Medical Research Council Unit, Gambia; Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom.
Medical Research Council Unit, Gambia.
Clin Microbiol Infect. 2018 Apr;24(4):389-395. doi: 10.1016/j.cmi.2017.07.018. Epub 2017 Jul 23.
Pneumococcal nasopharyngeal carriage occurs early in life. However, the role of vertical transmission is not well understood. The aims of this study were to describe carriage among mothers and their newborns, and to assess for risk factors for neonatal carriage.
In a nested retrospective cohort study, we analysed data from the control arm of a randomized controlled trial conducted in The Gambia 2 to 3 years after introduction of pneumococcal conjugate vaccine (PCV) 13. Nasopharyngeal swabs were collected from 374 women and their newborns on the day of delivery, then 3, 6, 14 and 28 days later. Pneumococci were isolated and serotyped using conventional microbiologic methods.
Carriage increased from 0.3% (1/373) at birth to 37.2% (139/374) at day 28 (p <0.001) among neonates and from 17.1% (64/374) to 24.3% (91/374) (p 0.015) among women. In both groups, PCV13 vaccine-type (VT) serotypes accounted for approximately one-third of the pneumococcal isolates, with serotype 19A being the most common VT. Maternal carriage (adjusted odds ratio (OR) = 2.82; 95% confidence interval (CI), 1.77-4.80), living with other children in the household (adjusted OR = 4.06; 95% CI, 1.90-8.86) and dry season (OR = 1.98; 95% CI, 1.15-3.43) were risk factors for neonatal carriage. Over half (62.6%) of the neonatal carriage was attributable to living with other children in the same household.
Three years after the introduction of PCV in The Gambia, newborns are still rapidly colonized with pneumococcus, including PCV13 VT. Current strategies for pneumococcal control in Africa do not protect this age group beyond the herd effect.
肺炎球菌鼻咽携带发生于生命早期。然而，垂直传播的作用尚未得到充分理解。本研究旨在描述母亲及其新生儿的携带情况，并评估新生儿携带的危险因素。
在一项嵌套的回顾性队列研究中，我们分析了在冈比亚进行的一项随机对照试验（PCV13 引入 2 至 3 年后的对照臂）的数据。在分娩当天以及随后的 3、6、14 和 28 天，从 374 名妇女及其新生儿中采集鼻咽拭子。使用常规微生物学方法分离和血清分型肺炎球菌。
新生儿的携带率从出生时的 0.3%（373 例中的 1 例）增加到第 28 天的 37.2%（374 例中的 139 例）（p<0.001），而妇女的携带率从 17.1%（374 例中的 64 例）增加到 24.3%（374 例中的 91 例）（p<0.015）。在两组中，PCV13 疫苗型（VT）血清型约占肺炎球菌分离株的三分之一，血清型 19A 是最常见的 VT。母亲携带（调整后的优势比（OR）=2.82；95%置信区间（CI），1.77-4.80）、与家中其他儿童同住（调整后的 OR=4.06；95%CI，1.90-8.86）和旱季（OR=1.98；95%CI，1.15-3.43）是新生儿携带的危险因素。超过一半（62.6%）的新生儿携带归因于与家中其他儿童同住。
在冈比亚引入 PCV 3 年后，新生儿仍迅速被肺炎球菌定植，包括 PCV13 VT。非洲目前的肺炎球菌控制策略不能在群体免疫效应之外保护这一年龄组。
