TY - JOUR
T1 - Nasopharyngeal carriage and transmission of Streptococcus pneumoniae in American Indian households after a decade of pneumococcal conjugate vaccine use
AU - Mosser, Jonathan F.
AU - Grant, Lindsay R.
AU - Millar, Eugene V.
AU - Weatherholtz, Robert C.
AU - Jackson, Delois M.
AU - Beall, Bernard
AU - Craig, Mariddie J.
AU - Reid, Raymond
AU - Santosham, Mathuram
AU - O'Brien, Katherine L.
N1 - Funding Information:
The authors have read the journal's policy and have the following potential conflicts to report: KLOB, LG, RW, RR, MS have received in the past year research grant support from Pfizer and GlaxoSmithKline (GSK). KLOB and MS have served on external expert committees for Sanofi-Pasteur, GSK and Merck. Co-author Bernard Beall is a PLOS ONE Editorial Board member. The authors confirm that their declarations in the conflict of interest section do not alter adherence to all PLOS ONE policies on data sharing and materials. All other authors have no conflicts to report.
PY - 2014/1/17
Y1 - 2014/1/17
N2 - Background: Young children played a major role in pneumococcal nasopharyngeal carriage, acquisition, and transmission in the era before pneumococcal conjugate vaccine (PCV) use. Few studies document pneumococcal household dynamics in the routine-PCV7 era. Methods: We investigated age-specific acquisition, household introduction, carriage clearance, and intra-household transmission in a prospective, longitudinal, observational cohort study of pneumococcal nasopharyngeal carriage in 300 American Indian households comprising 1,072 participants between March 2006 and March 2008. Results: Pneumococcal acquisition rates were 2-6 times higher in children than adults. More household introductions of new pneumococcal strains were attributable to children <9 years than adults >17 years (p<0.001), and older children (2-8 years) than younger children (<2 years) (p<0.008). Compared to children <2 years, carriage clearance was more rapid in older children (2-4 years, HRclearance 1.53 [95% CI: 1.22, 1.91]; 5-8 years, HRclearance 1.71 [1.36, 2.15]) and adults (HR clearance 1.75 [1.16, 2.64]). Exposure to serotype-specific carriage in older children (2-8 years) most consistently increased the odds of subsequently acquiring that serotype for other household members. Conclusions: In this community with a high burden of pneumococcal colonization and disease and routine PCV7 use, children (particularly older children 2-8 years) drive intra-household pneumococcal transmission: first, by acquiring, introducing, and harboring pneumococcus within the household, and then by transmitting acquired serotypes more efficiently than household members of other ages.
AB - Background: Young children played a major role in pneumococcal nasopharyngeal carriage, acquisition, and transmission in the era before pneumococcal conjugate vaccine (PCV) use. Few studies document pneumococcal household dynamics in the routine-PCV7 era. Methods: We investigated age-specific acquisition, household introduction, carriage clearance, and intra-household transmission in a prospective, longitudinal, observational cohort study of pneumococcal nasopharyngeal carriage in 300 American Indian households comprising 1,072 participants between March 2006 and March 2008. Results: Pneumococcal acquisition rates were 2-6 times higher in children than adults. More household introductions of new pneumococcal strains were attributable to children <9 years than adults >17 years (p<0.001), and older children (2-8 years) than younger children (<2 years) (p<0.008). Compared to children <2 years, carriage clearance was more rapid in older children (2-4 years, HRclearance 1.53 [95% CI: 1.22, 1.91]; 5-8 years, HRclearance 1.71 [1.36, 2.15]) and adults (HR clearance 1.75 [1.16, 2.64]). Exposure to serotype-specific carriage in older children (2-8 years) most consistently increased the odds of subsequently acquiring that serotype for other household members. Conclusions: In this community with a high burden of pneumococcal colonization and disease and routine PCV7 use, children (particularly older children 2-8 years) drive intra-household pneumococcal transmission: first, by acquiring, introducing, and harboring pneumococcus within the household, and then by transmitting acquired serotypes more efficiently than household members of other ages.
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U2 - 10.1371/journal.pone.0079578
DO - 10.1371/journal.pone.0079578
M3 - Article
C2 - 24465365
AN - SCOPUS:84898410897
SN - 1932-6203
VL - 9
JO - PLoS One
JF - PLoS One
IS - 1
M1 - e79578
ER -