The fundamental link between pneumococcal carriage and disease

Expert Rev Vaccines. 2012 Jul;11(7):841-55. doi: 10.1586/erv.12.53.


Streptococcus pneumoniae (pneumococcus) is a major cause of worldwide mortality and morbidity, and to a large extent is vaccine-preventable. Nasopharyngeal carriage of pneumococcus precedes disease and is the source of pneumococcal spread between people. The use of vaccine effect on carriage as part of the vaccine licensure and post-vaccine introduction evaluation could facilitate and expand the licensure of new, life-saving pneumococcal vaccines and enable a comprehensive estimate of population effects after vaccine introduction. The authors provide a review of the evidence supporting pneumococcal carriage at the individual level as an immediate and necessary precursor to pneumococcal disease. Based on such a causal link between carriage and disease, the authors emphasize the role of information on pneumococcal carriage in vaccine trials and in public health decision-making.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Animals
  • Carrier State*
  • Host-Pathogen Interactions
  • Humans
  • Immunity, Herd
  • Nasopharynx / microbiology*
  • Pneumococcal Infections / epidemiology
  • Pneumococcal Infections / immunology
  • Pneumococcal Infections / microbiology*
  • Pneumococcal Infections / prevention & control
  • Pneumococcal Infections / transmission
  • Pneumococcal Vaccines / immunology
  • Streptococcus pneumoniae / growth & development
  • Streptococcus pneumoniae / immunology
  • Streptococcus pneumoniae / pathogenicity*


  • Pneumococcal Vaccines