title: Epidemiological Markers for Interactions Among Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus in Upper Respiratory Tract Carriage.
abstract: BACKGROUND
  Cocolonization by Streptococcus pneumoniae and Haemophilus influenzae among children has been noted in numerous studies, as has an inverse relationship involving colonization with these species and Staphylococcus aureus. Interactions among these pathogens could mediate unanticipated outcomes of clinical interventions, including changes in H. influenzae and S. aureus disease incidence following pneumococcal vaccine introduction. However, it remains unclear whether cocolonization patterns represent true interspecies interactions or whether they result from confounding factors.
  
  
  METHODS
  We investigated polymicrobial carriage using longitudinal data from 369 Bedouin children and 400 Jewish children in Israel who were enrolled in a 7-valent pneumococcal conjugate vaccine (PCV7) trial. Children were swabbed 10 times between 2 and 30 months of age.
  
  
  RESULTS
  The pathogens followed distinct age and seasonal distributions, but polymicrobial carriage associations persisted after controlling for these and other confounding factors. Receipt of PCV7 resulted in pneumococcal serotype replacement but did not influence total carriage of S. pneumoniae, H. influenzae, or S. aureus.
  
  
  CONCLUSIONS
  The fact that S. pneumoniae, H. influenzae, and S. aureus polymicrobial carriage patterns do not result from confounding by age and season supports the idea of active interspecies interactions. However, pneumococcal serotype replacement may prevent changes in H. influenzae and S. aureus carriage among PCV7 recipients.
authors.affiliation: Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Lewnard
authors.affiliation: Pediatric Infectious Disease Unit, Soroka University Medical Center Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva.
authors.forename: Noga
authors.initials: N
authors.lastname: Givon-Lavi
authors.affiliation: Section of Biostatistics.
authors.forename: Amit
authors.initials: A
authors.lastname: Huppert
authors.affiliation: Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut.
authors.forename: Melinda M
authors.initials: MM
authors.lastname: Pettigrew
authors.affiliation: Section of Infectious Disease Epidemiology, Gertner Institute for Epidemiology and Health Policy Research Infectious Disease Unit, Sheba Medical Center, Ramat-Gan, Israel.
authors.forename: Gili
authors.initials: G
authors.lastname: Regev-Yochay
authors.affiliation: Pediatric Infectious Disease Unit, Soroka University Medical Center Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva.
authors.forename: Ron
authors.initials: R
authors.lastname: Dagan
authors.affiliation: Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Weinberger
mesh_terms: D002353:Carrier State / Q000453:epidemiology / Q000382:microbiology; D002675:Child, Preschool; D005260:Female; D006192:Haemophilus Infections / Q000453:epidemiology* / Q000382:microbiology; D006193:Haemophilus influenzae / Q000302:isolation & purification*; D000069443:Heptavalent Pneumococcal Conjugate Vaccine / Q000276:immunology*; D006801:Humans; D007223:Infant; D007557:Israel / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000382:microbiology; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013296:Streptococcus pneumoniae / Q000276:immunology / Q000302:isolation & purification; D018074:Vaccines, Conjugate
chemical_list: D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D018074:Vaccines, Conjugate
keywords: Haemophilus influenzae; Staphylococcus aureus; Streptococcus pneumoniae; pneumococcal conjugate vaccine; serotype replacement