Factors associated with pneumococcal carriage and density in children and adults in Fiji, using four cross-sectional surveys

by Eleanor F. G. Neal, Cattram D. Nguyen, Felista T. Ratu, Eileen M. Dunne, Mike Kama, Belinda D. Ortika, Laura K. Boelsen, Joseph Kado, Lisi Tikoduadua, Rachel Devi, Evelyn Tuivaga, Rita C. Reyburn, Catherine Satzke, Eric Rafai, E. Kim Mulholland, Fiona M. Russell

This study describes predictors of pneumococcal nasopharyngeal carriage and density in Fiji. We used data from four annual (2012–2015) cross-sectional surveys, pre- and post-introduction of ten-valent pneumococcal conjugate vaccine (PCV10) in October 2012. Infants (5–8 weeks), toddlers (12–23 months), children (2–6 years), and their caregivers participated. Pneumococci were detected and quantified using lytA qPCR, with molecular serotyping by microarray. Logistic and quantile regression were used to determine predictors of pneumococcal carriage and density, respectively. There were 8,109 participants. Pneumococcal carriage was negatively associated with years post-PCV10 introduction (global P<0.001), and positively associated with indigenous iTaukei ethnicity (aOR 2.74 [95% CI 2.17–3.45] P<0.001); young age (infant, toddler, and child compared with caregiver participant groups) (global P<0.001); urban residence (aOR 1.45 [95% CI 1.30–2.57] P<0.001); living with ≥2 children <5 years of age (aOR 1.42 [95% CI 1.27–1.59] P<0.001); low family income (aOR 1.44 [95% CI 1.28–1.62] P<0.001); and upper respiratory tract infection (URTI) symptoms (aOR 1.77 [95% CI 1.57–2.01] P<0.001). Predictors were similar for PCV10 and non-PCV10 carriage, except PCV10 carriage was negatively associated with PCV10 vaccination (0.58 [95% CI 0.41–0.82] P = 0.002) and positively associated with exposure to household cigarette smoke (aOR 1.21 [95% CI 1.02–1.43] P = 0.031), while there was no association between years post-PCV10 introduction and non-PCV10 carriage. Pneumococcal density was positively associated with URTI symptoms (adjusted median difference 0.28 [95% CI 0.16, 0.40] P<0.001) and toddler and child, compared with caregiver, participant groups (global P = 0.008). Predictors were similar for PCV10 and non-PCV10 density, except infant, toddler, and child participant groups were not associated with PCV10 density. PCV10 introduction was associated with reduced the odds of overall and PCV10 pneumococcal carriage in Fiji. However, after adjustment iTaukei ethnicity was positively associated with pneumococcal carriage compared with Fijians of Indian Descent, despite similar PCV10 coverage rates.