title: Streptococcus pneumoniae carriage in the Gaza strip.
abstract: BACKGROUND
  Pneumococcal infections cause major morbidity and mortality in developing countries. We report the epidemiology of S. pneumoniae carriage in a developing region, the Gaza strip, and evaluate the theoretical coverage of carriage strains by pneumococcal conjugate vaccines (PCVs).
  
  
  METHODS
  In 2009 we conducted a cross-sectional survey of S. pneumoniae carriage in healthy children and their parents, living throughout the Gaza strip. Data were collected and nasopharyngeal swabs were obtained. Antibiotic susceptibilities were determined by Vitek-2 and serotypes by the Quellung reaction.
  
  
  RESULTS
  S. pneumoniae carriage was detected in 189/379 (50%) of children and 30/376 (8%) of parents. Carriage prevalence was highest in children <6 months of age (63%). Significant predictors for child carriage were number of household members and DCC attendance. The proportion of pediatric and adults isolates with serotypes included in PCV7 were 32% and 20% respectively, and 46% and 33% in PCV13 respectively. The most prominent non-vaccine serotypes (NVT) were 35B, 15B/C and 23B. Penicillin-nonsusceptible strains were carried by 70% of carriers, penicillin-resistant strains (PRSP) by 13% and Multi-drug-resistant (MDR) by 30%. Of all PRSP isolates 54% belonged to serotypes included in PCV7 and 71% in the PCV13. Similarly, 59% and 73% of MDR-SP isolates, would theoretically be covered by PCV7 and PCV13, respectively.
  
  
  CONCLUSIONS
  This study demonstrates that, PCV13-included strains were carried by 46% and 33% of pediatric and adult subjects respectively. In the absence of definitive data regarding the virulence of the NVT strains, it is difficult to predict the effect of PCVs on IPD in this region.
authors.affiliation: Infectious Disease Unit, Sheba Medical Center, Tel-Hashomer affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel. gregev@hsph.harvard.edu
authors.forename: Gili
authors.initials: G
authors.lastname: Regev-Yochay
authors.forename: Izzeldin
authors.initials: I
authors.lastname: Abullaish
authors.forename: Richard
authors.initials: R
authors.lastname: Malley
authors.forename: Bracha
authors.initials: B
authors.lastname: Shainberg
authors.forename: Miriam
authors.initials: M
authors.lastname: Varon
authors.forename: Yulia
authors.initials: Y
authors.lastname: Roytman
authors.forename: Arnona
authors.initials: A
authors.lastname: Ziv
authors.forename: Aviva
authors.initials: A
authors.lastname: Goral
authors.forename: Abedallah
authors.initials: A
authors.lastname: Elhamdany
authors.forename: Galia
authors.initials: G
authors.lastname: Rahav
authors.forename: Meir
authors.initials: M
authors.lastname: Raz
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008877:Middle East / Q000453:epidemiology; D009305:Nasopharynx / Q000382:microbiology; D010406:Penicillins / Q000494:pharmacology; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000382:microbiology*; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000187:drug effects / Q000235:genetics* / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins