title: Transmission of Streptococcus pneumoniae in rural Gambian villages: a longitudinal study.
abstract: BACKGROUND. To prepare for national introduction of a pneumococcal vaccine of restricted valency, we studied the pattern of nasopharyngeal carriage of Streptococcus pneumoniae and its transmission in Gambian villages over time. METHODS. We collected nasopharyngeal swab specimens every 2 weeks from 158 villagers in 19 households in 2 villages over 1 year. We studied the prevalence and duration of S. pneumoniae carriage, the effect of household size and composition on carriage, and sequence type-specific carriage within and between households. RESULTS. Ninety-seven percent of children and 85% of adults carried S. pneumoniae at some time. Fifty-three serotypes were represented among 1522 isolates. Carriage was more common among children than adults for all serotypes studied except 9V. There was an overall trend toward shorter carriage with increasing age (P = .043) and significant differences in carriage duration between serotypes. For most serotypes, the odds of being a carrier were greater if there were other carriers in the household. The prevalence of carriage varied by serotype. Most notably, serotype 5 carriage occurred in only 1 village and was transient. Multilocus sequence typing of serotype 6B isolates from 1 village revealed 8 different sequence types and strong evidence of nonrandom distribution among households (P < .001). Study by sequence type suggested household spread starting most commonly in children, followed by spread to adults. CONCLUSIONS. This longitudinal carriage study in Gambian villages provides unique information on the pattern of spread of S. pneumoniae in rural Africa and a baseline for evaluating the impact of the introduction of pneumococcal conjugate vaccine into the region.
authors.affiliation: Bacterial Diseases Programme, Medical Research Council Laboratories, Fajara, The Gambia. Philip.hill@otago.ac.nz
authors.forename: Philip C
authors.initials: PC
authors.lastname: Hill
authors.forename: John
authors.initials: J
authors.lastname: Townend
authors.forename: Martin
authors.initials: M
authors.lastname: Antonio
authors.forename: Biodun
authors.initials: B
authors.lastname: Akisanya
authors.forename: Chinelo
authors.initials: C
authors.lastname: Ebruke
authors.forename: George
authors.initials: G
authors.lastname: Lahai
authors.forename: Brian M
authors.initials: BM
authors.lastname: Greenwood
authors.forename: Richard A
authors.initials: RA
authors.lastname: Adegbola
mesh_terms: D000293:Adolescent; D000328:Adult; D015373:Bacterial Typing Techniques; D002353:Carrier State / Q000453:epidemiology* / Q000635:transmission*; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D016172:DNA Fingerprinting; D005192:Family Health; D005260:Female; D005714:Gambia / Q000453:epidemiology; D005838:Genotype; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009305:Nasopharynx / Q000382:microbiology; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000635:transmission*; D015995:Prevalence; D012424:Rural Population; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D013997:Time Factors; D055815:Young Adult