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Microorganisms
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Epidemiology of Pneumococci and Pneumococcal Diseases
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Epidemiology of Pneumococci and Pneumococcal Diseases

A special issue of Microorganisms (ISSN 2076-2607). This special issue belongs to the section "Medical Microbiology".

Deadline for manuscript submissions: closed (30 September 2021) | Viewed by 23688

Special Issue Editor

Dr. Ardanuy Carmen

E-Mail Website
Guest Editor
Department of Microbiology and Parasitology, Hospital Universitari de Bellvitge, Barcelona, Spain
Interests: Streptococcus pneumoniae; molecular epidemiology; antimicrobial resistance; vaccines; pneumococcal diseases

Special Issue Information

Dear collegues,

Streptococcus pneumoniae is an important cause of morbidity and mortality worldwide. The introduction of pneumococcal conjugate vaccines (PCV) for children in 2001 changed the epidemiology of pneumococcal infections. The decrease in disease rates has been associated with changes in both the serotype composition and the genetic lineages causing infections. Moreover, the emergence of new clones or the expansion of former clones expressing non-PCV serotypes could mask the benefit of vaccines.

On the other hand, resistance to β-lactams and other antimicrobial agents has complicated antibiotic therapy for diseases such as meningitis, which requires a high concentration of antibiotics to cross the blood–brain barrier. Furthermore, the continuous increase in patients at risk of developing pneumococcal diseases (elderly patients, immunosuppressed, etc.) demands new strategies to improve disease control.

The objective of this Special Issue is to provide new knowledge on the current status of pneumococcal infections. We invite you to send contributions related to S. pneumoniae from a wide range of perspectives, from molecular epidemiology to clinical practice. We encourage submissions that help to elucidate the current status of pneumococcal clinical presentations, the emergence of potential high-risk clones, molecular and clinical characterization of newly discovered virulence factors or new aspects regarding S. pneumoniae treatment. All research that adds new knowledge in the field of pneumococcal infections is also welcome.

As a Guest Editor of this Special Issue, I look forward to receiving your submissions to draw the current perspective on pneumococci and pneumococcal disease.

Dr. Ardanuy Carmen
Guest Editor

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Microorganisms is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Streptococcus pneumoniae
  • Pneumococcal conjugate vaccines
  • Serotype
  • Genotype
  • Virulence
  • Antimicrobial resistance β-lactam resistance
  • Pneumonia Meningitis

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Published Papers (7 papers)

