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Maternal group B streptococcal immunization: Capsular polysaccharide (CPS)-based vaccines and their implications on prevention
Vaccine 29 (2011) 3729–3730
Contents lists available at ScienceDirect
Vaccine journal homepage: www.elsevier.com/locate/vaccine
Letter to the Editor Maternal group B streptococcal immunization: Capsular polysaccharide (CPS)-based vaccines and their implications on prevention
a r t i c l e
i n f o
Keywords: Group B streptococcus CPS-based vaccine Serotype IV
a b s t r a c t Group B streptococcal (GBS) capsular polysaccharide (CPS)-based conjugate vaccine, which includes types Ia, Ib, II, III, and V, could potentially prevent neonatal, pediatric, adult, and pregnancy-associated diseases. However, since GBS CPS types included in that vaccine are prevalent serotypes found in North America and Europe, it may not provide the necessary protection for individuals in countries in which other capsular types have been found. © 2011 Elsevier Ltd. All rights reserved.
Dear Sirs, The incidence of early-onset neonatal disease caused by group B streptococcus (GBS) has decreased by using antimicrobial intrapartum prophylaxis. However, the incidence of late-onset disease remains unchanged, and GBS has also emerged as an important pathogen in other patient groups, such as children, young adults with underlying medical conditions, and elderly individuals [1]. Recently, vaccine-development has been shown to be an effective alternative for preventing GBS diseases. Capsular polysaccharide (CPS) is a virulence factor that induces protective immunity, and has been considered a potential bacterial target for the production of vaccines. Nine different capsular types, Ia, Ib, and II–VIII, have been described, along with the recently proposed serotype IX [2]. Immunization studies have assessed the efficacy of CPS conjugate vaccines against the most common GBS capsular types of the Western hemisphere. These vaccines have been shown to be highly immunogenic results in animals [3], while in humans the results have been shown to be safe and well tolerated [4,5]. A CPS conjugate vaccine that has been recently tested in the United States contains five capsular types: types Ia, Ib, II, III, and V, which are the predominant serotypes in North America and Europe [1,6]. Serotypes VI and VIII have been more frequently found in Japan [7], and serotypes IV and VII are rarely isolated [8]. In contrast to the low percentage of GBS serotype IV previously reported for the United States, we have shown in recent study a considerable proportion of type IV among GBS isolates in Southern Brazil [9]. One-hundred sixty-eight GBS strains were isolated from community and hospitalized patients between April 2006 and May 2008 and all isolates were serotyped by classical method as previously described [10]. Our rate of occurrence of serotype IV was 13.1% (n = 23) of the total GBS isolated from a population comprised of late newborns (ages 8–90 days), teenagers, nonpregnant and pregnant adults, and elderly individuals. Furthermore, serotype IV was commonly found in infections and was associated with lateonset neonatal disease [9]. Epidemiological studies performed in the United Arab Emirates [11], Turkey [12], Zimbabwe [13], and more recently in the United States [14] have also found significant 0264-410X/$ – see front matter © 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.vaccine.2011.02.102
