Streptococcus pneumoniae Upper Respiratory Carriage in Costa Rican Children with Otitis Media before the Introduction of the Heptavalent Conjugated Vaccine in the National Immunization Program

Catalina Ulloa, Alfonso Pereira, Carolina Soley, Nurith Porat, Arturo Abdelnour, Ron Dagan, Adriano Arguedas

Instituto de Atención Pediátrica, San José, Costa Rica.
Instituto de Atención Pediátrica, San José, Costa Rica; Universidad de Ciencias Médicas, San José, Costa Rica.
Pediatric Infectious Disease Unit, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

DOI: 10.4236/wjv.2013.32007                

Abstract

Objective: The aim of this study was to analyze the NP/OP S. pneumoniae serotype distribution and potential vaccine coverage in Costa Rican children with Otitis Media (OM) before the introduction of PCV-7 in the National Immunization Program (NIP). Methods: Between 2002 and 2006, NP and OP samples were obtained from 641 children from 6 to 79 months of age, at the time of OM diagnosis. S. pneumoniae serotyping and antimicrobial susceptibility were performed. Results: 386 S. pneumoniae isolates were recovered. The most common S. pneumoniae serotypes (ST) were: ST 6B, ST 14, ST 19F. Penicillin non-susceptibility was observed among 57% of the isolates obtained from children < 24 months of age. 15% strains were multidrug resistant. Potential vaccine coverage was: PCV-7: 60%; PCV-10: 62%; and PCV-13: 76% and against penicillin non-susceptible and multidrug resistant isolates was: PCV-7; 59% and 83%, respectively; PCV-10: 60% and 85%, respectively and PCV-13: 74% and 96%, respectively. Conclusions: S. pneumoniae was isolated from the NP and/or OP in the majority (59%) of studied children with OM. At a statistical significant level, only serotype 3 was more frequently isolated among children >24 months of age. Antibiotic non-susceptibility and MDR were significantly higher in children <24 months of age. This study demonstrates that PCV-13 offers the highest potential vaccine coverage and serves to assess the impact of introduction of one of the conjugated vaccines in the NIP in Costa Rica.

Keywords

Streptococcus pneumoniae; Serotypes; Nasopharynx; Oropharynx; Pneumococcal Conjugated Vaccine

