• Distribution of serotypes of Streptococcus pneumoniae in nasopharyngeal carriage in healthy children aged 6 months to 5 years in Ukraine
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Distribution of serotypes of Streptococcus pneumoniae in nasopharyngeal carriage in healthy children aged 6 months to 5 years in Ukraine

SOVREMENNAYA PEDIATRIYA.2014.4(60):77-83;doi 10.15574/SP.2014.60.77

Distribution of serotypes of Streptococcus pneumoniae in nasopharyngeal carriage in healthy children aged 6 months to 5 years in Ukraine

Chernyshоvа L. I., Gilfanova A. M., Bondarenko A. V., Yakimovitch S. A, Rabosh O. V, Yanovska V. V., Glushkevich T. G. 
P.L. Shupic National Medical Academy of Postgraduate Education, Kiev, Ukraine 
Kiev City Children's Clinical Hospital №1, Ukraine 
Bacteriological laboratory SI «Ukrainian Center of Control and Monitoring of Diseases of the Ministry of Health Care of Ukraine», Kiev

Objective. To demonstrate S.pneumoniae serotypes distribution in Ukrainian children 6 months — 5 years old. To demonstrate sensitivity to antibiotics of S.pneumoniae serotypes circulating among young children. To evaluate age distribution of serotypes in children under 5 years old. To estimate possible influence of early social activities (early contacts or start of kindergarten) in children under 5 years old on S.pneumoniae carriage and serotypes distribution.

Materials and Methods. Examined in 1000 healthy children from 6 months to 4 years 11 months 30 days. Samples of mucus from the nasopharynx were taken once by deep transnasally smear. For identification of S. pneumoniae used classical bacteriological methods and real$time PCR. Serotyping was performed using the multiplex PCR to serotypes 1, 3, 4, 5, 6A, 6B, 6C, 7F, 9V, 14, 18C, 19A, 19F, 20, 23F. Sensitivity to antimicrobial agents was determined by disc — diffusion method.

Results. The overall incidence of pneumococcal carriage among children aged 6 months to 5 years is 50.4%: from «home» children — 37.3%, of children attending pre-schools with day care — 60.9%, in children with institutions with non-stop stay — 95.6%. Social activity siblings is essential for children who do not attend pre-schools. Among the selected strains of pneumococcus are 88.9% of the capsule, of which 14 different serotypes were identified: 3, 4, 5 , 6A, 6B, 6C, 7, 9, 14, 18C, 19A, 19F, 20, 23F. Dominated serotypes 19F (26.1%), 6A/B (18.2%), 14 (11.4%) and 23F (5.7%). Antimicrobial resistance: oxacillin (38%), erythromycin (32%), azithromycin (14%), ciprofloxacin (52%), levofloxacin (13%), chloramphenicol (9%), co-trimoxazole (55%). About one-third (34% strains of pneumococcus is a multi-resistant.

Conclusions. Every second nasopharynx of healthy children aged 6 months to 5 years colonized by pneumococcus. Social activity of children and their siblings significantly affect the level of pneumococcal nasopharyngeal carriage. Strains of pneumococci isolated from the nasopharynx, are highly resistant to antimicrobial agents. There is serotype 19A (which has a high potential for development of antibiotic resistance) occurs in Ukraine, even before the introduction of pneumococcal conjugate vaccine in National Immunization Program.

Keywords: Streptococcus pneumoniae, children, nasopharyngeal carriage, antimicrobial resistance, serotypes.

1. Sleeman KL, Griffiths D, Shackley F et al. 2006. Capsular serotype-specific attack rates and duration of carriage of Streptococcus pneumoniae in a population of children. J Infect Dis. 194(5): 682—688.

2. CDC. Prevention of Pneumococcal Disease Among Infants and Children — Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. 2010. 59(No. RR-11). http://www.cdc.gov.

3. Dagan R. 2009. New insights on pneumococcal disease: What we have learned over the past decade. Vaccine. 27: 3—5.

4. Park IH, Pritchard DG, Cartee R et al. 2007. Discovery of a new capsular serotype (6C) within serogroup 6 of Streptococcus pneumonia. J Clin Microbiol. 45(4): 1225—1233. http://dx.doi.org/10.1128/JCM.02199-06; PMid:17267625 PMCid:PMC1865839

5. Farha T, Thomson AH. 2005. The burden of pneumonia in children in the developed world. PaediatrRespir Rev. 6(2): 76—82. http://dx.doi.org/10.1016/j.prrv.2005.03.001

6. Rodgers GL, Arguedas A, Cohen R, Dagan R. 2009. Global serotype distribution among S. pneumoniae isolates causing otitis media in children: potential implications for pneumococcal conjugate vaccines. Vaccine. 27: 3802—3810.

7. Otsuka T, Chang B et al. 2013. Individual Risk Factors Associated With Nasopharyngeal Colonization With Streptococcus pneumonia and Haemophilus influenza: A Japanese Birth Cohort Study. The Pediatric Infectious Disease Journal. 32;7: 709—714.

8. Stancil JM, Peters TR, Givner LB, Poehling KA. 2009. Potential Impact of Accelerating the Primary Dose of Pneumococcal Conjugate Vaccine in Infants. Arch Pediatr Adolesc Med. 163(5): 422—425.

9. Tyrrell GJ, Lovgren M, Chui N et al. 2009. Serotypes and antimicrobial susceptibilities of invasive Streptococcus pneumoniae pre- and post-seven valent pneumococcal conjugate vaccine introduction in Alberta, Canada, 2000—2006. Vaccine. 27: 3553—3560.

10. Soley C, Arguedas A. 2009. Understanding the link between pneumococcal serotypes and invasive disease. Vaccine. 27: 19—21.

11. Cohen J, Johnson HL, Deloria-Knoll M et al. 2010. Systematic Evaluation of Serotypes Causing Invasive Pneumococcal Disease among Children Under Five: The Pneumococcal Global Serotype Project. PLoS Medicine. 7(10): 1000348. http://dx.doi.org/10.1371/journal.pmed.1000348

12. Brueggemann AB, Peto TE, Crook DW et al. 2004. Temporal and geographic stability of the serogroup-specific invasive disease potential of Streptococcus pneumoniae in children. J Infect Dis. 190(7): 1203—1211.

13. Kadioglu A, Weiser JN, Paton JC, Andrew PW. 2008. The role of Streptococcus pneumoniae virulence factors in host respiratory colonization and disease. Nat Rev Microbiol. 6(4): 288-301. http://dx.doi.org/10.1038/nrmicro1871; PMid:18340341

14. Tzanakaki G, Mastrantonio P. 2007. Aetiology of bacterial meningitis and resistance to antibiotics of causative pathogens in Europe and in the Mediterranean region. Int J Antimicrob Agents. 29(6): 621—629. http://dx.doi.org/10.1016/j.ijantimicag.2006.11.031; PMid:17368858

15. World Health Organization and UNICEF. Global immunization data. October 2012. Available at: http://www.who.int/immunization-monitoring/Global-Immunization-Data.pdf.p.2. Accessed February 4, 2013.

16. World Health Organization. Pneumococcal vaccines WHO position paper — 2012. Weekly epidemiological record. 2012. 87;14: 129—144.