Pneumococcal Carriage in Children in The Netherlands: a Molecular Epidemiological Study

doi:10.1128/JCM.39.9.3316-3320.2001

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Journal of Clinical Microbiology, September 2001, p. 3316-3320, Vol. 39, No. 9
0095-1137/01/$04.00+0 DOI: 10.1128/JCM.39.9.3316-3320.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.

Pneumococcal Carriage in Children in The Netherlands: a Molecular Epidemiological Study

Debby Bogaert,¹ Marlene N. Engelen,² Anja J. M. Timmers-Reker,¹ Kees P. Elzenaar,³ Paul G. H. Peerbooms,² Roel A. Coutinho,² Ronald de Groot,¹ and Peter W. M. Hermans¹^,^*

Department of Pediatrics, Sophia Children's Hospital, Erasmus University Rotterdam, Rotterdam,¹ Departments of Infectious Diseases and Youth Healthcare, Municipal Health Service, Amsterdam,² and National Institute of Public Health and the Environment, Bilthoven,³ The Netherlands

Received 16 April 2001/Returned for modification 24 June 2001/Accepted 5 July 2001

In 1999, Engelen and coworkers investigated colonization in Amsterdam among 259 children attending 16 day-care centers (DCCs)and among 276 children who did not attend day-care centers (NDCCs).A 1.6- to 3.4-fold increased risk for nasopharyngeal colonizationwas observed in children attending DCCs compared with NDCC children,while no difference in antibiotic resistance was found betweengroups. The serotype and genotype distributions of 305 nasopharyngealStreptococcus pneumoniae isolates of the latter study were investigated.The predominant serotypes in both the DCC and the NDCC groupsincluded 19F (19 and 18%, respectively), 6B (14 and 16%, respectively),6A (13 and 7%, respectively), 23F (9 and 7%, respectively), and9V (7 and 7%, respectively). The theoretical vaccine coverageof the 7-valent conjugate vaccine was 59% for the DCC childrenand 56% for the NDCC group. Genetic analysis of the pneumococcalisolates revealed 75% clustering among pneumococci isolated fromDCC attendees versus 50% among the NDCC children. The averagepneumococcal cluster size in the DCC group was 3.8 and 4.6 isolatesfor two respective sample dates (range, 2 to 13 isolates per cluster),while the average cluster size for the NDCC group was 3.0 (range,2 to 6 isolates per cluster). Similar to observations made inother countries, these results indicate a higher risk for horizontalspread of pneumococci in Dutch DCCs than in the general population.This study emphasizes the importance of molecular epidemiologicalmonitoring before, during, and after implementation of pneumococcalconjugate vaccination in national vaccination programs forchildren.

^* Corresponding author. Mailing address: Laboratory of Pediatrics, Room Ee1500, Erasmus University Rotterdam, P.O. Box 1738,3000 DR Rotterdam, The Netherlands. Phone: 31-10-4087998. Fax:31-10-4089486. E-mail: hermans{at}kgk.fgg.eur.nl.

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