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Updated: Mar 28, 2026

Experimental Human Pneumococcal Carriage
Published on: February 15, 2013
Epidemiological Markers for Interactions Among Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus
Joseph A Lewnard1, Noga Givon-Lavi2, Amit Huppert3
1Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut.
Insights
Polymicrobial carriage of Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus in children suggests true interactions, not just confounding factors. Pneumococcal vaccination did not alter overall carriage of these key respiratory pathogens.
Area of Science:
- Pediatric infectious diseases
- Microbiome research
- Vaccinology
Background:
- Cocolonization of Streptococcus pneumoniae and Haemophilus influenzae is common in children.
- An inverse relationship exists between Streptococcus pneumoniae/Haemophilus influenzae and Staphylococcus aureus colonization.
- Understanding these interactions is crucial for predicting outcomes of clinical interventions like pneumococcal vaccination.
Purpose of the Study:
- To investigate polymicrobial carriage patterns among children.
- To determine if observed cocolonization patterns are due to true interspecies interactions or confounding factors.
- To assess the impact of the 7-valent pneumococcal conjugate vaccine (PCV7) on carriage of Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus.
Main Methods:
- Longitudinal study of 769 children (369 Bedouin, 400 Jewish) in Israel.
- Data collected from a 7-valent pneumococcal conjugate vaccine (PCV7) trial.
- Children were swabbed 10 times between 2 and 30 months of age to analyze polymicrobial carriage.
Main Results:
- Distinct age and seasonal distributions were observed for the pathogens.
- Polymicrobial carriage associations remained significant after controlling for age and season.
- PCV7 introduction led to pneumococcal serotype replacement but did not affect the overall carriage of Streptococcus pneumoniae, Haemophilus influenzae, or Staphylococcus aureus.
Conclusions:
- The persistence of polymicrobial carriage patterns, independent of confounding factors, supports the existence of active interspecies interactions.
- Pneumococcal serotype replacement following PCV7 may influence or prevent changes in Haemophilus influenzae and Staphylococcus aureus carriage.
Background:
Cocolonization by Streptococcus pneumoniae and Haemophilus influenzae among children has been noted in numerous studies, as has an inverse relationship involving colonization with these species and Staphylococcus aureus. Interactions among these pathogens could mediate unanticipated outcomes of clinical interventions, including changes in H. influenzae and S. aureus disease incidence following pneumococcal vaccine introduction. However, it remains unclear whether cocolonization patterns represent true interspecies interactions or whether they result from confounding factors.
Methods:
We investigated polymicrobial carriage using longitudinal data from 369 Bedouin children and 400 Jewish children in Israel who were enrolled in a 7-valent pneumococcal conjugate vaccine (PCV7) trial. Children were swabbed 10 times between 2 and 30 months of age.
Results:
The pathogens followed distinct age and seasonal distributions, but polymicrobial carriage associations persisted after controlling for these and other confounding factors. Receipt of PCV7 resulted in pneumococcal serotype replacement but did not influence total carriage of S. pneumoniae, H. influenzae, or S. aureus.
Conclusions:
The fact that S. pneumoniae, H. influenzae, and S. aureus polymicrobial carriage patterns do not result from confounding by age and season supports the idea of active interspecies interactions. However, pneumococcal serotype replacement may prevent changes in H. influenzae and S. aureus carriage among PCV7 recipients.
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