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Research

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11 pages, 467 KiB  
Article
Age-Dependent Serotype-Associated Case-Fatality Rate in Invasive Pneumococcal Disease in the Autonomous Community of Madrid between 2007 and 2020
by Sara De Miguel, Pello Latasa, José Yuste, Luis García, María Ordobás, Belén Ramos, Marta Pérez, Maira Alejandra Ortiz and Juan Carlos Sanz
Microorganisms 2021, 9(11), 2286; https://doi.org/10.3390/microorganisms9112286 - 3 Nov 2021
Cited by 19 | Viewed by 2247
Abstract
The aim of this study was to investigate the serotype-associated fatality rate in cases of invasive pneumococcal disease (IPD) in the Spanish region of Madrid between 2007 and 2020. Serotyping was performed by Pneumotest Latex and the Quellung reaction using commercial antisera. Case-fatality [...] Read more.
The aim of this study was to investigate the serotype-associated fatality rate in cases of invasive pneumococcal disease (IPD) in the Spanish region of Madrid between 2007 and 2020. Serotyping was performed by Pneumotest Latex and the Quellung reaction using commercial antisera. Case-fatality rate was estimated as the ratio between the number of deaths at hospital discharge and the number of cases attributable to each serotype. To evaluate the association measures, the odds ratios with a 95% confidence interval were calculated. Twenty five pneumococcal serotypes were associated to mortality and comprised 87.8% of the total number of isolates characterized. Serotypes 8, 3, 19A, 1, 7F, 22F, 12F, and 11A were the most prevalent (≥3% each). Serotypes 31, 11A, and 19F were significantly associated to high case-fatality rates (>20% each). The lower significantly associated case-fatality rate (<10% each) was found in serotypes 5, 1, 12B, 7F, 12F, 8, 33, and 10A. The serotypes with higher mortality levels (≥0.04 per 100,000 population) were 11A (fatality 24.0%), 3 (fatality 18.7%), 19A (fatality 12.5%), and 8 (fatality 7.2%). Serotype 3 was worrisome because it is associated with important fatality levels combined with very high incidence and mortality rates. Serotype 11A also showed a high fatality with marked incidence and mortality levels. Some few frequent serotypes as 31, 19F, and 15A despite its high fatality had low levels of mortality. By contrast other serotypes as 8 showing low fatality had high mortality ranges because it shows a wide extended distribution. Finally, common serotypes, such as 1 and 5, presented small mortality length, due to their low case-fatality rates. Full article
(This article belongs to the Special Issue Epidemiology of Pneumococci and Pneumococcal Diseases)
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12 pages, 1291 KiB  
Article
Serotypes in Adult Pneumococcal Pneumonia in Spain in the Era of Conjugate Vaccines
by Lucía Fernández-Delgado, Jordi Càmara, Aida González-Díaz, Immaculada Grau, Hisashi Shoji, Fe Tubau, Sara Martí, Mª Ángeles Domínguez, Jordi Carratalà, Jose Yuste and Carmen Ardanuy
Microorganisms 2021, 9(11), 2245; https://doi.org/10.3390/microorganisms9112245 - 28 Oct 2021
Cited by 9 | Viewed by 3715
Abstract
We studied changes in serotype distribution and antimicrobial susceptibility in adult pneumococcal pneumonia in Spain (2011–2019). Among 895 pneumococci collected (433 bacteremic [BPP] and 462 non-bacteremic [non-BPP]), serotypes 3 (17%), 19A (10%), 8 (6.7%) and 11A (6.7%) were the most frequent. Serotypes 16F, [...] Read more.
We studied changes in serotype distribution and antimicrobial susceptibility in adult pneumococcal pneumonia in Spain (2011–2019). Among 895 pneumococci collected (433 bacteremic [BPP] and 462 non-bacteremic [non-BPP]), serotypes 3 (17%), 19A (10%), 8 (6.7%) and 11A (6.7%) were the most frequent. Serotypes 16F, 19A and 24F were associated with old people (≥65) and serotypes 4, 7F, 8, 12F and 19F to young adults. Serotypes 12F, 24F and 1 were significantly more frequent in BPP and serotypes 11A, 23A and 19F in non-BPP. Amoxicillin resistance was higher in non-BPP (17% vs. 11%) while penicillin non-susceptibility (37% vs. 24%) and macrolide resistance (29% vs. 14%) were higher in older adults. In the period 2017–2019, the vaccine coverages were: 32% (PCV13), 39% (PCV15), 65% (PCV20) and 69% (PPV23). Differences were found in serotype composition and antimicrobial resistance by age and type of infection. The maintenance of serotype 3 as a leading cause of adult pneumococcal pneumonia and the increase in highly invasive (serotype 8) or antimicrobial-resistant (serotype 11A) serotypes is worrisome. Further studies will be required to analyse the impact of the upcoming broader conjugate vaccines. Full article
(This article belongs to the Special Issue Epidemiology of Pneumococci and Pneumococcal Diseases)
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13 pages, 1010 KiB  
Article
Pediatric Invasive Pneumococcal Disease Three Years after PCV13 Introduction in the National Immunization Plan—The Continued Importance of Serotype 3
by Catarina Silva-Costa, Joana Gomes-Silva, Lúcia Prados, Mário Ramirez, José Melo-Cristino, on behalf of the Portuguese Group for the Study of Streptococcal Infections and the Portuguese Study Group of Invasive Pneumococcal Disease of the Pediatric Infectious Disease Society
Microorganisms 2021, 9(7), 1428; https://doi.org/10.3390/microorganisms9071428 - 1 Jul 2021
Cited by 10 | Viewed by 3258
Abstract
The introduction of pneumococcal conjugate vaccines PCV7 and PCV13 led to decreases in incidence of pediatric invasive pneumococcal disease (pIPD) and changes in serotype distribution. We evaluated the consequences of higher vaccine uptake after the introduction of PCV13 in the National Immunization Plan [...] Read more.
The introduction of pneumococcal conjugate vaccines PCV7 and PCV13 led to decreases in incidence of pediatric invasive pneumococcal disease (pIPD) and changes in serotype distribution. We evaluated the consequences of higher vaccine uptake after the introduction of PCV13 in the National Immunization Plan (NIP) in 2015. Besides culture and conventional serotyping, the use of molecular methods to detect and serotype pneumococci in both pleural and cerebrospinal fluid samples contributed to 30% of all pIPD (n = 232) in 2015–2018. The most frequently detected serotypes were: 3 (n = 59, 26%), 10A (n = 17, 8%), 8 (n = 16, 7%) and 19A (n = 10, 4%). PCV13 serotypes still accounted for 46% of pIPD cases. Serotypes not included in any currently available conjugate vaccine (NVT) are becoming important causes of pIPD, with the increases in serotypes 8 and 33F being of particular concern given the importance of serotype 8 in adult IPD and the antimicrobial resistance of serotype 33F isolates. This study highlights the importance of using molecular methods in pIPD surveillance since these allowed a better case ascertainment and the identification of serotype 3 as the leading cause of pIPD. Even in a situation of vaccine uptake >95% for 3 years, PCV13 serotypes remain important causes of pIPD. Full article
(This article belongs to the Special Issue Epidemiology of Pneumococci and Pneumococcal Diseases)
