#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

 

Abstract

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

 

Abstract

Background 

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.

Methods 

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.

Findings 

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).

Interpretation 

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

 

Footnotes

Contributors 

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.

Funding 

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.

Disclaimer 

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.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s Rights. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Copyright information: © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.

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

 

Abstract

Background

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).

Methods

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.

Results

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.

Conclusions

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

This content is only available as a PDF.

© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

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.

 

Abstract

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

 

Summary

Background

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.

Methods

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.

Findings

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.

Interpretation

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.

Funding

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

 

Highlights

  • 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

 

Summary

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

 

Summary

Background

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.

Methods

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.

Findings

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).

Interpretation

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.

Funding

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

Keywords: Streptococcus pneumoniae; Vaccines; IPD; Kenya.

——