Pneumococcal carriage in healthy Tanzanian toddlers

Master thesis, Programme in Medicine. TITLE: Pneumococcal carriage in healthy Tanzanian toddlers -A cross sectional study in Moshi, Tanzania. AUTHOR: Fredrika Johansson. 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 healthy children below 2 years of age in Moshi in northern Tanzania. In this region the pneumococcal conjugate vaccine was introduced into the child vaccination programme in January 2013. A second aim was to determine if there were any correlations between carriage of the bacteria and health status or socio-economic factors. Methods: During October and November 2013, 150 randomly selected healthy children were included in the study. The children were recruited from three different health clinics in Moshi. A nasopharyngeal sample was taken from the children and a questionnaire was given to the parents. The samples were then cultured for pneumococci and the resistance pattern of the bacteria was determined at the clinical laboratory at Kilimanjaro Christian Medical Centre (KCMC) in Moshi. Results: The carriage rate of pneumococci in the nasopharynx among the children was 29%. The rate of pneumococcal strains with reduced susceptibility against penicillin was 37 %, the rates against ceftriaxon and ampicillin were 2% for each. The rate of pneumococci with reduced susceptibility against co-trimoxazole, tetracycline and erythromycin were 95%, 33% and 10% respectively. All isolates were sensitive to norfloxacin and clindamycin. The only factors significantly more common in children carrying pneumococci than in children without pneumococci were malaria and among children aged 0-6 months exclusively breastfeeding. Discussion: The rather high rates of non-susceptible 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 may be needed in the Moshi area