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Proc Natl Acad Sci U S A. 2018 Mar 20;115(12):3102-3107. doi: 10.1073/pnas.1718712115. Epub 2018 Mar 6.

Vaccination can drive an increase in frequencies of antibiotic resistance among nonvaccine serotypes of Streptococcus pneumoniae.

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Department of Zoology, University of Oxford, Oxford OX2 6GG, United Kingdom;
Department of Zoology, University of Oxford, Oxford OX2 6GG, United Kingdom.
Division of Infection and Immunity, University College London, London WC1E 6BT, United Kingdom.


The bacterial pathogen Streptococcus pneumoniae is a major public health concern, being responsible for more than 1.5 million deaths annually through pneumonia, meningitis, and septicemia. Available vaccines target only a subset of serotypes, so vaccination is often accompanied by a rise in the frequency of nonvaccine serotypes. Epidemiological studies suggest that such a change in serotype frequencies is often coupled with an increase of antibiotic resistance among nonvaccine serotypes. Building on previous multilocus models for bacterial pathogen population structure, we have developed a theoretical framework incorporating variation of serotype and antibiotic resistance to examine how their associations may be affected by vaccination. Using this framework, we find that vaccination can result in a rapid increase in the frequency of preexisting resistant variants of nonvaccine serotypes due to the removal of competition from vaccine serotypes.


Streptococcus pneumoniae; antibiotic resistance; ecological competition; epidemiology; mathematical model

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