Microbial analysis of the upper respiratory tract to support the development of effective vaccine policy: a population-based pilot study

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• 作者：Abigail L Coughtrie ; MSc^a ; Robert N Whittaker ; DPH^a ; Nelupha Begum ; BSc^a ; Rebecca Anderson ; BSc^a ; Andrew Tuck ; FIBMS^a ; Saul N Faust ; MRCPCH^a ; ^b ; ^c ; Johanna M Jefferies ; PhD^a ; Ho Ming Yuen ; MSc^a ; Prof Paul J Roderick ; FFPH^a ; Mark A Mullee ; MSc^a ; Michael V Moore ; FRCGP^a ; Dr Stuart C Clarke ; FFPH^a ; ^c ; ^d ; ^e ; ^{s.c.clarke@southampton.ac.uk}
• 刊名：The Lancet
• 出版年：2012
• 出版时间：23 November, 2012
• 年：2012
• 卷：380
• 期：supp_S3
• 页码：S31
• 全文大小：1K

文摘

ass=""h4"">Background

Respiratory infections cause 7 % of deaths globally. Microbial upper respiratory tract (URT) carriage is a precursor to respiratory disease, meningitis, and septicaemia. Understanding carriage of URT pathogens is crucial to understanding the spread of respiratory disease. Vaccination against respiratory pathogens has reduced invasive disease rates but also profoundly modified carriage. Previous work shows the importance of individual URT pathogens, especially Streptococcus pneumoniae, and the effects of vaccination on carriage and disease. We aimed to assess carriage of multiple respiratory pathogens within a population benefitting from pneumococcal, Haemophilus influenzae b and meningitis C vaccines. This assessment will enable us to decipher the role of URT community dynamics.

ass=""h4"">Methods

We undertook a population-based respiratory carriage pilot study with 1574 participants, 1171 of whom were aged 5 years or older and 385 aged younger than 5 years (18 participants of age unknown because they did not return questionnaire). Patients registered at one of 19 Hampshire general practices, of any age and health status, were randomly selected using the ralloc command in Stata 12. Optimum sample collection method and carriage rates of the above species were assessed in two study groups: a self-swab group, in which participants did their own nose and mouth swabs; and a healthcare professional (HCP) group, in which HCPs did participants' nasopharyngeal and mouth swabs. Participant response rates in each study arm were compared. SPSS and a confidence interval calculator were used in the analysis.

ass=""h4"">Findings

Preliminary data suggest that nasal swabbing gave the greatest bacterial recovery at 40 % . Nasal carriage rates of S pneumoniae, Moraxella catarrhalis, Pseudomonas aeruginosa, Staphylococcus aureus, H influenzae, and Neisseria meningitidis were 10¡¤3 % , 2¡¤5 % , 1¡¤6 % , 21¡¤3 % , 2¡¤6 % , and 1¡¤7 % , respectively. Carriage of S pneumoniae and H influenzae were associated with young children whereas S aureus was associated with adults (p<0¡¤0001). Carriage of S pneumoniae and H influenzae were associated with recent respiratory infection (p<0¡¤0001 and p=0¡¤0003, respectively). Co-colonisation of S pneumoniae with other species was common, especially H influenzae. Polymicrobial carriage occurred in 2¡¤5 % (n=80) samples. Response rates were higher for self-swabbing (22¡¤3 % , 95 % CI 21¡¤2-23¡¤4) versus HCP-swabbing (6¡¤6 % , 5¡¤9-7¡¤3). However, isolation rates were greater for HCP-swabbing (36¡¤0 % , 30¡¤7-41¡¤3) versus self-swabbing (20¡¤2 % , 18¡¤0-22¡¤4).

ass=""h4"">Interpretation

Preliminary data show URT diversity and will aid continuation of the study in future years. We hope to use molecular methods to further understand the genetic composition and diversity of the URT community. Continuation of such studies will enable us to track changes in the rates of these interacting pathogens with ever-changing use of vaccines and antibiotics within the population. These studies are essential for enabling future improvements in clinical care by informing vaccine and antibiotic development and policy against infections causing meningitis, sepsis, and respiratory disease.

ass=""h4"">Funding

Bupa Foundation, The Rosetree's Trust.