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    Serotype distribution of Streptococcus pneumoniae and pneumococcal vaccine coverage in adults in Turkey between 2015 and 2018
    (Taylor and Francis Ltd., 2023) Hasçelik, Gülşen; Söyletir, Güner; Gülay, Zeynep; Sancak, Banu; Akgün, Yaman; Gürler, Nezahat; Akpolat, Nezahat
    Objective:To evaluate the serotype distribution and antibiotic resistance in pneumococcalinfections in adults and to provide a perspective regarding serotype coverage of both currentand future pneumococcal vaccines.Patients and methods:This passive surveillance study was conducted with theStreptococcuspneumoniaestrains isolated from the specimens of patients with pneumonia (materials isolatedfrom bronchoalveolar lavage), bacteraemia, meningitis, pleuritis and peritonitis between 2015and 2018. Serogrouping and serotyping were performed by latex particle agglutination andby conventional Quellung reaction using commercial type-specific antisera, respectively. Thestrains were analysed for penicillin, cefotaxime, erythromycin and moxifloxacin susceptibilitiesby E-test.Results:In the whole study group (410 samples from adults aged 18years), the most frequentserotypes were 3 (14.1%), 19 F (12%) and 1 (9.3%). The vaccine coverage for PCV13, PCV15,PCV20 and PPV23 was 63.9%, 66.6%, 74.1% and 75.9%, respectively, in all isolates. Penicillinnon-susceptibility in invasive pneumococcal disease (IPD) was 70.8% and 57.1% in the patientsaged<65 and 65 years, respectively. About 21.1% and 4.3% of the patients with and withoutIPD had cefotaxime resistance. Non-susceptibility to erythromycin and moxifloxacin was 38.2%and 1.2%, respectively.Conclusions:The results revealed that novel PCV vaccines may provide improved coverage ascompared with the currently available vaccine, PCV13. The significant antibiotic resistance ratesimply the need to extend the serotype coverage of the vaccines. Continuing the surveillance inpneumococcal diseases is critical to explore the serotype distribution and incidence changes ofIPD cases in the population and to inform policy makers to make necessary improvements inthe national immunization programmes.KEY MESSAGES This multicentre study demonstrated the most recent serotype distribution and antibioticresistance in adult population in Turkey.
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    Serotype distribution of Streptococcus pneumoniae in children with invasive diseases in Turkey: 2008–2014
    (Taylor and Francis Inc., 2016) Ceyhan, Mehmet; Özsürekçi, Yasemin; Gürler, Nezahat; Öksüz, Lütfiye; Aydemir, Şöhret; Özkan, Şengül; Akpolat, Nezahat
    Successful vaccination policies for protection from invasive pneumococcal diseases (IPD) dependent on determination of the exact serotype distribution in each country. We aimed to identify serotypes of pneumococcal strains causing IPD in children in Turkey and emphasize the change in the serotypes before and after vaccination with 7-valent pneumococcal conjugate vaccine (PCV-7) was included and PCV-13 was newly changed in Turkish National Immunization Program. Streptococcus pneumoniae strains were isolated at 22 different hospitals of Turkey, which provide healthcare services to approximately 65% of the Turkish population. Of the 335 diagnosed cases with S. pneumoniae over the whole period of 2008–2014, the most common vaccine serotypes were 19F (15.8%), 6B (5.9%), 14 (5.9%), and 3 (5.9%). During the first 5 y of age, which is the target population for vaccination, the potential serotype coverage ranged from 57.5 % to 36.8%, from 65.0% to 44.7%, and from 77.4% to 60.5% for PCV-7, PCV-10, and PCV-13 in 2008–2014, respectively. The ratio of non-vaccine serotypes was 27.2% in 2008–2010 whereas was 37.6% in 2011–2014 (p=0.045). S. penumoniae serotypes was less non-susceptible to penicillin as compared to our previous results (33.7 vs 16.5 %, p=0.001). The reduction of those serotype coverage in years may be attributed to increasing vaccinated children in Turkey and the increasing non-vaccine serotype may be explained by serotype replacement. Our ongoing IPD surveillance is a significant source of information for the decision-making processes on pneumococcal vaccination.
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    Serotype distribution of Streptococcus pneumoniain children with invasive disease in Turkey: 2015-2018
    (Taylor & Francis, 2020) Ceyhan, Mehmet; Aykaç, Kübra; Gürler, Nezahat; Özsürekçi, Yasemin; Öksüz, Lütfiye; Akisoğlu, Özlem Altay; Öz, Fatma Nur; Emiroğlu, Melike; TürkDağı, Hatice; Yaman, Akgün; Söyletir, Güner; Öztürk, Candan; Akpolat, Nezahat; Özakın, Cüneyt; Aydın, Faruk; Aydemir, Şöhret; Kiremitçi, Abdurrahman; Gültekin, Meral; Camcıoğlu, Yıldız; Zer, Yasemin; Güdücüoğlu, Hüseyin; Gülay, Zeynep; Birinci, Asuman; Arabacı, Çiğdem; Karbuz, Adem; Devrim, İlker; Sorguç, Yelda; Baysan, Betil Özhak; Öncel, Eda Karadağ; Yılmaz, Nisel; Altıntop, Yasemin Ay
    Objectives: To determine the serotype distribution of pneumococcus causing invasive pneumococcal disease (meningitidis, bacteremia and empyema) in children in Turkey, and to observe potential changes in this distribution in time to guide effective vaccine strategies. Methods: We surveyed S. pneumoniae with conventional bacteriological techniques and with real-time polymerase chain reaction (RT-PCR) in samples of cerebrospinal fluid (CSF), blood and pleural fluid. S. pneumoniae strains were isolated from 33 different hospitals in Turkey, which are giving health services to approximately 60% of the Turkish population. Results: A total of 167 cases were diagnosed with invasive pneumococcal disease between 2015 and 2018. We diagnosed 52 (31.1%) patients with meningitis, 104 (62.2%) patients with bacteremia, and 11 (6.6%) patients with empyema. Thirty-three percent of them were less than 2 years old and 56% less than 5 years old. Overall PCV13 serotypes accounted for 56.2% (94/167). The most common serotypes were 19 F (11.9%), 1 (10.7%) and 3 (10.1%). Conclusions: Besides the increasing frequency of non-vaccine serotypes, vaccine serotypes continue to be a problem for Turkey despite routine and high-rate vaccination with PCV13 and significant reduction reported for the incidence of IPD in young children. Since new candidate pneumococcal conjugate vaccines with more serotype antigens are being developed, continuing IPD surveillance is a significant source of information for decision-making processes on pneumococcal vaccination.