Pneumococcal meningitis in Greece: A retrospective serotype surveillance study in the post-PCV13 era (2010-2020)

Athanasia Xirogianni; Nektarios Marmaras; Theano Georgakopoulou; Anastasia Papandreou; Stelmos Simantirakis; Ioanna Magaziotou; Andreas Eliades; Vassiliki Getsi; Anastasia Anastasiou-Katsiardani; Efi Staikou; Fani Markou; Athina Argyrοpoulou; Georgia Vlachaki; Genovefa Chronopoulou; Anastasia Pangalis; Theodota Liakopoulou; Athanasios Michos; Vassiliki Spoulou; Evaggelia Lagona; George Panagiotakopoulos; Efthymia Petinaki; Elpis Mantadakis; Emmanuel Roilides; Manolis Galanakis; Vana Papaevangelou; Maria Tsolia; Georgina Tzanakaki

doi:10.1016/j.vaccine.2022.07.015

Pneumococcal meningitis in Greece: A retrospective serotype surveillance study in the post-PCV13 era (2010-2020)

Vaccine. 2022 Aug 12;40(34):5079-5087. doi: 10.1016/j.vaccine.2022.07.015. Epub 2022 Jul 22.

Authors

Athanasia Xirogianni¹, Nektarios Marmaras¹, Theano Georgakopoulou², Anastasia Papandreou¹, Stelmos Simantirakis¹, Ioanna Magaziotou², Andreas Eliades³, Vassiliki Getsi⁴, Anastasia Anastasiou-Katsiardani⁵, Efi Staikou⁶, Fani Markou⁷, Athina Argyrοpoulou⁸, Georgia Vlachaki⁹, Genovefa Chronopoulou¹⁰, Anastasia Pangalis¹¹, Theodota Liakopoulou¹², Athanasios Michos¹³, Vassiliki Spoulou¹³, Evaggelia Lagona¹⁴, George Panagiotakopoulos², Efthymia Petinaki¹⁵, Elpis Mantadakis¹⁶, Emmanuel Roilides¹⁷, Manolis Galanakis¹⁸, Vana Papaevangelou¹⁹, Maria Tsolia²⁰, Georgina Tzanakaki²¹

Affiliations

¹ National Meningitis Reference Laboratory, Dept. of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece.
² Department of Vaccine Preventable Diseases, National Public Health Organization (NPHO), Athens, Greece.
³ Dept. of Paediatric Intensive Care Unit, University Hospital of Patras, Greece.
⁴ Dept. of Paediatrics, (")Hatzikosta" General Hospital, Ioannina, Greece.
⁵ Dept. of Paediatrics, General Volos Hospital (")Achillopouleio", Greece.
⁶ Dept. of Microbiology, "Pentelis" Children Hospital, Athens, Greece.
⁷ Dept. of Microbiology, Serres General Hopsital, Serres, Greece.
⁸ Dept. of Clinical Microbiology "Evangelismos" General Hospital, Athens, Greece.
⁹ Dept. of Paediatrics, "Venizeleion" General Hospital, Heraklion, Crete, Greece.
¹⁰ Central Labs, Athens EUROCLINIC Group, Athens, Greece.
¹¹ Central Lab, "Iatriko" Medical Center, Athens, Greece.
¹² First Dept. of Paediatrics, "IASO" Children's Hospital, Athens, Greece.
¹³ First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, "Aghia Sophia" Children's Hospital, Athens, Greece.
¹⁴ Dept. of Paediatrics, "MITERA" General Hospital, Athens, Greece.
¹⁵ Dept. of Microbiology, Dept. of Microbiology, Medical School, University of Thessaly, Larissa, Greece.
¹⁶ Dept. of Paediatrics, Faculty of Medicine, Democritus University of Thrace, University General Hospital, Alexandroupolis, Greece.
¹⁷ 3rd Dept. of Paediatrics, School of Medicine, Aristotle University, and Hippokration General Hospital, Thessaloniki, Greece.
¹⁸ Paediatric Infectious Diseases Unit, Heraklion University Hospital, University of Crete, Heraklion, Greece.
¹⁹ Third Department of Pediatrics, National and Kapodistrian University of Athens, University General Hospital "ATTIKON", Athens, Greece.
²⁰ Second Dept. of Pediatrics, Medical School, National and Kapodistrian University of Athens, "A&P Kyriakou" Children's Hospital, Athens, Greece.
²¹ National Meningitis Reference Laboratory, Dept. of Public Health Policy, School of Public Health, University of West Attica, Athens, Greece. Electronic address: gtzanakaki@uniwa.gr.

PMID: 35871868
DOI: 10.1016/j.vaccine.2022.07.015

Abstract

Background: As Greece is a country which has introduced the 13-valent pneumococcal conjugate vaccine (PCV13) both in the infant and in the adult immunization programs, the aim of the study was to investigate age-specific and serotype-specific trends of pneumococcal meningitis over an 11-year period (2010-2020).

Materials and methods: Data are reported from pneumococcal meningitis cases [notified to the National Public Health Organization (NPHO)], with clinical samples and bacterial isolates sent for pneumococcal identification and serotyping at the National Meningitis Reference Laboratory (NMRL). Pneumococcal identification was performed directly on clinical samples or bacterial isolates by multiplex PCR (mPCR) assay, while serotyping was carried out by application of the Capsular Sequence Typing (CST) method with the combination of single tube PCR assays.

Results: A total of 427 pneumococcal meningitis cases were notified to the NPHO between 2010 and 2020. Among those, 405 (94.8%) were microbiologically confirmed, while samples from 273 patients were sent to the NMRL for identification and/or further typing. The annual notification rate peaked at 0.47/100,000 in 2016 and since then has been decreasing. The incidence was highest in infants and in older adults. Pneumococcal serotypes were identified in 260/273 (95.2%) cases, where clinical samples were sent to the NMRL. The most prevalent serotypes (≥5%) were 3, 19A, 23B, 15B/C, 11A/D, 23A, 22F. During the study period there has been a decrease of PCV13 serotypes combined with an increase of non-PCV13 serotypes (p = 0.0045).

Conclusions: This is the first study to report serotypes for pneumococcal meningitis across all ages in the post-PCV13 era in Greece. There is a need to enhance surveillance, by close monitoring of the emerging serotypes and the impact of vaccination programs. Higher-valency PCVs may help to improve the coverage of pneumococcal disease.

Keywords: CST; Meningitis; Multiplex PCR; S. pneumoniae; Serotypes; Surveillance; Vaccines.

Publication types

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

MeSH terms

Aged
Greece / epidemiology
Humans
Infant
Meningitis, Pneumococcal* / epidemiology
Meningitis, Pneumococcal* / prevention & control
Pneumococcal Infections* / epidemiology
Pneumococcal Infections* / microbiology
Pneumococcal Infections* / prevention & control
Pneumococcal Vaccines
Retrospective Studies
Serogroup
Serotyping
Streptococcus pneumoniae
Vaccines, Conjugate

Substances

Pneumococcal Vaccines
Vaccines, Conjugate