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Updated: Oct 12, 2025
Experimental Human Pneumococcal Carriage
Published on: February 15, 2013
Pneumococcal carriage among children in low and lower-middle-income countries: A systematic review
Ellen Signe Filtenborg Tvedskov1, Nichlas Hovmand2, Thomas Benfield2
1University of Copenhagen, Copenhagen, Denmark; Center of Research & Disruption of Infectious Diseases (CREDID), Department of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre, Denmark.
Insights
Pneumococcal conjugate vaccine (PCV) introduction has reduced vaccine-type Streptococcus pneumoniae carriage in children under five in low-income countries. However, overall carriage rates remain high, necessitating ongoing monitoring.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Streptococcus pneumoniae causes significant child mortality, particularly in low- and lower-middle-income countries.
- Pneumococcal conjugate vaccines (PCV) aim to reduce disease burden by targeting common S. pneumoniae serotypes.
Purpose of the Study:
- To review the prevalence of S. pneumoniae carriage in children under five in low- and lower-middle-income countries since 2012.
- To assess the impact of PCV on S. pneumoniae carriage rates.
Main Methods:
- Systematic literature review of PubMed publications.
- Screening of 149 identified publications, with 20 included in the final analysis.
Main Results:
- S. pneumoniae prevalence ranged from 26.7% to 90.7%.
- Vaccine-type carriage prevalence varied from 4.4% to 57.6%.
- PCV introduction led to a 15.6%–65.7% reduction in vaccine-type carriage, with half of post-PCV studies reporting rates below 15%.
Conclusions:
- PCV introduction has decreased vaccine-type S. pneumoniae carriage in most studied countries.
- Moderate PCV coverage and significant variations in overall S. pneumoniae carriage rates persist.
- Continuous monitoring is crucial for evaluating the impact of PCV10 and PCV13 introduction.
Objectives:
Streptococcus pneumoniae is one of the most important causes of diseases leading to child mortality, especially in low- and lower-middle-income countries. This review aims to describe the prevalence of carriage of S. pneumoniae and the impact of vaccination among children aged under five years in low- and lower-middle-income countries since 2012.
Method:
The study is a systematic review of the literature. Relevant publications were searched in PubMed and screened systematically for information on the prevalence of carriage of S. pneumoniae among children aged under five years. 149 publications were identified, and 20 were included in the review.
Results:
The prevalence of S. pneumoniae ranged between 26.7% - 90.7%. The prevalence of vaccine-type carriage ranged between 4.4% - 57.6% but generally decreased in countries after the introduction of PCV, with a reduction of 15.6% - 65.7%. Half of the post- pneumococcal conjugate vaccine (PCV) studies reported a vaccine-type carriage rate below 15%.
Conclusion:
Vaccine-type-carriage has decreased in most countries with the introduction of PCV. Still, coverage is only moderate, and carriage rates of S. pneumoniae vary significantly between countries. Continuous monitoring of carriage is needed to evaluate the effect of the further introduction of PCV10 and PCV13.
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