Multi-Serotype Pneumococcal Nasopharyngeal Carriage Prevalence in Vaccine Naïve Nepalese Children, Assessed Using Molecular Serotyping

Abstract

Invasive pneumococcal disease is one of the major causes of death in young children in resource poor countries. Nasopharyngeal carriage studies provide insight into the local prevalence of circulating pneumococcal serotypes. There are very few data on the concurrent carriage of multiple pneumococcal serotypes. This study aimed to identify the prevalence and serotype distribution of pneumococci carried in the nasopharynx of young healthy Nepalese children prior to the introduction of a pneumococcal conjugate vaccine using a microarray-based molecular serotyping method capable of detecting multi-serotype carriage. We conducted a cross-sectional study of healthy children aged 6 weeks to 24 months from the Kathmandu Valley, Nepal between May and October 2012. Nasopharyngeal swabs were frozen and subsequently plated on selective culture media. DNA extracts of plate sweeps of pneumococcal colonies from these cultures were analysed using a molecular serotyping microarray capable of detecting relative abundance of multiple pneumococcal serotypes. 600 children were enrolled into the study: 199 aged 6 weeks to <6 months, 202 aged 6 months to < 12 months, and 199 aged 12 month to 24 months. Typeable pneumococci were identified in 297/600 (49·5%) of samples with more than one serotype being found in 67/297 (20·2%) of these samples. The serotypes covered by the thirteen-valent pneumococcal conjugate vaccine were identified in 44·4% of samples containing typeable pneumococci. Application of a molecular serotyping approach to identification of multiple pneumococcal carriage demonstrates a substantial prevalence of co-colonisation. Continued surveillance utilising this approach following the introduction of routine use of pneumococcal conjugate vaccinates in infants will provide a more accurate understanding of vaccine efficacy against carriage and a better understanding of the dynamics of subsequent serotype and genotype replacement.

Streptococcus pneumoniae Carriage Prevalence in Nepal: Evaluation of a Method for Delayed Transport of Samples from Remote Regions and Implications for Vaccine Implementation

“…The most likely explanation is the recognised occurrence of multi-serotype carriage [24]. This phenomenon is especially important to understand in the context of the likely occurrence of serotype replacement following the introduction of routine pneumococcal immunisation.…”

Comparison of two schedules of two-dose priming with the ten-valent pneumococcal conjugate vaccine in Nepalese children: an open-label, randomised non-inferiority controlled trial

“…However, when all pneumonia cases prior to the booster were analysed there was no significant difference between groups (18/147 versus 9/149 in the 6+10 and 6+14 groups respectively, p=0•071). Across comparable time periods, no differences were seen between the groups for reported cases of tonsillitis, upper respiratory tract infections, bronchiolitis, and gastroenteritis (appendix tables [20][21][22][23].…”

The new first-line defense: the potential of nasopharyngeal colonization in vaccine strategies

“…6,29 Carriage prevalence depends on geographical location, and is generally higher in the developing world. [30][31][32] While initial colonization events may persist for up to 4 months, duration appears to shorten with increasing age to 2-4 weeks in adults. 33 The proportion of S. pneumoniae colonization events associated with disease is low in healthy adults.…”

“…This restricted serotype coverage has led to the replacement of S. pneumoniae vaccine serotypes by non-vaccine serotypes as both colonizers of the nasopharynx and causes of disease. 31,[41][42][43] Hence, there is a strong interest in alternative vaccine strategies that target all S. pneumoniae strains and could also prevent lung infection.…”