#Outbreak of invasive #pneumococcal disease among #shipyard #workers, Turku, #Finland, May to November 2019 (Euro Surveill., abstract)

[Source: Eurosurveillance, full page: (LINK). Abstract, edited.]

Outbreak of invasive pneumococcal disease among shipyard workers, Turku, Finland, May to November 2019

Marius Linkevicius 1,2, Veronica Cristea 3,4, Lotta Siira 1, Henna Mäkelä 3, Maija Toropainen 1, Marjaana Pitkäpaasi 3, Timothee Dub 3, Hanna Nohynek 3, Taneli Puumalainen 3, Esa Rintala 5, Merja E. Laaksonen 5, Thijs Feuth 6,7, Juha O. Grönroos 8, Jutta Peltoniemi 9, Heikki Frilander 10, Irmeli Lindström 10, Jussi Sane 3

Affiliations: 1 Expert Microbiology Unit, Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland; 2 European Programme for Public Health Microbiology Training (EUPHEM), European Centre for Disease Prevention and Control, Stockholm, Sweden; 3 Infectious Disease Control and Vaccinations Unit, Department of Health Security, Finnish Institute for Health and Welfare (THL), Helsinki, Finland; 4 European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, Stockholm, Sweden; 5 Department of Hospital Hygiene and Infection Control, Turku University Hospital (TYKS), Turku, Finland; 6 Division of Medicine, Department of Pulmonary Diseases, Turku University Hospital (TYKS), Turku Finland; 7 Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland; 8 Department of Clinical Microbiology, Turku University Hospital (TYKS), Turku, Finland; 9 Infection Control Unit, Welfare Division, City of Turku, Finland10 Finnish Institute of Occupational Health, Helsinki, Finland

Correspondence:  Marius Linkevicius

Citation style for this article: Linkevicius Marius, Cristea Veronica, Siira Lotta, Mäkelä Henna, Toropainen Maija, Pitkäpaasi Marjaana, Dub Timothee, Nohynek Hanna, Puumalainen Taneli, Rintala Esa, Laaksonen Merja E., Feuth Thijs, Grönroos Juha O., Peltoniemi Jutta, Frilander Heikki, Lindström Irmeli, Sane Jussi. Outbreak of invasive pneumococcal disease among shipyard workers, Turku, Finland, May to November 2019. Euro Surveill. 2019;24(49):pii=1900681. https://doi.org/10.2807/1560-7917.ES.2019.24.49.1900681

Received: 08 Nov 2019;   Accepted: 05 Dec 2019



We report an outbreak of invasive pneumococcal disease and pneumococcal pneumonia among shipyard workers, in Turku, Southwest Finland. In total, 31 confirmed and six probable cases were identified between 3 May and 28 November 2019. Streptococcus pneumoniae serotypes 12F, 4 and 8 were isolated from blood cultures of 25 cases. Occupational hygiene measures and vaccination of ca 4,000 workers are underway to control the outbreak at the shipyard.

©  This work is licensed under a Creative Commons Attribution 4.0 International License.

Keywords: Streptococcus pneumoniae; IPD; Pneumonia; Finland.


#Pneumococcal #serotype #trends, #surveillance and #risk factors in #UK adult #pneumonia, 2013–18 (Thorax, abstract)

[Source: Thorax, full page: (LINK). Abstract, edited.]

Pneumococcal serotype trends, surveillance and risk factors in UK adult pneumonia, 2013–18

Harry Pick1,2, Priya Daniel3, Chamira Rodrigo4, Thomas Bewick3, Deborah Ashton4, Hannah Lawrence5,6, Vadsala Baskaran1,6, Rochelle C Edwards-Pritchard2, Carmen Sheppard7, Seyi D Eletu7, Samuel Rose7, David Litt7, Norman K Fry8, Shamez Ladhani8, Meera Chand9, Caroline Trotter10, Tricia M McKeever6, Wei Shen Lim1

Author affiliations: 1 Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK; 2 Division of Respiratory Medicine, University of Nottingham, Nottingham, UK; 3 Respiratory Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK; 4 Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK; 5 Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK; 6 Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK; 7 Respiratory and Vaccine Preventable Bacteria Reference Unit, Public Health England Colindale, London, UK; 8 Immunisation and Countermeasures Division, Public Health England Colindale, London, UK; 9 Tuberculosis, Acute Respiratory, Gastrointestinal, Emerging/Zoonotic Infections, Travel and Migrant Health Service (TARGET), Public Health England Colindale, London, UK; 10 Disease Dynamic Unit, Department of Veterinary Medicine, University of Cambridge, Cambridge, UK

Correspondence to Dr Harry Pick, Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB, UK; harry.pick@nhs.net




Changes over the last 5 years (2013–18) in the serotypes implicated in adult pneumococcal pneumonia and the patient groups associated with vaccine-type disease are largely unknown.


