Population-based Assessment of Invasive Disease and Macrolide Resistance from Streptococcus pneumoniae in Atlanta from 2007 to 2010 Open Access

Abstract

Population-based Assessment of Invasive Disease and Macrolide Resistance from

Streptococcus pneumoniae in Atlanta from 2007 to 2010

The incidence of macrolide resistance in Streptococcus pneumoniae increased
in the last twenty years due to the widespread clinical use of macrolides. The seven-
valent pneumococcal conjugate vaccine (PCV7) and the 13-valent pneumococcal
conjugate (PCV13) were approved in February 2000 and in February 2010. We
assessed the changes in macrolide-resistance invasive S. pneumoniae disease and
molecular basis of resistance in Atlanta, GA, USA from 2007-2010. Pneumococcal
isolates and demographic data were obtained from a prospective population-based
surveillance under the active bacterial core surveillance (ABCs) of the Georgia
Emerging Infections Program. The mef(E) and erm(B) macrolide resistance genes
were detected by PCR. Incidence was calculated using population estimates and
census data from US Census Bureau.
The overall incidence of invasive pneumococcal disease (ranging from 13.3-
11.7/100,000) and macrolide resistance (ranging from 3.4 to 4.2/100,000) in
Atlanta appeared stable from 2007 to 2010. The incidence of disease and macrolide
resistance due to PCV7 vaccine serotypes however has reached all-time lows in all
age groups. But the incidence of isolates carrying both mef(E) and erm(B) increased
especially among children younger than 2 years old and in serotype 19A, 23.5%
(94/400) of available macrolide resistant isolates and 47% (24/51)
of available macrolide resistant 19A contained both genes. The continued emergence
of 19A and the presence of dual macrolide resistance genes in this serotype clearly
support the need for the new PCV13 vaccine containing this serotype.

Population-based Assessment of Invasive Disease and Macrolide Resistance from
Streptococcus pneumoniae in Atlanta from 2007 to 2010
Bachelor of Science
National Taiwan University
2009
Thesis Committee Chair: Dr. David S. Stephens, MD
A thesis submitted to the Faculty of the
Rollins School of Public Health of Emory University
in partial fulfillment of the requirements for the degree of
Master of Science in Public Health
in Epidemiology
2012

Table of Contents

Table of Contents

Introduction 1
Materials and Methods 4
Results 7
Discussion 13
References 17
Tables 20
Figures and Figure Legends 25

About this Master's Thesis

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Epidemiology
Degree	MSPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	Streptococcus pneumoniae mef(E) Macrolide Resistance erm(B)
Committee Chair / Thesis Advisor	Stephens, David S, Emory University
Partnering Agencies	Georgia state or local health department

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