Prevalence of streptococcus pneumoniae serotypes in and around Trichy and its clinical relevance: An audit

Thilagavathy

Microbiologist, Kauvery Hospital, Cantonment, Trichy 

Background

Abstract

Pneumococcal disease is a leading vaccine preventable disease globally, and especially in India. Invasive pneumococcal disease is the major cause of childhood mortality in India, account for 3.6% of paediatric hospitalization. In 2010, 31% of death in children were due to pneumonia.

Aim

To assess the prevalence of vaccine and non-vaccine serotypes causing Invasive and Non-invasive Pneumococcal disease.

Objective

  • To identify the common serotype causing Invasive and Non-invasive pneumococcal disease in the ‘at risk’ population
  • To assess the percentage of non-vaccine serotypes.

Summary: In adults >50yrs, S. pneumoniae accounts for 30-35% Of CAP,>60% of bacterial meningitis and case fatality rate 28% in invasive disease.
Materials and methods
Place of Audit: KMC specialty hospital, Cantonment
Duration of Audit: August 2021- January 2024
Audit Done by: Department of Microbiology.

 

 

 

 

Inclusion criteria

  • All age groups
  • All clinical samples
  • Samples from Kauvery hospital cantonment, Tennur and Heart City.

Methodology

  • Specimen processed as per standard protocol
  • Presumptive identification by optochin susceptibility
  • Confirmation by manual (Bile solubility) and automated methods (Vitek2 compact)
  • Isolates sent to reference centre (CMC Vellore) for serotyping by Quellung reaction

Results

Total number of isolates: 48

Men: 22

Women: 11

Children: 15

Age wise distribution

Age distribution

No of isolates

percentage
<5 13 27
5-15 2 4.16
16-59 17 35.4
>60 16 33.3

Total

 48

Specimen wise distribution

Specimen

No of isolates

percentage
Respiratory (Tracheal + sputum+BAL) 16+9+1 =26 54.1
Blood 18 37.5
Body fluids (Synovial fluid) 1 2.0
Tissue 1 2.0
CSF 1 2.0
Ear swab 1 2.0

Total

 48

Ward wise distribution

Ward

Total number of isolates

percentage
Critical care area(Adult + padiatric) 24 +7 =31 64.5
Genera Wards 12 25
Op Adult – 3

Paed – 2

 10.4

Total

 48

Serotype distribution (All Age groups included)

Serotype

n

percentage
19F 14 29.1
19A 4 8.3
6B 4 8.3
35B 4 8.3
11A 3 6.2
3 2 4.1
15B 2 4.1
6B 2 4.1
14 2 4.1
23F 2 4.1
13, 15, 16A, 24F,15C,17F,9V,20, 18C 1 each 18.8

Total

 48

Vaccines

pneumoniae1

Vaccines available in India

pneumoniae2

Age group wise serotype distribution

Age groups

Serotypes
<5 years 19F (n=3), 6B (n=3), 19A (n=2), 3 (n=1), 15(n=1), 16A(n=1), 23F(n=1), 13(n=1)

 

PCV 10

PCV 13
1

5

6A

7F

9V

14

19A

19F

23F

6B

 1

3

4

5

6A,6B

7F

9V

14

18C

19A,19F

23F
69.2% 77%

Serotypes not covered in PCV 10

  • Serotype 3 (n=2) (1-4 years and >60 years)
  • Serotype 4 (n=0)
  • Serotype 18C (n=1; >=60years)

Age group wise serotype distribution

Age groups

Serotypes
>60 years 19F (n=3), 35B (n=3), 11A (n=2), 19A (n=2), 20 (n=1), 18c (n=1), 51B(n=1), 14 (n=1),3(n=1), 6B(n=1).
16-59 years 19F (n=7), 6B (n=2), 24F(n=1), 11A(n=1), 15C(n=1), 23(n=1), 17F(n=1), 35B(n=1), 15B(n=1),9V(n=1)
PCV13 57.5%
PPSV 23 76%

