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Review
. 2014 Aug 1;9(8):e103293.
doi: 10.1371/journal.pone.0103293. eCollection 2014.

Carriage of Streptococcus pneumoniae and other respiratory bacterial pathogens in low and lower-middle income countries: a systematic review and meta-analysis

Richard A Adegbola  1 , Rodrigo DeAntonio  1 , Philip C Hill  2 , Anna Roca  3 , Effua Usuf  3 , Bernard Hoet  1 , Brian M Greenwood  4
Affiliations
Review

Carriage of Streptococcus pneumoniae and other respiratory bacterial pathogens in low and lower-middle income countries: a systematic review and meta-analysis

Richard A Adegbola et al. PLoS One. .

Abstract

Background: Infection with Streptococcus pneumoniae is a major cause of childhood morbidity and mortality worldwide, especially in low income countries where pneumococcal conjugate vaccines (PCVs) are still underused. In countries where PCVs have been introduced, much of their efficacy has resulted from their impact on nasopharyngeal carriage in vaccinated children. Understanding the epidemiology of carriage for S. pneumoniae and other common respiratory bacteria in developing countries is crucial for implementing appropriate vaccination strategies and evaluating their impact.

Methods and findings: We have systematically reviewed published studies reporting nasopharyngeal or oropharyngeal carriage of S. pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus, and Neisseria meningitidis in children and adults in low and lower-middle income countries. Studies reporting pneumococcal carriage for healthy children <5 years of age were selected for a meta-analysis. The prevalences of carriage for S. pneumoniae, H. influenzae, and M. catarrhalis were generally higher in low income than in lower-middle income countries and were higher in young children than in adults. The prevalence of S. aureus was high in neonates. Meta-analysis of data from young children before the introduction of PCVs showed a pooled prevalence estimate of 64.8% (95% confidence interval, 49.8%-76.1%) in low income countries and 47.8% (95% confidence interval, 44.7%-50.8%) in lower-middle income countries. The most frequent serotypes were 6A, 6B, 19A, 19F, and 23F.

Conclusions: In low and lower-middle income countries, pneumococcal carriage is frequent, especially in children, and the spectrum of serotypes is wide. However, because data are limited, additional studies are needed to adequately assess the impact of PCV introduction on carriage of respiratory bacteria in these countries.

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Conflict of interest statement

Competing Interests: Drs. Philip C. Hill, Anna Roca, and Effua Usuf have no conflicts of interest to declare. The institution that employs Dr. Brian M. Greenwood received a grant from PATH to support a clinical trial of a pneumococcal protein vaccine produced by GlaxoSmithKline and Dr. Greenwood has received travel fees for meetings related to this trial. Drs. Richard A. Adegbola, Rodrigo DeAntonio, and Bernard Hoet are employees of the GlaxoSmithKline group of companies and declare ownership of GlaxoSmithKline shares and stock options. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials. This manuscript is a systematic review and all included references are publicly available.

Figures

Figure 1
Figure 1. Flowchart of study selection.
CoCanCPG, Coordination of Cancer Clinical Practice Guidelines.
Figure 2
Figure 2. Meta-analysis of S. pneumoniae carriage in healthy children under 5 years of age.
(A) Low income countries. (B) Lower-middle income countries. The point prevalence estimate for each study is represented by a square. The 95% confidence interval (CI) for each study is represented by a horizontal line crossing the square. The size of the square corresponds to the weight of the study in the meta-analysis. All data were obtained before the introduction of the 7-valent pneumococcal conjugate vaccine.
See this image and copyright information in PMC

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