proportions of GBS type IV isolates, most of them were recovered from carriers. However, in previous Brazilian studies, serotype IV was not described [15,16]. Although a GBS pentavalent vaccine is expected to provide protection for a high percentage of GBS diseases, it does not offer protection against different serotypes found in other countries [7,14]. Moreover, the possibility of shifts in serotype prevalence, such as the emergence of type IV [14], the presence of new serotypes and nontypeable strains [11,17,18] support the need for ongoing surveillance of serotypes to contribute to the design of a universal vaccine. Vaccines based on conserved surface proteinconjugated GBS capsular polysaccharides could be more effective to serve as a serotype-independent vaccine. Conflict of interest: We have no competing interests to declare. Policy and ethics: Ethical approval for the project has been provided by the Research Ethics Committee of the Hospital de Clínicas, UFPR, under protocol 1772.189/2008–09. References [1] Phares CR, Lynfield R, Farley MM, Mohle-Boetani J, Harrison LH, Petit S, et al. Epidemiology of invasive group B streptococcal disease in the United States, 1999–2005. JAMA 2008;299(17):2056–65. [2] Slotved HC, Kong F, Lambertsen L, Sauer S, Gilbert GL, Serotype IX. A proposed new Streptococcus agalactiae serotype. J Clin Microbiol 2007;45(9):2929–36. [3] Paoletti LC, Wessels MR, Rodewald AK, Shroff AA, Jennings HJ, Kasper DL. Neonatal mouse protection against infection with multiple group B streptococcal (GBS) serotypes by maternal immunization with a tetravalent GBS polysaccharide-tetanus toxoid conjugate vaccine. Infect Immun 1994;62(8):3236–43. [4] Baker CJ, Paoletti LC, Wessels MR, Guttormsen HK, Rench MA, Hickman ME, et al. Safety and immunogenicity of capsular polysaccharide–tetanus toxoid conjugate vaccines for group B streptococcal types Ia and Ib. J Infect Dis 1999;179(1):142–50. [5] Johri AK, Paoletti LC, Glaser P, Dua M, Sharma PK, Grandi G, et al. Streptococcus: global incidence and vaccine development. Nat Rev Microbiol 2006;4(12):932–42. [6] Persson E, Berg S, Trollfors B, Larsson P, Ek E, Backhaus E, et al. Serotypes and clinical manifestations of invasive group B streptococcal infections in western Sweden 1998–2001. Clin Microbiol Infect 2004;10(9):791–6. [7] Lachenauer CS, Kasper DL, Shimada J, Ichiman Y, Ohtsuka H, Kaku M, et al. Serotypes VI and VIII predominate among group B streptococci isolated from pregnant Japanese women. J Infect Dis 1999;179(4):1030–3.
3730
Letter to the Editor / Vaccine 29 (2011) 3729–3730
[8] Paoletti LC, Kasper DL. Conjugate vaccines against group B streptococcus types IV and VII. J Infect Dis 2002;186(1):123–6. [9] Palmeiro JK, Dalla-Costa LM, Fracalanzza SE, Botelho AC, da Silva Nogueira K, Scheffer MC, et al. Phenotypic and genotypic characterization of group B streptococcal isolates in Southern Brazil. J Clin Microbiol 2010;48(12):4397–403. [10] Lancefield RC, Freimer EH. Type-specific polysaccharide antigens of group B streptococci. J Hyg (Lond) 1966;64(2):191–203. [11] Amin A, Abdulrazzaq YM, Uduman S. Group B streptococcal serotype distribution of isolates from colonized pregnant women at the time of delivery in United Arab Emirates. J Infect 2002;45(1):42–6. [12] Ekin IH, Gurturk K. Characterization of bovine and human group B streptococci isolated in Turkey. J Med Microbiol 2006;55(5):517–21. [13] Moyo SR, Maeland JA, Bergh K. Typing of human isolates of Streptococcus agalactiae (group B streptococcus, GBS) strains from Zimbabwe. J Med Microbiol 2002 Jul;51(7):595–600. [14] Diedrick MJ, Flores AE, Hillier SL, Creti R, Ferrieri P. Clonal analysis of colonizing group B Streptococcus, serotype IV, an emerging pathogen in the United States. J Clin Microbiol 2010;48(9):3100–4. [15] Duarte RS, Bellei BC, Miranda OP, Brito MA, Teixeira LM. Distribution of antimicrobial resistance and virulence-related genes among Brazilian group B streptococci recovered from bovine and human sources. Antimicrob Agents Chemother 2005;49(1):97–103. [16] Simoes JA, Alves VM, Fracalanzza SE, de Camargo RP, Mathias L, Milanez HM, et al. Phenotypical characteristics of group B streptococcus in parturients. Braz J Infect Dis 2007;11(2):261–6. [17] Lipsitch M. Bacterial vaccines and serotype replacement: lessons from Haemophilus influenzae and prospects for Streptococcus pneumoniae. Emerg Infect Dis 1999;5(3):336–45. [18] Cieslewicz MJ, Chaffin D, Glusman G, Kasper D, Madan A, Rodrigues S, et al. Structural and genetic diversity of group B streptococcus capsular polysaccharides. Infect Immun 2005;73(5):3096–103.
