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A long-term study of nasopharyngeal carriership in 405 children, aged 6 months to 5 years, attending day-care centres was performed. The effect of pneumococcal vaccination was evaluated in a double-blind investigation where the children received either Pneumovax (a 14-valent pneumococcal vaccine) or saline. Nasopharyngeal cultures were taken monthly by a trained nurse during a 2-year follow-up period. No difference in pneumococcal carriage was found between vaccinees and controls. Pneumococci were found in 31.9% of all cultures. In day-care centres attended by greater than or equal to 45 children the carriage rate of pneumococci was significantly higher than in centres with less than 45 children. Spreading of pneumococci within day-care centres was common but rather short-lived. Children younger than 2 years showed the highest carriage rates. Pneumococci of group 6 were carried most frequently and for longer periods than groups 19 and 23.

During a 2-year period nasopharyngeal specimens were taken monthly on scheduled occasions as well as at episodes of acute otitis media (AOM) from a population of children attending day-care centres. The carriage rates of pneumococci, Haemophilus influenzae and Branhamella catarrhalis in 26 otitis-prone (OP) children when asymptomatic and at episodes of AOM were compared with the carriage rates in 36 non-otitis-prone (NOP) children. Pneumococci, H. influenzae and B. catarrhalis were found as frequently in NOP as in asymptomatic OP children. At AOM episodes only B. catarrhalis was found significantly more often than in the scheduled cultures. The frequencies of the six most commonly isolated pneumococcal types/groups (6, 23, 19, 14, 11, 18) were similar in the cultures taken from NOP and OP children on scheduled occasions as well as in cultures taken at AOM episodes. In contrast to the NOP children H. influenzae and B. catarrhalis were isolated less frequently in the 3-4-year-old than in the 2-3-year-old asymptomatic OP children. Our data indicated that the presence of pneumococci, H. influenzae or B. catarrhalis in the nasopharynx does not per se increase the risk for the development of AOM.

Our investigation supports that PcV treatment of AOM does not affect the recovery time or complication rates. PcV provided some symptomatic benefit in the treatment of AOM in otherwise healthy children, aged 2-16 years.