Lack of effectiveness of 13-valent pneumococcal conjugate vaccination against pneumococcal carriage density in Papua New Guinean infants

Kathryn J Britton; Janessa L Pickering; William S Pomat; Camilla de Gier; Monica L Nation; Casey L Pell; Caitlyn M Granland; Vela Solomon; Rebecca L Ford; Andrew Greenhill; Jason Hinds; Hannah C Moore; Peter C Richmond; Christopher C Blyth; Deborah Lehmann; Catherine Satzke; Lea-Ann S Kirkham; 10v13vPCV trial team

doi:10.1016/j.vaccine.2021.07.085

Lack of effectiveness of 13-valent pneumococcal conjugate vaccination against pneumococcal carriage density in Papua New Guinean infants

Vaccine. 2021 Sep 7;39(38):5401-5409. doi: 10.1016/j.vaccine.2021.07.085. Epub 2021 Aug 9.

Authors

Kathryn J Britton¹, Janessa L Pickering², William S Pomat³, Camilla de Gier⁴, Monica L Nation⁵, Casey L Pell⁶, Caitlyn M Granland⁷, Vela Solomon⁸, Rebecca L Ford⁹, Andrew Greenhill¹⁰, Jason Hinds¹¹, Hannah C Moore¹², Peter C Richmond¹³, Christopher C Blyth¹⁴, Deborah Lehmann¹⁵, Catherine Satzke¹⁶, Lea-Ann S Kirkham¹⁷; 10v13vPCV trial team

Affiliations

¹ Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia; Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Australia. Electronic address: kate.britton@telethonkids.org.au.
² Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia. Electronic address: janessa.pickering@telethonkids.org.au.
³ Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia; Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea. Electronic address: william.pomat@pngimr.org.pg.
⁴ Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia; Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Australia. Electronic address: camilladegier@gmail.com.
⁵ Translational Microbiology Group, Murdoch Children's Research Institute, Melbourne, Australia. Electronic address: monica.nation@mcri.edu.au.
⁶ Translational Microbiology Group, Murdoch Children's Research Institute, Melbourne, Australia. Electronic address: casey.pell@mcri.edu.au.
⁷ Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia. Electronic address: caitlyn.granland@telethonkids.org.au.
⁸ Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea. Electronic address: veladurimao@gmail.com.
⁹ Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea. Electronic address: rebecca.ford@pngimr.org.pg.
¹⁰ School of Health and Life Sciences, Federation University, Victoria, Australia. Electronic address: andrew.greenhill@federation.edu.au.
¹¹ Institute for Infection and Immunity, St. George's University of London, London, United Kingdom. Electronic address: j.hinds@sghms.ac.uk.
¹² Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia. Electronic address: hannah.moore@telethonkids.org.au.
¹³ Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia; Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Australia. Electronic address: peter.richmond@uwa.edu.au.
¹⁴ Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia; Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Australia; Department of Paediatric Infectious Diseases, Perth Children's Hospital, Perth, Australia; Department of Microbiology, PathWest Laboratory Medicine WA, QEII Medical Centre, Perth, Australia. Electronic address: christopher.blyth@uwa.edu.au.
¹⁵ Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia. Electronic address: deborah.lehmann@telethonkids.org.au.
¹⁶ Translational Microbiology Group, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia. Electronic address: catherine.satzke@mcri.edu.au.
¹⁷ Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Australia; Centre for Child Health Research, The University of Western Australia, Perth, Australia. Electronic address: lea-ann.kirkham@telethonkids.org.au.

PMID: 34384633
DOI: 10.1016/j.vaccine.2021.07.085

Abstract

Background: Papua New Guinea (PNG) introduced the 13-valent pneumococcal conjugate vaccine (PCV13) in 2014, with administration at 1, 2, and 3 months of age. PCV13 has reduced or eliminated carriage of vaccine types in populations with low pneumococcal carriage prevalence, carriage density and serotype diversity. This study investigated PCV13 impact on serotype-specific pneumococcal carriage prevalence, density, and serotype diversity in PNG infants, who have some of the highest reported rates of pneumococcal carriage and disease in the world.

Methods: Nasopharyngeal swabs were collected at 1, 4 and 9 months of age from PCV13-vaccinated infants (n = 57) and age-/season-matched, unvaccinated infants (at approximately 1 month, n = 53; 4 months, n = 57; 9 months, n = 52). Serotype-specific pneumococcal carriage density and antimicrobial resistance genes were identified by qPCR and microarray.

Results: Pneumococci were present in 89% of swabs, with 60 different serotypes and four non-encapsulated variants detected. Multiple serotype carriage was common (47% of swabs). Vaccine type carriage prevalence was similar between PCV13-vaccinated and unvaccinated infants at 4 and 9 months of age. The prevalence of non-vaccine type carriage was also similar between cohorts, with non-vaccine types present in three-quarters of samples (from both vaccinated and unvaccinated infants) by 4 months of age. The median pneumococcal carriage density was high and similar at each age group (~7.0 log₁₀genome equivalents/mL). PCV13 had no effect on overall pneumococcal carriage density, vaccine type density, non-vaccine type density, or the prevalence of antimicrobial resistance genes.

Conclusion: PNG infants experience dense and diverse pneumococcal colonisation with concurrent serotypes from 1 month of age. PCV13 had no impact on pneumococcal carriage density, even for vaccine serotypes. The low prevalence of vaccine serotypes, high pneumococcal carriage density and abundance of non-vaccine serotypes likely contribute to the lack of PCV13 impact on carriage in PNG infants. Indirect effects of the infant PCV programs are likely to be limited in PNG. Alternative vaccines with broader coverage should be considered.

Keywords: Carriage; Microarray; Papua New Guinea; Pneumococcal conjugate vaccine; Serotype; Streptococcus pneumoniae.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Carrier State / epidemiology
Cross-Sectional Studies
Humans
Infant
Nasopharynx
Papua New Guinea / epidemiology
Pneumococcal Infections* / epidemiology
Pneumococcal Infections* / prevention & control
Vaccination