Nasopharyngeal carriage of Streptococcus pneumoniae

prevalence and risk factors in HIV-Positive children in Tanzania

Laura Anthony, Andrea Meehan, Ben Amos, George Mtove, Julius Mjema, Rajabu Malahiyo, Jiehui Yin, Shahin Oftadeh, Gwendolyn Gilbert, Delane Shingadia, Hugh Reyburn, Jacqueline Deen, Peter C Richmond, Robert booy

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Pneumococcal colonization of the nasopharynx is especially common in young children and is a pre-requisite for pneumococcal disease. Those with immunosuppression, such as HIV, are at higher risk of colonization and disease, especially at older ages. Currently, vaccination schedules are only offered to children under 6 months of age, despite the large impact of pneumococcal disease in older unvaccinated children with HIV. We conducted a study to assess the prevalence of, and risk factors for, pneumococcal carriage in HIV-positive children aged <15 years. 

Methods: We collected a single nasopharyngeal swab from 142 HIV-infected children aged 1-14 years over a 2-month period. To detect carriage of pneumococcus, these samples were cultured and serotyped; PCR was performed on negative samples. We also collected epidemiological data via survey and medical records. 

Results: The overall carriage rate was 81% and was at least 76% in those aged 5-14 years. The 7-, 10-, and 13-valent pneumococcal vaccines would cover 37%, 37%, and 49% of children with carriage, respectively. In the multivariate analysis, we identified increase in weight since last visit (p= 0.028) and the existence of care-givers who had respiratory symptoms in the past week (p= 0.022) as risk factors for carriage. Weight gain was also significantly associated with antiretroviral use (p= 0.002). 

Conclusions: These data illuminate the little known area of pneumococcal carriage in older HIV-infected children as well as finding novel risk factors for pneumococcal carriage, namely the association with household members who have respiratory symptoms and with an increase in the child's weight prior to swabbing. Weight gain may be due to an increase in health enabling more mobility and increasing the risk of acquiring carriage. The carriage rate observed (81%) is one of the highest recorded. Further research should address whether vaccination can prevent the acquisition of carriage and so protect against disease. 
Original languageEnglish
Pages (from-to)e753-e757
Number of pages5
JournalInternational Journal of Infectious Diseases
Volume16
Issue number10
DOIs
Publication statusPublished - Oct 2012

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Tanzania
Streptococcus pneumoniae
HIV
Weight Gain
Vaccination
Weights and Measures
Nasopharynx
Immunosuppression
Caregivers
Medical Records
Appointments and Schedules
Multivariate Analysis
Polymerase Chain Reaction
Health
Research

Cite this

Anthony, Laura ; Meehan, Andrea ; Amos, Ben ; Mtove, George ; Mjema, Julius ; Malahiyo, Rajabu ; Yin, Jiehui ; Oftadeh, Shahin ; Gilbert, Gwendolyn ; Shingadia, Delane ; Reyburn, Hugh ; Deen, Jacqueline ; Richmond, Peter C ; booy, Robert. / Nasopharyngeal carriage of Streptococcus pneumoniae : prevalence and risk factors in HIV-Positive children in Tanzania. In: International Journal of Infectious Diseases. 2012 ; Vol. 16, No. 10. pp. e753-e757.
@article{ce42f0b0574243eea17075f617220372,
title = "Nasopharyngeal carriage of Streptococcus pneumoniae: prevalence and risk factors in HIV-Positive children in Tanzania",
abstract = "Background: Pneumococcal colonization of the nasopharynx is especially common in young children and is a pre-requisite for pneumococcal disease. Those with immunosuppression, such as HIV, are at higher risk of colonization and disease, especially at older ages. Currently, vaccination schedules are only offered to children under 6 months of age, despite the large impact of pneumococcal disease in older unvaccinated children with HIV. We conducted a study to assess the prevalence of, and risk factors for, pneumococcal carriage in HIV-positive children aged <15 years. Methods: We collected a single nasopharyngeal swab from 142 HIV-infected children aged 1-14 years over a 2-month period. To detect carriage of pneumococcus, these samples were cultured and serotyped; PCR was performed on negative samples. We also collected epidemiological data via survey and medical records. Results: The overall carriage rate was 81{\%} and was at least 76{\%} in those aged 5-14 years. The 7-, 10-, and 13-valent pneumococcal vaccines would cover 37{\%}, 37{\%}, and 49{\%} of children with carriage, respectively. In the multivariate analysis, we identified increase in weight since last visit (p= 0.028) and the existence of care-givers who had respiratory symptoms in the past week (p= 0.022) as risk factors for carriage. Weight gain was also significantly associated with antiretroviral use (p= 0.002). Conclusions: These data illuminate the little known area of pneumococcal carriage in older HIV-infected children as well as finding novel risk factors for pneumococcal carriage, namely the association with household members who have respiratory symptoms and with an increase in the child's weight prior to swabbing. Weight gain may be due to an increase in health enabling more mobility and increasing the risk of acquiring carriage. The carriage rate observed (81{\%}) is one of the highest recorded. Further research should address whether vaccination can prevent the acquisition of carriage and so protect against disease. ",
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author = "Laura Anthony and Andrea Meehan and Ben Amos and George Mtove and Julius Mjema and Rajabu Malahiyo and Jiehui Yin and Shahin Oftadeh and Gwendolyn Gilbert and Delane Shingadia and Hugh Reyburn and Jacqueline Deen and Richmond, {Peter C} and Robert booy",
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Anthony, L, Meehan, A, Amos, B, Mtove, G, Mjema, J, Malahiyo, R, Yin, J, Oftadeh, S, Gilbert, G, Shingadia, D, Reyburn, H, Deen, J, Richmond, PC & booy, R 2012, 'Nasopharyngeal carriage of Streptococcus pneumoniae: prevalence and risk factors in HIV-Positive children in Tanzania', International Journal of Infectious Diseases, vol. 16, no. 10, pp. e753-e757. https://doi.org/10.1016/j.ijid.2012.05.1037

