Hill Philip C, Akisanya Abiodun, Sankareh Kawsu, Cheung Yin Bun, Saaka Mark, Lahai George, Greenwood Brian M, Adegbola Richard A
Bacterial Diseases Programme, Medical Research Council Laboratories, Banjul, The Gambia.
Clin Infect Dis. 2006 Sep 15;43(6):673-9. doi: 10.1086/506941. Epub 2006 Aug 4.
To prepare for the introduction of a pneumococcal conjugate vaccine of restricted valency, we studied the nasopharyngeal carriage of Streptococcus pneumoniae in Gambian villagers.
A cross-sectional survey was conducted in 21 villages after a census. We recorded demographic characteristics, information on medical history, and data on possible risk factors for carriage from subjects. We collected a nasopharyngeal swab specimen from each subject for isolation and serotyping of S. pneumoniae and for antibiotic susceptibility testing.
The prevalence of S. pneumoniae carriage among 2872 villagers was 72%. It was highest among infants (i.e., children aged <1 year; 97%); the rate was 93% among babies aged <1 month and decreased with increasing age (P<.001). Prevalence of carriage was linked to proximity to another village. Sixty-three percent of isolates recovered from children aged <5 years were covered by the 7-valent vaccine or were of a vaccine-related serotype, compared with 43% of isolates overall. Forty-three isolates (14.3%) tested were initially penicillin resistant; none had high-level resistance, and 4 had intermediate resistance. The rates of resistance to other antibiotics were as follows: trimethoprim-sulfamethoxazole, 39%; tetracycline, 32.3%; chloramphenicol, 6.3%; cefotaxime, 0.3%; and erythromycin, 0%. The rates were highest for isolates of vaccine serotypes.
Pneumococcal carriage rates among Gambian villagers are very high. A pneumococcal conjugate vaccine of restricted valency should reduce the pool of antibiotic-resistant pneumococci. The large reservoir of pneumococci of nonvaccine serotypes will require close monitoring when the vaccine is introduced.
为准备引入一种价数有限的肺炎球菌结合疫苗，我们对冈比亚村民的肺炎链球菌鼻咽部携带情况进行了研究。
在一次人口普查后，对21个村庄进行了横断面调查。我们记录了人口统计学特征、病史信息以及来自受试者的携带可能危险因素的数据。我们从每个受试者收集鼻咽拭子标本，用于肺炎链球菌的分离、血清分型以及抗生素敏感性测试。
2872名村民中肺炎链球菌携带率为72%。在婴儿（即年龄<1岁的儿童）中最高（97%）；<1个月的婴儿中携带率为93%，且随年龄增长而下降（P<0.001）。携带率与靠近另一个村庄有关。从<5岁儿童中分离出的菌株有63%可被7价疫苗覆盖或属于与疫苗相关的血清型，而总体分离株中这一比例为43%。检测的43株菌株（14.3%）最初对青霉素耐药；无一株具有高水平耐药，4株具有中度耐药。对其他抗生素的耐药率如下：甲氧苄啶-磺胺甲恶唑，39%；四环素，32.3%；氯霉素，6.3%；头孢噻肟，0.3%；红霉素，0%。疫苗血清型分离株的耐药率最高。
冈比亚村民中肺炎球菌携带率非常高。一种价数有限的肺炎球菌结合疫苗应能减少抗生素耐药肺炎球菌的数量。引入疫苗时，非疫苗血清型肺炎球菌的大量储存库需要密切监测。