Jussara K. Palmeiro a,b Laboratório de Bacteriologia, Hospital de Clínicas, Universidade Federal do Paraná, Rua Padre Camargo, 280, 1◦ andar, 80060-240, Alto da Glória, Curitiba, Paraná, Brazil b Programa de Pós-Graduac¸ão em Ciências da Saúde, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceic¸ão, 1155, Centro de Ciências Biológicas e da Saúde, 2◦ andar, 80215-901, Prado Velho, Curitiba, Paraná, Brazil a
Newton S. De Carvalho Departamento de Tocoginecologia – Setor de Doenc¸as Infecciosas
em Ginecologia e Obstetrícia, Hospital de Clínicas, Universidade Federal do Paraná, Rua General Carneiro, 181, 5◦ andar, 80060-900, Alto da Glória, Curitiba, Paraná, Brazil Ana C.N. Botelho Sérgio E.L. Fracalanzza Instituto de Microbiologia, Universidade Federal do Rio de Janeiro, Centro de Ciência da Saúde, Bloco I, Cidade Universitária, 21941-540, Ilha do Fundão, Rio de Janeiro, Rio de Janeiro, Brazil Humberto M.F. Madeira Programa de Pós-Graduac¸ão em Ciências da Saúde, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceic¸ão, 1155, Centro de Ciências Biológicas e da Saúde, 2◦ andar, 80215-901, Prado Velho, Curitiba, Paraná, Brazil Libera M. Dalla-Costa a,b,∗ Laboratório de Bacteriologia, Hospital de Clínicas, Universidade Federal do Paraná, Rua Padre Camargo, 280, 1◦ andar, 80060-240, Alto da Glória, Curitiba, Paraná, Brazil b Faculdades Pequeno Príncipe – Instituto de Pesquisa Pelé Pequeno Príncipe, Av. Silva Jardim, 1632, 80250-060, Centro, Curitiba, Paraná, Brazil a
∗ Corresponding
author. Tel.: +55 41 33607823; fax: +55 41 33607975. E-mail addresses: [email protected] (J.K. Palmeiro), [email protected] (N.S. De Carvalho), [email protected] (A.C.N. Botelho), [email protected] (S.E.L. Fracalanzza), [email protected] (H.M.F. Madeira), [email protected], [email protected] (L.M. Dalla-Costa) 27 December 2010 Available online 15 March 2011
Contents lists available at ScienceDirect
Vaccine journal homepage: www.elsevier.com/locate/vaccine
Letter to the Editor Maternal group B streptococcal immunization: Capsular polysaccharide (CPS)-based vaccines and their implications on prevention
a r t i c l e
i n f o
Keywords: Group B streptococcus CPS-based vaccine Serotype IV
a b s t r a c t Group B streptococcal (GBS) capsular polysaccharide (CPS)-based conjugate vaccine, which includes types Ia, Ib, II, III, and V, could potentially prevent neonatal, pediatric, adult, and pregnancy-associated diseases. However, since GBS CPS types included in that vaccine are prevalent serotypes found in North America and Europe, it may not provide the necessary protection for individuals in countries in which other capsular types have been found. © 2011 Elsevier Ltd. All rights reserved.
