The 13-valent pneumococcal conjugate vaccine (PCV13) does not appear to provide much protection on combined invasive disease due to the six PCV13 non-PCV7 serotypes 1, 3, 5, 6A, 7F, and 19A in Kuwait during 2010–2019

Figures & data

Table 1. Serotypes of invasive pneumococci in different age groups during pre-vaccination and postvaccination (with PCV13) periods

	Serotype count in
Serotype	<2 y age group & period	2–5 y age group & period	6–50 y age group & period	51–65 y age group & period	>65 y age group & period
	I^a II^b III^c II+III	I II III II+III	I II III II+III	I II III II+III	I II III II+III
1^d	0 0 0 0	1 0 0 0	0 0 4 4	3 0 0 0	1 0 1 1
2	0 0 0 0	1 0 0 0	2 0 0 0	0 0 0 0	0 0 0 0
3	0 0 0 0	0 0 0 0	0 0 1 1	0 0 0 0	0 1 2 3
4^e	O 0 0 0	0 0 0 0	1 0 0 0	1 0 0 0	0 0 0 0
5	0 0 1 1	0 0 0 0	1 0 1 1	0 0 0 0	0 0 0 0
6A	0 0 1 1	0 0 0 0	0 3 0 3	1 0 0 0	0 0 0 0
6B	0 0 0 0	1 0 0 0	0 0 0 0	0 0 0 0	0 0 0 0
6C^f	0 0 0 0	0 0 0 0	0 0 0 0	0 0 1 1	0 0 0 0
7A	0 0 1 1	0 0 0 0	0 0 0 0	0 0 0 0	0 0 0 0
7C	0 0 0 0	0 0 0 0	0 0 0 0	1 0 0 0	0 0 0 0
7F	1 0 0 0	0 0 0 0	0 0 0 0	0 1 1 2	0 0 0 0
8	0 0 1 1	0 0 0 0	2 0 2 2	1 2 1 3	0 1 0 1
9A	0 0 0 0	0 0 0 0	0 0 0 0	1 0 0 0	0 0 0 0
9L	0 0 0 0	0 0 1 1	0 2 0 2	0 0 0 0	0 0 0 0
9N	0 0 1 1	0 0 1 1	0 0 3 3	0 0 0 0	1 0 1 1
9V	0 0 0 0	0 0 0 0	1 0 1 1	3 0 1 1	2 1 0 1
10A	1 0 0 0	0 0 0 0	1 0 1 1	0 0 0 0	0 1 0 1
11A	0 0 0 0	0 0 1 1	0 0 0 0	0 0 0 0	1 0 1 1
11C	0 0 0 0	0 0 0 0	0 0 1 1	0 0 0 0	0 0 0 0
11D	0 0 0 0	0 0 0 0	0 0 2 2	0 0 0 0	0 0 0 0
12B	0 0 0 0	0 1 0 1	0 0 1 1	0 0 0 0	0 0 0 0
12F	0 0 5 5	0 0 1 1	0 0 1 1	0 3 1 4	0 0 1 1
14	2 0 2 2	0 0 0 0	0 0 0 0	3 0 0 0	1 0 0 0
15A	0 0 1 1	0 0 0 0	0 0 2 2	0 0 1 1	0 1 2 3
15B	0 1 0 1	0 1 0 1	0 2 1 3	0 0 1 1	0 0 0 0
15C	0 0 0 0	0 0 1 1	0 0 0 0	0 0 0 0	0 0 0 0
15F	0 0 0 0	0 0 0 0	0 0 0 0	0 1 0 1	0 0 0 0
17F	0 0 0 0	0 0 0 0	0 1 3 4	0 0 2 2	0 1 2 3
18A	0 0 0 0	0 0 0 0	0 0 1 1	0 0 0 0	0 0 0 0
18C	0 0 0 0	0 0 0 0	0 0 0 0	0 0 1 1	1 0 1 1
19A	0 1 1 2	1 2 0 2	1 0 4 4	2 1 0 1	0 1 2 3
19B	0 0 1 1	0 0 0 0	0 0 0 0	0 0 0 0	0 0 0 0
19C	0 0 1 1	0 0 0 0	0 0 0 0	0 0 0 0	0 0 0 0
19F	2 0 1 1	2 0 0 0	3 0 0 0	2 1 2 3	2 0 1 1
20	0 0 0 0	0 1 0 1	0 1 1 2	0 0 0 0	0 1 0 1
22A	0 0 0 0	0 0 0 0	0 0 0 0	2 0 0 0	0 0 1 1
22F	0 0 0 0	0 0 0 0	0 0 2 2	0 0 0 0	0 1 0 1
23A	0 0 1 1	1 0 1 1	0 0 4 4	0 0 0 0	0 1 1 2
23B	0 0 0 0	0 0 0 0	0 0 1 1	0 0 1 1	0 0 0 0
23F	1 1 0 1	1 0 0 0	0 0 1 1	4 0 0 0	0 0 0 0
24F	0 0 2 2	0 0 1 1	0 0 0 0	0 0 0 0	0 0 1 1
27	0 0 0 0	0 0 0 0	0 0 0 0	0 0 1 1	0 0 0 0
28	0 0 1 1	0 0 0 0	0 0 0 0	0 0 0 0	0 0 0 0
28A	0 0 0 0	0 0 0 0	0 0 1 1	0 0 0 0	0 0 0 0
28F	0 0 1 1	0 0 0 0	0 0 0 0	0 0 0 0	0 0 0 0
29	0 0 0 0	0 0 0 0	0 0 0 0	0 0 3 3	0 0 0 0
33A	0 0 0 0	0 0 0 0	0 0 0 0	0 0 0 0	0 1 0 1
33C	0 0 0 0	0 0 1 1	0 0 0 0	0 0 0 0	0 0 0 0
33D	1 0 1 1	0 0 0 0	0 3 0 3	0 0 0 0	0 0 2 2
NT^g	1 1 13 14	0 1 4 5	1 0 9 9	1 0 2 2	0 3 11 14
Total	9 4 36 40	7 6 12 18	13 12 48 60	25 9 19 28	9 14 30 44

