Epidemiology of pneumococcal carriage in children under five years of age in Accra, Ghana

Background: Although the majority of pneumococcal infections occur in the developing world, pneumococcal epidemiology is poorly understood in these settings. The aim of the study was to investigate the epidemiology of pneumococcal carriage among children younger than 5 years at a paediatric healthcare centre in Ghana. Method: Four-hundred and twenty-three children were randomly sampled and nasopharyngeal specimens were collected from them. The specimens were cultured for Streptococcus pneumoniae, and the isolates were subjected to antibiotic susceptibility testing and serotyping by latex agglutination. Epidemiological data on demographic and clinical features of the study subjects were collected. Results: The prevalence of pneumococcal carriage was 48.9% (207/422), with age groups 43 - 48 months having the highest carriage prevalence. In the multivariate analysis, pneumococcal carriage was significantly associated with runny nose (odds ratio = 1.9, p = 0.003) and day-care attendance (odds ratio = 1.5, p = 0.04). No pneumococcal resistance was observed for ceftriaxone, while the prevalence of resistance to the other antibiotics tested was: cotrimoxazole 100%, ampicillin 88%, tetracycline 78%, penicillin 63% and erythromycin 24%. Fourteen different pneumococcal serogroups/serotypes were identified and serogroup 6 was the most prevalent (30%), followed by serotype 19 (20%). Conclusions: We conclude that pneumococcal carriage among the study children is high and the carried strains have a high level of resistance (> 50%) to several antibiotics. Ceftriaxone is a suitable antibiotic for treating pneumococcal infections in Ghana, and the use of this antibiotic coupled with the pneumococcal vaccination is expected to significantly reduce the burden of pneumococcal disease in the country.