Pneumococcal carriage in Tanzanian children with respiratory tract infections

Abstract

Master thesis, Programme in Medicine. TITLE: Pneumococcal carriage in Tanzanian children with respiratory tract infections. AUTHOR: Josefine Blomqvist. Background: Pneumonia is the leading cause of death in children worldwide and the most important pathogen causing the disease is the bacterium Streptococcus pneumoniae (the pneumococcus). This study aimed to determine the carriage rate and the resistance pattern of pneumococci in children with respiratory tract infection in the Moshi area in Tanzania, a region in which the pneumococcal vaccine was introduced in January 2013, and to relate the carriage rate to social factors and health status of the children. Methods: During October and November 2013, 187 randomly selected children under two years of age with symptoms of a respiratory tract infection (chills, cough, running nose, rapid or difficult breathing or sore throat) was included in the study. The children were recruited from three different health clinics in the Moshi area. A nasopharyngeal sample was taken from the children and a questionnaire was given to the parents. The samples were cultured at the clinical laboratory at Kilimanjaro Christian Medical Centre (KCMC) in Moshi, where isolates of pneumococci were identified and tested for antibiotic susceptibility. Results: The carriage rate of pneumococci in the nasopharynx among the children was 39%. One fourth of the pneumococcal isolates had reduced susceptibility against penicillin, while only 5.5% and 1.4% were non-susceptible against ceftriaxone and ampicillin, respectively. While almost all isolates were non-susceptible against co-trimoxazole (97%), the rate of pneumococci with reduced susceptibility against, erythromycin, tetracycline and clindamycin were 32%, 15% and 5.5%, respectively. No resistance was detected against quinolones. Carriage of pneumococci among the 187 children was not related to social factors (living conditions, parents’ level of education, breastfeeding etc.) or health status (antibiotic use, previous illness, vaccination status etc.). Discussion: The carriage rate is consistent with other studies in this area before the pneumococcal conjugate vaccination was initiated. The rather high rates of resistant bacteria, as shown in this study, confirm that penicillin or co-trimoxazole should not be used as empirical treatment of pneumonia in this area, while amoxicillin could still be the first drug of choice. Conclusion: More restrictions on the antibiotic use are needed in the Moshi area and may lower the resistant rates.