Pneumococcal Carriage in Children under Five Years in Uganda-Will Present Pneumococcal Conjugate Vaccines Be Appropriate?
BACKGROUND
Pneumonia is the major cause of death in children globally, with more than 900,000 deaths annually in children under five years of age. Streptococcus pneumoniae causes most deaths, most often in the form of community acquired pneumonia. Pneumococcal conjugate vaccines (PCVs) are currently being implemented in many low-income countries. PCVs decrease vaccine-type pneumococcal carriage, a prerequisite for invasive pneumococcal disease, and thereby affects pneumococcal disease and transmission. In Uganda, PCV was launched in 2014, but baseline data is lacking for pneumococcal serotypes in carriage.


OBJECTIVE
To study pneumococcal nasopharyngeal carriage and serotype distribution in children under 5 years of age prior to PCV introduction in Uganda.


METHODS
Three cross-sectional pneumococcal carriage surveys were conducted in 2008, 2009 and 2011, comprising respectively 150, 587 and 1024 randomly selected children aged less than five years from the Iganga/Mayuge Health and Demographic Surveillance Site. The caretakers were interviewed about illness history of the child and 1723 nasopharyngeal specimens were collected. From these, 927 isolates of S. pneumoniae were serotyped.


RESULTS
Overall, the carriage rate of S. pneumoniae was 56% (957/1723). Pneumococcal carriage was associated with illness on the day of the interview (OR = 1.50, p = 0.04). The most common pneumococcal serotypes were in descending order 19F (16%), 23F (9%), 6A (8%), 29 (7%) and 6B (7%). One percent of the strains were non-typeable. The potential serotype coverage rate for PCV10 was 42% and 54% for PCV13.


CONCLUSIONS
About half of circulating pneumococcal serotypes in carriage in the Ugandan under-five population studied was covered by available PCVs.
Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.|Public Health Agency of Sweden, Stockholm, Sweden.
Ann
http://orcid.org/0000-0002-8271-9486
A
Lindstrand
Makerere University School of Public Health, Kampala, Uganda.
Joan
J
Kalyango
Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.|Sachs' Children and Youth Hospital, Stockholm, Sweden.
Tobias
T
Alfvén
Public Health Agency of Sweden, Stockholm, Sweden.
Jessica
J
Darenberg
Makerere University School of Public Health, Kampala, Uganda.|Ministry of Health, Kampala, Uganda.|Health and Demographic Surveillance Site, Iganga/Mayuge, Uganda.
Daniel
D
Kadobera
Makerere University Faculty of Medicine, Kampala, Uganda.
Freddie
F
Bwanga
Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.|Makerere University School of Public Health, Kampala, Uganda.|Department of International Maternal and Child health, Women´s and children´s health, Uppsala University, Uppsala, Sweden.
Stefan
S
Peterson
Public Health Agency of Sweden, Stockholm, Sweden.|Department of Microbiology, Tumor and Cellbiology, Karolinska Institutet, Stockholm, Sweden.|Department of Clinical Microbiology, Karolinska University hospital, Stockholm, Sweden.
Birgitta
B
Henriques-Normark
Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.|Makerere University School of Public Health, Kampala, Uganda.|Malaria Consortium, London, United Kingdom.
Karin
K
Källander
D002353:Carrier State / Q000276:immunology / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys / Q000379:methods / Q000706:statistics & numerical data; D054884:Host-Pathogen Interactions / Q000276:immunology; D006801:Humans; D007223:Infant; D008297:Male; D009305:Nasopharynx / Q000276:immunology* / Q000382:microbiology; D011008:Pneumococcal Infections / Q000276:immunology* / Q000382:microbiology / Q000517:prevention & control; D022242:Pneumococcal Vaccines / Q000008:administration & dosage / Q000276:immunology*; D065288:Serogroup; D013296:Streptococcus pneumoniae / Q000145:classification / Q000276:immunology* / Q000502:physiology; D014454:Uganda; D018074:Vaccines, Conjugate / Q000008:administration & dosage / Q000276:immunology
D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate