Nasopharyngeal carriage of Streptococcus pneumoniae in healthy Turkish infants

doi:10.1016/j.jinf.2008.02.010

Journal of Infection

Volume 56, Issue 5, May 2008, Pages 332-339

https://doi.org/10.1016/j.jinf.2008.02.010 Get rights and content

Summary

Objectives

The aims of this study were to determine nasopharyngeal carriage rates, serotype distribution and antimicrobial resistance patterns of Streptococcus pneumoniae in healthy 0 to 2 year-old infants who live within a rural or urban locale and not attending daycare centers. In order to evaluate the possible impact of pneumococcal conjugate vaccine in this population, coverage of the isolated serotypes by the vaccine was also calculated.

Methods

The study was conducted on 564 healthy infants attending 2 different well child clinics, one of which is located in an urban region and the other in a rural region. Specimens were collected with nasopharyngeal swabs. Serotyping was performed with standard antisera. Penicillin susceptibility was determined with E-test. Chi-square tests and logistic regression were used for data analysis.

Results

The pneumococcal carriage rate was 22.5%. Age (>2 months age) [2.98 (1.41–6.29) p = 0.004] and presence of another child within the house who attends school [1.72 (1.13–2.62) p = 0.01] increased the carriage rate. The most frequently isolated serotypes were 11 (11.8%), 23 (7.9%), 19F (7.1%), 22 (6.3%), 9 (5.5%), 19 (5.5%) and 23B (5.5%). The total coverage of vaccine and vaccine-related serotypes by 7, 11 and 13 valent pneumococcal conjugate vaccines were 51.2, 59.0 and 59.0%, respectively. Of the isolated pneumococci, 10 (8.5%) were intermediately resistant and 8 (6.8%) were highly resistant to penicillin.

Conclusion

This study provides data about the local carriage rate and serotype distribution of S. pneumoniae strains in Turkish children, which is important in predicting the possible effects of different valent pneumococcal conjugate vaccines in this population.

Introduction

Nasopharyngeal (NP) colonization of Streptococcus pneumoniae (S. pneumoniae) in infants is generally acquired at approximately 4–6 months of age.¹ Although there are differences in the prevalence and rank order of serotypes obtained from NP specimens and from those with invasive diseases, pneumococcal nasopharyngeal isolates may reflect the strains circulating in the community and may be used as a marker to predict serotype prevalence of invasive disease and resistance patterns.2, 3, 4 There are only a few studies about pneumococcal strains found in Turkish children and many of them include the strains obtained from the patients with invasive pneumococcal disease5, 6 and from older children attending daycare centers and schools. The information about NP carriage of infants is limited and these studies do not include children living in rural regions.7, 8, 9, 10, 11 Monitoring serotype distribution and antimicrobial resistance is essential for the appropriate application of vaccination and effective antibiotic treatment.¹² The aims of this study were to determine the frequency of NP carriage, serotype distribution and antimicrobial resistance patterns of the strains in infants less than 2 years old who are not attending daycare centers, who live in rural and urban areas, and to assess the theoretical efficacy of the pneumococcal conjugate vaccine in this population.

Section snippets

Population

The study was conducted on 564 healthy infants aged between 15 days and 2 years, attending 2 different well child clinics, one of which is placed in an urban region and the other in a rural region. The well child clinic in the rural area is a primary health care center affiliated with the Gazi University Faculty of Medicine, Department of Public Health, which serves small villages in the Golbasi district; and the urban clinic, which is located within the university hospital and usually serves a

Demographic characteristics of children included in the study

Of the 564 children included in our study, 56.4% (N = 318) were living in urban areas and 50.2% (N = 283) were males. The mean age of the participants was 12.07 ± 7.62 months (median: 12, range 0–24 months). There was no difference in terms of gender (p = 0.14) or age (p = 0.16) between urban and rural regions. Demographic characteristics of subjects living in different settlements and factors associated with NP carriage of S. pneumoniae were given in Table 1.

Prevalence of NP carriage and affecting factors

The overall pneumococcal carriage rate was

Discussion

Our study reveals that the NP carriage rate for S. pneumoniae is similar to developed countries, although colonization occurs earlier (after the first 2 months of life). Carriage rate was similar in rural and urban settlements, while age and presence of another child within the house who attends school were significant factors that impacted NP colonization. Seven valent pneumococcal conjugate vaccine, which is currently available in Turkey, covers 51.2% of the serotypes isolated in our study.

Acknowledgements

We thank Wyeth–Lederle vaccines for supplying the kits used for serotyping of pneumococci in this study.

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Nasopharyngeal carriage of Streptococcus pneumoniae in healthy Turkish infants

Summary

Objectives

Methods

Results

Conclusion

Introduction

Section snippets

Population

Demographic characteristics of children included in the study

Prevalence of NP carriage and affecting factors

Discussion

Acknowledgements

Clin Microbiol Infect

Zentralbl Bakteriol

Int J Antimicrob Agents

Lancet Infect Dis

Int J Pediatr Otorhinolaryngol

Clin Microbiol Infect

Lancet Infect Dis

Streptococcus pneumoniae

The use of Streptococcus pneumoniae nasopharyngeal isolates from healthy children to predict features of invasive disease

Pediatr Infect Dis J

Relationship between nasopharyngeal colonization and the development of otitis media in children

J Infect Dis

Serotypes and antibacterial susceptibility of pneumococci isolated from children with infections in Ankara in relation to proposed pneumococcal vaccine coverage

Acta Paediatr Jpn

Serotype distribution and antibiotic susceptibility of invasive Streptococcus pneumoniae disease isolates from children in Turkey, 2001–2004

Eur J Pediatr

Epidemiology of Streptococcus pneumoniae pharyngeal carriage among healthy Turkish infants and children

Eur J Pediatr

Serotype distribution of Streptococcus pneumoniae strains in the nasopharynx of healthy Turkish children

Indian J Med Res

Nasopharyngeal colonization with penicillin resistant Streptococcus pneumoniae in Turkish children

Pediatr Int

Nasopharyngeal carriage of Streptococcus pneumoniae in Finnish children younger than 2 years old

J Infect Dis

Dynamics of pneumococcal nasopharyngeal colonization during the first days of antibiotic treatment in pediatric patients

Pediatr Infect Dis J

A prospective study of the impact of community-based azithromycin treatment of trachoma on carriage and resistance of Streptococcus pneumoniae

Clin Infect Dis