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Vaccine. 2019 Jan 3;37(1):99-108. doi: 10.1016/j.vaccine.2018.11.026. Epub 2018 Nov 22.

Vaccine-driven serotype-rearrangement is seen with latency in clinical isolates: Comparison of carried and clinical pneumococcal isolates from the same time period in Hungary.

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Institute of Medical Microbiology, Semmelweis University, Nagyvárad tér 4, H-1089 Budapest, Hungary.
Institute of Laboratory Medicine, Semmelweis University, Üllői út 78/a, H-1082 Budapest, Hungary. Electronic address:
German National Reference Center for Streptococci, Department of Medical Microbiology, University Hospital RWTH Aachen, Pauwelsstrasse 30, D-52074 Aachen, Germany. Electronic address:
National Public Health Institute, Albert Flórián út 2-6, H-1097 Budapest, Hungary.
Institute of Medical Microbiology, Semmelweis University, Nagyvárad tér 4, H-1089 Budapest, Hungary. Electronic address:


Young children - the main asymptomatic carriers of pneumococcus - are often the source of pneumococcal infections. PCV13 replaced PCV7 in 2010 in Hungary and it became a mandatory vaccine in 2014. In this work we surveyed the effect of vaccination in three groups: in healthy children under 7 years; in children of the same age but infected with pneumococcus (P1); in older patients (P2) who were very likely not vaccinated. Nasal swabs were taken from 522 healthy children to screen pneumococcal carriage between March 2015 and May 2016. In the same time period, 146 clinical isolates were collected, mainly from mucosal infections. Serotypes, antibiotic susceptibility and clonality of the isolates was determined and compared. The carriage rate was 39.1%. Regarding carriage, the serotype distribution showed the total disappearance of serotypes 3 and 6A compared to former Hungarian studies. The prevalence of PCV13 serotypes was only 5.8% represented by three serotypes (19F, 19A, 9V). Of note, serotype 19A (a very resistant and invasive type) also decreased significantly. In the patient groups, PCV13 prevalence was higher: 17.5% (P1) and 32.6% (P2). Although serotype 3 was present in P1 (7.9%), the leading serotype was 23B (22.2%), a non-vaccine type (NVT). P2 showed the most diverse serotype distribution, but serotype 3 was predominant here (15.7%). Pneumococcal isolates from the patients were more resistant towards the tested antibiotics compared to those from carriers. PCV13 seems to be highly successful in reducing the prevalence of vaccine serotypes. The serotype-rearrangement can be seen also among clinical isolates, albeit somewhat later in time. Fortunately, the replacing serotypes are less invasive and less resistant, but, most worrisome, serotype 19F can be found again with increased frequency among carriage isolates and mucosal infections. Further surveillance is needed to carefully monitor such successful, antibiotic resistant "refugees".


Antibiotic resistance; Carriers; Pneumococcal conjugated vaccines (PCVs); Serotypes; Streptococcus pneumoniae

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