TY - JOUR
T1 - Pneumococcal colonization prevalence and density among Thai children with severe pneumonia and community controls
AU - Piralam, Barameht
AU - Prosperi, Christine
AU - Thamthitiwat, Somsak
AU - Bunthi, Charatdao
AU - Sawatwong, Pongpun
AU - Sangwichian, Ornuma
AU - Higdon, Melissa M.
AU - Watson, Nora L.
AU - Knoll, Maria Deloria
AU - Paveenkittiporn, Wantana
AU - Chara, Chuwattana
AU - Hurst, Cameron P.
AU - Akarasewi, Pasakorn
AU - Rhodes, Julia
AU - Maloney, Susan A.
AU - O’Brien, Katherine L.
AU - Baggett, Henry C.
N1 - Funding Information:
Funding Statement and Competing Interests Statement This work was supported by the Bill & Melinda Gates Foundation (grant 48968 to the International Vaccine Access Center, Department of International Health, Johns Hopkins Bloomberg School of Public Health, for the PERCH study). Representatives from the Bill & Melinda Gates Foundation participated in site selection and in Pneumonia Methods Working Group meetings, which informed the study design. They had no role in the data collection, data analysis, data interpretation, or writing of the report. The funder provided support in the form of salaries for some co-authors (B.P., C.C., C.P., M.M.H., M.D.K., and K. L.O.), but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ?author contributions? section.
Publisher Copyright:
© This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.
PY - 2020/4
Y1 - 2020/4
N2 - Background Pneumococcal colonization prevalence and colonization density, which has been associated with invasive disease, can offer insight into local pneumococcal ecology and help inform vaccine policy discussions. Methods The Pneumonia Etiology Research for Child Health Project (PERCH), a multi-country case-control study, evaluated the etiology of hospitalized cases of severe and very severe pneumonia among children aged 1–59 months. The PERCH Thailand site enrolled children during January 2012–February 2014. We determined pneumococcal colonization prevalence and density, and serotype distribution of colonizing isolates. Results We enrolled 224 severe/very severe pneumonia cases and 659 community controls in Thailand. Compared to controls, cases had lower colonization prevalence (54.5% vs. 62.5%, p = 0.12) and lower median colonization density (42.1 vs. 210.2 x 103 copies/mL, p <0.0001); 42% of cases had documented antibiotic pretreatment vs. 0.8% of controls. In no sub-group of assessed cases did pneumococcal colonization density exceed the median for controls, including cases with no prior antibiotics (63.9x103 copies/mL), with consolidation on chest xray (76.5x103 copies/mL) or with pneumococcus detected in whole blood by PCR (9.3x103 copies/mL). Serotype distribution was similar among cases and controls, and a high percentage of colonizing isolates from cases and controls were serotypes included in PCV10 (70.0% and 61.8%, respectively) and PCV13 (76.7% and 67.9%, respectively). Conclusions Pneumococcal colonization is common among children aged <5 years in Thailand. However, colonization density was not higher among children with severe pneumonia compared to controls. These results can inform discussions about PCV introduction and provide baseline data to monitor PCV impact after introduction in Thailand.
AB - Background Pneumococcal colonization prevalence and colonization density, which has been associated with invasive disease, can offer insight into local pneumococcal ecology and help inform vaccine policy discussions. Methods The Pneumonia Etiology Research for Child Health Project (PERCH), a multi-country case-control study, evaluated the etiology of hospitalized cases of severe and very severe pneumonia among children aged 1–59 months. The PERCH Thailand site enrolled children during January 2012–February 2014. We determined pneumococcal colonization prevalence and density, and serotype distribution of colonizing isolates. Results We enrolled 224 severe/very severe pneumonia cases and 659 community controls in Thailand. Compared to controls, cases had lower colonization prevalence (54.5% vs. 62.5%, p = 0.12) and lower median colonization density (42.1 vs. 210.2 x 103 copies/mL, p <0.0001); 42% of cases had documented antibiotic pretreatment vs. 0.8% of controls. In no sub-group of assessed cases did pneumococcal colonization density exceed the median for controls, including cases with no prior antibiotics (63.9x103 copies/mL), with consolidation on chest xray (76.5x103 copies/mL) or with pneumococcus detected in whole blood by PCR (9.3x103 copies/mL). Serotype distribution was similar among cases and controls, and a high percentage of colonizing isolates from cases and controls were serotypes included in PCV10 (70.0% and 61.8%, respectively) and PCV13 (76.7% and 67.9%, respectively). Conclusions Pneumococcal colonization is common among children aged <5 years in Thailand. However, colonization density was not higher among children with severe pneumonia compared to controls. These results can inform discussions about PCV introduction and provide baseline data to monitor PCV impact after introduction in Thailand.
UR - http://www.scopus.com/inward/record.url?scp=85084092447&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0232151
DO - 10.1371/journal.pone.0232151
M3 - Article
VL - 15
SP - 1
EP - 17
JO - PLoS One
JF - PLoS One
SN - 1932-6203
IS - 4
M1 - e0232151
ER -