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Upsurge of Conjugate Vaccine Serotype 4 Invasive Pneumococcal Disease Clusters Among Adults Experiencing Homelessness in California, Colorado, and New Mexico

Abstract After 7-valent pneumococcal conjugate vaccine introduction in the United States in 2000, invasive pneumococcal disease (IPD) due to serotype 4 greatly decreased in children and adults. Starting in 2013, serotype 4 IPD incidence increased among adults within 3 of 10 Active Bacterial Core sur...

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Published in:The Journal of infectious diseases 2021-04, Vol.223 (7), p.1241-1249
Main Authors: Beall, Bernard, Walker, Hollis, Tran, Theresa, Li, Zhongya, Varghese, Jasmine, McGee, Lesley, Li, Yuan, Metcalf, Benjamin J, Gierke, Ryan, Mosites, Emily, Chochua, Sopio, Pilishvili, Tamara
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Language:English
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Summary:Abstract After 7-valent pneumococcal conjugate vaccine introduction in the United States in 2000, invasive pneumococcal disease (IPD) due to serotype 4 greatly decreased in children and adults. Starting in 2013, serotype 4 IPD incidence increased among adults within 3 of 10 Active Bacterial Core surveillance sites. Of 325 serotype 4 cases among adults in 2010–2018, 36% were persons experiencing homelessness (PEH); incidence of serotype 4 IPD among PEH was 100–300 times higher than in the general population within these 3 areas. Genome sequencing for isolates recovered 2015–2018 (n = 246), revealed that increases in serotype 4 IPD were driven by lineages ST10172, ST244, and ST695. Within each lineage, clusters of near-identical isolates indicated close temporal relatedness. Increases in serotype 4 IPD were limited to Colorado, California, and New Mexico, with highest increases among PEH, who were at increased risk for exposure to and infections caused by these strains. Multiple genetic lineages of invasive vaccine serotype 4 pneumococci have increased incidences within 3 of 10 Active Bacterial Core surveillance sites. These lineages are composed of highly related isolate clusters and are disproportionally associated with persons experiencing homelessness.
ISSN:0022-1899
1537-6613
DOI:10.1093/infdis/jiaa501