Nasopharyngeal Carriage of Streptococcus pneumoniae in Navajo and White Mountain Apache Children Before the Introduction of Pneumococcal Conjugate Vaccine

Millar, Eugene V.; O'Brien, Katherine L.; Zell, Elizabeth R.; Bronsdon, Melinda A.; Reid, Raymond; Santosham, Mathuram

doi:10.1097/inf.0b013e3181a06303

Cited by 41 publications

(40 citation statements)

References 38 publications

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“…The findings in the Gaza strip are different, in that very few children attend DCC, and yet S. pneumoniae carriage was detected at a very early age. These findings are overall consistent with those obtained from other developing countries, and have been attributed to the low socioeconomic and high overcrowding conditions [12], [13], [14]. An intriguing finding in our study is the significantly lower carriage prevalence among children 6–11 months old.…”

Section: Discussionsupporting

confidence: 93%

Streptococcus pneumoniae Carriage in the Gaza Strip

et al. 2012

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BackgroundPneumococcal infections cause major morbidity and mortality in developing countries. We report the epidemiology of S. pneumoniae carriage in a developing region, the Gaza strip, and evaluate the theoretical coverage of carriage strains by pneumococcal conjugate vaccines (PCVs).MethodologyIn 2009 we conducted a cross-sectional survey of S. pneumoniae carriage in healthy children and their parents, living throughout the Gaza strip. Data were collected and nasopharyngeal swabs were obtained. Antibiotic susceptibilities were determined by Vitek-2 and serotypes by the Quellung reaction.Principal Findings S. pneumoniae carriage was detected in 189/379 (50%) of children and 30/376 (8%) of parents. Carriage prevalence was highest in children <6 months of age (63%). Significant predictors for child carriage were number of household members and DCC attendance. The proportion of pediatric and adults isolates with serotypes included in PCV7 were 32% and 20% respectively, and 46% and 33% in PCV13 respectively. The most prominent non-vaccine serotypes (NVT) were 35B, 15B/C and 23B. Penicillin-nonsusceptible strains were carried by70% of carriers, penicillin-resistant strains (PRSP) by 13% and Multi-drug-resistant (MDR) by 30%. Of all PRSP isolates 54% belonged to serotypes included in PCV7 and 71% in the PCV13. Similarly, 59% and 73% of MDR-SP isolates, would theoretically be covered by PCV7 and PCV13, respectively.ConclusionsThis study demonstrates that, PCV13-included strains were carried by 46% and 33% of pediatric and adult subjects respectively. In the absence of definitive data regarding the virulence of the NVT strains, it is difficult to predict the effect of PCVs on IPD in this region.

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Section: Discussionsupporting

confidence: 93%

Streptococcus pneumoniae Carriage in the Gaza Strip

et al. 2012

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“…A small number of studies conducted outside sSA have reported a higher prevalence of carriage in males compared to females [33]–[35]. However, in this review gender was not associated with carriage in 9/11 studies, and in two studies carriage was more common among females [36], [37].…”

Section: Discussionmentioning

confidence: 77%

Pneumococcal Carriage in Sub-Saharan Africa—A Systematic Review

et al. 2014

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BackgroundPneumococcal epidemiology varies geographically and few data are available from the African continent. We assess pneumococcal carriage from studies conducted in sub-Saharan Africa (sSA) before and after the pneumococcal conjugate vaccine (PCV) era.MethodsA search for pneumococcal carriage studies published before 2012 was conducted to describe carriage in sSA. The review also describes pneumococcal serotypes and assesses the impact of vaccination on carriage in this region.ResultsFifty-seven studies were included in this review with the majority (40.3%) from South Africa. There was considerable variability in the prevalence of carriage between studies (I-squared statistic = 99%). Carriage was higher in children and decreased with increasing age, 63.2% (95% CI: 55.6–70.8) in children less than 5 years, 42.6% (95% CI: 29.9–55.4) in children 5–15 years and 28.0% (95% CI: 19.0–37.0) in adults older than 15 years. There was no difference in the prevalence of carriage between males and females in 9/11 studies. Serotypes 19F, 6B, 6A, 14 and 23F were the five most common isolates. A meta-analysis of four randomized trials of PCV vaccination in children aged 9–24 months showed that carriage of vaccine type (VT) serotypes decreased with PCV vaccination; however, overall carriage remained the same because of a concomitant increase in non-vaccine type (NVT) serotypes.ConclusionPneumococcal carriage is generally high in the African continent, particularly in young children. The five most common serotypes in sSA are among the top seven serotypes that cause invasive pneumococcal disease in children globally. These serotypes are covered by the two PCVs recommended for routine childhood immunization by the WHO. The distribution of serotypes found in the nasopharynx is altered by PCV vaccination.

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“…30 Day care attendance and young children in the household have been described as risk factors for pneumococcal colonization in American children younger than 2 years. 31 36 In Utah, the incidence of IPD due to non-PCV7 serotypes in this age group increased by 67% during 2007-2010. 13 In the current study, IPD due to non-PCV7 serotypes in young infants increased by 57% in the postvaccine introduction period, with the resultant effect being no change in the ARTICLE overall incidence of IPD in infants aged 1 to 90 days.…”

Section: Figurementioning

confidence: 99%

Invasive Pneumococcal Disease in Infants Younger Than 90 Days Before and After Introduction of PCV7

et al. 2013

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BACKGROUND: Introduction of the heptavalent pneumococcal conjugate vaccine (PCV7) changed the epidemiology of invasive pneumococcal disease (IPD). We evaluated the changes that occurred after PCV7 introduction among Utah infants aged 1 to 90 days, too young to be fully immunized. METHODS: We identified children <18 years with culture-confirmed IPD from 1997–2010. We analyzed demographic, clinical, and serotype data for infants aged 1–90 days. The pre– and post–vaccine introduction periods spanned 1997–2000 and 2001–2010, respectively. RESULTS: Of 513 children with IPD, 36 were 1 to 90 days and accounted for 7% of IPD cases in both the pre– and post–vaccine introduction period. The pre–vaccine IPD incidence rate was 5.0 per 100 000 live births, and was unchanged in the post–vaccine introduction period. IPD caused by PCV7 serotypes decreased by 74% (from 2.2 to 0.58 per 100 000), whereas non-vaccine serotype IPD increased by 57% (from 2.8 to 4.4 per 100 000). Sixteen infants (44%) required intensive care, and 3 (8%) died. Bacteremia without focus (56%) and meningitis (44%) were the predominant syndromes in the pre– and post–vaccine introduction periods, respectively. In the post–vaccine introduction period, serotype 7F was the most common serotype among infants and was responsible for 50% of meningitis. CONCLUSIONS: The incidence of IPD in Utah infants aged 1 to 90 days caused by PCV7 serotypes decreased after PCV7 introduction, but overall incidence was unchanged. In the post–vaccine introduction period, serotype 7F predominated in this age group and was associated with meningitis.

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Nasopharyngeal Carriage of Streptococcus pneumoniae in Navajo and White Mountain Apache Children Before the Introduction of Pneumococcal Conjugate Vaccine

Abstract: The high carriage prevalence among Navajo and Apache children reflects an intense exposure to pneumococcus. The lack of modifiable risk factors for carriage highlights the importance of preventive strategies for disease control.

Cited by 41 publications

References 38 publications

Streptococcus pneumoniae Carriage in the Gaza Strip

Streptococcus pneumoniae Carriage in the Gaza Strip

Pneumococcal Carriage in Sub-Saharan Africa—A Systematic Review

Invasive Pneumococcal Disease in Infants Younger Than 90 Days Before and After Introduction of PCV7

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