We conducted a population-based prospective cohort study of adults admitted to two large university hospitals with community-acquired pneumonia (CAP) between September 2013 and August 2018. Pneumococcal serotypes were identified using a novel 24-valent urinary monoclonal antibody assay and from blood cultures. Trends in incidence rates were compared against national invasive pneumococcal disease (IPD) data. Persons at risk of vaccine-type pneumonia (pneumococcal conjugate vaccine (PCV)13 and pneumococcal polysaccharide vaccine (PPV)23) were determined from multivariate analyses.


Of 2934 adults hospitalised with CAP, 1075 (36.6%) had pneumococcal pneumonia. The annual incidence of pneumococcal pneumonia increased from 32.2 to 48.2 per 100 000 population (2013–18), predominantly due to increases in PCV13non7-serotype and non-vaccine type (NVT)-serotype pneumonia (annual incidence rate ratio 1.12, 95% CI 1.04 to 1.21 and 1.19, 95% CI 1.10 to 1.28, respectively). Incidence trends were broadly similar to IPD data. PCV13non7 (56.9% serotype 3) and PPV23non13 (44.1% serotype 8) serotypes were identified in 349 (32.5%) and 431 (40.1%) patients with pneumococcal pneumonia, respectively. PCV13-serotype pneumonia (dominated by serotype 3) was more likely in patients in the UK pneumococcal vaccination clinical risk group (adjusted OR (aOR) 1.73, 95% CI 1.31 to 2.28) while PPV23-serotype pneumonia was more likely in patients outside the clinical risk group (aOR 1.54, 95% CI 1.13 to 2.10).


The incidence of pneumococcal CAP is increasing, predominantly due to NVT serotypes and serotype 3. PPV23-serotype pneumonia is more likely in adults outside currently identified clinical risk groups.


DOI: http://dx.doi.org/10.1136/thoraxjnl-2019-213725




HJP, CS and WSL were responsible for study conception and design. HJP, PD, CR, TB, DA, HL, VB, RCE-P, CS and SE were responsible for data acquisition. HJP, TMM and CT were responsible for the statistical analysis. HJP and WSL drafted the initial versions of the Article. All authors contributed to data interpretation and read, commented on and approved the final version of the article.


This study is independent research supported by the Nottingham National Institute for Health Research Biomedical Research Centre (NIHR BRC) and arising from an unrestricted investigator-initiated research grant from Pfizer. The study concept was developed and agreed by the authors with no input from the funding bodies; Pfizer had no part in the design or execution of the study, the analysis and interpretation of the results, the writing of this manuscript or the decision to submit for publication. The data are the sole responsibility of the authors and the sponsor for the study was Nottingham University Hospitals NHS Trust.


The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR or PHE.

Competing interests 

None declared.

Patient consent for publication 

Not required.

Ethics approval 

Study procedures were approved by the Nottingham Research Ethics Committee (REC reference 08/H0403/80).

Provenance and peer review 

Not commissioned; externally peer reviewed.

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Keywords: Streptococcus pneumoniae; Vaccines; UK; Pneumonia; IPD.


#Nasopharyngeal #carriage of invasive #pneumococcal serotypes during #childhood #community-acquired alveolar #pneumonia is associated with specific clinical presentation (J Infect Dis., abstract)

[Source: Journal of Infectious Diseases, full page: (LINK). Abstract, edited.]