PCV 13

PPSV23
1

3

4

5

6A,6B

7F

9V

14

18C

19A,19F

23F

 1

2

3

4

5

6B

7F

8

9N,9V

10A

11A

12F

14

15B

17F

18C

19A, 19F

20

22F

23F

33F

Specimen wise serotype distribution

Specimen

Serotype
Tracheal aspirate 19F (n=6), 35B (n=4), 20 (n=1), 24F(n=1), 15B(n=1), 11A(n=1), 3(n=1), 23F(n=1)
Blood 6B (n=4), 19F(n=2), 19A(n=2), 9v(n=1), 16A(n=1), 15B(n=1), 13(n=1), 11A(n=1), 14(n=1), 3(n=1), 23F(n=1), 15C(n=1), 18C(n=1).
Sputum 19F (n=3), 6B(n=2), 19A(n=1), 14(n=1), 15C, 35B(n=1).
Bal 19F(n=1)
Synovial fluid 17F(n=1)
Tissue 19A(n=1)
CSF 19F(n=1)
Ear swab 19F(n=1)

PCV 10

PCV 13

PPSV23
1

5

6A

7F

9V

14

19A

19F

23F

6B

 1

3

4

5

6A,6B

7F

9V

14

18C

19A,19F

23F

 1

2

3

4

5

6B

7F

8

9N,9V

10A

11A

12F

14

15B

17F

18C

19A, 19F

20

22F

23F

33F

Pros and Cons of PPV23 and PCV 13

pneumoniae3

Discussion

Clinical significance of Serotype 35B (12% adult serotype)

  1. Non vaccine serotype
  2. High rate of Penicillin non susceptibility
  3. Multidrug resistance to both B lactam and non B lactam drugs
  4. High risk of mortality
  5. US – 59.9% of multidrug non susceptible non-vaccine serotypes among IPD isolates from all age groups (2013)
  6. Europe – highest risk for death due to IPD (relative risk [RR], 4.98; 95% confidence interval [CI], 2.49 to 9.95) among all serotypes affecting adults and children.
  7. Indian studies lacking

Vaccination in adults

  1. For Adults >65 years
  2. ACIP commmitee recommends PPSV 23 for immuno competent individuals >65YRS of age.
  3. Vaccination with PCV13 first, followed by PPSV23 is usually recommended for individuals who have immunocompromising conditions, functional or anatomic asplenia, cochlear implant, CSF leak, or history of invasive pneumococcal disease. In this group of patients, the decision regarding giving PCV13 before PPSV23 can be discussed on a case-to-case basis between the physician and the patient
  4. For adults with chronic conditions such as chronic heart disease, chronic liver disease, poorly controlled diabetes mellitus, chronic lung disease, and in current smokers and those with alcohol abuse, the decision to administer a dose of PCV13 preceding PPSV23 should be taken jointly by the physician and the patient, on a case-to-case basis

Conclusion

Pneumococcal conjugate vaccine 10 (69%) or 13 (77%) serotype coverage for paediatric. PCV 13(57%) and PPSV (76%) serotype coverage for Adult.

References

  1. Dhar R, Ghoshal AG, Guleria R, Sharma S, Kulkarni T, Swarnakar R et al,. Clinical practice guidelines 2019: Indian consensus-based recommendations on pneumococcal vaccination for adults. Lung India. 2020 Aug;37(Supplement):S19-S29.
  2. Introduction of Pneumococcal conjugate vaccines. National Operational Guidelines. Immunization Division Ministry of Health & Family Welfare Government of India January 2021.
  3. Shinohara K, Fujisawa T, Chang B, Ito Y et al. Frequent Transmission of Streptococcus pneumoniae Serotype 35B and 35D, Clonal Complex 558 Lineage, across Continents and the Formation of Multiple Clades in Japan. Antimicrob Agents Chemother. 2023 Feb 16;67(2):e0108322
  4. Olarte L, Kaplan SL, Barson WJ, Romero JR, Lin PL, Tan TQ, et al,. Emergence of Multidrug-Resistant Pneumococcal Serotype 35B among Children in the United States. J Clin Microbiol. 2017 Mar;55(3):724-734.
pneumoniaedr

Dr. Thilagavathy

Microbiologist

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