Pneumococcal carriage in United Kingdom families: estimating serotype-specific transmission parameters from longitudinal data.

Repeated observations of pneumococcal infection in 121 United Kingdom families (October 2001-July 2002) were used to explore the transmission properties of five highly prevalent pneumococcal serotypes (6A, 6B, 14, 19F, 23F). A family-based Markov model was developed, and maximum likelihood estimates were produced for model parameters. The authors found higher community acquisition rates among preschool children for all serotypes and higher within-household transmission for 6A and 14. Significant differences in the spontaneous clearance rate were estimated between age categories and serotypes, with 6B being carried for almost 4 months in children. Different mechanisms of competition between serotypes were investigated, and a complete exclusion model (i.e., the resident strain cannot be outcompeted by challengers) was discarded in favor of a competing mechanism that leaves a resident serotype partially or fully susceptible to challengers. Large variation was found in the challenging strength, which was low for 19F and 23F and high for 6A and 6B. Serotype 6B was the only one characterized by high resistance capacity. Only small differences in the transmission characteristics were found when vaccine and nonvaccine serotypes were grouped, suggesting that a serotype-specific analysis is needed to detect distinctive serotype behavior.