S. pneumoniae highly prevalent in urban Indonesians, especially children

By Joanna Lyford, Senior medwireNews Reporter

Streptococcus pneumoniae (S. pneumoniae) is present in the nasopharyngeal mucosa in nearly half of children under the age of 5 years and one in 10 adults living in Java Island, Indonesia, a survey has found.

The survey also found that the serotypes in this population had limited susceptibility to currently used vaccines, pointing to a need for region-specific information and infection control strategies.

The researchers, led by Helmia Farida (Dr. Kariadi Hospital, Semarang, Indonesia), undertook a population-based study in Semarang, a city with 1.5 million residents in Central Java.

They obtained nasopharyngeal swabs from 243 healthy children aged 6 to 60 months and 253 healthy adults aged 45 to 70 years. Information on demographics, sanitation and hygiene were recorded for all participants.

The overall prevalence of S. pneumoniae was 43% in children and 11% in adults, report Farida and colleagues online in PLoS ONE. The proportion of carriers varied across the districts of the city, tending to be higher in suburban and eastern parts of the city.

In multivariate analysis, being a child, passive smoking and contact with a toddler at home were each significantly associated with an increased risk of S. pneumoniae carriage, with odds ratios of 7.7, 2.1 and 3.0, respectively.

A total of 142 strains of the bacterium were isolated from 133 individuals. The most frequent serotype was 6A/B, which accounted for 19% and 39% of isolates in children and adults, respectively.

The next most common was 15B/C, found in 13% and 10% of children and adults, respectively.

Worryingly, a high proportion of isolates were not susceptible to widely used antibacterial drugs, including the two agents recommended for first-line use in national clinical guidelines for the treatment of paediatric community-acquired pneumonia.

There was no difference in susceptibility patterns between children and adults, the authors note.

Noting that information on the burden of pneumonoccal disease in Indonesia is limited, probably due to technical problems, the authors say their findings underscore the need for surveillance “using locally implementable laboratory methods”.

They conclude: “The low coverage of commercially available vaccine against the serotypes found among children in this urban population, and the high proportion of non-susceptibility… suggest the need for region-specific information and strategies to control S. pneumoniae.”

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