Nasopharyngeal carriage of invasive pneumococcal serotypes during childhood community-acquired alveolar pneumonia is associated with specific clinical presentation

Yaniv Faingelernt, Ron Dagan, Noga Givon-Lavi, Shalom Ben-Shimol, Jacob Bar-Ziv, David Greenberg

The Journal of Infectious Diseases, jiz513, https://doi.org/10.1093/infdis/jiz513

Published: 05 October 2019




Streptococcus pneumoniae (Pnc) serotypes differ in invasive potential. We examined whether community-acquired alveolar pneumonia (CAAP) in children carrying common recognized invasive pneumococcal serotypes (1, 5, 7F, 14 and 19A; PnIST) differs from CAAP in children carrying less invasive serotypes (non-PnIST) or no Pnc (Pnc-neg).


Children <5 years visiting the only regional Pediatric Emergency Room, with radiologically-proven CAAP were enrolled. Nasopharyngeal cultures were processed for pneumococcal isolation and serotyping. Clinical/demographic characteristics were recorded. The study was conducted before pneumococcal conjugate vaccine implementation in Israel.


A total of 1,423 CAAP episodes were recorded: PnIST, 300 (21.1%); non-PnIST, 591 (41.5%); and Pnc-neg, 532 (37.4%). After adjustment for age, ethnicity, seasonality and previous antibiotics, the following variables were positively associated with PnISRT carriage compared to both groups: temperature ≥39°C, peripheral WBC ≥20,000/mm3, C-reactive protein ≥70.0 mg/L and serum sodium <135 mEq/L. Lower oxygen saturation, viral detection and comorbidities were negatively associated with Pn-IST carriage (odds ratios <1.0). Differences between non-PnIST carriers and Pnc-neg groups were smaller or non-significant.


Young children with CAAP carrying common PnIST had a lower proportion of comorbidities, hypoxemia and viral detection, and had more intense systemic inflammatory response than those carrying non-PnISR or not carrying Pnc.

community-acquired alveolar pneumonia, children, pneumococcal serotypes, clinical signs, laboratory characteristics

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This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Keywords: Streptococcus pneumoniae; Invasive pneumococcal disease; Pediatrics.


#Risk for Invasive #Streptococcal #Infections among #Adults Experiencing #Homelessness, #Anchorage, #Alaska, #USA, 2002–2015 (Emerg Infect Dis., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases, full page: (LINK). Abstract, edited.]

Volume 25, Number 10—October 2019 / CME ACTIVITY – Research

Risk for Invasive Streptococcal Infections among Adults Experiencing Homelessness, Anchorage, Alaska, USA, 2002–2015

Emily Mosites  , Tammy Zulz, Dana Bruden, Leisha Nolen, Anna Frick, Louisa Castrodale, Joseph McLaughlin, Chris Van Beneden, Thomas W. Hennessy, and Michael G. Bruce

Author affiliations: Centers for Disease Control and Prevention, Anchorage, Alaska, USA (E. Mosites, T. Zulz, D. Bruden, L. Nolen, T.W. Hennessy, M.G. Bruce); Alaska Department of Health and Social Services, Anchorage (A. Frick, L. Castrodale, J. McLaughlin); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (C. Van Beneden)

CME Editor: Jude Rutledge, BA, Technical Writer/Editor, Emerging Infectious Diseases. Disclosure: Jude Rutledge has disclosed no relevant financial relationships.

CME Author: Charles P. Vega, MD, Health Sciences Clinical Professor of Family Medicine, University of California, Irvine School of Medicine, Irvine, California. Disclosure: Charles P. Vega, MD, has disclosed the following relevant financial relationships: served as an advisor or consultant for Genentech, Inc.; GlaxoSmithKline; Johnson & Johnson Pharmaceutical Research & Development, L.L.C.; served as a speaker or a member of a speakers bureau for Shire.

Authors Disclosures: Emily Mosites, PhD, MPH; Tammy Zulz, MPH; Dana Bruden, MS; Leisha Nolen, MD, PhD; Anna Frick, MPH; Louisa Castrodale, DVM, MPH; Joe McLaughlin, MD, MPH; Chris A. Van Beneden, MD, MPH; Thomas Hennessy, MD, MPH; and Michael G. Bruce, MD, MPH, have disclosed no relevant financial relationships.



