Infection and Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.
PLoS One. 2019 Oct 29;14(10):e0224392. doi: 10.1371/journal.pone.0224392. eCollection 2019.
Nasopharyngeal carriage of Streptococcus pneumoniae (the pneumococcus) is a precursor to pneumococcal disease. Several host and environmental factors have been associated with pneumococcal carriage, however few studies have examined the relationship between host factors and pneumococcal carriage density. We sought to identify risk factors for pneumococcal carriage and density using data from cross-sectional pneumococcal carriage surveys conducted in the Lao People's Democratic Republic before and after the introduction of the 13-valent pneumococcal conjugate vaccine (PCV13). Nasopharyngeal swabs were collected infants from aged 5-8 weeks old (n = 999) and children aged 12-23 months (n = 1,010), pneumococci detected by quantitative PCR, and a risk factor questionnaire completed. Logistic and linear regression models were used to evaluate associations between participant characteristics and pneumococcal carriage and density. In infants aged 5-8 weeks, living in a household with two or more children under the age of five years (aOR 1.97; 95% CI 1.39-2.79) and low family income (aOR 1.64; 95% CI 0.99-2.72) were positively associated with pneumococcal carriage. For children aged 12-23 months, upper respiratory tract infection (URTI) symptoms (aOR 2.64; 95% CI 1.97-3.53), two or more children under five in the household (aOR 2.40; 95% CI 1.80-3.20), and rural residence (aOR 1.84, 95% CI 1.35-2.50) were positively associated with pneumococcal carriage. PCV13 vaccination was negatively associated with carriage of PCV13 serotypes (aOR 0.60; 95% CI 0.44-0.83). URTI symptoms (p < 0.001), current breastfeeding (p = 0.005), rural residence (p = 0.012), and delivery by Caesarean section (p = 0.035) were associated with higher mean pneumococcal density in pneumococcal carriers (both age groups combined). This study provides new data on pneumococcal carriage and density in a high disease burden setting in southeast Asia.
鼻咽部携带肺炎链球菌（肺炎球菌）是肺炎球菌疾病的前兆。已有多种宿主和环境因素与肺炎球菌携带有关，但很少有研究探讨宿主因素与肺炎球菌携带密度之间的关系。我们试图利用在老挝人民民主共和国进行的 13 价肺炎球菌结合疫苗（PCV13）引入前后的肺炎球菌携带横断面研究的数据，确定肺炎球菌携带和密度的危险因素。采集了 5-8 周龄婴儿（n = 999）和 12-23 月龄儿童（n = 1,010）的鼻咽拭子，通过定量 PCR 检测肺炎球菌，并完成了风险因素调查问卷。使用逻辑和线性回归模型评估了参与者特征与肺炎球菌携带和密度之间的关联。在 5-8 周龄的婴儿中，与家中有两个或两个以上五岁以下儿童（优势比 1.97；95%置信区间 1.39-2.79）和低收入家庭（优势比 1.64；95%置信区间 0.99-2.72）相关。对于 12-23 月龄的儿童，上呼吸道感染（URTI）症状（优势比 2.64；95%置信区间 1.97-3.53）、家中有两个或两个以上五岁以下儿童（优势比 2.40；95%置信区间 1.80-3.20）和农村居住（优势比 1.84，95%置信区间 1.35-2.50）与肺炎球菌携带呈正相关。PCV13 疫苗接种与 PCV13 血清型携带呈负相关（优势比 0.60；95%置信区间 0.44-0.83）。URTI 症状（p < 0.001）、当前母乳喂养（p = 0.005）、农村居住（p = 0.012）和剖宫产分娩（p = 0.035）与肺炎球菌携带者的平均肺炎球菌密度较高有关（两个年龄组合并）。本研究提供了东南亚高疾病负担环境中肺炎球菌携带和密度的新数据。
