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High Rates of Transmission of and Colonization by Streptococcus pneumoniae and Haemophilus influenzae within a Day Care Center Revealed in a Longitudinal Study

Raquel Sá-Leão,^1,* Sónia Nunes,^1, António Brito-Avô,² Carla R. Alves,¹ João A. Carriço,^3,4 Joana Saldanha,⁵ Jonas S. Almeida,^3,6 Ilda Santos-Sanches,^1,7 and Hermíniade de Lencastre^1,8

Laboratory of Molecular Genetics, Instituto de Tecnologia Química e Biológica, Universidade Nova de Lisboa, Oeiras, Portugal,¹ Centro de Saúde de Oeiras, Oeiras, Portugal,² Biomathematics Group, Instituto de Tecnologia Química e Biológica, Universidade Nova de Lisboa, Oeiras, Portugal,³ KDBIO, Instituto de Engenharia de Sistemas e Computadores—Investigação e Desenvolvimento, Lisboa, Portugal,⁴ Hospital de Santa Maria, Lisboa, Portugal,⁵ Department of Bioinformatics and Computational Biology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas,⁶ Centro de Recursos Microbiológicos, Faculdade de Ciências e Tecnologia, Universidade Nova de Lisboa, Monte da Caparica, Portugal,⁷ Laboratory of Microbiology, The Rockefeller University, New York, New York⁸

Received 3 August 2007/ Returned for modification 9 October 2007/ Accepted 1 November 2007

Day care centers (DCCs) are unique settings where young children are at increased risk for colonization by pneumococci and Haemophilus influenzae. Although point prevalence studies in DCCs are frequent, only a few longitudinal studies on the dynamics of colonization have been published. We conducted a 1-year longitudinal study with 11 sampling periods on nasopharyngeal carriage of pneumococci and H. influenzae among 47 children who attended a single DCC. All isolates were antibiotyped and genotyped by pulsed-field gel electrophoresis. Pneumococci were also serotyped. Of the 414 samples obtained, 61.4% contained pneumococci, and 87% contained H. influenzae. Only 8.3% of the samples were negative for both species. Twenty-one pneumococcal clones and 47 H. influenzae clones were identified. Introduction of clones occurred during all year. Ninety-eight percent and 96% of all pneumococcal and H. influenzae isolates, respectively, belonged to clones shared by more than one child. Children were sequentially colonized with up to six pneumococcal clones (mean, 3.6) and five serotypes and nine H. influenzae clones (mean, 7.1). Clones with increased capacity for transmission and/or prolonged colonization were identified in both species. These two fitness properties appeared to be independent. In conclusion, among DCC attendees, a high rate of acquisition and turnover of strains was observed, and all children were overwhelmingly colonized by clones shared with others. DCCs are units where permanent introduction of new clones occurs, and attendees, as a whole, provide a pool of hosts where the fittest clones find privileged opportunities to persist and expand.

Published ahead of print on 14 November 2007.

R.S.-L. and S.N. contributed equally to this article.