgeir, Erlendsdóttir, Helga, Brueggemann, Angela B, Kristinsson, Karl G
• Format: Journal Article
• Language: English
• Published: United States American Society for Microbiology 01.04.2019
• Subjects: Adolescent; Adult; Anti-Bacterial Agents - pharmacology; Epidemiology; Humans; Iceland - epidemiology; Immunity, Herd; Microbial Sensitivity Tests; Middle Aged; Multilocus Sequence Typing; Nasopharynx - microbiology; Pneumococcal Vaccines - administration & dosage; Pneumococcal Vaccines - immunology; Pneumonia, Pneumococcal - epidemiology; Pneumonia, Pneumococcal - immunology; Pneumonia, Pneumococcal - microbiology; Pneumonia, Pneumococcal - prevention & control; Serogroup; Streptococcus pneumoniae - classification; Streptococcus pneumoniae - drug effects; Streptococcus pneumoniae - immunology; Streptococcus pneumoniae - isolation & purification; Vaccination - statistics & numerical data; Young Adult; Iceland; molecular epidemiology; epidemiology; pneumococcus; pneumonia; adults; Iceland; lower respiratory tract; Streptococcus pneumoniae; vaccination
• ISSN: 0095-1137; 1098-660X
• DOI: 10.1128/JCM.01766-18

The introduction of pneumococcal conjugate vaccines (PCVs) into childhood vaccination programs has reduced carriage of vaccine serotypes and pneumococcal disease. The 10-valent PCV was introduced in Iceland in 2011. The aim of this study was to determine PCV impact on the prevalence of serotypes, genetic lineages, and antimicrobial-resistant pneumococci isolated from the lower respiratory tract (LRT) of adults. Pneumococci isolated between 2009 and 2017 at the Landspitali University Hospital were included (  = 797). The hospital serves almost three-quarters of the Icelandic population. Isolates were serotyped and tested for antimicrobial susceptibility, and the genome of every other isolate collected between 2009 and 2014 was sequenced (  = 275). Serotypes and multilocus sequence types (STs) were extracted from the genome data. Three study periods were defined, 2009 to 2011 (PreVac), 2012 to 2014 (PostVac-I), and 2015 to 2017 (PostVac-II). The total number of isolates and vaccine-type (VT) pneumococci decreased from PreVac to PostVac-II (  = 314 versus  = 230 [  = 0.002] and  = 170 versus  = 33 [  < 0.001], respectively), but non-vaccine-type (NVT) pneumococci increased among adults 18 to 64 years old (  = 56 versus  = 114 [  = 0.008]). Serotype 19F decreased in the PostVac-II period; these isolates were all multidrug resistant (MDR) and were members of the Taiwan -14 PMEN lineage. Serotype 6A decreased among adults ≥65 years old in the PostVac-II period (  = 0.037), while serotype 6C increased (  = 0.021) and most serotype 6C isolates were MDR. Nonencapsulated (NESp) isolates increased among adults 18 to 64 years old in the PostVac-II period, and the majority were MDR (  = 0.028). An overall reduction in the number of LRT samples and pneumococcus-positive cultures and significant changes in the serotype distribution became evident within 4 years, thereby demonstrating a significant herd effect.