title: Streptococcus pneumoniae and Haemophilus influenzae type b carriage in Chinese children aged 12-18 months in Shanghai, China: a cross-sectional study.
abstract: BACKGROUND
  The bacteria Streptococcus pneumoniae (pneumococcus) and Haemophilus influenzae type b (Hib) are leading causes of childhood pneumonia and meningitis and are major contributors to worldwide mortality in children younger than 5 years of age. Asymptomatic nasopharyngeal carriage of pneumococcus and Hib was determined for healthy children in Shanghai in 2009.
  
  
  METHODS
  Children from 5 immunization clinics were enrolled in this study. Specimens from the nasopharynx were collected and cultured in Columbia and chocolate agar to identify pneumococcal and Hib carriage. Pneumococcal specimens were serotyped with the Neufeld test, and antibiotic resistance for pneumococcal and Hib specimens used the E-test method. Significance of risk factors for carriage was assessed through chi-square tests.
  
  
  RESULTS
  Among 614 children, 16.6% had pneumococcal carriage and 8.0% Hib carriage. The predominant serotype of pneumococcus that was isolated was 19 F (52.9%); serotype coverage was 68.6% for both 7-valent pneumococcal conjugate vaccine (PCV) and PCV-10, and 82.3% for PCV-13. Household residency and father's education were both significantly related to pneumococcal and Hib carriage. The majority of S. pneumoniae isolates were sensitive to most antimicrobials but there were high levels of resistance to azithromycin (51.0 %) and erythromycin (51.0%). Haemophilus influenzae isolates were sensitive to almost all antimicrobials tested although 12.2% of isolates were resistant to ampicillin.
  
  
  CONCLUSIONS
  The pneumococcal and Hib vaccines require payment, and the children with the highest burden of disease may not be receiving these vaccines. Moreover, the presence of high antibiotic susceptibility towards pneumococcus, and to a lesser extent towards Hib, underscores the need for preventive protection against these diseases. Public funding of pneumococcal and Hib vaccines would be one mechanism to increase uptake of these vaccines.
authors.affiliation: Shanghai Centers for Disease Control and Prevention, 1380 Zhongshan West Road, Shanghai, 200336, China.
authors.forename: Jiayu
authors.initials: J
authors.lastname: Hu
authors.affiliation: Shanghai Centers for Disease Control and Prevention, 1380 Zhongshan West Road, Shanghai, 200336, China.
authors.forename: Xiaodong
authors.initials: X
authors.lastname: Sun
authors.affiliation: Shanghai Centers for Disease Control and Prevention, 1380 Zhongshan West Road, Shanghai, 200336, China.
authors.forename: Zhuoying
authors.initials: Z
authors.lastname: Huang
authors.affiliation: Department of Epidemiology, University of Michigan, 1415 Washington Heights, SPH II, Ann Arbor, MI, 48109, USA.
authors.forename: Abram L
authors.initials: AL
authors.lastname: Wagner
authors.affiliation: Department of Epidemiology, University of Michigan, 1415 Washington Heights, SPH II, Ann Arbor, MI, 48109, USA.
authors.forename: Bradley
authors.initials: B
authors.lastname: Carlson
authors.affiliation: Shanghai Centers for Disease Control and Prevention, 1380 Zhongshan West Road, Shanghai, 200336, China.
authors.forename: Jianping
authors.initials: J
authors.lastname: Yang
authors.affiliation: Shanghai Centers for Disease Control and Prevention, 1380 Zhongshan West Road, Shanghai, 200336, China.
authors.forename: Suwen
authors.initials: S
authors.lastname: Tang
authors.affiliation: Shanghai Centers for Disease Control and Prevention, 1380 Zhongshan West Road, Shanghai, 200336, China.
authors.forename: Yunyi
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Epidemiology, University of Michigan, 1415 Washington Heights, SPH II, Ann Arbor, MI, 48109, USA. mboulton@umich.edu.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Boulton
authors.affiliation: Shanghai Centers for Disease Control and Prevention, 1380 Zhongshan West Road, Shanghai, 200336, China. yuanzhengan@scdc.sh.cn.
authors.forename: Zhengan
authors.initials: Z
authors.lastname: Yuan
mesh_terms: D000890:Anti-Infective Agents / Q000494:pharmacology; D017963:Azithromycin / Q000494:pharmacology; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006192:Haemophilus Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D019741:Haemophilus influenzae type b / Q000187:drug effects / Q000302:isolation & purification*; D006801:Humans; D007223:Infant; D008297:Male; D008826:Microbial Sensitivity Tests; D009305:Nasopharynx / Q000382:microbiology; D016017:Odds Ratio; D011008:Pneumococcal Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D013296:Streptococcus pneumoniae / Q000187:drug effects / Q000302:isolation & purification*
chemical_list: D000890:Anti-Infective Agents; D017963:Azithromycin
keywords: Antimicrobial susceptibility; China; Haemophilus influenzae type b; Seroprevalence; Streptococcus pneumoniae