Population Structure of Streptococcus pneumoniae Causing Invasive Disease in Adults in Portugal before PCV13 Availability for Adults: 2008-2011

PLoS One. 2016 May 11;11(5):e0153602. doi: 10.1371/journal.pone.0153602. eCollection 2016.


Among the 1660 isolates recovered from invasive pneumococcal disease (IPD) in adults (> = 18 yrs) in 2008-2011, a random sample of ≥50% of each serotype (n = 871) was chosen for MLST analysis and evaluation for the presence and type of pilus islands (PIs). The genetic diversity was high with 206 different sequence types (STs) detected, but it varied significantly between serotypes. The different STs represented 80 clonal complexes (CCs) according to goeBURST with the six more frequent accounting for more than half (50.6%) of the isolates-CC156 (serotypes 14, 9V and 23F), CC191 (serotype 7F), CC180 (serotype 3), CC306 (serotype 1), CC62 (serotypes 8 and 11A) and CC230 (serotype 19A). Most of the isolates (n = 587, 67.3%) were related to 29 Pneumococcal Molecular Epidemiology Network recognized clones. The overall proportion of isolates positive for any of the PIs was small (31.9%) and declined gradually during the study period (26.6% in 2011), mostly due to the significant decline of serotype 1 which is associated with PI-2. The changes in serotypes that occurred in adult IPD after the introduction of the seven-valent pneumococcal conjugate vaccine (PCV7) for children were mostly due to the expansion of previously circulating clones, while capsular switching was infrequent and not related to vaccine use. The reduction of IPD caused by PCV7 serotypes in the years following PCV7 implementation did not result in a decline of antimicrobial resistance in part due to the selection of resistant genotypes among serotypes 14 and 19A.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Child
  • Child, Preschool
  • Clone Cells
  • Female
  • Fimbriae, Bacterial / genetics
  • Fimbriae, Bacterial / immunology
  • Heptavalent Pneumococcal Conjugate Vaccine / administration & dosage*
  • Humans
  • Middle Aged
  • Molecular Epidemiology
  • Multilocus Sequence Typing
  • Pneumococcal Infections / epidemiology*
  • Pneumococcal Infections / immunology
  • Pneumococcal Infections / microbiology
  • Pneumococcal Infections / prevention & control
  • Pneumococcal Vaccines / administration & dosage
  • Portugal / epidemiology
  • Serogroup*
  • Streptococcus pneumoniae / classification*
  • Streptococcus pneumoniae / genetics
  • Streptococcus pneumoniae / immunology
  • Streptococcus pneumoniae / pathogenicity*


  • 13-valent pneumococcal vaccine
  • Heptavalent Pneumococcal Conjugate Vaccine
  • Pneumococcal Vaccines

Grant support

A.N. Horácio and J. Diamantino-Miranda were supported by grants SFRH/BD/81205/2011and SFRH/BD/81766/2011, respectively, from Fundação para a Ciência e Tecnologia, Portugal. This work was partly supported by Fundação para a Ciência e Tecnologia (PTDC/DTP-EPI/1759/2012 and PTDC/DTP-EPI/1555/2014) and an unrestricted Investigator initiated project from Pfizer awarded to J. Melo-Cristino. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.