Antibiotic Use Affects the Efficacy of Pneumococcal Conjugate Vaccines in Children

Although the widespread introduction of pneumococcal conjugate vaccines (PCVs) have successfully reduced the prevalence of invasive pneumococcal disease in the United States, several factors—including recent antibiotic use—are associated with a higher risk of PCV13 colonization among children younger than 7 years, according to a recent study.

For their study, the researchers extended previously reported data on 6537 children younger than 7 years who had been seen for well-child or acute-care visits in Massachusetts.
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Nasopharyngeal swab samples were collected over the course of 6 surveillance seasons from 2000 to 2014. Immunization status and recent antibiotic use were determined via parent surveys and medical record reviews. The proportions of children who were colonized with PCV7-included, additional PCV13-included, and non-PCV13 serotypes were estimated. Generalized linear mixed models were used to analyze risk factors for colonization with additional PCV13-included and non-PCV13 serotypes.

Results indicated that, in 2004, 19A had emerged as the predominant serotype. However, in 2014, there had been significant reductions in 19A. In 2014, 15B/C, 35B, 23B, 11A, and 23A had been the most common non-PCV serotypes. Younger children, those with more child care exposure, and those with a concomitant respiratory tract infection had a higher likelihood of additional PCV13 and non-PCV13 colonization.

The researchers noted that adjusted odds for additional PCV13 colonization had been lower in children who were up-to-date for PCV13 vaccines. Additionally, recent antibiotic use was associated with an increased likelihood of additional PCV13 colonization, but a significantly lower likelihood of non-PCV13 colonization.

“Despite the success of pneumococcal vaccines in reducing colonization and disease due to targeted serotypes, ongoing community-based surveillance will be critical to evaluate the impact of interventions on pneumococcal colonization and disease,” the researchers concluded.

—Christina Vogt

Reference:

Lee GM, Kleinman K, Pelton S, et al. Immunization, antibiotic use, and pneumococcal colonization over a 15-year period [Published online October 4, 2017]. Pediatrics. doi:10.1542/peds.2017-0001.