1887

Abstract

For children, the gold standard for the detection of pneumococcal carriage is conventional culture of a nasopharyngeal swab. Saliva, however, has a history as one of the most sensitive methods for surveillance of pneumococcal colonization and has recently been shown to improve carriage detection in older age groups. Here, we compared the sensitivity of paired nasopharyngeal and saliva samples from PCV7-vaccinated 24-month-old children for pneumococcal carriage detection using conventional and molecular detection methods. Nasopharyngeal and saliva samples were collected from 288 24-month-old children during the autumn/winter, 2012/2013. All samples were first processed by conventional diagnostic culture. Next, DNA extracted from all plate growth was tested by qPCR for the presence of the pneumococcal genes and and a subset of serotypes. By culture, 161/288 (60 %) nasopharyngeal swabs tested positive for pneumococcus, but detection was not possible from saliva due to abundant polymicrobial growth on culture plates. By qPCR, 155/288 (54 %) culture-enriched saliva samples and 187/288 (65 %) nasopharyngeal swabs tested positive. Altogether, 219/288 (76 %) infants tested positive for pneumococcus, with qPCR-based carriage detection of culture-enriched nasopharyngeal swabs detecting significantly more carriers compared to either conventional culture (<0.001) or qPCR detection of saliva (=0.002). However, 32/219 (15 %) carriers were only positive in saliva, contributing significantly to the overall number of carriers detected (=0.002). While testing nasopharyngeal swabs by qPCR proved most sensitive for pneumococcal detection in infants, saliva sampling could be considered as complementary to provide additional information on carriage and serotypes that may not be detected in the nasopharynx and may be particularly useful in longitudinal studies, requiring repeated sampling of study participants.

Funding
This study was supported by the:
  • Pfizer Pharmaceuticals (Award WS2312079 and WS2312119)
    • Principle Award Recipient: KrzysztofTrzciński
  • Dutch Ministry of Health
  • This is an open-access article distributed under the terms of the Creative Commons Attribution License. This article was made open access via a Publish and Read agreement between the Microbiology Society and the corresponding author’s institution.
Loading

Article metrics loading...

/content/journal/micro/10.1099/mic.0.001394
2023-10-11
2024-05-15
Loading full text...

Full text loading...

/deliver/fulltext/micro/169/10/mic001394.html?itemId=/content/journal/micro/10.1099/mic.0.001394&mimeType=html&fmt=ahah

References

  1. Simell B, Auranen K, Käyhty H, Goldblatt D, Dagan R et al. The fundamental link between pneumococcal carriage and disease. Expert Rev Vaccines 2012; 11:841–855 [View Article] [PubMed]
    [Google Scholar]
  2. Mitchell AM, Mitchell TJ. Streptococcus pneumoniae: virulence factors and variation. Clin Microbiol Infect 2010; 16:411–418 [View Article] [PubMed]
    [Google Scholar]
  3. Ganaie F, Maruhn K, Li C, Porambo RJ, Elverdal PL et al. Structural, genetic, and serological elucidation of Streptococcus pneumoniae serogroup 24 serotypes: discovery of a new serotype, 24C, with a variable capsule structure. J Clin Microbiol 2021; 59:e0054021 [View Article] [PubMed]
    [Google Scholar]
  4. Whitney CG, Farley MM, Hadler J, Harrison LH, Bennett NM et al. Decline in invasive pneumococcal disease after the introduction of protein-polysaccharide conjugate vaccine. N Engl J Med 2003; 348:1737–1746 [View Article] [PubMed]
    [Google Scholar]
  5. Lexau CA, Lynfield R, Danila R, Pilishvili T, Facklam R et al. Changing epidemiology of invasive pneumococcal disease among older adults in the era of pediatric pneumococcal conjugate vaccine. JAMA 2005; 294:2043–2051 [View Article] [PubMed]
    [Google Scholar]
  6. Wagenvoort GHJ, Sanders EAM, Vlaminckx BJ, Elberse KE, de Melker HE et al. Invasive pneumococcal disease: clinical outcomes and patient characteristics 2-6 years after introduction of 7-valent pneumococcal conjugate vaccine compared to the pre-vaccine period, the Netherlands. Vaccine 2016; 34:1077–1085 [View Article] [PubMed]
    [Google Scholar]
  7. Flasche S, Van Hoek AJ, Sheasby E, Waight P, Andrews N et al. Effect of pneumococcal conjugate vaccination on serotype-specific carriage and invasive disease in England: a cross-sectional study. PLoS Med 2011; 8:e1001017 [View Article] [PubMed]
    [Google Scholar]
  8. Reinert R, Jacobs MR, Kaplan SL. Pneumococcal disease caused by serotype 19A: review of the literature and implications for future vaccine development. Vaccine 2010; 28:4249–4259 [View Article] [PubMed]
    [Google Scholar]
  9. Knol MJ, Wagenvoort GHJ, Sanders EAM, Elberse K, Vlaminckx BJ et al. Invasive pneumococcal disease 3 years after introduction of 10-valent pneumococcal conjugate vaccine, the Netherlands. Emerg Infect Dis 2015; 21:2040–2044 [View Article]
    [Google Scholar]
  10. Lipsitch M. Vaccination against colonizing bacteria with multiple serotypes. Proc Natl Acad Sci U S A 1997; 94:6571–6576 [View Article] [PubMed]
    [Google Scholar]
  11. Zhou J, Enright MC, Spratt BG. Identification of the major Spanish clones of penicillin-resistant pneumococci via the Internet using multilocus sequence typing. J Clin Microbiol 2000; 38:977–986 [View Article] [PubMed]
    [Google Scholar]
  12. Weinberger DM, Malley R, Lipsitch M. Serotype replacement in disease after pneumococcal vaccination. Lancet 2011; 378:1962–1973 [View Article] [PubMed]
    [Google Scholar]
  13. Hanage WP, Finkelstein JA, Huang SS, Pelton SI, Stevenson AE et al. Evidence that pneumococcal serotype replacement in Massachusetts following conjugate vaccination is now complete. Epidemics 2010; 2:80–84 [View Article]
    [Google Scholar]
  14. Bosch AATM, van Houten MA, Bruin JP, Wijmenga-Monsuur AJ, Trzciński K et al. Nasopharyngeal carriage of Streptococcus pneumoniae and other bacteria in the 7th year after implementation of the pneumococcal conjugate vaccine in the Netherlands. Vaccine 2016; 34:531–539 [View Article] [PubMed]
    [Google Scholar]
  15. Weinberger DM, Grant LR, Weatherholtz RC, Warren JL, O’Brien KL et al. Relating pneumococcal carriage among children to disease rates among adults before and after the introduction of conjugate vaccines. Am J Epidemiol 2016; 183:1055–1062 [View Article] [PubMed]
