Children with SAM have impaired immune function (including mucosal defences) and an increased risk of pneumococcal pneumonia. We evaluated if SAM was associated with increased nasopharyngeal carriage of S. pneumoniae (Spn).
Pulmaun Saudavel is an ongoing surveillance study of children aged 1-59 months hospitalised with SAM and/or pneumonia in Dili, Timor-Leste, where no pneumococcal conjugate vaccine (PCV) is in use. SAM is defined according to World Health Organization (WHO) criteria. Pneumonia is defined as cough or difficulty breathing and any one of: respiratory rate >50bpm, oxygen saturation <90%, lower chest wall indrawing, or WHO-defined radiological pneumonia. NP swabs are collected after admission and processed according to WHO guidelines.
Of 160 cases enrolled to date, 103 (64%) had pneumonia, 27 (17%) SAM, and 30 (19%) both pneumonia and SAM. Overall NP carriage of Spn was 27% (43/160). There was no difference in carriage between SAM cases (15/57, 26%) and pneumonia-only cases (27/97, 28%). Among children with SAM, those with pneumonia had higher carriage (11/30, 37%) compared to those without pneumonia (4/27, 15%; p=0.08).
Pneumonia is a common complication of SAM and may be associated with increased Spn carriage. PCV use in Timor-Leste is likely to benefit children with SAM.