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Volume 27, Number 8—August 2021
Letter

Post–13-Valent Pneumococcal Conjugate Vaccine Dynamics in Young Children

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To the Editor: We read with interest the article by Ben-Shimol et al. (1), which described the disproportionate increase of non–13-valent pneumococcal conjugate vaccine (PCV) additional PCV20 serotypes (vaccine type [VT] 20–13) in patients who had respiratory infections or invasive pneumococcal disease (IPD) after PCV13 implementation in Israel. The authors emphasized the higher disease potential of VT20–13 serotypes compared with non-VT20 serotypes. We would like to complement their results with data from France and highlight the similarities and the differences in serotype distribution. Our long-term prospective population-based surveillance comprises pneumococcal isolates from 793 healthy carriers, 4,474 acute otitis media patients, and 441 IPD patients, all of whom were children <24 months of age (24). We found that VT13 serotypes accounted for 8%, VT20–13 for 30%, and non-VT20 for 60% of infections in healthy carriers and acute otitis media patients during 2015–2018. Like Ben-Shimol et al. (1), we found that the most common VT20–13 serotypes were 15B/C and 11A, and the most common non-VT20 serotypes were 23B, 15A, and 35B.

From the early PCV13 (2009–2011 in both countries) to late PCV13 period (2015–2017 in Israel and 2015–2018 in France), the prevalence of IPD caused by VT13 serotypes declined by ≈90% in both countries. However, VT20–13 serotypes predominated in Israel, whereas non-VT20 serotypes predominated in France. Although Israel had higher proportions of serotypes 12F (26.9% vs. 0.9%) and 33F (10.6% vs. 4.4%) than France (1), France saw the emergence of the non-VT20 serotype 24F (27.4%) during 2015–2018. This emergent serotype led to a higher proportion of PCV20 serotypes in Israel (62%) than in France (41.6%). The differences in vaccine type distribution between the 2 countries were mainly based on the very high rates of serotypes 12F and 33F in Israel and the emerging serotype 24F in France (5). Apart from these serotypes, the serotype distribution in IPD was very similar (Table).

In conclusion, data from Israel and France show a similar effect of PCV13 on the distribution of VT13 serotypes. The role of emerging non-PCV13 serotypes in carriage was also similar. However, we observed unexpected discrepancies in the serotype replacement pattern, driven by few highly invasive non-PCV13 serotypes. This finding suggests that serotype replacement during the PCV13 era is complex and multifactorial, and has implications for the expected effects of next-generation PCVs. Finally, France and Israel had similar serotype distributions that differed in only the late PCV13 period as a result of the emergence of some invasive specific clones (58).

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Acknowledgments

These studies were supported by the Pediatric Infectious Diseases Group of the French Pediatrics Society, Association Clinique et Thérapeutique Infantile du Val de Marne, and Pfizer Investigator-Initiated Research grants. The National Reference Center for Pneumococci was partially funded by the French National Health Agency.

R.C., C.L., and E.V. received personal fees and nonfinancial support from Pfizer. R.C. reports personal fees from AstraZeneca GSK, Merck Sharp & Dohme, and Sanofi outside of the context of the submitted work.

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Corinne LevyComments to Author , Naim Ouldali, Emmanuelle Varon, Stéphane Béchet, Stéphane Bonacorsi, and Robert Cohen
Author affiliations: Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France (C. Levy, N. Ouldali, S. Béchet, R. Cohen); Groupe de Pathologie Infectieuse Pédiatrique, Paris, France (C. Levy, N. Ouldali, E. Varon, S. Bonacorsi, R. Cohen); Université Paris Est, IMRB-GRC GEMINI, Créteil (C. Levy, E. Varon, R. Cohen); Centre Hospitalier Intercommunal de Créteil, Créteil (C. Levy, E. Varon, R. Cohen); Association Française de Pédiatrie Ambulatoire, Saint-Germain-en-Laye, France (C. Levy, R. Cohen); Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, ECEVE INSERM UMR 1123, Paris (N. Ouldali, S. Bonacorsi); Université de Paris, IAME, UMR 1137, INSERM, Paris (S. Bonacorsi)

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References

  1. Ben-Shimol  S, Givon-Lavi  N, Kotler  L, Adriaan van der Beek  B, Greenberg  D, Dagan  R. Post-13-valent pneumococcal conjugate vaccine dynamics in young children of serotypes included in candidate extended-spectrum conjugate vaccines. Emerg Infect Dis. 2021;27:15060. DOIPubMed
  2. Cohen  R, Levy  C, Ouldali  N, Goldrey  M, Béchet  S, Bonacorsi  S, et al. Invasive disease potential of pneumococcal serotypes in children after PCV13 implementation. Clin Infect Dis. 2021;72:14536. DOIPubMed
  3. Levy  C, Vie le Sage  F, Varon  E, Chalumeau  M, Grimprel  E, Cohen  R. Pediatric ambulatory and hospital networks for surveillance and clinical epidemiology of community-acquired infections. J Pediatr. 2018;194:269270.e2. DOIPubMed
  4. Ouldali  N, Cohen  R, Levy  C, Gelbert-Baudino  N, Seror  E, Corrard  F, et al. Pneumococcal susceptibility to antibiotics in carriage: a 17 year time series analysis of the adaptive evolution of non-vaccine emerging serotypes to a new selective pressure environment. J Antimicrob Chemother. 2019;74:307786. DOIPubMed
  5. Rokney  A, Ben-Shimol  S, Korenman  Z, Porat  N, Gorodnitzky  Z, Givon-Lavi  N, et al. Emergence of Streptococcus pneumoniae serotype 12F after sequential introduction of 7- and 13-valent vaccines, Israel. Emerg Infect Dis. 2018;24:45361. DOIPubMed
  6. Janoir  C, Lepoutre  A, Gutmann  L, Varon  E. Insight into resistance phenotypes of emergent non 13-valent pneumococcal conjugate vaccine type pneumococci isolated from invasive disease after 13-valent pneumococcal conjugate vaccine implementation in France. Open Forum Infect Dis. 2016;3:ofw020. DOIPubMed
  7. Lo  SW, Gladstone  RA, van Tonder  AJ, Lees  JA, du Plessis  M, Benisty  R, et al.; Global Pneumococcal Sequencing Consortium. Pneumococcal lineages associated with serotype replacement and antibiotic resistance in childhood invasive pneumococcal disease in the post-PCV13 era: an international whole-genome sequencing study. Lancet Infect Dis. 2019;19:75969. DOIPubMed
  8. Ouldali  N, Levy  C, Varon  E, Bonacorsi  S, Béchet  S, Cohen  R, et al.; French Pediatric Meningitis Network. Incidence of paediatric pneumococcal meningitis and emergence of new serotypes: a time-series analysis of a 16-year French national survey. Lancet Infect Dis. 2018;18:98391. DOIPubMed

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Cite This Article

DOI: 10.3201/eid2708.210037

Original Publication Date: July 15, 2021

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Table of Contents – Volume 27, Number 8—August 2021

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Corinne Levy, ACTIV, 31, rue Le Corbusier, 94000 Créteil, France

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Page created: May 17, 2021
Page updated: July 19, 2021
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The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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