    [Google Scholar]
  16. Auranen K, Rinta-Kokko H, Goldblatt D, Nohynek H, O’Brien KL et al. Colonisation endpoints in Streptococcus pneumoniae vaccine trials. Vaccine 2013; 32:153–158 [View Article] [PubMed]
    [Google Scholar]
  17. Nzenze SA, Madhi SA, Shiri T, Klugman KP, de Gouveia L et al. Imputing the direct and indirect effectiveness of childhood pneumococcal conjugate vaccine against invasive pneumococcal disease by surveying temporal changes in nasopharyngeal pneumococcal colonization. Am J Epidemiol 2017; 186:435–444 [View Article] [PubMed]
    [Google Scholar]
  18. Satzke C, Turner P, Virolainen-Julkunen A, Adrian PV, Antonio M et al. Standard method for detecting upper respiratory carriage of Streptococcus pneumoniae: updated recommendations from the World Health Organization Pneumococcal Carriage Working Group. Vaccine 2013; 32:165–179 [View Article] [PubMed]
    [Google Scholar]
  19. Heffron R. Epidemiology. In Pneumonia with Special Reference to Pneumococcus Lobar Pneumonia Epidemiology Oxford University Press; 1939 pp 258–394
    [Google Scholar]
  20. Krone CL, van de Groep K, Trzciński K, Sanders EAM, Bogaert D. Immunosenescence and pneumococcal disease: an imbalance in host-pathogen interactions. Lancet Respir Med 2014; 2:141–153 [View Article] [PubMed]
    [Google Scholar]
  21. Webster LT, Hughes TP. The epidemiology of pneumococcus infection: the incidence and spread of pneumococci in the nasal passages and throats of healthy persons. J Exp Med 1931; 53:535–552 [View Article] [PubMed]
    [Google Scholar]
  22. Arguedas A, Trzciński K, O’Brien KL, Ferreira DM, Wyllie AL et al. Upper respiratory tract colonization with Streptococcus pneumoniae in adults. Expert Rev Vaccines 2020; 19:353–366 [View Article] [PubMed]
    [Google Scholar]
  23. Wyllie AL, Chu MLJN, Schellens MHB, van Engelsdorp Gastelaars J, Jansen MD et al. Streptococcus pneumoniae in saliva of Dutch primary school children. PLoS One 2014; 9:e102045 [View Article] [PubMed]
    [Google Scholar]
  24. Krone CL, Wyllie AL, van Beek J, Rots NY, Oja AE et al. Carriage of Streptococcus pneumoniae in aged adults with influenza-like-illness. PLoS One 2015; 10:e0119875 [View Article] [PubMed]
    [Google Scholar]
  25. Trzciński K, Bogaert D, Wyllie A, Chu MLJN, van der Ende A et al. Superiority of trans-oral over trans-nasal sampling in detecting Streptococcus pneumoniae colonization in adults. PLoS One 2013; 8:e60520 [View Article] [PubMed]
    [Google Scholar]
  26. Wyllie AL, Rümke LW, Arp K, Bosch AATM, Bruin JP et al. Molecular surveillance on Streptococcus pneumoniae carriage in non-elderly adults; little evidence for pneumococcal circulation independent from the reservoir in children. Sci Rep 2016; 6:34888 [View Article] [PubMed]
    [Google Scholar]
  27. Branche AR, Yang H, Java J, Holden-Wiltse J, Topham DJ et al. Effect of prior vaccination on carriage rates of Streptococcus pneumoniae in older adults: a longitudinal surveillance study. Vaccine 2018; 36:4304–4310 [View Article] [PubMed]
    [Google Scholar]
  28. Miellet WR, van Veldhuizen J, Nicolaie MA, Mariman R, Bootsma HJ et al. Influenza-like illness exacerbates pneumococcal carriage in older adults. Clin Infect Dis 2021; 73:e2680–e2689 [View Article] [PubMed]
    [Google Scholar]
  29. Wyllie AL, Wijmenga-Monsuur AJ, van Houten MA, Bosch AATM, Groot JA et al. Molecular surveillance of nasopharyngeal carriage of Streptococcus pneumoniae in children vaccinated with conjugated polysaccharide pneumococcal vaccines. Sci Rep 2016; 6:23809 [View Article] [PubMed]
