Further examination Cytoskeletal Signaling inhibitor showed

that the rise in LF PCV7-STs was associated with PCV7-ST serotypes while the rise in the NonPCV7-STs is more associated with PCV7-ST serotypes than NonPCV7-ST serotypes. Amongst non-PCV7 serotypes and STs not primarily associated with these serotypes, there was some evidence of a change in the distribution. IPD from NVT serotypes 19A and 22F increased, whilst serotype 20 showed a decrease. Serotypes 19A and 22F were linked to LF PCV7-STs, the group of serotypes which showed an increase. Serotype 20 was not linked to PCV7-STs and, on the whole, this group of serotypes was relatively static compared to PCV7-ST serotypes. Prior to routine PCV7 use, the distribution of serotypes and STs in Scottish IPD appeared static, only serotype 1 IPD was found to increase, alongside an increase in ST306 IPD. Routine PCV7 vaccination drastically reduced the burden of VT IPD in Scotland, not only among children targeted for vaccination but also the rest of the population. Little evidence of serotype replacement was found except for the elderly where increases in NVT IPD outbalanced decreases in VT IPD. The major replacement serotypes

were 19A and 22F alongside GS-7340 cost STs 199 and 433. Routine collection of information on both the genetic background and capsular serotype allowed an analysis of relationships in response to vaccine implementation. Interestingly, the proportional increase of serotypes after vaccination was greatly attributable to serotypes which were associated with PCV7 STs. This implies that ST perhaps plays a role in determining the fitness of a pneumococcus and that it may be possible to predict serotypes

likely to increase most following the use of increased valency vaccines by examining STs associated with VT serotypes and identifying the NVT serotypes also found to be associated with these STs. It is important to note, however, that STs linked to disease causing serotypes in the developing world may not correspond with those in the developed world (e.g., outbreaks attributable to serotype 1 in sub-Saharan Africa were associated with ST 618 and 217, not 306 and Resminostat 227 as in the developed world) [28]. Therefore, results presented here may not be applicable worldwide. Our findings on pre and post-vaccination trends correspond to existing literature. Serotype 1 bacteraemia was found to increase over time in the UK and Ireland [29], as well as serotype 1 IPD in England and Wales [25]. Furthermore, the increase observed in serotype 19A IPD has been widely observed [13], [14], [15], [16], [30], [31] and [32]. Following PCV7 use, VT serotypes were almost eliminated from IPD in those aged <5 years, providing clear evidence of a strong vaccine effect in this group, as has been documented in other countries [33], [34] and [35].