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	J. A. Willians, E. Gouvs, C. Bosghi-Pinto, J. Brice and C. Dye, “Estimates of World-Wide Distribution of Child Deaths from Acute Respiratory Infections,” Lancet Infectious Diseases, Vol. 2, No. 1, 2002, pp. 25-35. doi:10.1016/S1473-3099(01)00170-0
[2]	D. Bogoaert, R. De Groot and P. W. Hermans, “Streptococcus pneumonia Colonization: The Key to the Pneumococcal Disease,” Lancet Infectious Diseases, Vol. 4, No. 3, 2004, pp. 144-154. doi:10.1016/S1473-3099(04)00938-7
[3]	R. Dagan, E. Leibovitz, D. Greenberg, P. Yagupsky, D. M. Fliss and A. Leiberman, “Dynamics of Pneumococcal Nasopharyngeal Colonization during the First Days of Antibiotic Treatment in Pediatric Patients,” The Pediatric Infectious Disease Journal, Vol. 17, No. 10, 1998, pp. 880-885. doi:10.1097/00006454-199810000-00006
[4]	L. Igvarsson, K. Lundgren and L. Ursing, “Bacterial Flora in the Nasopharynx in Healthy Children,” Actas Otolaryngologica, Vol. 93, No. S386, 1982, pp. S94-S96. doi:10.3109/00016488209108482
[5]	G. Anianson, B. Alm, B. Anderson, et al., “Nasopharyngeal Colonization during the First Year of Life,” Journal of Infectious Diseases, Vol. 165, No. S1, 1992, pp. 8-41.
[6]	R. Dagan, R. Melamed, M. Muallem and P. Yagupsky, “Nasopahryngeal Colonization in Southern Israel with Antibiotic Resistant Pneumococci during the First 2 Years of Life: Relation to Serotypes Likely to Be Included in Pneumococcal Conjugate Vaccines,” Journal of Infectious Diseases, Vol. 174, No. 6, 1996, pp. 1352-1355. doi:10.1093/infdis/174.6.1352
[7]	K. P. Klugman, H. J. Koornhof, A. Wasas, K. Storey and I. Gilbertson, “Carriage of Penicillin-Resistant Pneumococci,” Archives of Disease in Childhood, Vol. 61, No. 4, 1986, pp. 377-381. doi:10.1136/adc.61.4.377
[8]	T. D. Mastro, N. K. Nomani, Z. Ishaq, et al., “Use of Nasopharyngeal Isolates of Streptococcus pneumoniae and Haemophilus influenzae from Children in Pakistan for Surveillance for Antimicrobial Resistance,” The Pediatric Infectious Disease Journal, Vol. 12, No. 10, 1993, pp. 824-830. doi:10.1097/00006454-199310000-00006
[9]	E. N. Berezin, M. D. Cardenuto, L. L. Ferreira, et al., “Distribution of Streptococcus pneumoniae Serotypes in Nasopharyngeal Carriage and in Invasive Pneumococcal Disease in Sao Paulo, Brazil,” The Pediatric Infectious Disease Journal, Vol. 26, No. 7, 2007, pp. 643-644. doi:10.1097/INF.0b013e3180616d0f
[10]	M. Vives, M. Garcia, P. Saenz, M. Mora, L. Mata, et al., “Nasopharyngeal Colonization in Costa Rican Children during the First Year of Life,” The Pediatric Infectious Disease Journal, Vol. 16, No. 9, 1997, pp. 852-858. doi:10.1097/00006454-199709000-00007
[11]	E. V. Millar, K. L. O. Brien, E. R. Zell, et al., “Nasopharyngeal Carriage of Streptococcus pneumoniae in Navajo and White Mountain Apache Children before Introduction of Pneumococcal Conjugate Vaccine,” The Pediatric Infectious Disease Journal, Vol. 28, No. 8, 2009, pp. 711-716. doi:10.1097/INF.0b013e3181a06303
[12]	B. M. Gray, G. M. Converse and H. C. Dillon, “Epidemiologic Studies of Streptococcus pneumonia in Infants: Acquisition, Carriage, and Infection during the First 24 Months of Life,” Journal of Infectious Diseases, Vol. 142, No. 6, 1980, pp. 923-933. doi:10.1093/infdis/142.6.923
[13]	R. K. Syrjanen, T. M. Kilpi, T. H. Kaijalainen, et al., “Nasopharyngeal Carriage of Streptococcus pneumoniae in Finnish Children Younger than 2 Years Old,” Journal of Infectious Diseases, Vol. 184, No. 4, 2001, pp. 451-459. doi:10.1086/322048