The risk for invasive streptococcal infection has not been clearly quantified among persons experiencing homelessness (PEH). We compared the incidence of detected cases of invasive group A Streptococcus infection, group B Streptococcus infection, and Streptococcus pneumoniae (pneumococcal) infection among PEH with that among the general population in Anchorage, Alaska, USA, during 2002–2015. We used data from the Centers for Disease Control and Prevention’s Arctic Investigations Program surveillance system, the US Census, and the Anchorage Point-in-Time count (a yearly census of PEH). We detected a disproportionately high incidence of invasive streptococcal disease in Anchorage among PEH. Compared with the general population, PEH were 53.3 times as likely to have invasive group A Streptococcus infection, 6.9 times as likely to have invasive group B Streptococcus infection, and 36.3 times as likely to have invasive pneumococcal infection. Infection control in shelters, pneumococcal vaccination, and infection monitoring could help protect the health of this vulnerable group.

Keywords: Streptococcus pneumoniae; Invasive Streptococcal Disease; Society; USA; Alaska.


#Pneumococcal #lineages associated with serotype #replacement and #antibiotic #resistance in #childhood #IPD in the post- #PCV13 era: an international #WGS study (Lancet Infect Dis., abstract)

[Source: The Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]

Pneumococcal lineages associated with serotype replacement and antibiotic resistance in childhood invasive pneumococcal disease in the post-PCV13 era: an international whole-genome sequencing study

Stephanie W Lo, PhD  *,  Rebecca A Gladstone, PhD *, Andries J van Tonder, DPhil, John A Lees, PhD, Mignon du Plessis, PhD, Rachel Benisty, PhD, Noga Givon-Lavi, PhD, Paulina A Hawkins, MPH, Jennifer E Cornick, PhD, Brenda Kwambana-Adams, PhD, Pierra Y Law, PhD, Pak Leung Ho, MD, Martin Antonio, PhD, Dean B Everett, PhD, Prof Ron Dagan, MD, Anne von Gottberg, PhD, Prof Keith P Klugman, MD, Lesley McGee, PhD, Prof Robert F Breiman, MD, Stephen D Bentley, PhD,  The Global Pneumococcal Sequencing Consortium

Open Access / Published: June 10, 2019 / DOI: https://doi.org/10.1016/S1473-3099(19)30297-X




Invasive pneumococcal disease remains an important health priority owing to increasing disease incidence caused by pneumococci expressing non-vaccine serotypes. We previously defined 621 Global Pneumococcal Sequence Clusters (GPSCs) by analysing 20 027 pneumococcal isolates collected worldwide and from previously published genomic data. In this study, we aimed to investigate the pneumococcal lineages behind the predominant serotypes, the mechanism of serotype replacement in disease, as well as the major pneumococcal lineages contributing to invasive pneumococcal disease in the post-vaccine era and their antibiotic resistant traits.


We whole-genome sequenced 3233 invasive pneumococcal disease isolates from laboratory-based surveillance programmes in Hong Kong (n=78), Israel (n=701), Malawi (n=226), South Africa (n=1351), The Gambia (n=203), and the USA (n=674). The genomes represented pneumococci from before and after pneumococcal conjugate vaccine (PCV) introductions and were from children younger than 3 years. We identified predominant serotypes by prevalence and their major contributing lineages in each country, and assessed any serotype replacement by comparing the incidence rate between the pre-PCV and PCV periods for Israel, South Africa, and the USA. We defined the status of a lineage as vaccine-type GPSC (≥50% 13-valent PCV [PCV13] serotypes) or non-vaccine-type GPSC (>50% non-PCV13 serotypes) on the basis of its initial serotype composition detected in the earliest vaccine period to measure their individual contribution toward serotype replacement in each country. Major pneumococcal lineages in the PCV period were identified by pooled incidence rate using a random effects model.


The five most prevalent serotypes in the PCV13 period varied between countries, with only serotypes 5, 12F, 15B/C, 19A, 33F, and 35B/D common to two or more countries. The five most prevalent serotypes in the PCV13 period varied between countries, with only serotypes 5, 12F, 15B/C, 19A, 33F, and 35B/D common to two or more countries. These serotypes were associated with more than one lineage, except for serotype 5 (GPSC8). Serotype replacement was mainly mediated by expansion of non-vaccine serotypes within vaccine-type GPSCs and, to a lesser extent, by increases in non-vaccine-type GPSCs. A globally spreading lineage, GPSC3, expressing invasive serotypes 8 in South Africa and 33F in the USA and Israel, was the most common lineage causing non-vaccine serotype invasive pneumococcal disease in the PCV13 period. We observed that same prevalent non-vaccine serotypes could be associated with distinctive lineages in different countries, which exhibited dissimilar antibiotic resistance profiles. In non-vaccine serotype isolates, we detected significant increases in the prevalence of resistance to penicillin (52 [21%] of 249 vs 169 [29%] of 575, p=0·0016) and erythromycin (three [1%] of 249 vs 65 [11%] of 575, p=0·0031) in the PCV13 period compared with the pre-PCV period.


