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Updated: May 25, 2025

Experimental Human Pneumococcal Carriage
Published on: February 15, 2013
Nasopharyngeal Carriage, Antimicrobial Resistance, and Serotype Distribution of Streptococcus pneumoniae in Children
Rayane Rafei1, Mazen Zaylaa2, Mohamad Diab1
1Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School for Science and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon.
Insights
Pneumococcal conjugate vaccines (PCV) showed limited coverage for circulating serotypes in Lebanese children in 2016. This highlights the need for broader-coverage vaccines to combat antibiotic-resistant bacteria.
Area of Science:
- Microbiology
- Epidemiology
- Vaccinology
Background:
- Nasopharyngeal carriage of *Streptococcus pneumoniae* is a key transmission route and precursor to invasive pneumococcal disease.
- Monitoring pneumococcal carriage serotypes and antimicrobial resistance is crucial following vaccine integration.
Purpose of the Study:
- To investigate *S. pneumoniae* carriage epidemiology in children under five in Tripoli, Lebanon, in 2016.
- To assess the impact of PCV13 integration on pneumococcal carriage and resistance patterns.
Main Methods:
- A cross-sectional study was conducted among 104 children under five years old in Tripoli, Lebanon.
- Nasopharyngeal swabs were cultured for *S. pneumoniae*, followed by antimicrobial susceptibility testing and serotyping.
Main Results:
- *S. pneumoniae* was carried by 54.8% of children, with 26.3% of isolates showing multidrug resistance.
- Limited coverage was observed for PCV13 (31.3%) and PCV20 (50%) vaccine serotypes.
- Serotypes 11A, 19F, 23A, and Sg24 were the most prevalent, accounting for 37.5% of isolates.
Conclusions:
- A significant burden of antibiotic-resistant pneumococci exists in young children in Tripoli.
- Current PCV13 vaccine coverage is insufficient, necessitating vaccines with broader serotype coverage in Lebanon.
- Further longitudinal studies are needed to evaluate PCV impact and guide future vaccine development.
Background:
The nasopharyngeal carriage of Streptococcus pneumoniae can be the source of transmission between humans and the starting step towards invasive pneumococcal diseases. Data on the carriage of pneumococci in children before and after the pneumococcal conjugate vaccines (PCV) integration in a country are essential for monitoring any change in pneumococcal carriage serotypes and their antimicrobial-resistance profiles.
Methods:
We investigated the epidemiology of S. pneumoniae carriage among children younger than five years old in Tripoli, Lebanon, in 2016, the same year of integration of PCV13 in the country's Expanded Program on Immunization.
Results:
Of 104 participating children, 57 (54.8%) gave a positive culture for S. pneumoniae. Antimicrobial susceptibility testing revealed that 26.3% of isolates were multidrug-resistant. Resistance was detected mainly against oxacillin (77.2%), tetracycline (29.8%), erythromycin (22.8%), trimethoprim-sulfamethoxazole (22.8%), clindamycin (19.3%), minocycline (19.3%), and teicoplanin (1.8%). Serotyping analysis identified 14 distinct serotypes, with only 31.3% and 50% of isolates corresponding to vaccine serotypes covered by PCV13 and PCV20, respectively. The most common serotypes were 11A, 19F, 23A, and those of serogroup 24 (Sg24) accounted for 37.5% of the serotyped isolates.
Conclusions:
Our findings have revealed the circulation of a pool of pneumococci isolates with high levels of antibiotic resistance and different degrees of likelihood of causing invasive diseases in children under five years old in Tripoli in 2016. The overall limited PCV13 vaccine coverage in this study highlighted the need for vaccines with greater coverage in the immunization programs in Lebanon. Longitudinal national studies investigating the carriage of pneumococci in children are required to further assess the impact of the PCV vaccine on pneumococci carriage in children and steer new vaccine development.
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