Lack of pneumococcal carriage in the hospitalised elderly.

UNLABELLED There have been few surveys of Streptococcus pneumoniae and Neisseria meningitidis carriage in sick or frail elderly people who, with the very young, comprise the group who are at highest risk for pneumococcal disease. We studied pneumococcal carriage among participants in a pneumococcal immunisation study in the frail elderly. METHODS Subjects aged >or=60 years were recruited from a large tertiary referral hospital in Sydney, Australia. Nose and throat swabs were collected at the time of enrolment and 12 months after immunisation. RESULTS Before immunisation, only 1 of 315 participants was identified as a nasal carrier of S. pneumoniae; another was identified as throat carrier of N. meningitidis. None of the participants examined after immunisation was carrying either S. pneumoniae or N. meningitidis. CONCLUSION The low rate of pneumococcal carriage in this population of hospitalised elderly patients was unexpected. The most likely reason is that long-term carriage is rare in this population and suggests that pneumococcal disease primarily follows recent acquisition of S. pneumoniae types not associated with carriage.

[1]  Ron Dagan,et al.  Nasopharyngeal carriage of Streptococcus pneumoniae by adults and children in community and family settings. , 2004, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[2]  David Coleman,et al.  Invasive pneumococcal disease in Australia, 2002. , 2003, Communicable diseases intelligence quarterly report.

[3]  K. Ekdahl,et al.  Duration of nasopharyngeal carriage of penicillin-resistant Streptococcus pneumoniae: experiences from the South Swedish Pneumococcal Intervention Project. , 1997, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[4]  K. Poehling,et al.  National Impact of Universal Childhood Immunization With Pneumococcal Conjugate Vaccine on Outpatient Medical Care Visits in the United States , 2006, Pediatrics.

[5]  C. Whitney,et al.  Herd immunity and pneumococcal conjugate vaccine: a quantitative model. , 2007, Vaccine.

[6]  N. Yamanaka,et al.  Household Transmission of Streptococcus pneumoniae among Siblings with Acute Otitis Media , 2002, Journal of Clinical Microbiology.

[7]  D. Fisher,et al.  Pneumococcal carriage in an Alaskan drug-using population. , 1998, International journal of circumpolar health.

[8]  K. Oishi,et al.  High Rate of Transmission of Penicillin-Resistant Streptococcus pneumoniae between Parents and Children , 2002, Journal of Clinical Microbiology.

[9]  Tamara Pilishvili,et al.  Changing epidemiology of invasive pneumococcal disease among older adults in the era of pediatric pneumococcal conjugate vaccine. , 2005, JAMA.

[10]  M. Sande,et al.  Spread of Streptococcus pneumoniae in families. I. Carriage rates and distribution of types. , 1975, The Journal of infectious diseases.

[11]  D. Isaacman,et al.  Indirect effects associated with widespread vaccination of infants with heptavalent pneumococcal conjugate vaccine (PCV7; Prevnar). , 2007, Vaccine.

[12]  K. Auranen,et al.  Pneumococcal carriage in children during their first two years: important role of family exposure , 2001, The Pediatric infectious disease journal.

[13]  D. Hansman.  TYPE DISTRIBUTION AND ANTIBIOTIC SENSITIVITY OF DIPLOCOCCUS PNEUMONIAE A FIVE‐YEAR STUDY IN SYDNEY , 1974, The Medical journal of Australia.

[14]  K. O'Brien,et al.  Nasopharyngeal versus Oropharyngeal Sampling for Detection of Pneumococcal Carriage in Adults , 2004, Journal of Clinical Microbiology.

[15]  E. Shapiro,et al.  Pneumococcal vaccines: history, current status, and future directions. , 1999, The American journal of medicine.

[16]  C. Macintyre,et al.  Immunological responses to pneumococcal vaccine in frail older people. , 2009, Vaccine.

[17]  M. Farley,et al.  Changing characteristics of invasive pneumococcal disease in Metropolitan Atlanta, Georgia, after introduction of a 7-valent pneumococcal conjugate vaccine. , 2007, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[18]  J. E. Bennett,et al.  Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases , 2014 .

[19]  B. Gray,et al.  Epidemiologic studies of Streptococcus pneumoniae in infants: acquisition, carriage, and infection during the first 24 months of life. , 1980, The Journal of infectious diseases.

[20]  R. Dagan,et al.  Antibiotic-resistant pneumococci carried by young children do not appear to disseminate to adult members of a closed community. , 2001, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[21]  John E. Bennett,et al.  Principles and practice of infectious diseases. Vols 1 and 2. , 1979 .