Gili Regev-Yochay, MD; Ron Dagan, MD; Meir Raz, MD; Yehuda Carmeli, MD, MPH; Bracha Shainberg, PhD; Estela Derazne, MSc; Galia Rahav, MD; Ethan Rubinstein, MD
JAMA. 2004;292:716-720.
Context Widespread pneumococcal conjugate vaccinationmay bring about epidemiologic changes in upper respiratory tractflora of children. Of particular significance may be an interactionbetween
Streptococcus pneumoniae and
Staphylococcus aureus,in view of the recent emergence of community-acquired methicillin-resistant
S aureus.
Objective To examine the prevalence and risk factors ofcarriage of
S pneumoniae and
S aureus in the prevaccinationera in young children.
Design, Setting, and Patients Cross-sectional surveillancestudy of nasopharyngeal carriage of
S pneumoniae and nasal carriageof
S aureus by 790 children aged 40 months or younger seen atprimary care clinics in central Israel during February 2002.
Main Outcome Measures Carriage rates of
S pneumoniae (byserotype) and
S aureus; risk factors associated with carriageof each pathogen.
Results Among 790 children screened, 43% carried
S pneumoniaeand 10% carried
S aureus.
Staphylococcus aureus carriage among
S pneumoniae carriers was 6.5% vs 12.9% in
S pneumoniae noncarriers.
Streptococcus pneumoniae carriage among
S aureus carriers was27.5% vs 44.8% in
S aureus noncarriers. Only 2.8% carried bothpathogens concomitantly vs 4.3% expected dual carriage (
P =.03). Risk factors for
S pneumoniae carriage (attending daycare, having young siblings, and age older than 3 months) werenegatively associated with
S aureus carriage.
Conclusions Streptococcus pneumoniae carriage, specificallyof vaccine-type strains, is negatively associated with
S aureuscarriage in children. The implications of these findings inthe pneumococcal vaccine era require further investigation.
Author Affiliations: Sheba Medical Center, Tel Hashomer (Drs Regev-Yochay, Rahav, and Rubinstein and Ms Derazne), and Sourasky Medical Center (Dr Carmeli), Sackler School of Medicine, Tel-Aviv University, and Tel-Aviv, Israel; and Soroka University Medical Center and Faculty of Health Science, Ben Gurion University of the Negev, Beer-Sheva, Israel (Dr Dagan).
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