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Impact of the Pneumococcal Conjugate Vaccine and Antibiotic Use on Nasopharyngeal Colonization by Antibiotic Nonsusceptible Streptococcus pneumoniae — Alaska, 2000–2010
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  • Alternative Title:
    Pediatr Infect Dis J
  • Description:
    Background We describe the relative impact of the heptavalent pneumococcal conjugate vaccine (PCV7, introduced 2001) and antibiotic use on colonization by antibiotic resistant pneumococci in urban Alaskan children during 2000–2010. Methods We obtained nasopharyngeal swab specimens from a convenience sample of children aged <5 years at clinics annually during 2000–2004 and 2008–2010. PCV7 status and antibiotic use <90 days before enrollment was determined by interview/medical records review. Pneumococci were characterized by serotype and susceptibility to penicillin (PCN). Isolates with full PCN resistance (PCN-R) or intermediate PCN resistance (PCN-I) were classified as PCN-NS. Results We recruited 3,496 children (median: 452/year). During 2000–2010, a range of 18–29%/year of children used PCN/amoxicillin (p-value for trend [p] = 0.09); the proportion age-appropriately vaccinated with PCV7 increased (0%–90%; p <0.01). Among pneumococcal isolates, the PCV7-serotype proportion decreased (53%–<1%; p <0.01) and non-PCV7–serotype proportion increased (43%–95%; p <0.01). PCN-R pneumococcal colonization prevalence decreased (23%–9%, p <0.01) and PCN-I pneumococcal colonization prevalence increased (13%–24%, p <0.01); overall PCN-NS pneumococcal colonization prevalence was unchanged. PCN-NS among colonizing PCV7-type and non-PCV7-type pneumococci remained unchanged; a mean of 31%/year of PCV7-type and 10%/year of non-PCV7-type isolates were PCN-R, and 10%/year of PCV7 and 20%/year of non-PCV7-type isolates were PCN-I. Conclusions Overall PCN-NS pneumococcal colonization remained unchanged during 2000–2010 because increased colonization by predominantly PCN-I non-PCV7 serotypes offset decreased colonization by predominantly PCN-R PCV7 serotypes. Proportion PCN-NS did not increase within colonizing pneumococcal serotype-groups (PCV7 versus non-PCV7) despite stable penicillin use in our population.
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