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Dynamics of Pneumococcal Carriage in Adults: A New Look at an Old Paradigm
The Journal of Infectious Diseases ( IF 5.0 ) Pub Date : 2020-09-02 , DOI: 10.1093/infdis/jiaa558
Sónia T Almeida 1 , Ana Cristina Paulo 1 , Filipe Froes 2 , Hermínia de Lencastre 3, 4 , Raquel Sá-Leão 1
Affiliation  

Abstract
Background
Limited information is available on pneumococcal colonization among adults. We studied pneumococcal carriage dynamics in healthy adults using high-sensitivity approaches.
Methods
Eighty-seven adults (25–50 years old) were followed for 6 months in Portugal. Nasopharyngeal, oropharyngeal, and saliva samples were obtained monthly; pneumococcal carriers were also sampled weekly. Carriage was investigated by quantitative polymerase chain reaction (targeting lytA and piaB) and culture. Positive samples were serotyped.
Results
Approximately 20% of the adults were intermittent carriers; 10% were persistent carriers (>4 months). Pneumococcal acquisition and clearance rates were 16.5 (95% confidence interval [CI], 11.2–24.2) and 95.9 (95% CI, 62.3–145.0) cases/1000 person-weeks, respectively. Living with children increased pneumococcal acquisition (hazard ratio, 9.7 [95% CI, 2.6–20.5]; P < .001). Median duration of carriage was 7 weeks and did not depend on regular contact with children.
Conclusions
The pneumococcal carrier state in healthy adults is more dynamic than generally assumed: Acquisition is frequent and duration of carriage is often long. This suggests that some adults may act as reservoirs of pneumococci and hence, depending on the social structure of a community, the magnitude of herd effects potentially attainable through children vaccination may vary. These findings are important when designing strategies to prevent pneumococcal disease in adults.


中文翻译:

成人肺炎球菌携带动力学:旧范式的新视角

摘要
背景
关于成人肺炎球菌定植的信息有限。我们使用高灵敏度方法研究了健康成人的肺炎球菌携带动力学。
方法
在葡萄牙对 87 名成年人(25-50 岁)进行了为期 6 个月的随访。每月采集鼻咽、口咽和唾液样本;还每周对肺炎球菌携带者进行采样。通过定量聚合酶链式反应(靶向lytApiaB)和培养来研究载运。对阳性样品进行血清分型。
结果
大约 20% 的成年人是间歇性携带者;10% 是持续携带者(>4 个月)。肺炎球菌感染率和清除率分别为 16.5(95% 置信区间 [CI],11.2-24.2)和 95.9(95% CI,62.3-145.0)例/1000 人周。与儿童一起生活增加了肺炎球菌感染(风险比,9.7 [95% CI,2.6–20.5];P  < .001)。平均运输时间为 7 周,不依赖于与儿童的定期接触。
结论
健康成人的肺炎球菌携带者状态比一般假设的更具动态性:获得频繁且携带持续时间通常很长。这表明一些成年人可能是肺炎球菌的宿主,因此,根据社区的社会结构,通过儿童疫苗接种可能达到的群体效应的程度可能会有所不同。在设计预防成人肺炎球菌病的策略时,这些发现非常重要。
更新日期:2020-09-02
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