title: Prevalence of nasopharyngeal carriage of pneumococcus in preschool children attending day care in London.
abstract: OBJECTIVE
  To estimate the prevalence of nasopharyngeal (NP) carriage of pneumococcus (Streptococcus pneumoniae) and describe the antibiotic resistance patterns and serotypes in young children attending group day care in London.
  
  
  METHODS
  Cross-sectional survey of attendees at a sample of registered child day care centres (CDCCs) in a London borough.
  
  
  METHODS
  Urban setting with a socially and culturally diverse population.
  
  
  METHODS
  19 CDCCs (13% of total) participated between March and November 2003. A single NP swab was required from each child, and parents completed a questionnaire about their child's health and attendance at day care. WHO methodology for pneumococcal carriage studies was followed.
  
  
  RESULTS
  30% of parents consented. 234 swabs were collected from children aged 6 months to 5 years. 53% were boys and 81% were white. 120 children (51%, 95% CI 45% to 58%) carried pneumococci in their nasopharynx. None of the isolates were resistant to penicillin (upper CL 3%). 21 isolates were resistant to erythromycin (17.5%, 95% CI 11% to 25.5%). 68 isolates (57%) were serotypes included in the 7-valent conjugate vaccine. Non-white children had a lower prevalence of carriage (27% vs 58%).
  
  
  CONCLUSIONS
  The prevalence of pneumococcal NP carriage was high. The penicillin resistance rate is lower than in many other countries and may reflect a decrease in community antibiotic prescribing in the UK. Monitoring circulating serotypes is important in the context of recent changes to the vaccination policy. Further study is required to explore the association with ethnicity and risk factors for antibiotic resistance.
authors.affiliation: South West London Health Protection Unit, Springfield University Hospital, 61 Glenburnie Road, London SW17 7DB, UK. anita.roche@wpct.nhs.uk
authors.forename: Anita
authors.initials: A
authors.lastname: Roche
authors.forename: Paul T
authors.initials: PT
authors.lastname: Heath
authors.forename: Mike
authors.initials: M
authors.lastname: Sharland
authors.forename: David
authors.initials: D
authors.lastname: Strachan
authors.forename: Aodhan
authors.initials: A
authors.lastname: Breathnach
authors.forename: John
authors.initials: J
authors.lastname: Haigh
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Young
mesh_terms: D002353:Carrier State / Q000453:epidemiology*; D002656:Child Day Care Centers / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007223:Infant; D008131:London / Q000453:epidemiology; D008297:Male; D009305:Nasopharynx / Q000382:microbiology*; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D015995:Prevalence; D012307:Risk Factors; D013296:Streptococcus pneumoniae / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification*