PubMed searches and references from relevant articles and recent conferences were used for this paper. Search terms were “Streptococcus pneumoniae and (colonization or carriage)”, “Streptococcus pneumoniae and children”, “Streptococcus pneumoniae and vaccin*”, “streptococ* and protein and vaccin*”, “streptococcus and (interference or interaction or competition)”, “Streptococcus pneumoniae and (protection or immun*)”. Only papers published in English were reviewed.
ReviewStreptococcus pneumoniae colonisation: the key to pneumococcal disease
Section snippets
Dynamics of nasopharyngeal colonisation
The upper respiratory tract is the ecological niche for many bacterial species. In children, the nasopharyngeal flora become established during the first months of life.7, 18 A broad variety of microorganisms including S pneumoniae, H influenzae, and M catarrhalis can colonise the nasopharyngeal niche. Every individual is likely to be colonised with these pathogens at least once during life. In general, there is simply asymptomatic carriage; but in some cases, colonisation is followed by
Mechanism of colonisation
The pneumococcal outer surface is covered by a polysaccharide capsule. Capsular polysaccharides are highly heterogeneous, and almost 100 different capsular serotypes have been described so far.5 The polysaccharide capsule is the most important virulence factor of pneumococci because it protects the bacteria from phagocytosis.41 Reduced expression results in greater access of antibodies and complement to the pneumococcal surface,42 and hence increased clearance by the immune system. Capsular
Pneumococcal colonisation in children
Nasopharyngeal colonisation of S pneumoniae in children mainly depends on age. We investigated the age-dependent carriage rate in a large cohort of healthy children and adolescents aged 1–19 years.38 The peak incidence of pneumococcal colonisation was 55% at the age of 3 years. There was then a steady decline until a stable prevalence of 8% was observed after the age of 10 years. Although most other colonisation studies have not extended the age-group studied into adulthood, those that did have
Serotype distribution among pneumococcal isolates
The serotype distribution among nasopharyngeal carriage isolates varies slightly by country, age-group, and type of cohort. Europe and the US show similar serotype distributions with minor differences in several serotypes. For example, in the Netherlands, serotypes 19F (19%), 6B (16%), 6A (13%), 9V (7%), and 23F (7%) are most frequently found among children under 3 years of age.23 In Greece, similarly, the most predominant serotypes among children younger than 2 years are 6B, 19F, 23F, 14, and
Current vaccine strategies
The ACIP has recommended vaccination against pneumococcal infections for several risk groups. Although the 23-valent vaccine, with a theoretical coverage of 85–90% of circulating strains, is immunogenic in adults and children older than 5 years, young children (<2 years) have a severely impaired antibody response to polysaccharide vaccination.93, 101, 103 Therefore, the recommendations of the ACIP in 1997 excluded the major risk group of children under 2 years of age. The remaining groups were
New vaccine strategies
New vaccine strategies focus on the use of pneumococcal surface-associated proteins. This approach has several advantages. First, the production of protein vaccines is expected to be cheap and therefore within reach of developing countries. Second, a protein-based vaccine is expected to elicit protection in all age-groups, including children younger than 2 years. Finally, if highly conserved proteins or protein epitopes are used as vaccine components, broad and serotype-independent protection
Discussion
Nasopharyngeal colonisation provides an important key to the burden of pneumococcal disease and its prevention. Colonisation not only is obligatory for invasive disease, but also provides the basis for horizontal spread of pneumococci.
Although the major goal of all vaccine strategies is to reduce the burden of pneumococcal disease, they involve also prevention of pneumococcal colonisation. Opinion about reduction in colonisation ranges from “secondary aim” to “fortunate side-effect”. However,
Search strategy and selection criteria
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