Pneumococcal sequence type replacement among American Indian children: A comparison of pre- and routine-PCV7 eras

BackgroundMulti-locus sequence typing (MLST) of pneumococcal isolates collected during an efficacy trial of the 7-valent pneumococcal conjugate vaccine (PCV7) among Navajo and White Mountain Apache children from 1998 to 2000 showed a non-differential expansion of pre-existing sequence types (STs) and only one capsule-switching event in the PCV7-randomized communities. PCV7 was introduced as a routine infant vaccine in October 2000. We assessed variability in PCV7 effectiveness and mechanisms of ST replacement after prolonged routine PCV7 use.MethodsWe applied MLST to 267 non-vaccine type pneumococcal carriage and invasive disease isolates from Navajo and White Mountain Apache children from 2006 to 2008, and compared them to those from 1998 to 2000. Microarray was used to confirm capsule switching events.ResultsThe primary mechanism of ST replacement among Navajo and White Mountain Apache children was expansion of existing STs, although introduction of new STs was an important secondary mechanism. ST199, a majority being serotype 19A, was the most common ST in both eras. Only ST193 (serotype 21) was preferentially expanding in the PCV7 era. Three examples of capsule switching were identified. No variability in vaccine effectiveness by ST was observed.ConclusionWe did not observe an influence of ST on PCV7 serotype-specific effectiveness, although some STs may be favored in replacement.

► We assessed variability in PCV7 effectiveness and mechanisms of ST replacement after prolonged PCV7 use.
► We applied MLST to 267 non-vaccine type pneumococcal carriage and invasive disease isolates from Native Americans from 2006 to 2008, and compared them to those from 1998 to 2000.
► The primary mechanism of ST replacement was expansion of existing STs, although introduction of new STs was an important secondary mechanism.
► We did not observe an influence of ST on PCV7 serotype-specific effectiveness, although some STs appear favored in replacement.