{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T23:23:16Z","timestamp":1787008996986,"version":"build-2736575974"},"reference-count":42,"publisher":"Oxford University Press (OUP)","issue":"4","funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,4,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The Centers for Disease Control and Prevention's Active Bacterial Core surveillance (ABCs) identified increased serotype 4 invasive pneumococcal disease (IPD), particularly among adults experiencing homelessness (AEH).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We quantified increased proportions of IPD cases in AEH during 2016\u20132022. Employing genomic-based characterization of IPD isolates, we identified serotype-switch variants. Recombinational analyses were used to identify the genetic donor and recipient strain that generated a serotype 4 progeny strain. We performed phylogenetic analyses of the serotype 4 progeny and of the serotype 12F genetic recipient to determine genetic distances.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We identified a cluster of 30 highly related (0\u201321 nucleotide differences) IPD isolates recovered during 2022\u20132023, corresponding to a serotype 4 capsular-switch variant. This strain arose through a multifragment recombination event between serotype 4\/ST10172 and serotype 12F\/ST220 parental strains. Twenty-five of the 30 cases occurred in Oregon. Of 29 cases with known residence status, 16 occurred in AEH. Variant emergence coincided with a 2.6-fold increase (57 to 148) of cases caused by the serotype 4\/ST10172 donor lineage in 2022 compared to 2019 and its first appearance in Oregon. Most serotypes showed sequential increases of AEH IPD\/all IPD ratios during 2016\u20132022 (eg, for all serotypes combined, 247\/2198, 11.2% during 2022 compared to 405\/5317, 7.6% for 2018\u20132019, P &amp;lt; .001). Serotypes 4 and 12F each caused more IPD than any other serotype in AEH during 2020\u20132022 (207 combined case isolates accounting for 38% of all IPD in AEH).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Expansion and increased transmission of serotypes 4 and 12F among adults potentially led to recent genesis of an impactful hybrid serotype-switch variant.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/infdis\/jiae453","type":"journal-article","created":{"date-parts":[[2024,9,9]],"date-time":"2024-09-09T23:26:45Z","timestamp":1725924405000},"page":"871-882","source":"Crossref","is-referenced-by-count":12,"title":["Increased Proportions of Invasive Pneumococcal Disease Cases Among Adults Experiencing Homelessness Sets the Stage for New Serotype 4 Capsular-Switch Recombinants"],"prefix":"10.1093","volume":"231","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5315-1070","authenticated-orcid":false,"given":"Bernard","family":"Beall","sequence":"first","affiliation":[{"name":"Contractor to Division of Bacterial Diseases, Centers for Disease Control and Prevention, Eagle Global Scientific, LLC , Atlanta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8222-7353","authenticated-orcid":false,"given":"Sopio","family":"Chochua","sequence":"additional","affiliation":[{"name":"Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben","family":"Metcalf","sequence":"additional","affiliation":[{"name":"Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wuling","family":"Lin","sequence":"additional","affiliation":[{"name":"Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theresa","family":"Tran","sequence":"additional","affiliation":[{"name":"Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhongya","family":"Li","sequence":"additional","affiliation":[{"name":"Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2331-2694","authenticated-orcid":false,"given":"Yuan","family":"Li","sequence":"additional","affiliation":[{"name":"Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meghan L","family":"Bentz","sequence":"additional","affiliation":[{"name":"Biotechnology Core Facility Branch, Division of Core Laboratory Services and Response, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mili","family":"Sheth","sequence":"additional","affiliation":[{"name":"Biotechnology Core Facility Branch, Division of Core Laboratory Services and Response, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gunars","family":"Osis","sequence":"additional","affiliation":[{"name":"Contractor to National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lesley","family":"McGee","sequence":"additional","affiliation":[{"name":"Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention , Atlanta, Georgia ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,9,11]]},"reference":[{"key":"2025041514224157300_jiae453-B1","author":"ABCs Bactfacts Interactive Data Dashboard"},{"key":"2025041514224157300_jiae453-B2","doi-asserted-by":"crossref","first-page":"e948","DOI":"10.1093\/cid\/ciaa1680","article-title":"Invasive pneumococcal strain distributions and isolate clusters associated with persons experiencing homelessness during 2018","volume":"72","author":"Metcalf","year":"2021","journal-title":"Clin Infect Dis"},{"key":"2025041514224157300_jiae453-B3","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1093\/infdis\/jiac058","article-title":"Invasive pneumococcal disease clusters disproportionally impact persons experiencing homelessness, injecting drug users, and the western United States","volume":"226","author":"Beall","year":"2022","journal-title":"J Infect 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