Unmasking Pneumococcal Carriage in a High Human Immunodeficiency Virus (HIV) Prevalence Population in two Community Cohorts in South Africa, 2016–2018: The PHIRST Study

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dc.contributor.authorMaimuna Carrim
dc.contributor.authorStefano Tempia
dc.contributor.authorDeus Thindwa
dc.contributor.authorNeil A Martinson
dc.contributor.authorKathleen Kahn
dc.contributor.authorStefan Flasche
dc.contributor.authorOrienka Hellferscee
dc.contributor.authorFlorette K Treurnicht
dc.contributor.authorMeredith L McMorrow
dc.contributor.authorJocelyn Moyes
dc.contributor.authorThulisa Mkhencele
dc.contributor.authorAzwifarwi Mathunjwa
dc.contributor.authorJackie Kleynhans
dc.contributor.authorLimakatso Lebina
dc.contributor.authorKatlego Mothlaoleng
dc.contributor.authorFloidy Wafawanaka
dc.contributor.authorFrancesc Xavier Gómez-Olivé
dc.contributor.authorCheryl Cohen
dc.contributor.authorAnne von Gottberg
dc.contributor.authorNicole Wolter
dc.date.accessioned2023-10-19T10:46:03Z
dc.date.available2023-10-19T10:46:03Z
dc.date.issued2022-07-19
dc.departmentSA-MRC/Wits Agincourt UnitE
dc.description.abstractBackground Longitudinal pneumococcus colonization data in high human immunodeficiency virus (HIV) prevalence settings following pneumococcal conjugate vaccine introduction are limited. Methods In 327 randomly selected households, 1684 individuals were enrolled and followed-up for 6 to 10 months during 2016 through 2018 from 2 communities. Nasopharyngeal swabs were collected twice weekly and tested for pneumococcus using quantitative lytA real-time polymerase chain reaction. A Markov model was fitted to the data to define the start and end of an episode of colonization. We assessed factors associated with colonization using logistic regression. Results During the study period, 98% (1655/1684) of participants were colonized with pneumococcus at least once. Younger age (<5 years: adjusted odds ratio [aOR], 14.1; 95% confidence [CI], 1.8–111.3, and 5–24 years: aOR, 4.8, 95% CI, 1.9–11.9, compared with 25–44 years) and HIV infection (aOR, 10.1; 95% CI, 1.3–77.1) were associated with increased odds of colonization. Children aged <5 years had fewer colonization episodes (median, 9) than individuals ≥5 years (median, 18; P < .001) but had a longer episode duration (<5 years: 35.5 days; interquartile range, 17–88) vs. ≥5 years: 5.5 days (4–12). High pneumococcal loads were associated with age (<1 year: aOR 25.4; 95% CI, 7.4–87.6; 1–4 years: aOR 13.5, 95% CI 8.3–22.9; 5–14 years: aOR 3.1, 95% CI, 2.1–4.4 vs. 45–65 year old patients) and HIV infection (aOR 1.7; 95% CI 1.2–2.4). Conclusions We observed high levels of pneumococcus colonization across all age groups. Children and people with HIV were more likely to be colonized and had higher pneumococcal loads. Carriage duration decreased with age highlighting that children remain important in pneumococcal transmission.
dc.description.librarianPM2023
dc.facultyFaculty of Health Sciences
dc.identifier.urihttps://hdl.handle.net/10539/36824
dc.language.isoen
dc.schoolPublic Health
dc.subjectStreptococcus pneumoniae, carriage, pneumococcus colonization, community cohort, South Africa
dc.titleUnmasking Pneumococcal Carriage in a High Human Immunodeficiency Virus (HIV) Prevalence Population in two Community Cohorts in South Africa, 2016–2018: The PHIRST Study
dc.typeArticle
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