Globally spreading lineages expressing invasive serotypes have an important role in serotype replacement, and emerging non-vaccine serotypes associated with different pneumococcal lineages in different countries might be explained by local antibiotic-selective pressures. Continued genomic surveillance of the dynamics of the pneumococcal population with increased geographical representation in the post-vaccine period will generate further knowledge for optimising future vaccine design.


Bill & Melinda Gates Foundation, Wellcome Sanger Institute, and the US Centers for Disease Control.

Keywords: Antibiotics; Drugs Resistance; S. Pneumoniae; Vaccines.


#Bacterial Factors Required for #Transmission of #Streptococcus pneumoniae in #Mammalian Hosts (Cell Host Microbe, abstract)

[Source: Cell, Host & Microbe, full page: (LINK). Abstract, edited.]

Bacterial Factors Required for Transmission of Streptococcus pneumoniae in Mammalian Hosts

Hannah M. Rowe, Erik Karlsson, Haley Echlin, Ti-Cheng Chang, Lei Wang, Tim van Opijnen, Stanley B. Pounds, Stacey Schultz-Cherry, Jason W. Rosch

Published: May 21, 2019 / DOI: https://doi.org/10.1016/j.chom.2019.04.012



  • A pneumococcal Tn-seq library was screened in a ferret transmission model
  • The fitness landscape of S. pneumoniae genes during mammalian transmission established
  • Metabolic factors enhance pneumococcal environmental stability
  • Vaccinating dams with identified factors blocks pneumococcal transmission in offspring



The capacity of Streptococcus pneumoniae to successfully transmit and colonize new human hosts is a critical aspect of pneumococcal population biology and a prerequisite for invasive disease. However, the bacterial mechanisms underlying this process remain largely unknown. To identify bacterial factors required for transmission, we conducted a high-throughput genetic screen with a transposon sequencing (Tn-seq) library of a pneumococcal strain in a ferret transmission model. Key players in both metabolism and transcriptional regulation were identified as required for efficient bacterial transmission. Targeted deletion of the putative C3-degrading protease CppA, iron transporter PiaA, or competence regulatory histidine kinase ComD significantly decreased transmissibility in a mouse model, further validating the screen. Maternal vaccination with recombinant surface-exposed PiaA and CppA alone or in combination blocked transmission in offspring and were more effective than capsule-based vaccines. These data underscore the possibility of targeting pneumococcal transmission as a means of eliminating invasive disease in the population.

Keywords: Streptococcus pneumoniae – transmission – ferret – influenza

Keywords: Streptococcus pneumoniae; IPD; Animal models.


Effect of 10-valent #PCV on #IPD and #nasopharyngeal carriage in #Kenya: a longitudinal surveillance study (Lancet, abstract)

[Source: The Lancet, full page: (LINK). Abstract, edited.]

Effect of ten-valent pneumococcal conjugate vaccine on invasive pneumococcal disease and nasopharyngeal carriage in Kenya: a longitudinal surveillance study

Laura L Hammitt, MD, Anthony O Etyang, ChB, Susan C Morpeth, FRACP, John Ojal, PhD, Alex Mutuku, MSc, Neema Mturi, MRCPCH, Jennifer C Moisi, PhD, Ifedayo M Adetifa, PhD, Angela Karani, BSc, Donald O Akech, BSc, Mark Otiende, MSc, Tahreni Bwanaali, MBA, Jackline Wafula, BSN, Christine Mataza, KRCHN, Edward Mumbo, BSc, Collins Tabu, MPH, Maria Deloria Knoll, PhD, Evasius Bauni, PhD, Prof Kevin Marsh, FMedSci, Prof Thomas N Williams, FMedSci, Tatu Kamau, MPH, Shahnaaz K Sharif, MD, Prof Orin S Levine, PhD, Prof J Anthony G Scott, FRCP

