Vaccine escape of piliated Streptococcus pneumoniae strains

Introduction: Type1-pilus proteins were suggested as targets of future protein-based vaccines. Here we studied the effect of pneumococcal-conjugate vaccine (PCV7) implementation on the prevalence of piliated strains in a unique study setting which controls for typical confounders; the Palestinian-Israeli Collaborative Research (PICR). Methods: Annual cross-sectional surveys of pneumococcal carriage were performed during 2009-2011 among two closely related population that live under different health policies (a) Palestinian-Authority (PA) (n = 1773), where PCV7 was not yet introduced (b) East-Jerusalem (EJ) (n = 983) where PCV7 was rapidly implemented. Clinical data were collected, pneumococci identified and characterized and the presence of Type1-pilus genes was determined by rrgC PCR. Results: Following PCV7 implementation in EJ, overall carriage prevalence did not change (~30%), but VT7 strains decreased from 61.5% to 33.8%. While prevalence of non-piliated-VT7 isolates decreased from 37% to 10%, p < 0.001, the prevalence of piliated-VT7 strains persisted ~25%. Additionally, piliated non-VT13 strains emerged (1-15%, p < 0.001). These changes were not observed in PA. These dynamics were independent of the bacteria's resistance pattern. Conclusions: A differential effect of PCV7 was observed with a relative resistance of piliated strains to the vaccine. This suggests that Type1-pilus confers an intrinsic advantage for colonization and may be an attractive vaccine target.