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Antimicrobial Agents and Chemotherapy, June 2004, p. 2206-2213, Vol. 48, No. 6
0066-4804/04/$08.00+0     DOI: 10.1128/AAC.48.6.2206-2213.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.

Short- and Long-Term Effects of Pneumococcal Conjugate Vaccination of Children on Penicillin Resistance

L. Temime,1* D. Guillemot,2 and P. Y. Boëlle1,3

INSERM U444, Epidémiologie et Sciences de l'Information, 75571 Paris Cedex 12,1 Institut Pasteur,2 Assistance Publique, Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France3

Received 24 September 2003/ Returned for modification 15 December 2003/ Accepted 10 February 2004

Recent observations have shown that wide-scale vaccination with pneumococcal conjugate vaccines was associated with a reduction in invasive disease, supporting the expectation that vaccination could help reduce carriage of Streptococcus pneumoniae and control the spread of resistant strains. However, it is too early to assess whether these effects can be sustained in the long term. Here, we used mathematical modeling to investigate time changes in pneumococcal colonization and resistance induced by conjugate vaccination in an environment where antibiotic exposure is high and resistance is widespread. According to model predictions, vaccination induced a decrease in carriage of vaccine-type pneumococci to very low levels, typically in 10 to 15 years under epidemiologically realistic conditions. Almost simultaneously, non-vaccine-type pneumococci spread in the community. Consequently, while there was a short-term decrease in the overall carriage rate, it was followed after a few years by a renewed, although limited, increase. Vaccination with a heptavalent vaccine did not affect the extent to which antibiotic resistance was selected: in all cases, the distribution of resistance levels peaked at high levels (MIC > 2 µg/ml) after 20 years. With a vaccine optimally designed to include all serotypes currently exhibiting decreased susceptibility to penicillin G, the selection of resistance was slowed down, although not prevented. These results suggest that because of serotype replacement, the effects of vaccination observed today may not be sustained in the long term. As a consequence, vaccination alone may not be successful in controlling selection for resistance in S. pneumoniae.

* Corresponding author. Mailing address: INSERM U444-27, rue Chaligny, 75571 Paris Cedex 12, France. Phone: 33 1 49 28 32 26. Fax: 33 1 49 28 32 33. E-mail: laura.temime{at}sat.ap-hop-paris.fr.

Antimicrobial Agents and Chemotherapy, June 2004, p. 2206-2213, Vol. 48, No. 6
0066-4804/04/$08.00+0     DOI: 10.1128/AAC.48.6.2206-2213.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.



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