    [Google Scholar]
  30. Bogaert D, Veenhoven RH, Ramdin R, Luijendijk IHT, Rijkers GT et al. Pneumococcal conjugate vaccination does not induce a persisting mucosal IgA response in children with recurrent acute otitis media. Vaccine 2005; 23:2607–2613 [View Article] [PubMed]
    [Google Scholar]
  31. van Gils EJM, Veenhoven RH, Hak E, Rodenburg GD, Bogaert D et al. Effect of reduced-dose schedules with 7-valent pneumococcal conjugate vaccine on nasopharyngeal pneumococcal carriage in children: a randomized controlled trial. JAMA 2009; 302:159–167 [View Article] [PubMed]
    [Google Scholar]
  32. Carvalho M da GS, Tondella ML, McCaustland K, Weidlich L, McGee L et al. Evaluation and improvement of real-time PCR assays targeting lytA, ply, and psaA genes for detection of pneumococcal DNA. J Clin Microbiol 2007; 45:2460–2466 [View Article] [PubMed]
    [Google Scholar]
  33. Azzari C, Moriondo M, Indolfi G, Cortimiglia M, Canessa C et al. Realtime PCR is more sensitive than multiplex PCR for diagnosis and serotyping in children with culture negative pneumococcal invasive disease. PLoS One 2010; 5:e9282 [View Article] [PubMed]
    [Google Scholar]
  34. Pimenta FC, Roundtree A, Soysal A, Bakir M, du Plessis M et al. Sequential triplex real-time PCR assay for detecting 21 pneumococcal capsular serotypes that account for a high global disease burden. J Clin Microbiol 2013; 51:647–652 [View Article] [PubMed]
    [Google Scholar]
  35. Regev-Yochay G, Raz M, Dagan R, Porat N, Shainberg B et al. Nasopharyngeal carriage of Streptococcus pneumoniae by adults and children in community and family settings. Clin Infect Dis 2004; 38:632–639 [View Article] [PubMed]
    [Google Scholar]
  36. Hamaluba M, Kandasamy R, Ndimah S, Morton R, Caccamo M et al. A cross-sectional observational study of pneumococcal carriage in children, their parents, and older adults following the introduction of the 7-valent pneumococcal conjugate vaccine. Medicine 2015; 94:e335 [View Article] [PubMed]
    [Google Scholar]
  37. Satzke C, Dunne EM, Porter BD, Klugman KP, Mulholland EK et al. The pneucarriage project: a multi-centre comparative study to identify the best serotyping methods for examining pneumococcal carriage in vaccine evaluation studies. PLoS Med 2015; 12:e1001903 [View Article] [PubMed]
    [Google Scholar]
  38. Adler H, Nikolaou E, Gould K, Hinds J, Collins AM et al. Pneumococcal colonization in healthy adult research participants in the conjugate vaccine era, United Kingdom, 2010-2017. J Infect Dis 2019; 219:1989–1993 [View Article] [PubMed]
    [Google Scholar]
  39. Miellet WR, Almeida ST, Trzciński K, Sá-Leão R. Streptococcus pneumoniae carriage studies in adults: Importance, challenges, and key issues to consider when using quantitative PCR-based approaches. Front Microbiol 2023; 14:1122276 [View Article] [PubMed]
    [Google Scholar]
  40. Carvalho M da G, Pimenta FC, Jackson D, Roundtree A, Ahmad Y et al. Revisiting pneumococcal carriage by use of broth enrichment and PCR techniques for enhanced detection of carriage and serotypes. J Clin Microbiol 2010; 48:1611–1618 [View Article] [PubMed]
    [Google Scholar]
  41. van den Bergh MR, Spijkerman J, Swinnen KM, François NA, Pascal TG et al. Effects of the 10-valent pneumococcal nontypeable Haemophilus influenzae protein D-conjugate vaccine on nasopharyngeal bacterial colonization in young children: a randomized controlled trial. Clin Infect Dis 2013; 56:e30–9 [View Article] [PubMed]
    [Google Scholar]