Open Access / PublishedApril 15, 2019 / DOI: https://doi.org/10.1016/S0140-6736(18)33005-8




Ten-valent pneumococcal conjugate vaccine (PCV10), delivered at 6, 10, and 14 weeks of age was introduced in Kenya in January, 2011, accompanied by a catch-up campaign in Kilifi County for children aged younger than 5 years. Coverage with at least two PCV10 doses in children aged 2–11 months was 80% in 2011 and 84% in 2016; coverage with at least one dose in children aged 12–59 months was 66% in 2011 and 87% in 2016. We aimed to assess PCV10 effect against nasopharyngeal carriage and invasive pneumococcal disease (IPD) in children and adults in Kilifi County.


This study was done at the KEMRI-Wellcome Trust Research Programme among residents of the Kilifi Health and Demographic Surveillance System, a rural community on the Kenyan coast covering an area of 891 km2. We linked clinical and microbiological surveillance for IPD among admissions of all ages at Kilifi County Hospital, Kenya, which serves the community, to the Kilifi Health and Demographic Surveillance System from 1999 to 2016. We calculated the incidence rate ratio (IRR) comparing the prevaccine (Jan 1, 1999–Dec 31, 2010) and postvaccine (Jan 1, 2012–Dec 31, 2016) eras, adjusted for confounding, and reported percentage reduction in IPD as 1 minus IRR. Annual cross-sectional surveys of nasopharyngeal carriage were done from 2009 to 2016.


Surveillance identified 667 cases of IPD in 3 211 403 person-years of observation. Yearly IPD incidence in children younger than 5 years reduced sharply in 2011 following vaccine introduction and remained low (PCV10-type IPD: 60·8 cases per 100 000 in the prevaccine era vs 3·2 per 100 000 in the postvaccine era [adjusted IRR 0·08, 95% CI 0·03–0·22]; IPD caused by any serotype: 81·6 per 100 000 vs 15·3 per 100 000 [0·32, 0·17–0·60]). PCV10-type IPD also declined in the post-vaccination era in unvaccinated age groups (<2 months [no cases in the postvaccine era], 5–14 years [adjusted IRR 0·26, 95% CI 0·11–0·59], and ≥15 years [0·19, 0·07–0·51]). Incidence of non-PCV10-type IPD did not differ between eras. In children younger than 5 years, PCV10-type carriage declined between eras (age-standardised adjusted prevalence ratio 0·26, 95% CI 0·19–0·35) and non-PCV10-type carriage increased (1·71, 1·47–1·99).


Introduction of PCV10 in Kenya, accompanied by a catch-up campaign, resulted in a substantial reduction in PCV10-type IPD in children and adults without significant replacement disease. Although the catch-up campaign is likely to have brought forward the benefits by several years, the study suggests that routine infant PCV10 immunisation programmes will provide substantial direct and indirect protection in low-income settings in tropical Africa.


Gavi, The Vaccine Alliance and The Wellcome Trust of Great Britain.

Keywords: Streptococcus pneumoniae; Vaccines; IPD; Kenya.


#Effectiveness of #pneumococcal conjugate #vaccines against IPD among #children under five years of age in #Africa: A systematic review (PLoS One, abstract)

[Source: PLoS One, full page: (LINK). Abstract, edited.]


Effectiveness of pneumococcal conjugate vaccines against invasive pneumococcal disease among children under five years of age in Africa: A systematic review

James Samwel Ngocho , Best Magoma, Gaudencia Alois Olomi, Michael Johnson Mahande, Sia Emmanueli Msuya, Marien Isaäk de Jonge, Blandina Theophil Mmbaga

Published: February 19, 2019 / DOI: https://doi.org/10.1371/journal.pone.0212295




Despite the widespread implementation of the pneumococcal conjugate vaccine, Streptococcus pneumoniae remains the leading cause of severe pneumonia associated with mortality among children less than 5 years of age worldwide, with the highest mortality rates recorded in Africa and Asia. However, information on the effectiveness and prevalence of vaccine serotypes post-roll out remains scarce in most African countries. Hence, this systematic review aimed to describe what is known about the decline of childhood invasive pneumococcal disease post-introduction of the pneumococcal conjugate vaccine in Africa.


