title: Streptococcus pneumoniae and noncapsular Haemophilus influenzae nasal carriage and hand contamination in children: a comparison of two populations at risk of otitis media.
abstract: BACKGROUND
  Australian Indigenous children living in remote areas have rates of tympanic membrane perforation as high as 60%, almost 100 times the prevalence in urban child care settings (<1%). Relative rates of pneumococcal nasal carriage do not reflect this difference in disease risk.
  
  
  METHODS
  Cross-sectional comparison of nasal carriage and hand contamination in children younger than 4 years of age from urban child-care centers and Indigenous children 3-7 years of age from a remote community. Almost identical methods of nasal swab collection, transport and culture were used. Data on pneumococcal antimicrobial susceptibility patterns and serotypes are also reported.
  
  
  RESULTS
  For Indigenous children compared with children in child care, the relative risk of nasal carriage of either pneumococcus or noncapsular Haemophilus influenzae was <2-fold [relative risk, 1.7; 95% confidence interval (CI), 1.5, 1.9], the risk of simultaneous nasal carriage was almost 3-fold (78% versus 28%; relative risk, 2.9; 95% CI 2.3, 3.5), and the risk of pneumococcal hand contamination was 8-fold higher (37% versus 4%; relative risk, 8.4; 95% CI 4.6, 15.2). For simultaneous hand contamination, the risk was 23-fold (8% versus 0.3%; relative risk, 23.1; 95% CI 2.9, 185.4). Remote Indigenous children also had a more diverse serotype distribution (25 versus 14 serotypes identified).
  
  
  CONCLUSIONS
  Simultaneous nasal carriage of Streptococcus pneumoniae and H. influenzae and hand contamination are simple indicators of risk for use in studies of otitis media in populations at risk for tympanic membrane perforation.
authors.affiliation: Menzies School of Health Research and the Institute of Advanced Studies, Charles Darwin University, Darwin, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Stubbs
authors.forename: Kim
authors.initials: K
authors.lastname: Hare
authors.forename: Cate
authors.initials: C
authors.lastname: Wilson
authors.forename: Peter
authors.initials: P
authors.lastname: Morris
authors.forename: Amanda Jane
authors.initials: AJ
authors.lastname: Leach
mesh_terms: D017677:Age Distribution; D001315:Australia / Q000453:epidemiology; D002353:Carrier State; D002648:Child; D002656:Child Day Care Centers; D002675:Child, Preschool; D015331:Cohort Studies; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D006192:Haemophilus Infections / Q000175:diagnosis / Q000453:epidemiology; D006193:Haemophilus influenzae / Q000302:isolation & purification*; D006225:Hand / Q000382:microbiology*; D006801:Humans; D015994:Incidence; D008297:Male; D009297:Nasal Mucosa / Q000382:microbiology*; D010033:Otitis Media / Q000453:epidemiology / Q000382:microbiology*; D011336:Probability; D018570:Risk Assessment; D017678:Sex Distribution; D013290:Streptococcal Infections / Q000453:epidemiology / Q000209:etiology; D013296:Streptococcus pneumoniae / Q000302:isolation & purification*; D014505:Urban Population