^aPre-vaccination period, August 2003-July 2006³

^bPost-vaccination (with PCV13) period, August 2010-July 2013³

^cPost-vaccination (with PCV13) period, August 2014-July 2019

The serotypes in PCV13 are in bold-face; among those underlined are PCV13 non-PCV7 serotypes^d, and not underlined are PCV7 serotypes^e. Other serotypes are non-PCV13^f. NT is non-typeable^g.

Table 2. Differences in the distribution of vaccine serotypes in <2 y age group

Serotype	Serotype count (no./total serotype no.) (%) in period			P-value (CI) for comparisons
	I^a	III^b	II^c +III	I vs III	I vs II+III	III vs II+III
4	0/9 (0%)	0/36 (0%)	0/40 (0%)	1.00 (NaN^d-NaN)	1.00 (NaN-NaN)	1.00 (NaN-NaN)
6B	0/9 (0%)	0/36 (0%)	0/40 (0%)	1.00 (NaN-NaN)	1.00 (NaN-NaN)	1.00 (NaN-NaN)
9V	0/9 (0%)	0/36 (0%)	0/40 (0%)	1.00 (NaN-NaN)	1.00 (NaN-NaN)	1.00 (NaN-NaN)
14	2/9 (22.2)	2/36 (5.6)	2/40 (5.0)	0.17 (0.58–40.5)	0.15 (0.65–45.2)	1.00 (0.15–8.38)
18C	0/9 (0%)	0/36 (0%)	0/40 (0%)	1.00 (NaN-NaN)	1.00 (NaN-NaN)	1.00 (NaN-NaN)
19F	2/9 (22.2)	1/36 (2.8)	1/40 (2.5)	0.09 (0.79–126.03)	0.08 (0.88–140.12)	1.00 (0.06–18.49)
23F	1/9 (11.1)	0/36 (0%)	1/40 (2.5)	0.2 (NaN-Infinity)	0.33 (0.27–86.35)	1.00 (0-NaN)
Total PCV7 serotypes	5/9 (55.6)	3/36 (8.3)	4/40 (10.0)	0.004^e (2.35–80.56)	0.006 (2.11–59.89)	0.56 (0.17–3.93)
1	0/9 (0%)	0/36 (0%)	0/40 (0%)	1.00 (NaN-NaN)	1.00 (NaN-NaN)	1.00 (NaN-NaN)
3	0/9 (0%)	0/36 (0%)	0/40 (0%)	1.00 (NaN-NaN)	1.00 (NaN-NaN)	1.00 (NaN-NaN)
5	0/9 (0%)	1/36 (2.8)	1/40 (2.5)	1.00 (0-NaN)	0.82 (0-NaN)	0.73 (0.07–18.49)
6A	0/9 (0%)	1/36 (2.8%)	1/40 (2.5%)	0.80 (0-NaN)	1.00 (0-NaN)	1.00 (0.07–18.49)
7F	1/9 (11.1)	0/36 (0%)	0/40 (0%)	0.20 (NaN-Infinity)	0.18 (NaN-Infinity)	1.00 (NaN-NaN)
19A	0/9 (0%)	1/36 (2.8)	2/40 (5.0%)	0.80 (0-NaN)	1.00 (0-NaN)	1.00 (0.05–6.25)
Total PCV13 non-PCV7 serotypes	1/9 (11.1)	3/36 (8.3)	4/40 (10.0)	1.00 (0.13–15.03)	1.00 (0.11–11.46)	1.00 (0.17–3.93)
Total PCV13 serotypes	6/9 (66.7)	6/36 (16.7)	8/40 (20.0)	0.006 (1.94–51.54)	0.011 (1.64–39.14)	0.77 (0.92–0.71)