This systematic review included articles published between 2009 and 2018 on the implementation of the pneumococcal conjugate vaccine in Africa. We searched PubMed, Scopus and African Index Medicus for articles in English. Studies on implementation programmes of pneumococcal conjugate vaccine 10/13, with before and after data from different African countries, were considered eligible. The review followed the procedures published in PROSPERO (ID = CRD42016049192).


In total, 2,280 studies were identified through electronic database research, and only 8 studies were eligible for inclusion in the final analysis. Approximately half (n = 3) of these studies were from South Africa. The overall decline in invasive pneumococcal disease ranged from 31.7 to 80.1%. Invasive pneumococcal diseases caused by vaccine serotypes declined significantly, the decline ranged from 35.0 to 92.0%. A much higher decline (55.0–89.0%) was found in children below 24 months of age. Of all vaccine serotypes, the relative proportions of serotypes 1, 5 and 19A doubled following vaccine roll out.


Following the introduction of the pneumococcal conjugate vaccine, a significant decline was observed in invasive pneumococcal disease caused by vaccine serotypes. However, data on the effectiveness in this region remain scarce, meriting continued surveillance to assess the effectiveness of pneumococcal vaccination to improve protection against invasive pneumococcal disease.


Citation: Ngocho JS, Magoma B, Olomi GA, Mahande MJ, Msuya SE, de Jonge MI, et al. (2019) Effectiveness of pneumococcal conjugate vaccines against invasive pneumococcal disease among children under five years of age in Africa: A systematic review. PLoS ONE 14(2): e0212295. https://doi.org/10.1371/journal.pone.0212295

Editor: Wisit Cheungpasitporn, University of Mississippi Medical Center, UNITED STATES

Received: October 27, 2018; Accepted: January 30, 2019; Published: February 19, 2019

Copyright: © 2019 Ngocho et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the manuscript and its Supporting Information files.

Funding: This research was supported by the Fogarty International Center of the National Institutes of Health under Award Number D43TW010138. Additionally, this work was supported partly by the German Academic Exchange Service (Deutscher Akademischer Austauschdienst-DAAD). James Samwel Ngocho is a medical education partnership junior faculty fellow and DAAD fellow. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interest exist.

Keywords: Streptococcus pneumoniae; Vaccines; Africa Region.


Effect of childhood #pneumococcal conjugate #vaccination on invasive disease in older #adults of 10 #European countries: implications for adult vaccination (Thorax, abstract)

[Source: Thorax, full page: (LINK). Abstract, edited.]

Effect of childhood pneumococcal conjugate vaccination on invasive disease in older adults of 10 European countries: implications for adult vaccination

Germaine Hanquet1,2, Pavla Krizova3, Palle Valentiner-Branth4, Shamez N Ladhani5, J Pekka Nuorti6,7, Agnes Lepoutre8, Jolita Mereckiene9, Mirjam Knol10, Brita A Winje11, Pilar Ciruela12,13, Maria Ordobas14, Marcela Guevara13,15, Eisin McDonald16, Eva Morfeldt17, Jana Kozakova3, Hans-Christian Slotved4, Norman K Fry5, Hanna Rinta-Kokko6, Emmanuelle Varon18, Mary Corcoran19, Arie van der Ende20, Didrik F Vestrheim11, Carmen Munoz-Almagro13,21, Pello Latasa14, Jesus Castilla13,15, Andrew Smith22, Birgitta Henriques-Normark17,23,24, Robert Whittaker25, Lucia Pastore Celentano25, Camelia Savulescu1 on behalf of The SpIDnet/I-MOVE+ Pneumo Group

