Streptococcus pneumoniae is a major cause of childhood morbidity and mortality, especially in low- and middle-income countries. Angola introduced the conjugated pneumococcal vaccine (PCV13) in 2013. Our objective was to study pneumococcal carriage and antibiotic resistance in unvaccinated children in Angola.
The study enrolled children in Luanda and Lunda Sul in November and December 2017. Nasopharyngeal samples were transported frozen in STGG medium to Sweden where bacteria were identified by optochin susceptibility. Pneumococci were serotyped by a multiplex PCR and the Quellung reaction. Antimicrobial susceptibility testing was done according to EUCAST.
Of 940 children, 443 (47%) were females, and median age was 8 years (range 4-12 years). The carriage of pneumococci was 35% (332/940), and 45% (127/280) of strains exhibited PCV13-serotypes. Reduced sensitivity to penicillin was found in 39%, more commonly in vaccine-type than in non-vaccine-type pneumococci (50% vs 33%, p=0.003). Underweight children (BMI under 5th percentile) carried pneumococci more often than other children (44% vs 34%, p=0.013).
If implemented successfully PCV-13 may have a significant impact on pneumococcal disease in Angola. It may also prevent pneumococcal penicillin resistance. Our data may be used as an estimate of the pre-vaccine situation in Angola.