[14]	C. Coles, R. Kanungo, L. Rahmathullah, et at., “Pneumococcal Nasopharyngeal Colonization in Young South Indian Infants,” The Pediatric Infectious Disease Journal, Vol. 20, No. 3, 2001, pp. 289-7295. doi:10.1097/00006454-200103000-00014
[15]	M. Gratten, H. Gratten, A. Poil, et al., “Colonization of Influenza and Streptococcus pneumoniae in the Upper Respiratory Tract of Neonates in Papua New Guinea: Primary Acquisition, Duration of Carriage and Relationship to Carriage in Mothers,” Biology of the Neonate, Vol. 50, No. 2, 1986, pp. 114-120. doi:10.1159/000242576
[16]	H. Goossens, M. Ferech, R. Vnder Stichele and M. Elseviers, “Outpatient Antibiotic Use in Europe and Association with Resistance: A Cross National Database Study,” Lancet, Vol. 365, No. 9459, 2005, pp. 579-587.
[17]	F. Baquero and E. Loza, “Antibiotic Resistance of Microorganisms Involved in Ear, Nose and Throat Infections,” The Pediatric Infectious Disease Journal, Vol. 174, 1994, pp. 1352-1355.
[18]	P. C. Appelbaum, “Epidemiology and in Vitro Susceptibility of Drug-Resistance Streptococcus pneumoniae,” The Pediatric Infectious Disease Journal, Vol. 15, No. 10, 1996, pp. 932-939. doi:10.1097/00006454-199610000-00030
[19]	K. P. Klugman, “Efficacy of Pneumococcal Conjugate Vaccines and Their Effect on Carriage and Antimicrobial Resistance,” Lancet Infectious Diseases, Vol. 1, No. 2, 2001, pp. 85-91. doi:10.1016/S1473-3099(01)00063-9
[20]	C. G. Whitney, M. M. Farley, J. Hadler, et al., “Increasing Prevalence of Multidrug-Resistant Streptococcus pneumoniae in the United States,” The New England Journal of Medicine, Vol. 343, No. 26, 2000, pp. 1917-1924. doi:10.1056/NEJM200012283432603
[21]	R. Dagan, N. Givon-Lavi, O. Zamir, et al., “Reduction of Nasopharyngeal Carriage of Streptococcus pneumoniae after Administration of a 9-Valent Pneumococcal Conjugate Vaccine to Toddlers Attending Day Care Centers,” Journal of Infectious Diseases, Vol. 185, No. 7, 2002, pp. 927-936. doi:10.1086/339525
[22]	R. Dagan, R. Melmed, M. Muallem, et al., “Reduction of Nasopharyngeal Carriage of Pneumococcci during the Second Year of Life by the Heptavalent Conjugate Pneumococcal Vaccine,” Journal of Infectious Diseases, Vol. 174, No. 6, 1996, pp. 1271-1278. doi:10.1093/infdis/174.6.1271
[23]	R. Dagan, R. Melmed, M. Muallem, R. Melamed, O. Leroy and P. Yagupsky, “Reduction of Pneumococcal Nasopharyngeal Carriage in Early Infancy after Immunization with Tetravalent Pneumococcal Vaccines Conjugated to Either Tetanus Toxoid or Diphtheria Toxoid,” The Pediatric Infectious Disease Journal, Vol. 16, No. 11, 1997, pp. 1060-1064. doi:10.1097/00006454-199711000-00011
[24]	N. Mbelle, R. E. Huebner, A. D. Wasas, A. Kimura, I. Chang and K. P. Klugman, “Inmunogenicity and Impact on Nasopharyngeal Carriage of a Nonavalent Pneumococcal Conjugate Vaccine,” Journal of Infectious Diseases, Vol. 180, No. 4, 1999, pp. 1171-1176. doi:10.1086/315009
[25]	S. K. Obaro, R. A. Adegbola, W. A. Banya and B. M. Greenwood, “Carriage of Pneumococci after Pneumococcal Vaccination,” Lancet, Vol. 348, No. 9022, 1996, pp. 271-272. doi:10.1016/S0140-6736(05)65585-7
[26]	R. Dagan, N. Givon-Lavi, O. Zamir and D. Fraser, “Effect of a Nonavalent Conjugate Vaccine on Carriage of Antibiotic-Resistant Streptococcus pneumoniae in Day-Care Centers,” The Pediatric Infectious Disease Journal, Vol. 22, No. 6, 2003, pp. 532-540. doi:10.1097/01.inf.0000069761.11093.c3
