title: Streptococcus pneumoniae oropharyngeal colonization in school-age children and adolescents with type 1 diabetes mellitus: Impact of the heptavalent pneumococcal conjugate vaccine.
abstract: This study evaluated Streptococcus pneumoniae colonization in children and adolescents with type 1 diabetes mellitus (DM1) to investigate the theoretical risk of invasive pneumococcal disease (IPD) in these patients and the potential protective efficacy of pneumococcal conjugate vaccines (PCVs). An oropharyngeal swab was obtained from 299 patients aged 6-17 y with DM1 who were enrolled during routine clinical visits. DNA from swabs was analyzed for S. pneumoniae using real-time polymerase chain reaction. S. pneumoniae was identified in the swabs of 148 subjects (49.8%). Colonization was strictly age-related and declined significantly in the group aged ≥15 years (odds ratio [OR] 0.28; 95% confidence interval [CI], 0.14-0.57). Carriage was also significantly influenced by sex (lower in females: OR 0.56; 95% CI, 0.35-0.91), ethnicity (less common among non-Caucasians: OR 0.34; 95% CI, 0.13-0.89), parental smoking habit (more frequent among children with at least one smoker between parents: OR 1.76; 95% CI, 0.90-2.07), and the administration of antibiotic therapy in the previous 3 months (less frequent among patients who received antibiotics: OR 0.21; 95% CI, 0.07-0.62). Multivariate analyses of the entire study population showed no association between carriage and PCV7 vaccination status. Serotypes 19F, 9V, and 4 were the most frequently identified serotypes. In conclusion, school-age children and adolescents with DM1 are frequently colonized by S. pneumoniae, and protection against pneumococcal carriage following infant and toddler vaccination was not effective after several years. Together with the need to increase vaccine uptake in all the children aged <2 years, these results suggest that PCV booster doses are needed in DM1 patients to maintain the protection offered by these vaccinations.
authors.affiliation: a Pediatric Highly Intensive Care Unit ; Department of Pathophysiology and Transplantation; Università degli Studi di Milano; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico ; Milan , Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Principi
authors.affiliation: b Pediatric Clinic; University of Modena and Reggio Emilia ; Modena , Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Iughetti
authors.affiliation: c Unit of Endocrinology and Diabetic Bambino Gesù Children's Hospital IRCCS ; Rome , Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Cappa
authors.affiliation: d UOC di Pediatria ad Indirizzo Diabetologico e Malattie del Metabolismo; Azienda Ospedaliera Universitaria Integrata di Verona ; Verona , Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Maffeis
authors.affiliation: e Department of Pediatrics ; University of Cheti ; Chieti , Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Chiarelli
authors.affiliation: f Division of Pediatrics ; Department of Health Sciences; Università del Piemonte Orientale "Amedeo Avogadro" ; Novara , Italy.
authors.forename: Gianni
authors.initials: G
authors.lastname: Bona
authors.affiliation: a Pediatric Highly Intensive Care Unit ; Department of Pathophysiology and Transplantation; Università degli Studi di Milano; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico ; Milan , Italy.
authors.forename: Monia
authors.initials: M
authors.lastname: Gambino
authors.affiliation: a Pediatric Highly Intensive Care Unit ; Department of Pathophysiology and Transplantation; Università degli Studi di Milano; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico ; Milan , Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Ruggiero
authors.affiliation: b Pediatric Clinic; University of Modena and Reggio Emilia ; Modena , Italy.
authors.forename: Viviana
authors.initials: V
authors.lastname: Patianna
authors.affiliation: c Unit of Endocrinology and Diabetic Bambino Gesù Children's Hospital IRCCS ; Rome , Italy.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Matteoli
authors.affiliation: d UOC di Pediatria ad Indirizzo Diabetologico e Malattie del Metabolismo; Azienda Ospedaliera Universitaria Integrata di Verona ; Verona , Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Marigliano
authors.affiliation: e Department of Pediatrics ; University of Cheti ; Chieti , Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Cipriano
authors.affiliation: f Division of Pediatrics ; Department of Health Sciences; Università del Piemonte Orientale "Amedeo Avogadro" ; Novara , Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Parlamento
authors.affiliation: a Pediatric Highly Intensive Care Unit ; Department of Pathophysiology and Transplantation; Università degli Studi di Milano; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico ; Milan , Italy.
authors.forename: Susanna
authors.initials: S
authors.lastname: Esposito
mesh_terms: D000293:Adolescent; D002353:Carrier State / Q000382:microbiology / Q000517:prevention & control*; D002648:Child; D004269:DNA, Bacterial / Q000235:genetics; D003922:Diabetes Mellitus, Type 1; D005260:Female; D000069443:Heptavalent Pneumococcal Conjugate Vaccine / Q000276:immunology*; D006801:Humans; D008297:Male; D009305:Nasopharynx / Q000382:microbiology*; D011008:Pneumococcal Infections / Q000382:microbiology / Q000517:prevention & control*; D060888:Real-Time Polymerase Chain Reaction; D013296:Streptococcus pneumoniae / Q000145:classification / Q000235:genetics*; D014611:Vaccination; D018074:Vaccines, Conjugate / Q000276:immunology*
chemical_list: D004269:DNA, Bacterial; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D018074:Vaccines, Conjugate
keywords: Streptococcus pneumoniae; children; diabetes; diabetes mellitus; pediatrics; pneumococcal conjugate vaccine; pneumococcal infection; pneumococcal vaccine; type 1 diabetes mellitus