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15 pages, 1093 KiB  
Article
The Impact of Pneumococcal Conjugate Vaccine (PCV) Coverage Heterogeneities on the Changing Epidemiology of Invasive Pneumococcal Disease in Switzerland, 2005–2019
by Oluwaseun Rume-Abiola Oyewole, Phung Lang, Werner C. Albrich, Kerstin Wissel, Stephen L. Leib, Carlo Casanova and Markus Hilty
Microorganisms 2021, 9(5), 1078; https://doi.org/10.3390/microorganisms9051078 - 18 May 2021
Cited by 10 | Viewed by 3591
Abstract
Pneumococcal conjugate vaccines (PCVs) have lowered the incidence of invasive pneumococcal disease (IPD) worldwide. However, the influence of regional vaccine uptake differences on the changing epidemiology of IPD remains unclear. We aimed to examine the overall impact of both seven- and 13-valent PCVs [...] Read more.
Pneumococcal conjugate vaccines (PCVs) have lowered the incidence of invasive pneumococcal disease (IPD) worldwide. However, the influence of regional vaccine uptake differences on the changing epidemiology of IPD remains unclear. We aimed to examine the overall impact of both seven- and 13-valent PCVs (PCV7 and PCV13) on IPD in Switzerland. Three-year periods from 2005–2010 and 2011–2019 were considered, respectively, as (early and late) PCV7 eras and (early, mid and late) PCV13 eras. Vaccine coverage was estimated from a nationwide survey according to east (German-speaking) and west (French/Italian-speaking) regions for each period. Reported incidence rate ratios (IRRs) were compared between successive periods and regions using nationwide IPD surveillance data. Overall IPD incidence across all ages was only 16% lower in the late PCV13 era compared to the early PCV7 era (IRR 0.83, 95% CI 0.79–0.88), due to increasing incidence of non-PCV-type IPD (2.59, 2.37–2.83) in all age groups, except children <5 years. PCV uptake rates in swiss children were slightly higher in the west than the east (p < 0.001), and were accompanied by lower IPD incidences across all age groups in the former region. Post-PCV13, non-PCV serotypes 8, 22F and 9N were the major cause of IPD in adults ≥65 years. Increased PCV coverage in both areas of Switzerland resulted in a decrease in vaccine-type and overall IPD incidence across all age groups, in a regionally dependent manner. However, the rising incidence of non-vaccine-type IPD, exclusive to older adults, may undermine indirect beneficial effects. Full article
(This article belongs to the Special Issue Epidemiology of Pneumococci and Pneumococcal Diseases)
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14 pages, 2370 KiB  
Article
Invasive Pneumococcal Disease in Adults in Portugal: The Importance of Serotypes 8 and 3 (2015–2018)
by Catarina Silva-Costa, Joana Gomes-Silva, Inês Teodoro, Mário Ramirez, José Melo-Cristino and on behalf of the Portuguese Group for the Study of Streptococcal Infections
Microorganisms 2021, 9(5), 1016; https://doi.org/10.3390/microorganisms9051016 - 8 May 2021
Cited by 14 | Viewed by 3175
Abstract
Increasing the uptake of the 13-valent pneumococcal conjugate vaccine (PCV13) in children is expected to alter the serotypes causing invasive pneumococcal disease (IPD) in adults due to herd protection. We characterized 2172 cases of adult IPD in 2015–2018 in Portugal after the introduction [...] Read more.
Increasing the uptake of the 13-valent pneumococcal conjugate vaccine (PCV13) in children is expected to alter the serotypes causing invasive pneumococcal disease (IPD) in adults due to herd protection. We characterized 2172 cases of adult IPD in 2015–2018 in Portugal after the introduction of PCV13 in the national immunization plan of 2015. Among the 58 detected serotypes, serotypes 8 (n = 413; 19%), 3 (n = 334; 15%), 22F (n = 148; 7%), 14 (n = 138; 6%), and 19A (n = 116; 5%) were the most frequent. Among PCV13 serotypes, 7F and 19A IPD decreased, but serotype 3 IPD remained stable. The non-PCV13 serotypes were a heterogeneous group, with serotypes 23A and 23B enriched among CSF cases; serotype 8 associated with younger patients; and serotypes 22F, 6C, and 31 associated with older patients. The continued increase of serotype 8 IPD was one of the drivers for the increased coverage of the 23-valent pneumococcal polysaccharide vaccine (PPV23; 80% in 2015–2018). Antimicrobial resistance was associated with older age and serotypes 6C, 11A, 14, 15A, 19A, and 19F. Three years after the introduction of PCV13 in the NIP with an uptake of >95%, the proportion of PCV13 serotypes causing IPD in adults stabilized in Portugal. The direct vaccination of adults may be important in preventing IPD in this age group. Full article
(This article belongs to the Special Issue Epidemiology of Pneumococci and Pneumococcal Diseases)
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11 pages, 1095 KiB  
Communication
Comparison of Four Streptococcus pneumoniae Urinary Antigen Tests Using Automated Readers
by Alicia Yoke Wei Wong, Alexander Tony Arvind Johnsson, Karolina Ininbergs, Simon Athlin and Volkan Özenci
Microorganisms 2021, 9(4), 827; https://doi.org/10.3390/microorganisms9040827 - 13 Apr 2021
Cited by 7 | Viewed by 3098
Abstract
Streptococcus pneumoniae urinary antigen tests (UATs) may be interpreted using automatic readers to potentially automate sample incubation and provide standardized results reading. Here, we evaluated four UATs the BinaxNOW S. pneumoniae Antigen Card (Abbott, Chicago, IL, USA), ImmuView S. pneumoniae and Legionella (SSI [...] Read more.
Streptococcus pneumoniae urinary antigen tests (UATs) may be interpreted using automatic readers to potentially automate sample incubation and provide standardized results reading. Here, we evaluated four UATs the BinaxNOW S. pneumoniae Antigen Card (Abbott, Chicago, IL, USA), ImmuView S. pneumoniae and Legionella (SSI Diagnostica, Hillerød, Denmark), STANDARD F S. pneumoniae Ag FIA (SD Biosensor, Gyeonggi, South Korea), and Sofia S. pneumoniae FIA (Quidel Corporation, San Diego, CA, USA) with their respective benchtop readers for their ability to detect S. pneumoniae urinary antigen. We found that these assays had a sensitivity of 76.9–86.5%, and specificity of 84.2–89.7%, with no significant difference found among the four UATs. The assays had a high level of agreement with each other, with 84.5% of samples testing consistently across all four assays. The automatically and visually read test results from the two immunochromatographic assays, BinaxNOW and ImmuView, were compared and showed excellent agreement between the two types of reading. Immunofluorescent-based assays, Sofia and STANDARD F, had significantly less time to detect compared to the two immunochromatographic assays due to having less assay setup procedures and shorter sample incubation times. In conclusion, the four UATs performed similarly in the detection of S. pneumoniae urinary antigen, and readers can bring increased flexibility to running UATs in the clinical routine. Full article
(This article belongs to the Special Issue Epidemiology of Pneumococci and Pneumococcal Diseases)
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Review

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14 pages, 435 KiB  
Review
Recent Topics of Pneumococcal Vaccination: Indication of Pneumococcal Vaccine for Individuals at a Risk of Pneumococcal Disease in Adults
by Nobuhiro Asai and Hiroshige Mikamo
Microorganisms 2021, 9(11), 2342; https://doi.org/10.3390/microorganisms9112342 - 12 Nov 2021
Cited by 4 | Viewed by 3229
Abstract
Pneumococcal disease is one of the most common and severe vaccine-preventable diseases (VPDs). Despite the advances in antimicrobial treatment, pneumococcal disease still remains a global burden and exhibits a high mortality rate among people of all ages worldwide. The immunization program of the [...] Read more.
Pneumococcal disease is one of the most common and severe vaccine-preventable diseases (VPDs). Despite the advances in antimicrobial treatment, pneumococcal disease still remains a global burden and exhibits a high mortality rate among people of all ages worldwide. The immunization program of the pneumococcal conjugate vaccine (PCV) in children has decreased pneumococcal disease incidence in several countries. However, there are several problems regarding the pneumococcal vaccine, such as indications for immunocompetent persons with underlying medical conditions with a risk of pneumococcal disease, the balance of utility and cost, i.e., cost-effectiveness, vaccine coverage rate, serotype replacement, and adverse events. Especially for individuals aged 19–64 at risk of pneumococcal disease, physicians and vaccine providers should make a rational decision whether the patients should be vaccinated or not, since there is insufficient evidence supporting it. We describe this review regarding topics and problems regarding pneumococcal vaccination from the clinician’s point of view. Full article
(This article belongs to the Special Issue Epidemiology of Pneumococci and Pneumococcal Diseases)
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