title: Pneumococcal carriage at age 2 months is associated with growth deficits at age 6 months among infants in South India.
abstract: Nasopharyngeal colonization is the first step in the pathway to Streptococcus pneumoniae (Spn) infection, a leading cause of childhood morbidity and mortality. We investigated the effect of Spn colonization at ages 2 and 4 mo on growth at age 6 mo among 389 infants living in rural South India by using data from an Spn carriage study nested within a randomized, double-blind, placebo-controlled community trial designed to evaluate the impact of newborn vitamin A supplementation on Spn carriage in the first 6 mo of life. Primary outcomes were weight, length, and anthropometric indices of nutritional status. Growth data at age 6 mo were available for 84% (389 of 464) of infants in the Spn carriage study. Carriage at age 2 mo was associated with increased odds of stunting [OR: 3.07 (95% CI: 1.29, 7.36) P = 0.012] and lower weight [β: -266 g (95% CI: -527, -5) P = 0.045], length [β: -1.31 cm (95% CI: -2.32, -0.31) P = 0.010], and length-for-age Z scores [β: -0.59; (95% CI: -1.05, -0.13) P = 0.012] at age 6 mo. Spn carriage at age 4 mo did not affect growth. Carriage of invasive serotypes at age 2 mo was associated with decreases in mean weight [β: -289 g; (95% CI: -491, -106) P = 0.002] and length [β:-0.38 cm (95% CI: -1.49, -0.01) P = 0.047] at age 6 mo. Newborn vitamin A supplementation did not modify the association between Spn carriage and growth. Results suggest that pneumococcal carriage at age 2 mo is an independent risk factor for poor growth in young infants. Future studies need to clarify the role of Spn carriage on growth retardation in low-income countries.
authors.affiliation: Department of International Health, Bloomberg School of Public Health, Baltimore, MD, USA. ccoles@jhsph.edu
authors.forename: Christian L
authors.initials: CL
authors.lastname: Coles
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Rahmathullah
authors.forename: Reba
authors.initials: R
authors.lastname: Kanungo
authors.forename: Joanne
authors.initials: J
authors.lastname: Katz
authors.forename: Debora
authors.initials: D
authors.lastname: Sandiford
authors.forename: Sheela
authors.initials: S
authors.lastname: Devi
authors.forename: R D
authors.initials: RD
authors.lastname: Thulasiraj
authors.forename: James M
authors.initials: JM
authors.lastname: Tielsch
mesh_terms: D000375:Aging; D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology; D019587:Dietary Supplements; D005260:Female; D006130:Growth Disorders / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D008297:Male; D009305:Nasopharynx / Q000382:microbiology*; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000517:prevention & control; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification / Q000302:isolation & purification*; D014801:Vitamin A / Q000008:administration & dosage; D014815:Vitamins / Q000008:administration & dosage / Q000494:pharmacology
chemical_list: D014815:Vitamins; D014801:Vitamin A