Nasopharyngeal carriage of Streptococcus pneumoniae in healthy Turkish infants
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.
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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.
In
Acknowledgements
We thank Wyeth–Lederle vaccines for supplying the kits used for serotyping of pneumococci in this study.
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