Vaccine-type pneumococcal carriage was lower among adults and unvaccinated children living with a PCV7 vaccinee. This is attributable to reduced exposure and reduced transmission when exposure occurs.

Community-wide PnCRM7 vaccination in infancy reduces the prevalence of vaccine-type carriage and increases the prevalence of nonvaccine-type carriage through at least 3 years of age.

Several studies have shown that nasopharyngeal sampling is more sensitive than oropharyngeal sampling for the detection of pneumococcal carriage in children. The data for adults are limited and conflicting. This study was part of a larger study of pneumococcal carriage on the Navajo and White Mountain Apache Reservation following a clinical trial of a seven-valent pneumococcal conjugate vaccine. Persons aged 18 years and older living in households with children enrolled in the vaccine trial were eligible. We collected both nasopharyngeal and oropharyngeal specimens by passing a flexible calcium alginate wire swab either nasally to the posterior nasopharynx or orally to the posterior oropharynx. Swabs were placed in skim milk-tryptoneglucose-glycerin medium and frozen at ؊70°C. Pneumococcal isolation was performed by standard techniques. Analyses were based on specimens collected from 1,994 adults living in 1,054 households. Nasopharyngeal specimens (11.1%; 95% confidence interval [CI], 9.8 and 12.6%) were significantly more likely to grow pneumococci than were oropharyngeal specimens (5.8%; 95% CI, 4.8 to 6.9%) (P < 0.0001). Few persons had pneumococcal growth from both specimens (1.7%). Therefore, both tests together were more likely to identify pneumococcal carriage (15.2%; 95% CI, 13.7 to 16.9%) than either test alone. Although we found that nasopharyngeal sampling was more sensitive than oropharyngeal sampling, nasopharyngeal sampling alone would have underestimated the prevalence of pneumococcal carriage in this adult population. Sampling both sites may give more accurate results than sampling either site alone in studies of pneumococcal carriage in adults.Infection with Streptococcus pneumoniae (pneumococcus) can result in a range of illnesses, including bacteremia, meningitis, pneumonia, otitis media, and sinusitis, which together cause substantial morbidity and mortality worldwide. The ascertainment of pneumococcal colonization is important for many types of studies. Several investigators have demonstrated that nasopharyngeal (NP) sampling is more sensitive than oropharyngeal (OP) sampling for detecting pneumococcal carriage in children (4,8,10,14), although contrary results exist (3). The optimal sampling method for identifying pneumococcal colonization in adults is not clear for several reasons. First, few studies have compared the yields from different sampling sites. Second, in some studies the sampling methods are not clearly specified. Third, the optimal sampling method may vary depending on the type of medium and the microbiologic methods used. Four studies that have compared NP and OP sampling in adults have come to different conclusions (2, 6, 9, 10). To our knowledge, no studies have been published that compared sampling sites when skim milk-tryptone-glucose-glycerin (STGG) medium was used to collect and store specimens. The inoculation of STGG medium is at least as sensitive as direct plating (12) and is a commonly used methodology that can be used under a wide variety of conditions. The objec...

In a prospective study of mortality in a large group of Scottish diabetic patients, ischaemic heart disease was responsible for 51% of deaths, with the diabetic relative risks of death being 3.8, 2.7 and 2.2 for the age groups 45-64, 65-74, and 75 years and over, respectively. The diabetic relative risks for mortality from all causes were 5.5, 2.3, 1.7, 1.3 for age ranges 15-44, 45-64, 65-74, and 75 and over, respectively. The all cancer mortality rate is not reduced in diabetic individuals.

In a study of 1,955 primigravidae who gave birth to a live singleton baby, 227 (11.6%) scored 'positive' (7+) in an antenatal Health Questionnaire enquiring into pre-pregnancy emotional disturbances. This group of mothers had more frequent depression, and this was of longer duration after their delivery compared with those scoring less than 7 (less than or equal to 6). Those scoring 7+ were less likely to breast-feed and the infants were more often ill during the first year of life. There were also differences in 'minor obstetric complications' between the two survey groups. This suggests that the application of this Health Questionnaire antenatally can identify emotionally vulnerable women, who could benefit from support and education during the antenatal period.