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Pneumococcal serotype epidemiology and resistance after PCV13 replacement with PCV10, Sweden

Yamba Yamba, Linda LU orcid ; Uddén, Fabian LU orcid ; Dalence, Silvana LU ; de Bruijn, Anouschka LU ; Köster, Wiebke ; Ahl, Jonas LU and Riesbeck, Kristian LU orcid (2026) In Journal of Infection 92(5). p.1-8
Abstract

Objectives: To evaluate the impact of the 2018 switch from PCV13 to PCV10 in Sweden’s childhood immunisation programme on the serotype distribution of Streptococcus pneumoniae.MethodsRespiratory tract (RT) S. pneumoniae isolates (n=1615; 2020–2023) were serotyped, tested for antimicrobial susceptibility and compared with invasive pneumococcal disease (IPD) isolates (n=397) and PCV13-era data (2016–2018).ResultsPredominant serotypes were 3 (13%), 19A (11%), 23B (10%), and 11A (7.5%). PCV10 coverage was low (4.1%), but increased with PCV13 (29%), PCV15 (30%), PCV20 (47%) and PCV21 (71%). After reintroduction of PCV10, the proportions of serotypes 3 (8.7% to 13%) and 19A (4.5% to 11%) increased (p<0.001), and an increase in serotype 19A... (More)

Objectives: To evaluate the impact of the 2018 switch from PCV13 to PCV10 in Sweden’s childhood immunisation programme on the serotype distribution of Streptococcus pneumoniae.MethodsRespiratory tract (RT) S. pneumoniae isolates (n=1615; 2020–2023) were serotyped, tested for antimicrobial susceptibility and compared with invasive pneumococcal disease (IPD) isolates (n=397) and PCV13-era data (2016–2018).ResultsPredominant serotypes were 3 (13%), 19A (11%), 23B (10%), and 11A (7.5%). PCV10 coverage was low (4.1%), but increased with PCV13 (29%), PCV15 (30%), PCV20 (47%) and PCV21 (71%). After reintroduction of PCV10, the proportions of serotypes 3 (8.7% to 13%) and 19A (4.5% to 11%) increased (p<0.001), and an increase in serotype 19A was also observed in IPD (5.6% to 19%, p<0.001). Serotype 8 dominated IPD (21%) but was uncommon in RT isolates (2.8%). Among RT isolates, reduced benzylpenicillin susceptibility was observed in 11%. Resistance was highest to trimethoprim/sulfamethoxazole (13%), followed by erythromycin (9.3%), tetracycline (8.5%), and clindamycin (6.9%). Multidrug- and extensively drug-resistant isolates were uncommon (7.9% and 1.1%) and were predominantly serotypes 15A and 19A.ConclusionsSerotypes 19A and 3 re-emerged as predominant, indicating the need for continued surveillance. Our study emphasises the risk of rapid serotype resurgence when lower-valency vaccines are reintroduced.

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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Antimicrobial resistance, Pneumococcal infection, Pneumococcal vaccine, Respiratory tract infection, Serotype,Streptococcus pneumoniae
in
Journal of Infection
volume
92
issue
5
article number
106723
pages
1 - 8
publisher
W.B. Saunders
external identifiers
  • pmid:41831653
  • scopus:105034587622
ISSN
0163-4453
DOI
10.1016/j.jinf.2026.106723
project
Streptococcus pneumoniae and pneumonia - epidemiology, pathogenesis and immunity
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2026 The Author(s). Published by Elsevier Ltd on behalf of British Infection Association. This is an open access article under the CC BY license. http://creativecommons.org/licenses/by/4.0/
id
2a110b27-5cad-451f-9b24-e1a75048566b
date added to LUP
2026-05-01 22:19:56
date last changed
2026-05-15 23:14:29
@article{2a110b27-5cad-451f-9b24-e1a75048566b,
  abstract     = {{<p>Objectives: To evaluate the impact of the 2018 switch from PCV13 to PCV10 in Sweden’s childhood immunisation programme on the serotype distribution of Streptococcus pneumoniae.MethodsRespiratory tract (RT) S. pneumoniae isolates (n=1615; 2020–2023) were serotyped, tested for antimicrobial susceptibility and compared with invasive pneumococcal disease (IPD) isolates (n=397) and PCV13-era data (2016–2018).ResultsPredominant serotypes were 3 (13%), 19A (11%), 23B (10%), and 11A (7.5%). PCV10 coverage was low (4.1%), but increased with PCV13 (29%), PCV15 (30%), PCV20 (47%) and PCV21 (71%). After reintroduction of PCV10, the proportions of serotypes 3 (8.7% to 13%) and 19A (4.5% to 11%) increased (p&lt;0.001), and an increase in serotype 19A was also observed in IPD (5.6% to 19%, p&lt;0.001). Serotype 8 dominated IPD (21%) but was uncommon in RT isolates (2.8%). Among RT isolates, reduced benzylpenicillin susceptibility was observed in 11%. Resistance was highest to trimethoprim/sulfamethoxazole (13%), followed by erythromycin (9.3%), tetracycline (8.5%), and clindamycin (6.9%). Multidrug- and extensively drug-resistant isolates were uncommon (7.9% and 1.1%) and were predominantly serotypes 15A and 19A.ConclusionsSerotypes 19A and 3 re-emerged as predominant, indicating the need for continued surveillance. Our study emphasises the risk of rapid serotype resurgence when lower-valency vaccines are reintroduced.</p>}},
  author       = {{Yamba Yamba, Linda and Uddén, Fabian and Dalence, Silvana and de Bruijn, Anouschka and Köster, Wiebke and Ahl, Jonas and Riesbeck, Kristian}},
  issn         = {{0163-4453}},
  keywords     = {{Antimicrobial resistance; Pneumococcal infection; Pneumococcal vaccine; Respiratory tract infection; Serotype,Streptococcus pneumoniae}},
  language     = {{eng}},
  number       = {{5}},
  pages        = {{1--8}},
  publisher    = {{W.B. Saunders}},
  series       = {{Journal of Infection}},
  title        = {{Pneumococcal serotype epidemiology and resistance after PCV13 replacement with PCV10, Sweden}},
  url          = {{http://dx.doi.org/10.1016/j.jinf.2026.106723}},
  doi          = {{10.1016/j.jinf.2026.106723}},
  volume       = {{92}},
  year         = {{2026}},
}