Molecular characteristics of 94 MRSA isolates.

*<p>MLST and CC was deducted from PFGE pattern after at least one isolate representative of each PFGE pattern was submitted to MLST typing.</p><p>n-numer of isolates,ery- erythromycin, cli- clindamycin, fus- fusidic acid, gen- gentamicin, tri- trimethoprin/sulfamethoxazole, min- minocycline, R-resistance, I- intermediate resistance, S- susceptibility.</p

Distribution of MLSTs among MRSA and MSSA isolates tested.

<p>Black – MRSA, Grey- MSSA, striped – ST22.</p

Initial Effects of the National PCV7 Childhood Immunization Program on Adult Invasive Pneumococcal Disease in Israel

<div><p>Background</p><p>PCV7 was introduced as universal childhood vaccination in Israel in July 2009 and PCV13 in November 2010. Here we report data on adult invasive pneumococcal disease (IPD), two years post PCV7 implementation and before an expected effect of PCV13.</p><p>Methods</p><p>An ongoing nationwide active-surveillance (all 27 laboratories performing blood cultures in Israel), providing all blood & CSF <i>S. pneumoniae</i> isolates from persons >18 y was initiated in July 2009. Capture-recapture method assured reporting of >95% cases. All isolates were serotyped in one central laboratory. IPD outcome and medical history were recorded in 90%. Second year post PCV implementation is compared to the first year.</p><p>Results</p><p>During July 2009 to June 2011, 970 IPD cases were reported (annual incidence [/100,000] of 9.17 and 10.16 in the two consecutive years, respectively). Respective case fatality rates (CFRs) were 20% and 19.1%. Incidence of IPD and CFR increased with age and number of comorbidities. Incidence rate was significantly greater during the second winter, 7.79/100,000 vs. 6.14/100,000 in first winter, p = 0.004, with a non-significant decrease during summer months (3.02 to 2.48/100,000). The proportion of IPD cases due to PCV7-serotypes decreased from 27.5% to 13.1% (first to second year) (p<0.001). Yet, non-PCV13-strains increased from 32.7% to 40.2% (p = 0.017). The increase in non-PCV13-strains was highly significant in immunocompromised patients and to a lesser degree in non-immunocompromised at risk or in older patients (>64 y). Among younger/healthier patients serotype 5 was the major increasing serotype. Penicillin and ceftriaxone resistance decreased significantly in the second year.</p><p>Conclusions</p><p>While overall annual incidence of IPD did not change, the indirect effect of PCV7 vaccination was evident by the significant decrease in PCV7 serotypes across all age groups. Increase in non-VT13 strains was significant in immunocompromised patients. A longer follow-up is required to appreciate the full effect of infant vaccination on annual IPD.</p></div

Molecular relatedness of ST22 isolates in this survey.

<p>Dendrogram of all isolates corresponding to ST22, by deduction from PFGE patterns (see <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0042864#s2" target="_blank">Methods</a>), including MRSA SSC<i>mec</i> IV and V, MSSA and EMRSA-15 isolate as a reference strain.</p

IPD cases by age and vaccine serotype coverage.

<p>Dark grey – serotypes included in PCV7 (VT7), light grey – serotypes included in PCV13 (but not 7) (+VT13), white – serotypes not included in either PCV7 or PCV13 (Non-VT13).</p

Molecular characterization and relatedness of MRSA isolates carried by parent-child pairs.

<p>Molecular characterization and relatedness of MRSA isolates carried by parent-child pairs.</p

Predictors for <i>S. aureus</i> and MRSA acquisition among children in Gaza, by multivariate analyses.

*<p>Multivariate model for child <i>S. aureus</i> carriage included: being a cat owner, parental <i>S. aureus</i> carriage, day care center attendance, number of household members, child sex and age.</p>**<p>% from <i>S. aureus carriers</i>.</p>$<p>Multivariate model for child MRSA carriage included: child age, sex and parental MRSA carriage.</p>+<p>Models adjusted as described above.</p

Seasonality effect; monthly IPD cases (bars) and weekly ILI cases (line).

<p>Blue: IPD cases that were discharged from the hospital, Red: In hospital mortality cases.</p

Serotype distribution of IPD cases in the two consecutive study years.

<p>Dark grey – First year (2009–10), light grey – Second year (2010–11).</p

Antibiotic susceptibility of IPD strains.

<p>a. Antibiotic susceptibility to different antibiotic classes. Black – resistant, Grey – intermediate, White – susceptible. b. Serotype distribution of isolates with penicillin MIC≥2 µg/ml, Blue shades- VT7 strains, Red shades – strains covered by PCV13, but not PCV7 (+VT13). Green shades – NonVT13 strains.</p