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Updated: Oct 21, 2025
Experimental Human Pneumococcal Carriage
Published on: February 15, 2013
Impact of 13-Valent Pneumococcal Conjugate Vaccine on Nasopharyngeal Carriage Rates of Streptococcus pneumoniae in a
Maria G Dunn1, Fernanda C Lessa2, Jacqueline Sánchez3
1Department of Pediatrics, Global Health Center and Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Insights
Pneumococcal conjugate vaccine (PCV13) reduced vaccine-type pneumococcal colonization in young children. Increased PCV13 coverage could further decrease pneumococcal carriage, lowering disease risk.
Area of Science:
- Pediatrics
- Immunology
- Epidemiology
Background:
- Invasive pneumococcal disease (IPD) causes significant pediatric mortality.
- Pneumococcal colonization is a precursor to IPD.
- The Dominican Republic implemented the 13-valent pneumococcal conjugate vaccine (PCV13) in 2013 for routine infant immunization.
Purpose of the Study:
- To evaluate the prevalence of pneumococcal nasopharyngeal colonization after PCV13 introduction.
- To assess the impact of PCV13 on vaccine-type pneumococcal carriage in children.
Main Methods:
- A prospective cohort study involved 125 children aged 2-35 months in rural Dominican Republic.
- Nasopharyngeal swabs and clinical/vaccination data were collected at baseline and follow-up.
- Colonization rates, serotype distribution, and vaccination status associations were analyzed.
Main Results:
- Overall pneumococcal colonization was 62% at baseline and 60% at follow-up.
- Vaccine-type colonization was 25% at baseline and 28% at follow-up.
- Children up-to-date with PCV13 vaccination showed reduced vaccine-type pneumococcal colonization at baseline.
Conclusions:
- Vaccine-type pneumococcal colonization remained prevalent three years post-PCV13 introduction.
- Low vaccination coverage for the full PCV13 schedule may have contributed to persistent colonization.
- Increased PCV13 coverage is suggested to significantly reduce pneumococcal vaccine-type carriage.
Background:
Invasive pneumococcal disease (IPD) leads to thousands of pediatric deaths annually. Pneumococcal colonization precedes IPD. In 2013, the Dominican Republic introduced the 13-valent pneumococcal conjugate vaccine (PCV13) into its routine infant immunization program, with doses at ages 2, 4, and 12 months. Prevalence of pneumococcal nasopharyngeal colonization was evaluated post-PCV13 introduction.
Methods:
A prospective cohort study of 125 children aged 2-35 months was conducted in a rural Dominican Republic community November 2016 through July 2017. Nasopharyngeal swabs and clinical and vaccination data were collected at enrollment and 4-6 months later. Serotypes included in PCV13 were defined as vaccine-type. Colonization rates and serotype distribution were compared at baseline and follow-up, and the association between colonization and vaccination status among the entire cohort was evaluated at each time point.
Results:
Of 125 children enrolled, 118 (94%) completed follow-up. Overall and vaccine-type pneumococcal colonization rates were 62% and 25%, respectively, at baseline and 60% and 28% at follow-up. Among children age-eligible for 3 doses, 50% and 51% were fully vaccinated at baseline and follow-up, respectively. At baseline assessment, children up-to-date for age for PCV13 were less likely to be colonized with vaccine-type pneumococci than children not up-to-date, and the same was found for fully vaccinated children (3 doses) compared to those not fully vaccinated (odds ratios [ORs], 0.38 [95% confidence interval {CI}, .18-.79], and 0.14 [95% CI, .04-.45], respectively). The same associations were not found at follow-up assessment.
Conclusions:
Three years post -PCV13 introduction, vaccine-type colonization rates remained high. Low vaccination coverage for 3 PCV13 doses may have contributed. The protective effect of PCV13 on vaccine-type carriage suggests an increase in PCV13 coverage could lead to substantial declines in pneumococcal vaccine-type carriage.
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