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. 2014 Jan 17;9(1):e79578.
doi: 10.1371/journal.pone.0079578. eCollection 2014.

Nasopharyngeal carriage and transmission of Streptococcus pneumoniae in American Indian households after a decade of pneumococcal conjugate vaccine use

Jonathan F Mosser  1 , Lindsay R Grant  1 , Eugene V Millar  2 , Robert C Weatherholtz  1 , Delois M Jackson  3 , Bernard Beall  3 , Mariddie J Craig  4 , Raymond Reid  1 , Mathuram Santosham  1 , Katherine L O'Brien  1
Affiliations

Nasopharyngeal carriage and transmission of Streptococcus pneumoniae in American Indian households after a decade of pneumococcal conjugate vaccine use

Jonathan F Mosser et al. PLoS One. .

Erratum in

  • PLoS One. 2014;9(3):e93878

Abstract

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 (HRclearance 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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Conflict of interest statement

Competing Interests: 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.

Figures

Figure 1
Figure 1. Adjusted number of pneumococcal acquisition events, by age category.
Each point represents the mean number of individual acquisitions or household introduction for an individual in a given age category (with 95% confidence interval) over the course of the study, adjusted by all other covariates in the Poisson models set to their means.
See this image and copyright information in PMC

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