Author affiliations: 1 EpiConcept, Paris, France; 2 Antwerp University, Antwerp, Belgium; 3 National Institute of Public Health, Prague, Czech Republic; 4 Statens Serum Institut, Copenhagen, Denmark; 5 Public Health England, London, UK; 6 National Institute for Health and Welfare, Helsinki, Finland; 7 University of Tampere, Tampere, Finland; 8 Santé publique France, Saint-Maurice, France; 9 Health Protection Surveillance Centre, Dublin, Ireland; 10 National Institute for Public Health and the Environment, Bilthoven, The Netherlands; 11 Norwegian Institute of Public Health, Oslo, Norway; 12 Public Health Agency of Catalunya, Barcelona, Spain; 13 CIBER Epidemiología y Salud Pública, Madrid, Spain; 14 General Directorate of Public Health, Madrid, Spain; 15 Instituto de Salud Pública de Navarra – IdiSNA, Pamplona, Spain; 16 Health Protection Scotland, National Services Scotland, Glasgow, UK; 17 Public Health Agency of Sweden, Solna, Sweden; 18 National Centre for Pneumococci, European Hospital George Pompidou, Paris, France; 19 Irish Pneumococcal Reference Laboratory, Temple Street Children’s University Hospital, Dublin, Ireland; 20 Netherlands Reference Laboratory for Bacterial Meningitis, Academic Medical Centre, Amsterdam, The Netherlands; 21 Instituto de Recerca Pediátrica, Hospital Sant Joan de Deu, Universitat Internacional de Catalunya, Barcelona, Spain; 22 Scottish Haemophilus, Legionella, Meningococcus and Pneumococcus Reference Laboratory, Glasgow, UK; 23 Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden; 24 Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden; 25 European Centre for Disease Prevention and Control, Stockholm, Sweden

Correspondence to Dr Germaine Hanquet, Epidemiology Department, EpiConcept, Paris 75012, France; ghanquet@skynet.be




Pneumococcal conjugate vaccines (PCVs) have the potential to prevent pneumococcal disease through direct and indirect protection. This multicentre European study estimated the indirect effects of 5-year childhood PCV10 and/or PCV13 programmes on invasive pneumococcal disease (IPD) in older adults across 13 sites in 10 European countries, to support decision-making on pneumococcal vaccination policies.


For each site we calculated IPD incidence rate ratios (IRR) in people aged ≥65 years by serotype for each PCV10/13 year (2011–2015) compared with 2009 (pre-PCV10/13). We calculated pooled IRR and 95% CI using random-effects meta-analysis and PCV10/13 effect as (1 − IRR)*100.


After five PCV10/13 years, the incidence of IPD caused by all types, PCV7 and additional PCV13 serotypes declined 9% (95% CI −4% to 19%), 77% (95% CI 67% to 84%) and 38% (95% CI 19% to 53%), respectively, while the incidence of non-PCV13 serotypes increased 63% (95% CI 39% to 91%). The incidence of serotypes included in PCV13 and not in PCV10 decreased 37% (95% CI 22% to 50%) in six PCV13 sites and increased by 50% (95% CI −8% to 146%) in the four sites using PCV10 (alone or with PCV13). In 2015, PCV13 serotypes represented 20–29% and 32–53% of IPD cases in PCV13 and PCV10 sites, respectively.


Overall IPD incidence in older adults decreased moderately after five childhood PCV10/13 years in 13 European sites. Large declines in PCV10/13 serotype IPD, due to the indirect effect of childhood vaccination, were countered by increases in non-PCV13 IPD, but these declines varied according to the childhood vaccine used. Decision-making on pneumococcal vaccination for older adults must consider the indirect effects of childhood PCV programmes. Sustained monitoring of IPD epidemiology is imperative.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

DOI: http://dx.doi.org/10.1136/thoraxjnl-2018-211767

Keywords: S. Pneumoniae; Vaccines; European Region; Invasive Pneumococcal Disease.


Invasive #Pneumococcal #Disease in #Refugee #Children, #Germany (Emerg Infect Dis., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Volume 24, Number 10—October 2018 / Dispatch

Invasive Pneumococcal Disease in Refugee Children, Germany

Stephanie Perniciaro  , Matthias Imöhl, and Mark van der Linden

Author affiliations: University Hospital RWTH Aachen, Aachen, Germany



Refugee children in Germany are not routinely given a pneumococcal conjugate vaccine. Cases of invasive pneumococcal disease (IPD) in 21 refugee children were compared with those in 405 Germany-born children for 3 pneumococcal seasons. Refugee children had significantly higher odds of vaccine-type IPD and multidrug-resistant IPD than did Germany-born children.

Keywords: S. Pneumoniae; Antibiotics; Drugs Resistance; Invasive pneumococcal disease; Migrants; Germany.