[27]	N. Givon-Lavi, D. Fraser and R. Dagan, “Vaccination of Day-Care Center Attendees Reduces Carriage of Streptococcus pneumoniae among Younger Siblings,” The Pediatric Infectious Disease Journal, Vol. 22, No. 6, 2003, pp. 524-532. doi:10.1097/01.inf.0000069760.65826.f2
[28]	K. L. O. Brien and R. Dagan, “The Potential Indirect Effect of Conjugate Pneumococcal Vaccines,” Vaccine, Vol. 21, No. 17-18, 2003, pp. 1815-1825. doi:10.1016/S0264-410X(02)00807-1
[29]	L. Temine, D. Guillemont and P. Y. Boelle, “Short and Long Term Effects of Pneumococcal Conjugate Vaccination of Children on Penicillin Resistance,” Antimicrobial Agents and Chemotherapy, Vol. 48, No. 6, 2004, pp. 2206-2213. doi:10.1128/AAC.48.6.2206-2213.2004
[30]	National Committee for Clinical Laboratory Standards, “Performance Standards for Antimicrobial Susceptibility Testing,” 12th Informational Supplement. NCCLS Document M100-512, Wayne, 2002.
[31]	R. Austrian, “The Quellung Reaction, a Neglected Microbiologic Tecnique,” Mount Sinai Journal of Medicine, Vol. 43, No. 6, 1976, pp. 699-709.
[32]	A. Arguedas, et al., “Middle Ear Fluid Streptococcus pneumoniae Serotype Distribution in Costa Rican Children with Otitis Media,” The Pediatric Infectious Disease Journal, Vol. 24, No. 7, 2005, pp. 631-634. doi:10.1097/01.inf.0000168748.92510.45
[33]	A. Arguedas, R. Dagan, C. Soley, C. Loaiza, K. Knudsen, N. Porat, A. Pérez, E. Brilla and M. L. Herrera, “Microbiology of Otitis Media in Costa Rican Children, 1999 through 2001,” The Pediatric Infectious Disease Journal, Vol. 22, No. 12, 2003, pp. 1063-1068. doi:10.1097/01.inf.0000101189.81501.e9
[34]	A. Arguedas, C. Loaiza, A. Perez, et al., “Microbiology of Otitis Media in Costa Rican Children,” The Pediatric Infectious Disease Journal, Vol. 17, No. 8, 1998, pp. 680-689. doi:10.1097/00006454-199808000-00004
[35]	S. Guevara, C. Soley, A. Arguedas, N. Porat and R. Dagan, “Seasonal Distribution of Otitis Media Pathogens among Costa Rican Children,” The Pediatric Infectious Disease Journal, Vol. 27, No. 1, 2008, pp. 12-16. doi:10.1097/INF.0b013e3181468643
[36]	A. Arguedas, R. Dagan, S. Guevara, et al., “Middle Ear Fluid Streptococcus pneumoniae Serotype. Distribution in Costa Rican Children with Otitis Media,” The Pediatric Infectious Disease Journal, Vol. 24, No. 7, 2005, pp. 631-634. doi:10.1097/01.inf.0000168748.92510.45
[37]	D. Greenberg, et al., “Nasopharyngeal Carriage of Individual Streptococcus pneumoniae Serotypes during Pediatric Pneumonia as a Means to Estimate Serotype Disease Potential,” The Pediatric Infectious Disease Journal, Vol. 30, No. 3, 2011, pp. 227-233. doi:10.1097/INF.0b013e3181f87802
[38]	L. Aguilar, O. Alvarado, C. Soley, A. Abdelnour, R. Dagan and A. Arguedas, “Microbiology of the Middle Ear Fluid in Costa Rican Children between 2002 and 2007,” International Journal of Pediatric Otorhinolaryngology, Vol. 73, No. 10, 2009, pp. 1407-1411. doi:10.1016/j.ijporl.2009.07.005
[39]	S. Guevara, A. Abdelnour, C. Soley, N. Porat, R. Dagan and A. Arguedas, “Streptococcus pneumoniae Serotypes Isolated from the Middle Ear Fluid of Costa Rican Children Following Introduction of the Heptavalent Pneumococcal Conjugate Vaccine into a Limited Population,” Vaccine, Vol. 30, No. 26, 2012, pp. 3857-3861. doi:10.1016/j.vaccine.2012.04.010