Long-term impact of 10-valent pneumococcal conjugate vaccine in Kenya: Nasopharyngeal carriage among children in a rural and an urban site six years after introduction.

BACKGROUND: Kenya introduced Synflorix™ (GlaxoSmithKline, PCV10-GSK), a 10-valent pneumococcal conjugate vaccine, in 2011, using three primary doses and, in select areas, catch-up campaigns. Surveys conducted 1-2 years post-introduction showed a stable prevalence of pneumococcal colonization, with declines in vaccine-type carriage. However, little is known about the long-term impact of PCV10-GSK in Kenya. METHODS: We conducted a cross-sectional survey of pneumococcal carriage among children aged <5 years in November-December 2017 in Kibera (Nairobi informal settlement, no catch-up) and Asembo (rural western Kenya, 2-dose catch-up for children 1-4 years), using the same methods and settings as prior annual surveys from 2009 to 2013. Participants were randomly selected from an ongoing population-based surveillance platform. Nasopharyngeal swabs were frozen in skim milk-tryptone-glucose-glycerin media within 4 h and underwent culture with broth enrichment for pneumococcus. Isolates were serotyped by polymerase chain reaction and Quellung. RESULTS: We enrolled 504 children, including 252 from each site; >90 % of participants had received 3 doses of PCV10-GSK. Pneumococcal colonization was detected in 210 (83.3 %) participants in Kibera and 149 (59.1 %) in Asembo, which was significantly lower than the prevalence observed in 2013 (92.9 % and 85.7 %, respectively). PCV10-GSK serotypes were detected in 35/252 (13.9 %) participants in Kibera and 23/252 (9.1 %) in Asembo, respectively; these prevalences were lower, but not statistically different, from vaccine-type carriage prevalences in 2013 (17.3 % and 13.3 %, respectively). In 2017 in both sites, serotypes 3, 6A, 19A, 19F, and 35B were among the most common serotypes. CONCLUSION: Six years post-PCV10-GSK introduction, the prevalence of pneumococcal carriage among children has decreased, and the impact of PCV10-GSK on vaccine-type carriage has plateaued. Kenya recently changed from PCV10-GSK to Pneumosil™ (Serum Institute of India), a 10-valent PCV that includes serotypes 6A and 19A; these data provide historical context for interpreting changes in vaccine-type carriage following the PCV formulation switch.

Knowledge, attitudes and perceptions of Latin American healthcare workers relating to antibiotic stewardship and antibiotic use: a cross-sectional multi-country study.

BACKGROUND: The burden of antimicrobial resistance (AMR) in Latin America is high. Little is known about healthcare workers' (HCWs) knowledge, attitudes, and perceptions of antimicrobial stewardship (AS), AMR, and antibiotic use (AU) in the region. METHODS: HCWs from 42 hospitals from 5 Latin American countries were invited to take an electronic, voluntary, anonymous survey regarding knowledge, attitudes, and perceptions of AS, AMR, and AU between March-April 2023. FINDINGS: Overall, 996 HCWs completed the survey (52% physicians, 32% nurses, 11% pharmacists, 3% microbiologists, and 2% "other"). More than 90% of respondents indicated optimizing AU was a priority at their healthcare facility (HCF), 69% stated the importance of AS was communicated at their HCF, and 23% were unfamiliar with the term "antibiotic stewardship". Most (> 95%) respondents acknowledged that appropriate AU can reduce AMR; however, few thought AU (< 30%) or AMR (< 50%) were a problem in their HCF. Lack of access to antibiogram and to locally endorsed guidelines was reported by 51% and 34% of HCWs, respectively. Among prescribers, 53% did not consider non-physicians' opinions to make antibiotic-related decisions, 22% reported not receiving education on how to select antibiotics based on culture results and 60% stated patients and families influence their antibiotic decisions. CONCLUSIONS: Although HCWs perceived improving AU as a priority, they did not perceive AU or AMR as a problem in their HCF. AS opportunities include improved access to guidelines, access to AMR/AU data, teamwork, and education on AS for HCWs and patients and families.

Efficacy of guaco mouthwashes (Mikania glomerata and Mikania laevigata) on the disinfection of toothbrushes

Guaco Mikania glomerata Spreng. and M. laevigata Sch. Bip. ex Baker, Asteraceae, has antimicrobial activity and may be helpful in reducing the incidence of oral diseases. This double-blinded randomized clinical trial aimed to evaluate the efficacy of guaco mouthwashes on the disinfection of toothbrushes used by preschool children, tested positive for mutans streptococci (MS), as well as the quantification of its coumarin contents by high performance liquid chromatography. Ethanol extracts were obtained by percolation. The mouthwashes were prepared with 2.5% g/mL M. glomerata and M. laevigata ethanol extracts, standardized for their coumarin content (% mg/mg). Antimicrobial effect of the mouthwashes and extracts were assessed in vitro against Streptococcus mutans (ATCC 25175TM), using 2.4 to 500 µg/mL to calculate the minimum inhibitory concentration (MIC). For the in vivo study, 24 patients were randomly assigned to a 4-stage changeover system with a one-week interval between each stage. All solutions were used in all stages by a different group of children. After brushing without toothpaste, toothbrushes (n=96) were sprayed with water and solutions of M. glomerata (2.5%), M. laevigata (2.5%) and chlorhexidine (0.12%). Microbiological analysis was carried out after 4 h and 30 days, respectively. MIC values were 400, 125 and 14 µg/mL, respectively, for both crude ethanol extracts, mouthwashes of M. glomerata and M. laevigata. Statistical analysis showed that all solutions decreased contamination of toothbrushes by mutans streptococci (chlorhexidine 50.7±17.7%; M. glomerata 37.3±23.7% and M. laevigata 28.7±25.1% of inhibition). Treatment with chlorhexidine and M. glomerata were statistically similar (p>0.05). M. glomerata mouthwash could be useful in herbal strategy programs against mutans streptococci and the marker coumarin may be not related to the activity observed.