^aPre-vaccination period (August 2003-July 2006)³

^bPost-vaccination (with PCV13) period (August 2013-July 2019)

^cPost-vaccination (with PCV13) period (August 2010-July 2013) (data from Table 1)³

^dNaN: not a number

^esignificant P value in bold face.

Table 3. Differences in the distribution of vaccine serotypes in 2 y->65 y age group

Serotype	Serotype count (no./total serotype no.) (%) in period			P-value (CI) for comparisons
	I^a	III^b	II^c +III	I vs III	I vs II+III	III vs II+III
4	2/54(3.70)	0/109 (0)	0/150(0)	0.108 (NaN^d-Infinity)	0.069 (NaN-Infinity)	1.00 (NaN-NaN)
6B	1/54 (1.85)	0/109 (0)	0/150 (0)	0.33 (NaN-Infinity)	0.27 (NaN-Infinity)	1.00 (naN-NaN)
9V	6/54 (11.11)	2/109 (1.83)	3/150 (2.0)	0.017e (1.30–34.34)	0.012 (1.48–25.43)	1.00 (0.15–5.58)
14	4/54(7.41)	0/109 (0)	0/150 (0)	0.011 (NaN-Infinity)	0.005 (NaN-Infinity)	1.00 (NaN-NaN)
18C	1/54 (1.85)	2/109 (1.83)	2/150 (1.33)	0.70 (0.09–11.39)	0.61 (0.13–15.72)	0.56 (0.19–9.98)
19F	9/54 (16.7)	3/109 (2.75)	4/150 (2.67)	0.003 (1.83–27.32)	0.001 (2.15–24.83)	0.63 (0.23–4.71)
23F	5/54 (9.26)	1/109 (0.92)	1/150 (0.67)	0.016 (1.25–96.85)	0.005 (1.73–133.32)	0.67 (0.09–22.30)
Total PCV7 serotypes	28/54(51.85)	8/109 (7.34)	10/150 (6.67)	<0.0001 (5.55–33.31)	<0.0001 (6.54–34.74)	1.000(0.43–2.91)
1	5/54 (9.26)	5/109 (4.59)	5/150 (3.33)	0.30 (0.59–7.67)	0.134 (0.82–10.66)	0.75 (0.39–4.94)
3	0/54 (0)	3/109 (2.75)	4/150 (2.67)	0.55 (0-NaN)	0.35 (0-NaN)	1.00 (0.23–4.71)
5	1/54 (1.85)	1/109 (0.92)	1/150 (0.67)	1.00 (0.13–33.22)	1.00 (0.17–45.8)	1.00 (0.09–22.30)
6A	1/54 (1.85)	0/109 (0)	3/150 (2.0)	0.33 (NaN-Infinity)	1.00 (0.09–9.08)	0.27 (0-NaN)
7F	0/54 (0)	1/109 (0. 92)	2/150 (1.33)	1.00 (0-NaN)	1.00 (0-NaN)	1.00 (0.06–7.65)
19A	4/54 (7.41)	6/109 (5.50)	10/150(6.67)	0.73 (0.37–5.09)	1.00 (0.34–3.73)	0.80 (0.29–2.32)
Total PCV13 non PCV7 serotypes	11/54 (20.37)	16/109 (14.68)	25/150 (16.67)	0.49 (0.64–3.47)	0.68 (0.58–2.82)	0.79 (0.43–1.70)
Total PCV13 serotypes	39/54 (72.22)	24/109 (22.02)	35/150 (23.33)	<0.0001 (0.44–19.46)	<0.0001 (4.22–17.30)	0.92 (0.51–1.67)

^aPre-vaccination period (August 2003-July 2006)³

^bPost-vaccination (with PCV13) period (August 2013-July 2019)

^cPost-vaccination (with PCV13) period (August 2010-July 2013) (data from Table 1)³

^dNaN: not a number

^eSignificant P value in boldface.

Mokaddas E, Albert MJ. Serotype distribution and penicillin non-susceptibility of Streptococcus pneumoniae causing invasive diseases in Kuwait: a 10-year study of impact of pneumococcal conjugate vaccines. Expert Rev Vaccines. 2016;15:1337–45. doi:10.1080/14760584.2016.1198698.

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