TABLE 4.
Summary of the meta-analyses completeda
| Cluster | emm type(s) in vaccine | emm types in African isolatesb | Combined prevalence (95% CI) | No. (%) of emm type isolates |
|||
|---|---|---|---|---|---|---|---|
| NINV | INV | N/D | Total | ||||
| E6 | 11, 75, 81 | Prot: 11, 48, 59, 65, 75, 81, 85, 94 (n = 235 [79,9%]); N/P: 42, 63, 67, 99, 158, 182; NINV: n = 160/191 (83.8%); INV: n = 59/82 (72.0%) | 18.0 (12.62–24.01) | 191 (65.0) | 82 (27.9) | 21 (7.1) | 294 |
| E3 | 44, 49, 58, 87,118 | Prot: 9, 15, 44, 49, 58, 79, 87, 118 (n = 130 [53.5%]); N/P: 25, 61, 82, 103, 113, 180, 183, 209; NINV: n = 73/126 (57.9%); INV: n = 47/91 (51.6%) | 14.2 (11.20–17.42) | 126 (51.9) | 91 (37.4) | 26 (10.7) | 243 |
| E4 | 2, 22, 28, 73, 77, 89, 114 | Prot: 2, 8, 22, 28, 73, 77, 89, 109, 114 (n = 202 [89.8%]); N/P: 84, 112, 124, 175, 225; NINV: n = 115/119 (96.6%); INV: n = 52/70 (74.3%) | 12.6 (9.51–16.03) | 119 (52.9) | 70 (31.1) | 36 (16.0) | 225 |
| D4 | 83 | Prot: 33, 83 (n = 15 [7.5%]); N/P: 41, 43, 53, 56, 64, 70, 80, 86, 93, 98, 116, 119, 121, 186, 192, 208, 223, 224, 230; NINV: n = 5/95 (5.3%); INV: n = 9/77 (11.7%) | 10.9 (6.94–15.53) | 95 (47.7) | 77 (38.7) | 27 (13.6) | 199 |
| E2 | 92 | Prot: 66, 68, 76, 92, 102 (n = 92 [71.9%]); N/P: 50, 90, 104, 106, 110, 168; NINV: n = 49/63 (77.8%); INV: n = 38/55 (69.1%) | 9.1 (4.61–14.86) | 63 (49.2) | 55 (43.0) | 10 (7.8) | 128 |
| E1 | 4, 78 | Prot: 4, 78 (n = 31 [66.0%]); N/P: 60, 165; NINV: n = 22/28 (78.6%); INV: n = 8/17 (47.1%) | 1.9 (0.62–3.81) | 28 (59.6) | 17 (36.2) | 2 (4.3) | 47 |
| A-C4 | 12 | Prot: 12 (n =35 [87.5%]); I (n = 3 [42.9%]); N/P: 39, 193, 229; NINV: n = 17/18 (94.4%); INV: n = 3/7 (42.9%) | 2.1 (0.37–4.81) | 18 (45.0) | 7 (17.5) | 15 (38.0) | 40 |
| A-C3 | 1 | Prot: 1 (n = 32 [88.9%]); N/P: 238; NINV: n = 21/22 (95.5%); INV: n = 1/4 (25.0%) | 2.0 (0.46–4.31) | 22 (61.1) | 4 (11.1) | 10 (27.8) | 36 |
| A-C5 | 3 | Prot: 3 (n = 19 [100%]); N/P: NA; NINV: n = 17/17 (100%); INV: n = 2/2 (100%) | 0.9 (0.01–2.72) | 17 (89.5) | 2 (10.5) | 0 (0.0) | 19 |
Three hundred one isolates (19.6%) comprising 39 emm types are not included in any of the emm clusters contained in the 30-valent vaccine; these include 60 isolates representing seven emm clusters, 186 isolates representing single-isolate clusters, and 55 isolates that were not classified as according to Sanderson-Smith et al. (13).
Bold emm types represent cross-opsonized nonvaccine types. The study completed by Tewodros and Kronvall (21) did not clearly differentiate its emm types according to clinical manifestation. Combined prevalence calculated with Mantel-Haenszel (M-H) meta-analysis procedures. NINV, noninvasive; INV, invasive; Prot, protected; N/P, not protected; N/D, not differentiated; NA, none.