Pneumococcal carriage and disease in adults in England 2011-2019: the importance of adults as a reservoir for pneumococcus in communities

ElSafadi, Dima, Hitchins, Lisa, Howard, Ashleigh, Aley, P, Bowman, J, Bertran, M, Collins, Andrea ORCID: https://orcid.org/0000-0002-4094-1572, Colin-Jones, R, Elterish, F, Fry, N K, Gordon, Stephen ORCID: https://orcid.org/0000-0001-6576-1116, Gould, K, Hinds, J, Horn, Emilie, Hyder-Wright, Angela, Kandasamy, R, Ladhani, S, Litt, D, Mitsi, Elena, Murphy, Annabel, Pollard, A J, Plested, E, Pojar, Sherin ORCID: https://orcid.org/0000-0002-7746-3279, Ratcliffe, H, Robertson, Maria, Robinson, H, Snape, M D, SolorzanoGonzalez, Carla, Voysey, M, Begier, E, Catusse, J, Lahuerta, M, Theilacker, C, Gessner, B D, Tiley, K S and Ferreira, Daniela ORCID: https://orcid.org/0000-0002-0594-0902 (2024) 'Pneumococcal carriage and disease in adults in England 2011-2019: the importance of adults as a reservoir for pneumococcus in communities'. Journal of Infectious Disease. (In Press)

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Abstract

Background
Pneumococcal carriage in children has been extensively studied, but carriage in healthy adults and its relationship to invasive pneumococcal disease (IPD) is less understood.
Methods
Nasal wash samples from adults without close contact with young children (Liverpool, UK), 2011-2019, were cultured, and culture-negative samples tested by PCR. Pneumococcal carriage in adults 18-44 years was compared with carriage among PCV-vaccinated children 13-48 months (nasopharyngeal swabs, Thames Valley, UK) and IPD data for England for the same ages for 2014-2019. Age-group specific serotype invasiveness was calculated and used with national IPD data to estimate carriage serotype distributions for adults aged 65+ years.
Results
In total 98 isolates (97 carriers) were identified from 1,631 adults aged 18+ years (age and sex standardized carriage prevalence 6.4%), with only three identified solely by PCR. Despite different carriage and IPD serotype distributions between adults and children, serotype invasiveness was highly correlated (R=0.9). Serotypes 3, 37 and 8 represented a higher proportion of adult carriage than expected from direct low-level transmission from children to adults. The predicted carriage serotype distributions for 65+ years aligned more closely with the carriage serotype distribution for young adults than young children.
Conclusions
The nasal wash technique is highly sensitive; additional benefit of PCR is limited. Comparison of carriage serotype distributions suggests some serotypes may be circulating preferentially within these specific young adults. Our data suggest that for some serotypes carried by adults 65+ years, other adults may be an important reservoir for transmission. Age groups such as older children should also be considered.

Item Type:	Article
Subjects:	WC Communicable Diseases > WC 20 Research (General) WC Communicable Diseases > Infection. Bacterial Infections > Bacterial Infections > WC 217 Pneumococcal infections
Faculty: Department:	Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):	https://doi.org/10.1093/infdis/jiae351
SWORD Depositor:	JISC Pubrouter
Depositing User:	JISC Pubrouter
Date Deposited:	06 Aug 2024 13:52
Last Modified:	10 Sep 2024 13:08
URI:	https://archive.lstmed.ac.uk/id/eprint/24994

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