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Clustering of serotypes in a longitudinal study of Streptococcus pneumoniae carriage in three day care centres

DOI: 10.1186/1471-2334-8-173

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Abstract:

We followed attendees (N = 59) with their family members (N = 117) and the employees (N = 37) in three Finnish day care centres for 9 months with monthly sampling of nasopharyngeal carriage. Pneumococci were cultured, identified and serotyped by standard methods.Children in day care constitute a core group of pneumococcal carriage: of the 36 acquisitions of carriage with documented exposure to homologous pneumococci, the attendee had been exposed in her/his day care centre in 35 cases and in the family in 9 cases. Day care children introduce pneumococci to the family: 66% of acquisitions of a new serotype in a family were associated with simultaneous or previous carriage of the same type in the child attending day care. Consequently, pneumococcal transmission was found to take place as micro-epidemics driven by the day care centres. Each of the three day care centres was dominated by a serotype of its own, accounting for 100% of the isolates of that serotype among all samples from the day care attendees.The transmission of pneumococci is more intense within than across clusters defined by day care facilities. The ensuing micro-epidemic behaviour enhances pneumococcal transmission.Contrary to most other pathogens, Streptococcus pneumoniae (pneumococcus) is not primarily spread by individuals with clinical disease but by healthy carriers who harbour the bacteria in the nasopharynx. Data about cases of pneumococcal disease are therefore of little use in studies of pneumococcal transmission and preventive interventions targeting transmission. Studies of transmission are currently of specific interest because new pneumococcal polysaccharide-conjugate vaccines affect not only pneumococcal disease but also nasopharyngeal carriage and through this have indirect population level effects on invasive disease [1]. Detailed data about carriage and transmission are therefore of utmost value when aiming to forecast the entire prevention potential of the conjugate vaccines.Acquisit

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