Dear Sirs, The incidence of early-onset neonatal disease caused by group B streptococcus (GBS) has decreased by using antimicrobial intrapartum prophylaxis. However, the incidence of late-onset disease remains unchanged, and GBS has also emerged as an important pathogen in other patient groups, such as children, young adults with underlying medical conditions, and elderly individuals [1]. Recently, vaccine-development has been shown to be an effective alternative for preventing GBS diseases. Capsular polysaccharide (CPS) is a virulence factor that induces protective immunity, and has been considered a potential bacterial target for the production of vaccines. Nine different capsular types, Ia, Ib, and II–VIII, have been described, along with the recently proposed serotype IX [2]. Immunization studies have assessed the efficacy of CPS conjugate vaccines against the most common GBS capsular types of the Western hemisphere. These vaccines have been shown to be highly immunogenic results in animals [3], while in humans the results have been shown to be safe and well tolerated [4,5]. A CPS conjugate vaccine that has been recently tested in the United States contains five capsular types: types Ia, Ib, II, III, and V, which are the predominant serotypes in North America and Europe [1,6]. Serotypes VI and VIII have been more frequently found in Japan [7], and serotypes IV and VII are rarely isolated [8]. In contrast to the low percentage of GBS serotype IV previously reported for the United States, we have shown in recent study a considerable proportion of type IV among GBS isolates in Southern Brazil [9]. One-hundred sixty-eight GBS strains were isolated from community and hospitalized patients between April 2006 and May 2008 and all isolates were serotyped by classical method as previously described [10]. Our rate of occurrence of serotype IV was 13.1% (n = 23) of the total GBS isolated from a population comprised of late newborns (ages 8–90 days), teenagers, nonpregnant and pregnant adults, and elderly individuals. Furthermore, serotype IV was commonly found in infections and was associated with lateonset neonatal disease [9]. Epidemiological studies performed in the United Arab Emirates [11], Turkey [12], Zimbabwe [13], and more recently in the United States [14] have also found significant 0264-410X/$ – see front matter © 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.vaccine.2011.02.102
proportions of GBS type IV isolates, most of them were recovered from carriers. However, in previous Brazilian studies, serotype IV was not described [15,16]. Although a GBS pentavalent vaccine is expected to provide protection for a high percentage of GBS diseases, it does not offer protection against different serotypes found in other countries [7,14]. Moreover, the possibility of shifts in serotype prevalence, such as the emergence of type IV [14], the presence of new serotypes and nontypeable strains [11,17,18] support the need for ongoing surveillance of serotypes to contribute to the design of a universal vaccine. Vaccines based on conserved surface proteinconjugated GBS capsular polysaccharides could be more effective to serve as a serotype-independent vaccine. Conflict of interest: We have no competing interests to declare. Policy and ethics: Ethical approval for the project has been provided by the Research Ethics Committee of the Hospital de Clínicas, UFPR, under protocol 1772.189/2008–09. References [1] Phares CR, Lynfield R, Farley MM, Mohle-Boetani J, Harrison LH, Petit S, et al. Epidemiology of invasive group B streptococcal disease in the United States, 1999–2005. JAMA 2008;299(17):2056–65. [2] Slotved HC, Kong F, Lambertsen L, Sauer S, Gilbert GL, Serotype IX. A proposed new Streptococcus agalactiae serotype. J Clin Microbiol 2007;45(9):2929–36. [3] Paoletti LC, Wessels MR, Rodewald AK, Shroff AA, Jennings HJ, Kasper DL. Neonatal mouse protection against infection with multiple group B streptococcal (GBS) serotypes by maternal immunization with a tetravalent GBS polysaccharide-tetanus toxoid conjugate vaccine. Infect Immun 1994;62(8):3236–43. [4] Baker CJ, Paoletti LC, Wessels MR, Guttormsen HK, Rench MA, Hickman ME, et al. Safety and immunogenicity of capsular polysaccharide–tetanus toxoid conjugate vaccines for group B streptococcal types Ia and Ib. J Infect Dis 1999;179(1):142–50. [5] Johri AK, Paoletti LC, Glaser P, Dua M, Sharma PK, Grandi G, et al. Streptococcus: global incidence and vaccine development. Nat Rev Microbiol 2006;4(12):932–42. [6] Persson E, Berg S, Trollfors B, Larsson P, Ek E, Backhaus E, et al. Serotypes and clinical manifestations of invasive group B streptococcal infections in western Sweden 1998–2001. Clin Microbiol Infect 2004;10(9):791–6. [7] Lachenauer CS, Kasper DL, Shimada J, Ichiman Y, Ohtsuka H, Kaku M, et al. Serotypes VI and VIII predominate among group B streptococci isolated from pregnant Japanese women. J Infect Dis 1999;179(4):1030–3.