  42. Ansaldi F, de Florentiis D, Canepa P, Ceravolo A, Rappazzo E et al. Carriage of Streptoccoccus pneumoniae in healthy adults aged 60 years or over in a population with very high and long-lasting pneumococcal conjugate vaccine coverage in children: rationale and perspectives for PCV13 implementation. Hum Vaccin Immunother 2013; 9:614–620 [View Article] [PubMed]
    [Google Scholar]
  43. Huebner RE, Dagan R, Porath N, Wasas AD, Klugman KP. Lack of utility of serotyping multiple colonies for detection of simultaneous nasopharyngeal carriage of different pneumococcal serotypes. Pediatr Infect Dis J 2000; 19:1017–1020 [View Article] [PubMed]
    [Google Scholar]
  44. Miellet WR, van Veldhuizen J, Litt D, Mariman R, Wijmenga-Monsuur AJ et al. A spitting image: molecular diagnostics applied to saliva enhance detection of Streptococcus pneumoniae and pneumococcal serotype carriage. Front Microbiol 2023; 14:1156695 [View Article] [PubMed]
    [Google Scholar]
  45. Wróbel-Pawelczyk I, Ronkiewicz P, Wanke-Rytt M, Rykowska D, Górska-Kot A et al. Pneumococcal carriage in unvaccinated children at the time of vaccine implementation into the national immunization program in Poland. Sci Rep 2022; 12:5858 [View Article] [PubMed]
    [Google Scholar]
  46. Turner P, Turner C, Jankhot A, Helen N, Lee SJ et al. A longitudinal study of Streptococcus pneumoniae carriage in a cohort of infants and their mothers on the Thailand-Myanmar border. PLoS One 2012; 7:e38271 [View Article] [PubMed]
    [Google Scholar]
  47. Murad C, Dunne EM, Sudigdoadi S, Fadlyana E, Tarigan R et al. Pneumococcal carriage, density, and co-colonization dynamics: a longitudinal study in Indonesian infants. Int J Infect Dis 2019; 86:73–81 [View Article] [PubMed]
    [Google Scholar]
  48. Valente C, Hinds J, Gould KA, Pinto FR, de Lencastre H et al. Impact of the 13-valent pneumococcal conjugate vaccine on Streptococcus pneumoniae multiple serotype carriage. Vaccine 2016; 34:4072–4078 [View Article] [PubMed]
    [Google Scholar]
  49. Chaguza C, Andam CP, Harris SR, Cornick JE, Yang M et al. Recombination in Streptococcus pneumoniae lineages increase with carriage duration and size of the polysaccharide capsule. mBio 2016; 7:e01053-16 [View Article] [PubMed]
    [Google Scholar]
  50. Kilian M, Riley DR, Jensen A, Brüggemann H, Tettelin H. Parallel evolution of Streptococcus pneumoniae and Streptococcus mitis to pathogenic and mutualistic lifestyles. mBio 2014; 5:e01490-14 [View Article] [PubMed]
    [Google Scholar]
  51. Allicock OM, Petrone ME, Yolda-Carr D, Breban M, Walsh H et al. Evaluation of saliva self-collection devices for SARS-CoV-2 diagnostics. BMC Infect Dis 2022; 22:284 [View Article] [PubMed]
    [Google Scholar]
  52. Laxton CS, Peno C, Hahn AM, Allicock OM, Perniciaro S et al. The potential of saliva as an accessible and sensitive sample type for the detection of respiratory pathogens and host immunity. Lancet Microbe 2023S2666-5247(23)00135-0 [View Article] [PubMed]
    [Google Scholar]
  53. Rodrigues F, Christensen H, Morales-Aza B, Sikora P, Oliver E et al. Viable Neisseria meningitidis is commonly present in saliva in healthy young adults: non-invasive sampling and enhanced sensitivity of detection in a follow-up carriage study in Portuguese students. PLOS One 2019; 14:e0209905 [View Article] [PubMed]
    [Google Scholar]
  54. Miellet WR, Mariman R, Pluister G, de Jong LJ, Grift I et al. Detection of Neisseria meningitidis in saliva and oropharyngeal samples from college students. Sci Rep 2021; 11:23138 [View Article] [PubMed]
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/micro/10.1099/mic.0.001394
Loading
/content/journal/micro/10.1099/mic.0.001394
Loading

Data & Media loading...

Supplements

Supplementary material 1

PDF
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error