Serotype distribution and antibiotic resistance of Streptococcus pneumoniae isolated from invasive infections after optional use of the 7-valent conjugate vaccine in Korea, 2006–2010 Eun Young Cho, Hyunju Lee, Eun Hwa Choi, Yae-Jean Kim, Byung Wook Eun, Yong Kyun Cho, Yun-Kyung Kim, Dae Sun Jo, Hye Soo Lee, Jina Lee, Mi-Na Kim, Dong Soo Kim, Hoan Jong Lee PII: DOI: Reference:

S0732-8893(14)00006-6 doi: 10.1016/j.diagmicrobio.2013.12.016 DMB 13507

To appear in:

Diagnostic Microbiology and Infectious Disease

Received date: Accepted date:

13 October 2013 26 December 2013

Please cite this article as: Cho Eun Young, Lee Hyunju, Choi Eun Hwa, Kim Yae-Jean, Eun Byung Wook, Cho Yong Kyun, Kim Yun-Kyung, Jo Dae Sun, Lee Hye Soo, Lee Jina, Kim Mi-Na, Kim Dong Soo, Lee Hoan Jong, Serotype distribution and antibiotic resistance of Streptococcus pneumoniae isolated from invasive infections after optional use of the 7-valent conjugate vaccine in Korea, 2006–2010, Diagnostic Microbiology and Infectious Disease (2014), doi: 10.1016/j.diagmicrobio.2013.12.016

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ACCEPTED MANUSCRIPT Title Serotype distribution and antibiotic resistance of Streptococcus pneumoniae isolated from

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invasive infections after optional use of the 7-valent conjugate vaccine in Korea, 2006-2010

Running Title

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Invasive pneumococcal serotypes in Korea

Authors and Affiliations

Eun Young Choa, Hyunju Leeb, Eun Hwa Choia, Yae-Jean Kimc, Byung Wook Eund, Yong Kyun Choe, Yun-Kyung Kimf, Dae Sun Jog, Hye Soo Leeh, Jina Leei, Mi-Na Kimj, Dong Soo

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Kimk, and Hoan Jong Leea

Department of Pediatrics, Seoul National University Children’s Hospital, Seoul National

Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National

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b

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University College of Medicine, Seoul, Republic of Korea

University College of Medicine, Seongnam, Republic of Korea Department of Pediatrics, Sungkyunkwan University School of Medicine, Samsung Medical

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c

Center, Seoul, Republic of Korea d

Department of Pediatrics, Eulji University School of Medicine, Eulji General Hospital,

Seoul, Republic of Korea e

Department of Internal Medicine, Gachon University School of Medicine, Gachon

University Gil Hospital, Incheon, Republic of Korea f

Department of Pediatrics, Korea University College of Medicine, Korea University Ansan

Hospital, Ansan, Republic of Korea g

Department of Pediatrics, Chonbuk National University Medical School, Chonbuk National 1

ACCEPTED MANUSCRIPT University Hospital, Jeonju, Republic of Korea Department of Laboratory Medicine, Chonbuk National University Medical School,

Chonbuk National University Hospital, Jeonju, Republic of Korea

Department of Pediatrics, University of Ulsan College of Medicine and Asan Medical

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Center, Seoul, Republic of Korea

Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan

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Medical Center, Seoul, Republic of Korea k

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Department of Pediatrics, Yonsei University College of Medicine, Severance Children’s

Hospital, Seoul, Republic of Korea

Professor of Pediatrics,

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Hoan Jong Lee, MD, PhD

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Corresponding Author

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Seoul National University College of Medicine Seoul National University Children’s Hospital,

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101 Daehak-ro, Jongno-gu, Seoul 110-769, Republic of Korea Tel: 82-2-2072-3633, Fax: 82-2-745-4703 E-mail: [email protected]

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ACCEPTED MANUSCRIPT Abstract

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This study examined the serotype distribution and antimicrobial resistance of pneumococcal

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isolates from invasive infections in children between 2006 and 2010, when the 7-valent pneumococcal conjugate vaccine (PCV7) was offered as an optional vaccine in Korea.

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Among 140 isolates collected from 8 centers, the common serotypes were 19A (22.9%), 19F

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(12.1%), and 6B (8.6%). Between 2006 and 2010, PCV7 serotypes decreased from 62.5% to 21.4% (P=0.002), whereas 3 PCV13-specific serotypes (3, 6A, and 19A) increased from 18.8% to 42.9% (P=0.016). Among 102 multidrug-resistant isolates, the proportion of PCV7 serotypes decreased from 65.2% to 21.7% (P=0.001), and 3 PCV13-specific serotypes

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increased from 17.4% to 47.8% (P=0.008). Optional PCV7 vaccination has influenced the proportion of PCV7 serotypes in Korea, resulting in a decrease, whereas the proportions of 3

Keywords

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PCV13-specific serotypes, particularly 19A, have increased.

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Streptococcus pneumoniae; Serotype; Antimicrobial Resistance; Pneumococcal Vaccines

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Introduction

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Streptococcus pneumoniae is a leading cause of invasive infections, manifesting as

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bacteremia, meningitis and other forms in children and adults worldwide. It is also a major

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cause of mucosal infections, including pneumonia, sinusitis, and acute otitis media (Advisory

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Committee on Immunization Practices, 2000). In a multicenter study on the etiology of

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invasive bacterial infections in immunocompetent children in Korea during the period 1996-

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2005, S. pneumoniae was the most common cause in children aged 3 months to 5 years (Lee

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et al. 2011). Currently, more than 90 serotypes of S. pneumoniae have been identified, yet a

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relatively limited number of serotypes cause the majority of invasive pneumococcal disease

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(IPD) cases (Advisory Committee on Immunization Practices, 2000).

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In 2000 in the United States, a 7-valent pneumococcal conjugate vaccine (PCV7;

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Prevenar®, Wyeth) was introduced in the national immunization program. In 2008, data from

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Active Bacterial Core Surveillance (ABCs) showed that the overall incidence of IPD among

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children aged