Immunization, Antibiotic Use, and Pneumococcal Colonization Over a 15-Year Period

Pediatrics. 2017 Nov;140(5):e20170001. doi: 10.1542/peds.2017-0001. Epub 2017 Oct 4.


Background: Rates of invasive pneumococcal disease have declined since widespread introduction of pneumococcal conjugate vaccines (PCVs) in the United States. We evaluated the impact of immunization status and recent antibiotic use on an individual child's risk of colonization.

Methods: This study extends previously reported data from children <7 years of age seen for well child or acute care visits in Massachusetts communities. Nasopharyngeal swabs were collected during 6 surveillance seasons from 2000 to 2014. Parent surveys and medical record reviews confirmed immunization status and recent antibiotic use. We estimated the proportions of children colonized with PCV7-included, additional PCV13-included, and non-PCV13 serotypes. Risk factors for colonization with additional PCV13-included and non-PCV13 serotypes were assessed by using generalized linear mixed models adjusted for clustering by community.

Results: Among 6537 children, 19A emerged as the predominant serotype in 2004, with substantial reductions in 2014. Among non-PCV serotypes, 15B/C, 35B, 23B, 11A, and 23A were most common in 2014. We observed greater odds for both additional PCV13 and non-PCV13 colonization in younger children, those with more child care exposure, and those with a concomitant respiratory tract infection. Adjusted odds for additional PCV13 colonization was lower (odds ratio 0.48 [95% confidence interval 0.31-0.75]) among children up-to-date for PCV13 vaccines. Recent antibiotic use was associated with higher odds of additional PCV13 colonization but substantially lower odds of non-PCV13 colonization.

Conclusions: Despite the success of pneumococcal vaccines in reducing colonization and disease due to targeted serotypes, ongoing community-based surveillance will be critical to evaluate the impact of interventions on pneumococcal colonization and disease.

MeSH terms

  • Anti-Bacterial Agents / therapeutic use*
  • Child
  • Child, Preschool
  • Female
  • Heptavalent Pneumococcal Conjugate Vaccine / therapeutic use*
  • Humans
  • Immunization / trends*
  • Infant
  • Male
  • Massachusetts / epidemiology
  • Pneumococcal Infections / drug therapy
  • Pneumococcal Infections / epidemiology
  • Pneumococcal Infections / prevention & control*
  • Pneumococcal Vaccines / therapeutic use*
  • Serogroup
  • Streptococcus pneumoniae / isolation & purification*
  • Time Factors


  • 13-valent pneumococcal vaccine
  • Anti-Bacterial Agents
  • Heptavalent Pneumococcal Conjugate Vaccine
  • Pneumococcal Vaccines