Carriage of Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus in Indonesian children: A cross-sectional study.

Eileen M Dunne,Casey L Pell,Sunaryati Sudigdoadi,Nurhandini Eka Dewi,Eddy Fadlyana,E Kim Mulholland,Sang Ayu Kompiyang Indriyani,Cissy Kartasasmita,Catherine Satzke,Jason Hinds,Chrysanti Murad,Emma Watts,Rodman Tarigan,Finny Fitry Yani,Kusnandi Rusmil,Daniela Flavia Hozbor

doi:10.1371/journal.pone.0195098

Abstract

Streptococcus pneumoniae is an important cause of infection and commonly colonizes the nasopharynx of young children, along with other potentially pathogenic bacteria. The objectives of this study were to estimate the carriage prevalence of S. pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus in young children in Indonesia, and to examine interactions between these bacterial species. 302 healthy children aged 12–24 months were enrolled in community health centers in the Bandung, Central Lombok, and Padang regions. Nasopharyngeal swabs were collected and stored according to World Health Organization recommendations, and bacterial species detected by qPCR. Pneumococcal serotyping was conducted by microarray and latex agglutination/Quellung. Overall carriage prevalence was 49.5% for S. pneumoniae, 27.5% for H. influenzae, 42.7% for M. catarrhalis, and 7.3% for S. aureus. Prevalence of M. catarrhalis and S. pneumoniae, as well as pneumococcal serotype distribution, varied by region. Positive associations were observed for S. pneumoniae and M. catarrhalis (OR 3.07 [95%CI 1.91–4.94]), and H. influenzae and M. catarrhalis (OR 2.34 [95%CI 1.40–3.91]), and a negative association was found between M. catarrhalis and S. aureus (OR 0.06 [95%CI 0.01–0.43]). Densities of S. pneumoniae, H. influenzae, and M. catarrhalis were positively correlated when two of these species were present. Prior to pneumococcal vaccine introduction, pneumococcal carriage prevalence and serotype distribution varies among children living in different regions of Indonesia. Positive associations in both carriage and density identified among S. pneumoniae, H. influenzae, and M. catarrhalis suggest a synergistic relationship among these species with potential clinical implications.

Highlights

Streptococcus pneumoniae is a Gram-positive bacterium that causes a wide range of infections including otitis media, pneumonia, sepsis, and meningitis
To evaluate whether differences in carriage prevalence were due to differences in risk factors among regions, adjusted odds ratios were determined by logistic regression models that included income, the presence of two or more children under five in the household, maternal education level, and presence of upper respiratory tract infection (URTI) symptoms
For S. pneumoniae, adjusted odds ratios (aOR) compared to Padang was 3.47 (95%CI 1.87–6.53) for Bandung and 1.78 (95%CI 0.93–3.42) for Central Lombok (p = 0.0006, chi-squared test)

Summary

Introduction

Streptococcus pneumoniae (pneumococcus) is a Gram-positive bacterium that causes a wide range of infections including otitis media, pneumonia, sepsis, and meningitis. Pneumococcal disease is a major cause of pediatric morbidity and mortality worldwide, with disease primarily occurring in low and middle income countries [1]. The primary reservoir for pneumococci is the human nasopharynx, and nasopharyngeal carriage rates are highest among young children, ranging from 19–86% in different epidemiological settings [2]. Colonization of the nasopharynx is typically asymptomatic can be associated with mild respiratory symptoms such as runny nose [3]. High pneumococcal carriage density has been linked to respiratory infection and pneumonia in children, and implicated in transmission in animal studies [5, 6]

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