Abstract
BackgroundOutbreaks and sporadic cases of pneumococcal illness occur among young adults in confined settings. Our aim was to characterize pneumococcal acquisition and carriage among healthy young adults in Israel during military training in confined settings.MethodsDuring the years 2007–2008, an observational longitudinal study was conducted in three cohorts of healthy soldiers, during a 7-month basic training period. Epidemiological data, oropharyngeal and nasopharyngeal cultures were sampled on 5 occasions: before and 3, 6, 12 and 24 weeks after start of training. Samples were processed within 2–18 hours. Relatedness of isolates was investigated by capsular typing of all isolates and pulsed-field gel electrophoresis to determine acquisition and transmission. Carriage and acquisition patterns were analyzed and multivariable logistic regression analysis was performed to assess the impact of time on acquisition after mixing, controlling for other covariates.ResultsPneumococci were recovered on 202 of 1872 visits among 742 individuals, including 40 different serotypes. Mean carriage prevalence increased in all visits following training initiation. Acquisition during training was high, as 36.9% of individuals acquired pneumococci at least once during training, and for almost one fourth of the whole population this occurred during the first 6 weeks. Significant clustering was noted. Sharing drinking glass/bottle was found to be a significant and common risk factor for pneumococcal acquisition.ConclusionsPneumococcal acquisition is highly frequent when young adults live in close contact in confined settings, especially early after mixing.
Highlights
Streptococcus pneumoniae is the most common bacterial etiology of community-acquired pneumonia in all ages, and can cause outbreaks in closed settings [1,2,3]
Proportions of carriage prevalence and acquisition rates were calculated for each cohort and visit. 95% confidence intervals (CIs) for prevalence and acquisition rates were calculated through binomial distribution
There were no significant differences in any of the socio-economic and health behavior characteristics or pneumococcal carriage before start of training between the 346 participants who were sampled in the second visit and the other 396 participants, not selected for the longitudinal study, except higher household crowding among participants in the second visit
Summary
Streptococcus pneumoniae is the most common bacterial etiology of community-acquired pneumonia in all ages, and can cause outbreaks in closed settings [1,2,3]. Most data on pneumococcal transmission derive from studies conducted in children and less often in their caregivers [5,6,7,8,9], but transmission patterns and dynamics among healthy young adults are less known [5]. A recent outbreak of severe pneumococcal illness in an Israeli army training base [10] led to undertake a study to characterize pneumococcal carriage prevalence, acquisition and dynamics among healthy young recruits before and during military training in confined settings. Our hypothesis was that during military training, especially soon after mixing, a significant rise in pneumococcal carriage rates will be common due to frequent acquisitions, as previously found for other pathogens [11,12]. Our aim was to characterize pneumococcal acquisition and carriage among healthy young adults in Israel during military training in confined settings
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