3730
Letter to the Editor / Vaccine 29 (2011) 3729–3730
[8] Paoletti LC, Kasper DL. Conjugate vaccines against group B streptococcus types IV and VII. J Infect Dis 2002;186(1):123–6. [9] Palmeiro JK, Dalla-Costa LM, Fracalanzza SE, Botelho AC, da Silva Nogueira K, Scheffer MC, et al. Phenotypic and genotypic characterization of group B streptococcal isolates in Southern Brazil. J Clin Microbiol 2010;48(12):4397–403. [10] Lancefield RC, Freimer EH. Type-specific polysaccharide antigens of group B streptococci. J Hyg (Lond) 1966;64(2):191–203. [11] Amin A, Abdulrazzaq YM, Uduman S. Group B streptococcal serotype distribution of isolates from colonized pregnant women at the time of delivery in United Arab Emirates. J Infect 2002;45(1):42–6. [12] Ekin IH, Gurturk K. Characterization of bovine and human group B streptococci isolated in Turkey. J Med Microbiol 2006;55(5):517–21. [13] Moyo SR, Maeland JA, Bergh K. Typing of human isolates of Streptococcus agalactiae (group B streptococcus, GBS) strains from Zimbabwe. J Med Microbiol 2002 Jul;51(7):595–600. [14] Diedrick MJ, Flores AE, Hillier SL, Creti R, Ferrieri P. Clonal analysis of colonizing group B Streptococcus, serotype IV, an emerging pathogen in the United States. J Clin Microbiol 2010;48(9):3100–4. [15] Duarte RS, Bellei BC, Miranda OP, Brito MA, Teixeira LM. Distribution of antimicrobial resistance and virulence-related genes among Brazilian group B streptococci recovered from bovine and human sources. Antimicrob Agents Chemother 2005;49(1):97–103. [16] Simoes JA, Alves VM, Fracalanzza SE, de Camargo RP, Mathias L, Milanez HM, et al. Phenotypical characteristics of group B streptococcus in parturients. Braz J Infect Dis 2007;11(2):261–6. [17] Lipsitch M. Bacterial vaccines and serotype replacement: lessons from Haemophilus influenzae and prospects for Streptococcus pneumoniae. Emerg Infect Dis 1999;5(3):336–45. [18] Cieslewicz MJ, Chaffin D, Glusman G, Kasper D, Madan A, Rodrigues S, et al. Structural and genetic diversity of group B streptococcus capsular polysaccharides. Infect Immun 2005;73(5):3096–103.
Jussara K. Palmeiro a,b Laboratório de Bacteriologia, Hospital de Clínicas, Universidade Federal do Paraná, Rua Padre Camargo, 280, 1◦ andar, 80060-240, Alto da Glória, Curitiba, Paraná, Brazil b Programa de Pós-Graduac¸ão em Ciências da Saúde, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceic¸ão, 1155, Centro de Ciências Biológicas e da Saúde, 2◦ andar, 80215-901, Prado Velho, Curitiba, Paraná, Brazil a
Newton S. De Carvalho Departamento de Tocoginecologia – Setor de Doenc¸as Infecciosas
em Ginecologia e Obstetrícia, Hospital de Clínicas, Universidade Federal do Paraná, Rua General Carneiro, 181, 5◦ andar, 80060-900, Alto da Glória, Curitiba, Paraná, Brazil Ana C.N. Botelho Sérgio E.L. Fracalanzza Instituto de Microbiologia, Universidade Federal do Rio de Janeiro, Centro de Ciência da Saúde, Bloco I, Cidade Universitária, 21941-540, Ilha do Fundão, Rio de Janeiro, Rio de Janeiro, Brazil Humberto M.F. Madeira Programa de Pós-Graduac¸ão em Ciências da Saúde, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceic¸ão, 1155, Centro de Ciências Biológicas e da Saúde, 2◦ andar, 80215-901, Prado Velho, Curitiba, Paraná, Brazil Libera M. Dalla-Costa a,b,∗ Laboratório de Bacteriologia, Hospital de Clínicas, Universidade Federal do Paraná, Rua Padre Camargo, 280, 1◦ andar, 80060-240, Alto da Glória, Curitiba, Paraná, Brazil b Faculdades Pequeno Príncipe – Instituto de Pesquisa Pelé Pequeno Príncipe, Av. Silva Jardim, 1632, 80250-060, Centro, Curitiba, Paraná, Brazil a
∗ Corresponding
author. Tel.: +55 41 33607823; fax: +55 41 33607975. E-mail addresses: [email protected] (J.K. Palmeiro), [email protected] (N.S. De Carvalho), [email protected] (A.C.N. Botelho), [email protected] (S.E.L. Fracalanzza), [email protected] (H.M.F. Madeira), [email protected], [email protected] (L.M. Dalla-Costa) 27 December 2010 Available online 15 March 2011