BACKGROUND: Infants and children are frequently colonized with pneumococcus. Recent nasopharyngeal acquisition of pneumococcus is thought to precede disease episodes. The increased risk of pneumococcal disease among Navajo and White Mountain Apache populations has been documented. Little is known about the dynamics of pneumococcal carriage in these populations. METHODS: A group randomized, controlled trial of 7-valent conjugate pneumococcal vaccine (PnCRM7, Wyeth) was conducted on the Navajo and Apache reservations. A nasopharyngeal (NP) carriage study was nested in the trial to evaluate the impact of PnCRM7 on carriage. Children <6 years of age had NP swabs collected at enrollment and at 6 and 12 months following enrollment. We analyzed carriage data from children in control vaccine randomized communities to describe the epidemiology of pneumococcal carriage. RESULTS: Of the 410 participants enrolled, 92% were colonized with pneumococcus at least once during the course of the study. Sixty-three percent of NP specimens were positive for pneumococcus. The most common serotypes were 6A, 6B, nontypable, 23F, 14, 19F, 19A, and 9V. Thirty-eight percent of isolates were vaccine serotypes. Age <2 years, male sex, daycare attendance, and having a sibling colonized with pneumococcus were associated with an increased risk of carriage. CONCLUSIONS: The high carriage prevalence among Navajo and Apache children reflects an intense exposure to pneumococcus. The lack of modifiable risk factors for carriage highlights the importance of preventive strategies for disease control.
RCT Entities:
BACKGROUND:Infants and children are frequently colonized with pneumococcus. Recent nasopharyngeal acquisition of pneumococcus is thought to precede disease episodes. The increased risk of pneumococcal disease among Navajo and White Mountain Apache populations has been documented. Little is known about the dynamics of pneumococcal carriage in these populations. METHODS: A group randomized, controlled trial of 7-valent conjugate pneumococcal vaccine (PnCRM7, Wyeth) was conducted on the Navajo and Apache reservations. A nasopharyngeal (NP) carriage study was nested in the trial to evaluate the impact of PnCRM7 on carriage. Children <6 years of age had NP swabs collected at enrollment and at 6 and 12 months following enrollment. We analyzed carriage data from children in control vaccine randomized communities to describe the epidemiology of pneumococcal carriage. RESULTS: Of the 410 participants enrolled, 92% were colonized with pneumococcus at least once during the course of the study. Sixty-three percent of NP specimens were positive for pneumococcus. The most common serotypes were 6A, 6B, nontypable, 23F, 14, 19F, 19A, and 9V. Thirty-eight percent of isolates were vaccine serotypes. Age <2 years, male sex, daycare attendance, and having a sibling colonized with pneumococcus were associated with an increased risk of carriage. CONCLUSIONS: The high carriage prevalence among Navajo and Apache children reflects an intense exposure to pneumococcus. The lack of modifiable risk factors for carriage highlights the importance of preventive strategies for disease control.
Authors: Jennifer R Scott; Jason Hinds; Katherine A Gould; Eugene V Millar; Raymond Reid; Mathuram Santosham; Katherine L O'Brien; William P Hanage Journal: J Infect Dis Date: 2012-04-25 Impact factor: 5.226
Authors: Taj Azarian; Lindsay R Grant; Maria Georgieva; Laura L Hammitt; Raymond Reid; Stephen D Bentley; David Goldblatt; Mathuran Santosham; Robert Weatherholtz; Paula Burbidge; Novalene Goklish; Claudette M Thompson; William P Hanage; Kate L O'Brien; Marc Lipsitch Journal: J Infect Dis Date: 2017-03-01 Impact factor: 5.226
Authors: Pilar Ciruela; Núria Soldevila; Laura Selva; Sergi Hernández; Juan Jose Garcia-Garcia; Fernando Moraga; Mariona F de Sevilla; Gemma Codina; Ana Maria Planes; Cristina Esteva; Francis Coll; Neus Cardeñosa; Iolanda Jordan; Joan Batalla; Luis Salleras; Carmen Muñoz-Almagro; Angela Domínguez Journal: Hum Vaccin Immunother Date: 2013-01-07 Impact factor: 3.452
Authors: Jennifer R Scott; Eugene V Millar; Marc Lipsitch; Lawrence H Moulton; Robert Weatherholtz; Mindy J Perilla; Delois M Jackson; Bernard Beall; Mariddie J Craig; Raymond Reid; Mathuram Santosham; Katherine L O'Brien Journal: J Infect Dis Date: 2011-11-29 Impact factor: 5.226
Authors: Shabir A Madhi; Avy Violari; Keith P Klugman; Gina Lin; James A McIntyre; Anne von Gottberg; Patrick Jean-Philippe; Mark F Cotton; Peter Adrian Journal: Vaccine Date: 2011-07-23 Impact factor: 3.641
Authors: Liset Olarte; Krow Ampofo; Chris Stockmann; Edward O Mason; Judy A Daly; Andrew T Pavia; Carrie L Byington Journal: Pediatrics Date: 2013-06-03 Impact factor: 7.124