Carriage of Streptococcus pneumoniae in children under 5 years of age at Hospital Nacional Guido Valadares, Dili, Timor-Leste

Pneumonia and malnutrition are leading causes of the high child mortality rate in Timor-Leste (TL). Reducing child mortality and malnutrition are key indicators of the Sustainable Development Goals, and important ways we can improve the lives of future generations. Children with malnutrition are at higher risk of pneumonia. The TL Ministry of Health plans to introduce a pneumococcal conjugate vaccine (PCV) to prevent pneumonia.
Pulmaun Saudavel (PULSA, “healthy lungs”) is a prospective cross-sectional surveillance study that aims to assess the prevalence of S. pneumoniae nasopharyngeal carriage in children aged 1-59 months admitted to Hospital Nacional Guido Valadares (HNGV) with pneumonia and/or malnutrition between August 2019 and July 2020.
Two nasopharyngeal swabs (NPS) will be collected. The NPS will be separated for bacterial culture and for an automated multiplex reverse transcriptase polymerase chain reaction (PCR) test for viruses. Culture, identification and serotyping of S. pneumoniae colonies will be performed. Other nasopharyngeal colonisers, namely S. aureus, M. catarrhalis, non-typeable H. influenzae, will also be identified. Bacterial culture, sensitivity and PCR will be done at National Health Laboratory, Timor-Leste. The serotyping of S. pneumoniae will be done at Menzies School of Health Research.
We will calculate the overall and vaccine-type S. pneumoniae carriage prevalence. We will compare carriage between age groups and between malnourished and non-malnourished children. Our study will provide preliminary data to support the National Immunization Technical Advisory Group (NITAG) to advise the Ministry of Health to introduce pneumococcal conjugate vaccine in TL, and allow for monitoring of vaccine effectiveness.