Observed among Navajo children [20]. As has been reported [19, 21], higher carriage rates are observed in children less than 5 years of age. The younger the patient, the greater the chance of pneumococcal colonization [22]. Although, variability in carriage rates were not observed in different age groups from this study population, in general, the observed carriage rate is in agreement with previous studies conducted in others Brazilian cities [7, 23].Vaccine. Author manuscript; available in PMC 2017 February 03.Menezes et al.PageIn Brazil, as in many developing countries, a significant proportion of the population lives in slum communities [24]. These urban informal settlement, characterized by crowded households and lower incomes, have been identified as factors associated with increased pneumococcal carriage in children [25]. The household density phenomenon of pneumococcal disease and carriage has been discussed in previous studies [22, 25, 26]. In this cohort study, conducted in an urban community, the prevalence of pneumococcal carriage increased with increasing household density. Furthermore, we have identified that in this community, living in a crowded home (as defined by the number of household contacts with other children, the number of people per bed, or number of people per room) is associated with an increased risk for being colonized with pneumococcus. Households in Brazilian’ slums are very small in size and can be overcrowded with as many as 5 persons per room [11]. This study suggests that having a URTI in the last month increases the odds of being colonized, although not statistically significant. In addition, URTI also trended towards increasing the odds of carriage pneumococcal serotypes of lower invasiveness potential. Another study showed that influenza co-infection was associated with the greatest increases in the incidence of URTI caused by pneumococcal serotypes of lower invasiveness potential [27]. Unfortunately, we have not done laboratory diagnosis of influenza in this population to further explore this association. The serotype distribution among nasopharyngeal isolates in the present study was similar to that found in previous studies in Brazil [7?, 23] and other countries in Latin America and Europe [28, 29]. Overall, the serotypes isolated from the nasopharynx included the most common serotypes causing invasive disease [30] and represented in the PCV-10 vaccine ( 52 ). No significant AZD4547 site additional protection against carriage was provided by the PCV-13 formulation of the vaccine, as the two additional serotypes (3 and 19A) represented only 3 of carriage isolates. In Brazil, PCV13 is only available in private clinics at a high cost (about US 100/dose). The most common non-vaccine serotypes found in this study (16F, 15B/C, 6C and 34) are rarely associated with invasive disease in Salvador [30]. However, some of these non-vaccine serotypes (34 and 15B / C) are successful in carriage, with persistent carriage in the same children for up to six months. Other studies of colonization identified a high prevalence of those serotypes [21, 31], and these findings might indicate the possibility of serotype replacement, as observed in others places after PCV7 introduction [32, 33]. The rates of antimicrobial (R)-K-13675 site resistance observed in this study population were higher for both penicillin non-susceptible and SXT than previously shown in another colonization study conducted in Salvador [9]. Likewise, increasing resistance h.Observed among Navajo children [20]. As has been reported [19, 21], higher carriage rates are observed in children less than 5 years of age. The younger the patient, the greater the chance of pneumococcal colonization [22]. Although, variability in carriage rates were not observed in different age groups from this study population, in general, the observed carriage rate is in agreement with previous studies conducted in others Brazilian cities [7, 23].Vaccine. Author manuscript; available in PMC 2017 February 03.Menezes et al.PageIn Brazil, as in many developing countries, a significant proportion of the population lives in slum communities [24]. These urban informal settlement, characterized by crowded households and lower incomes, have been identified as factors associated with increased pneumococcal carriage in children [25]. The household density phenomenon of pneumococcal disease and carriage has been discussed in previous studies [22, 25, 26]. In this cohort study, conducted in an urban community, the prevalence of pneumococcal carriage increased with increasing household density. Furthermore, we have identified that in this community, living in a crowded home (as defined by the number of household contacts with other children, the number of people per bed, or number of people per room) is associated with an increased risk for being colonized with pneumococcus. Households in Brazilian’ slums are very small in size and can be overcrowded with as many as 5 persons per room [11]. This study suggests that having a URTI in the last month increases the odds of being colonized, although not statistically significant. In addition, URTI also trended towards increasing the odds of carriage pneumococcal serotypes of lower invasiveness potential. Another study showed that influenza co-infection was associated with the greatest increases in the incidence of URTI caused by pneumococcal serotypes of lower invasiveness potential [27]. Unfortunately, we have not done laboratory diagnosis of influenza in this population to further explore this association. The serotype distribution among nasopharyngeal isolates in the present study was similar to that found in previous studies in Brazil [7?, 23] and other countries in Latin America and Europe [28, 29]. Overall, the serotypes isolated from the nasopharynx included the most common serotypes causing invasive disease [30] and represented in the PCV-10 vaccine ( 52 ). No significant additional protection against carriage was provided by the PCV-13 formulation of the vaccine, as the two additional serotypes (3 and 19A) represented only 3 of carriage isolates. In Brazil, PCV13 is only available in private clinics at a high cost (about US 100/dose). The most common non-vaccine serotypes found in this study (16F, 15B/C, 6C and 34) are rarely associated with invasive disease in Salvador [30]. However, some of these non-vaccine serotypes (34 and 15B / C) are successful in carriage, with persistent carriage in the same children for up to six months. Other studies of colonization identified a high prevalence of those serotypes [21, 31], and these findings might indicate the possibility of serotype replacement, as observed in others places after PCV7 introduction [32, 33]. The rates of antimicrobial resistance observed in this study population were higher for both penicillin non-susceptible and SXT than previously shown in another colonization study conducted in Salvador [9]. Likewise, increasing resistance h.
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