Nasopharyngeal carriage of S. pneumoniae among young children in rural Nepal.
OBJECTIVE
To provide epidemiologic data on Streptococcus pneumoniae (Spn) carriage in Nepal.


METHODS
Prospective, population-based study among children in Sarlahi, Nepal to estimate carriage prevalence, identify risk factors, and determine antibiotic susceptibility patterns and serotype distribution. Between December 2003 and July 2004, NP specimens were collected from 604 children aged 1-36 months with acute lower respiratory infection (ALRI) and 604 healthy, age- and season-matched controls.


RESULTS
Of the 1100 specimens analysed, carriage prevalence was approximately 80% in both groups. In the multivariate analyses, significant risk factors for Spn carriage in controls were Muslim religion [adjusted odds ratio (AOR): 2.93] and no latrine in the household (AOR: 2.41). Those treated for a recent illness had lower carriage rates (AOR: 0.37). Results were similar for ALRI cases with the addition of age >or=12 months (AOR: 1.68), and symptomatic infection (AOR: 3.78) as risk factors. The antibiotics and proportions of isolates resistant to them were as follows: penicillin 4.5%, cotrimoxazole 89.2%, chloramphenicol 1.4%, erythromycin 1.5% and tetracycline 22.7%. The most prevalent serogroups/types were 6, 19, 23, 15, 9 and 10.


CONCLUSIONS
Young children in rural Nepal experience high rates of Spn carriage. Most isolates were resistant to cotrimoxazole. Current conjugate Spn vaccines may substantially reduce the risk of a severe pneumonia and other Spn infections.
Coles
Christian L
CL
Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA. ccoles@jhsph.edu
Sherchand
Jeevan B
JB
Khatry
Subarna K
SK
Katz
Joanne
J
Leclerq
Steven C
SC
Mullany
Luke C
LC
Tielsch
James M
JM
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002353:Carrier State / Q000453:epidemiology / Q000382:microbiology*; D002675:Child, Preschool; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009305:Nasopharynx / Q000382:microbiology*; D009390:Nepal / Q000453:epidemiology; D011008:Pneumococcal Infections / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission*; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission*; D013296:Streptococcus pneumoniae / Q000302:isolation & purification*
D000900:Anti-Bacterial Agents