#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.


Emergence of #ceftriaxone #resistance during a #pneumococcal #meningitis with #fatal evolution (Antimicrob Agents Chemother., abstract)

[Source: Antimicrobial Agents and Chemotherapy, full page: (LINK). Abstract, edited.]

Emergence of ceftriaxone resistance during a pneumococcal meningitis with fatal evolution

A. Mizrahi, J.C. Marvaud, B. Pilmis, J.C. Nguyen Van, C. Couzigou, C. Bruel, N. Engrand, A. Le Monnier, T. Lambert

DOI: 10.1128/AAC.01958-19



We report a case of a 62-year old man treated for a Streptococcus pneumoniae meningitis by ceftriaxone and dexamethasone. After a neurological improvement, neurological degradation by vasculitis occurred, despite effective concentrations of ceftriaxone in serum and CSF. S. pneumoniae with increased MICs to third-generation-cephalosporins (3GC) was isolated from the ventricular fluid ten days after the isolation of the first strain. Isolates analysis showed that a mutation of penicillin-binding proteins in PBP2x has occurred under treatment.

Copyright © 2019 American Society for Microbiology. All Rights Reserved.

Keywords: Antibiotics; Drugs Resistance; Ceftriaxone; Streptococcus pneumoniae; Meningitis.


#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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© 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.



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 susceptibility to #antibiotics in #carriage: a 17 year time series analysis of the adaptive #evolution of non-vaccine emerging #serotypes to a new selective pressure environment (J Antimicrob Chemother., abstract)

[Source: Journal of Antimicrobial Chemotherapy, full page: (LINK). Abstract, edited.]

Pneumococcal susceptibility to antibiotics in carriage: a 17 year time series analysis of the adaptive evolution of non-vaccine emerging serotypes to a new selective pressure environment

Naim Ouldali, Robert Cohen, Corinne Levy, Nathalie Gelbert-Baudino, Elisa Seror. François Corrard, François Vie Le Sage, Anne-Sylvestre Michot, Olivier Romain, Stéphane Bechet, Stéphane Bonacorsi, François Angoulvant, Emmanuelle Varon

Journal of Antimicrobial Chemotherapy, dkz281, https://doi.org/10.1093/jac/dkz281

Published: 06 July 2019




Pneumococcal conjugate vaccine (PCV) implementations led to major changes in serotype distribution and antibiotic resistance in carriage, accompanied by changes in antibiotic consumption.


To assess the dynamic patterns of antimicrobial non-susceptibility across non-PCV13 serotypes following PCV implementations.


We conducted a quasi-experimental interrupted time series analysis based on a 17 year French nationwide prospective cohort. From 2001 to 2018, 121 paediatricians obtained nasopharyngeal swabs from children with acute otitis media who were aged 6 months to 2 years. The main outcome was the rate of penicillin-non-susceptible pneumococci (PNSP), analysed by segmented regression.


We enrolled 10 204 children. After PCV13 implementation, the PNSP rate decreased (−0.5% per month; 95% CI −0.9 to −0.1), then, after 2014, the rate slightly increased (+0.7% per month; 95% CI +0.2 to +1.2). Global antibiotic use within the previous 3 months decreased over the study period (−22.2%; 95% CI −33.0 to −11.3), but aminopenicillin use remained high. Among the main non-PCV13 serotypes, four dynamic patterns of penicillin susceptibility evolution were observed, including unexpected patterns of serotypes emerging while remaining or even becoming penicillin susceptible. In contrast to PNSP strains, for these latter patterns, the rate of co-colonization with Haemophilus influenzae increased concomitant with their emergence.


In a context of continuing high antibiotic selective pressure, a progressive increase in PNSP rate was observed after 2014. However, we highlighted an unexpected variability in dynamic patterns of penicillin susceptibility among emerging non-PCV13 serotypes. Antibiotic resistance may not be the only adaptive mechanism to antimicrobial selective pressure, and co-colonization with H. influenzae may be involved.


© The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: 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: Antibiotics; Drugs Resistance; Penicillin; Streptococcus pneumoniae; Vaccines; Haemophilus Influenzae.


Causes of severe #pneumonia requiring #hospital admission in #children without HIV infection from #Africa and #Asia: the #PERCH multi-country case-control study (Lancet, abstract)

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

Causes of severe pneumonia requiring hospital admission in children without HIV infection from Africa and Asia: the PERCH multi-country case-control study

The Pneumonia Etiology Research for Child Health (PERCH) Study Group †

Open Access / Published: June 27, 2019 / DOI: https://doi.org/10.1016/S0140-6736(19)30721-4




Pneumonia is the leading cause of death among children younger than 5 years. In this study, we estimated causes of pneumonia in young African and Asian children, using novel analytical methods applied to clinical and microbiological findings.


We did a multi-site, international case-control study in nine study sites in seven countries: Bangladesh, The Gambia, Kenya, Mali, South Africa, Thailand, and Zambia. All sites enrolled in the study for 24 months. Cases were children aged 1–59 months admitted to hospital with severe pneumonia. Controls were age-group-matched children randomly selected from communities surrounding study sites. Nasopharyngeal and oropharyngeal (NP-OP), urine, blood, induced sputum, lung aspirate, pleural fluid, and gastric aspirates were tested with cultures, multiplex PCR, or both. Primary analyses were restricted to cases without HIV infection and with abnormal chest x-rays and to controls without HIV infection. We applied a Bayesian, partial latent class analysis to estimate probabilities of aetiological agents at the individual and population level, incorporating case and control data.


Between Aug 15, 2011, and Jan 30, 2014, we enrolled 4232 cases and 5119 community controls. The primary analysis group was comprised of 1769 (41·8% of 4232) cases without HIV infection and with positive chest x-rays and 5102 (99·7% of 5119) community controls without HIV infection. Wheezing was present in 555 (31·7%) of 1752 cases (range by site 10·6–97·3%). 30-day case-fatality ratio was 6·4% (114 of 1769 cases). Blood cultures were positive in 56 (3·2%) of 1749 cases, and Streptococcus pneumoniae was the most common bacteria isolated (19 [33·9%] of 56). Almost all cases (98·9%) and controls (98·0%) had at least one pathogen detected by PCR in the NP-OP specimen. The detection of respiratory syncytial virus (RSV), parainfluenza virus, human metapneumovirus, influenza virus, S pneumoniae, Haemophilus influenzae type b (Hib), H influenzae non-type b, and Pneumocystis jirovecii in NP-OP specimens was associated with case status. The aetiology analysis estimated that viruses accounted for 61·4% (95% credible interval [CrI] 57·3–65·6) of causes, whereas bacteria accounted for 27·3% (23·3–31·6) and Mycobacterium tuberculosis for 5·9% (3·9–8·3). Viruses were less common (54·5%, 95% CrI 47·4–61·5 vs 68·0%, 62·7–72·7) and bacteria more common (33·7%, 27·2–40·8 vs 22·8%, 18·3–27·6) in very severe pneumonia cases than in severe cases. RSV had the greatest aetiological fraction (31·1%, 95% CrI 28·4–34·2) of all pathogens. Human rhinovirus, human metapneumovirus A or B, human parainfluenza virus, S pneumoniae, M tuberculosis, and H influenzae each accounted for 5% or more of the aetiological distribution. We observed differences in aetiological fraction by age for Bordetella pertussis, parainfluenza types 1 and 3, parechovirus–enterovirus, P jirovecii, RSV, rhinovirus, Staphylococcus aureus, and S pneumoniae, and differences by severity for RSV, S aureus, S pneumoniae, and parainfluenza type 3. The leading ten pathogens of each site accounted for 79% or more of the site’s aetiological fraction.


In our study, a small set of pathogens accounted for most cases of pneumonia requiring hospital admission. Preventing and treating a subset of pathogens could substantially affect childhood pneumonia outcomes.


Bill & Melinda Gates Foundation.

Keywords: Pneumonia; Pediatrics; Africa; Asia; Streptococcus pneumoniae; RSV; Metapneumovirus; Seasonal Influenza.