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Abstract
BackgroundStreptococcus pneumoniae is a major cause of pneumonia, meningitis, and other serious infections among children in India. India introduced the 13-valent pneumococcal conjugate vaccine (PCV) in several states in 2017, and is expected to expand to nationwide coverage in the near future. To establish a baseline for measuring the impact of PCV in India, we assessed overall and serotype-specific nasopharyngeal carriage in two pediatric populations.MethodsA cross-sectional study was conducted in Palwal District, Haryana, from December 2016 to July 2017, prior to vaccine introduction. Children 2–59 months of age with clinical pneumonia seeking healthcare and those in the community with no clear illness were targeted for enrollment. A nasopharyngeal swab was collected and tested for pneumococcus using conventional culture and sequential multiplex PCR. Isolates were tested for antimicrobial resistance using an E test. Children were considered colonized if pneumococcus was isolated by culture or PCR. The prevalence of pneumococcal and serotype-specific colonization was compared between groups of children using log-binomial regression.ResultsAmong 601 children enrolled, 91 had clinical pneumonia and 510 were community children. The proportion colonized with S. pneumoniae was 74.7 and 54.5% among children with clinical pneumonia and community children, respectively (adjusted prevalence ratio: 1.38; 95% confidence interval: 1.19, 1.60). The prevalence of PCV13 vaccine-type colonization was similar between children with clinical pneumonia (31.9%) and community children (28.0%; p = 0.46). The most common colonizing serotypes were 6A, 6B, 14, 19A, 19F, and 23F, all of which are included in the PCV13 vaccine product. Antimicrobial resistance to at least one drug was similar between isolates from children with clinical pneumonia (66.1%) and community children (61.5%; p = 0.49); while resistance to at least two drugs was more common among isolates from children with clinical pneumonia (25.8% vs. 16.4%; p = 0.08). Resistance for all drugs was consistently higher for PCV13 vaccine-type serotypes compared to non-vaccine serotypes in both groups.ConclusionThis study provides baseline information on the prevalence of serotype-specific pneumococcal colonization among children prior to the introduction of PCV in India. Our results suggest a role for pneumococcal vaccines in reducing pneumococcal colonization and antimicrobial resistant isolates circulating in India.
Highlights
Streptococcus pneumoniae is a major cause of pneumonia, meningitis, and other serious infections among children in India
Children with clinical pneumonia were significantly more likely to be colonized with S. pneumoniae (Fig. 1; Additional File 2), even after adjusting for age and weight-for-length z-score
38, 34, 35B bSerotypes: children with clinical pneumonia: 33B; community children: 10B, 27, 33B, 48, non-typeable. In this community in Haryana, India, approximately three-quarters of children with clinical pneumonia and half of community children were colonized with S. pneumoniae, and approximately a quarter of children in both groups were colonized with PCV13 serotypes
Summary
Streptococcus pneumoniae is a major cause of pneumonia, meningitis, and other serious infections among children in India. Streptococcus pneumoniae (pneumococcus) is a major cause of pneumonia, meningitis, and other serious infections in children. In 2015, there were an estimated 294, 000 deaths in children 1–59 months due to pneumococcus globally [1]. India accounted for an estimated 68,700 pneumococcal deaths in this age group in 2015 [2]. High nasopharyngeal colonization with pneumococcus has been observed in several studies from India [5,6,7]. In addition to serving as a reservoir for respiratory infections and invasive diseases, colonization of the nasopharynx is a source of transmission of pneumococcus to other individuals
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