Title
International genomic definition of pneumococcal lineages, to contextualise disease, antibiotic resistance and vaccine impact
Date Issued
01 May 2019
Access level
open access
Resource Type
journal article
Author(s)
Gladstone R.A.
Lo S.W.
Lees J.A.
Croucher N.J.
van Tonder A.J.
Corander J.
Page A.J.
Marttinen P.
Bentley L.J.
Ho P.L.
du Plessis M.
Cornick J.E.
Kwambana-Adams B.
Benisty R.
Nzenze S.A.
Madhi S.A.
Hawkins P.A.
Everett D.B.
Antonio M.
Dagan R.
Klugman K.P.
von Gottberg A.
McGee L.
Breiman R.F.
Bentley S.D.
Publisher(s)
Elsevier B.V.
Abstract
Background: Pneumococcal conjugate vaccines have reduced the incidence of invasive pneumococcal disease, caused by vaccine serotypes, but non-vaccine-serotypes remain a concern. We used whole genome sequencing to study pneumococcal serotype, antibiotic resistance and invasiveness, in the context of genetic background. Methods: Our dataset of 13,454 genomes, combined with four published genomic datasets, represented Africa (40%), Asia (25%), Europe (19%), North America (12%), and South America (5%). These 20,027 pneumococcal genomes were clustered into lineages using PopPUNK, and named Global Pneumococcal Sequence Clusters (GPSCs). From our dataset, we additionally derived serotype and sequence type, and predicted antibiotic sensitivity. We then measured invasiveness using odds ratios that relating prevalence in invasive pneumococcal disease to carriage. Findings: The combined collections (n = 20,027) were clustered into 621 GPSCs. Thirty-five GPSCs observed in our dataset were represented by >100 isolates, and subsequently classed as dominant-GPSCs. In 22/35 (63%) of dominant-GPSCs both non-vaccine serotypes and vaccine serotypes were observed in the years up until, and including, the first year of pneumococcal conjugate vaccine introduction. Penicillin and multidrug resistance were higher (p < .05) in a subset dominant-GPSCs (14/35, 9/35 respectively), and resistance to an increasing number of antibiotic classes was associated with increased recombination (R2 = 0.27 p < .0001). In 28/35 dominant-GPSCs, the country of isolation was a significant predictor (p < .05) of its antibiogram (mean misclassification error 0.28, SD ± 0.13). We detected increased invasiveness of six genetic backgrounds, when compared to other genetic backgrounds expressing the same serotype. Up to 1.6-fold changes in invasiveness odds ratio were observed. Interpretation: We define GPSCs that can be assigned to any pneumococcal genomic dataset, to aid international comparisons. Existing non-vaccine-serotypes in most GPSCs preclude the removal of these lineages by pneumococcal conjugate vaccines; leaving potential for serotype replacement. A subset of GPSCs have increased resistance, and/or serotype-independent invasiveness.
Start page
338
End page
346
Volume
43
Language
English
OCDE Knowledge area
Ciencias médicas, Ciencias de la salud Biología celular, Microbiología
Scopus EID
2-s2.0-85064282117
PubMed ID
Source
EBioMedicine
ISSN of the container
23523964
Sponsor(s)
This study was co-funded by the Bill and Melinda Gates Foundation (grant code OPP1034556 ), the Wellcome Sanger Institute (core Wellcome grants 098051 and 206194 ) and the US Centers for Disease Control and Prevention . The funding sources had no role in isolate selection, analysis, or data interpretation. The corresponding authors had full access to the data and are responsible for the final decision to submit for publication. Isolates included from Qatar were collected through research project supported by NPRP 6-496-3-127 from Qatar National Research Foundation (QNRF).
Sources of information: Directorio de Producción Científica Scopus