Nasopharyngeal carriage of Streptococcus pneumoniae : prevalence and risk factors in HIV-Positive children in Tanzania. / Anthony, Laura; Meehan, Andrea; Amos, Ben; Mtove, George; Mjema, Julius; Malahiyo, Rajabu; Yin, Jiehui; Oftadeh, Shahin; Gilbert, Gwendolyn; Shingadia, Delane; Reyburn, Hugh; Deen, Jacqueline; Richmond, Peter C; booy, Robert.

In: International Journal of Infectious Diseases, Vol. 16, No. 10, 10.2012, p. e753-e757.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Nasopharyngeal carriage of Streptococcus pneumoniae

T2 - prevalence and risk factors in HIV-Positive children in Tanzania

AU - Anthony, Laura

AU - Meehan, Andrea

AU - Amos, Ben

AU - Mtove, George

AU - Mjema, Julius

AU - Malahiyo, Rajabu

AU - Yin, Jiehui

AU - Oftadeh, Shahin

AU - Gilbert, Gwendolyn

AU - Shingadia, Delane

AU - Reyburn, Hugh

AU - Deen, Jacqueline

AU - Richmond, Peter C

AU - booy, Robert

PY - 2012/10

Y1 - 2012/10

N2 - Background: Pneumococcal colonization of the nasopharynx is especially common in young children and is a pre-requisite for pneumococcal disease. Those with immunosuppression, such as HIV, are at higher risk of colonization and disease, especially at older ages. Currently, vaccination schedules are only offered to children under 6 months of age, despite the large impact of pneumococcal disease in older unvaccinated children with HIV. We conducted a study to assess the prevalence of, and risk factors for, pneumococcal carriage in HIV-positive children aged <15 years. Methods: We collected a single nasopharyngeal swab from 142 HIV-infected children aged 1-14 years over a 2-month period. To detect carriage of pneumococcus, these samples were cultured and serotyped; PCR was performed on negative samples. We also collected epidemiological data via survey and medical records. Results: The overall carriage rate was 81% and was at least 76% in those aged 5-14 years. The 7-, 10-, and 13-valent pneumococcal vaccines would cover 37%, 37%, and 49% of children with carriage, respectively. In the multivariate analysis, we identified increase in weight since last visit (p= 0.028) and the existence of care-givers who had respiratory symptoms in the past week (p= 0.022) as risk factors for carriage. Weight gain was also significantly associated with antiretroviral use (p= 0.002). Conclusions: These data illuminate the little known area of pneumococcal carriage in older HIV-infected children as well as finding novel risk factors for pneumococcal carriage, namely the association with household members who have respiratory symptoms and with an increase in the child's weight prior to swabbing. Weight gain may be due to an increase in health enabling more mobility and increasing the risk of acquiring carriage. The carriage rate observed (81%) is one of the highest recorded. Further research should address whether vaccination can prevent the acquisition of carriage and so protect against disease. 

AB - Background: Pneumococcal colonization of the nasopharynx is especially common in young children and is a pre-requisite for pneumococcal disease. Those with immunosuppression, such as HIV, are at higher risk of colonization and disease, especially at older ages. Currently, vaccination schedules are only offered to children under 6 months of age, despite the large impact of pneumococcal disease in older unvaccinated children with HIV. We conducted a study to assess the prevalence of, and risk factors for, pneumococcal carriage in HIV-positive children aged <15 years. Methods: We collected a single nasopharyngeal swab from 142 HIV-infected children aged 1-14 years over a 2-month period. To detect carriage of pneumococcus, these samples were cultured and serotyped; PCR was performed on negative samples. We also collected epidemiological data via survey and medical records. Results: The overall carriage rate was 81% and was at least 76% in those aged 5-14 years. The 7-, 10-, and 13-valent pneumococcal vaccines would cover 37%, 37%, and 49% of children with carriage, respectively. In the multivariate analysis, we identified increase in weight since last visit (p= 0.028) and the existence of care-givers who had respiratory symptoms in the past week (p= 0.022) as risk factors for carriage. Weight gain was also significantly associated with antiretroviral use (p= 0.002). Conclusions: These data illuminate the little known area of pneumococcal carriage in older HIV-infected children as well as finding novel risk factors for pneumococcal carriage, namely the association with household members who have respiratory symptoms and with an increase in the child's weight prior to swabbing. Weight gain may be due to an increase in health enabling more mobility and increasing the risk of acquiring carriage. The carriage rate observed (81%) is one of the highest recorded. Further research should address whether vaccination can prevent the acquisition of carriage and so protect against disease. 

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