1887

Chapter 10 : Pneumococcal Serotype Epidemiology

Authors: William P. Hausdorff1, Angela B. Brueggemann2, Jill G. Hackell3, J. Anthony G. Scott4
VIEW AFFILIATIONS HIDE AFFILIATIONS
Affiliations: 1: GlaxoSmithKline Biologicals, B-1330 Rixensart, Belgium; 2: Department of Zoology, University of Oxford, Oxford OX1 3PS, United Kingdom; 3: New York, NY 10956; 4: Wellcome Trust/KEMRI Centre for Geographic Medicine Research, Coast, Kilifi, Kenya; 5: Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Headington, Oxford OX3 9DU, United Kingdom
Content Type: Monograph
Publication Year: 2008

Category: Bacterial Pathogenesis; Immunology

MyBook is a cheap paperback edition of the original book and will be sold at uniform, low price.

Preview this chapter:
Preview Magnify
Zoom in
Zoomout

Pneumococcal Serotype Epidemiology, Page 1 of 2

| /docserver/preview/fulltext/10.1128/9781555815820/9781555814083_Chap10-1.gif /docserver/preview/fulltext/10.1128/9781555815820/9781555814083_Chap10-2.gif

Abstract:

This chapter summarizes the relative prevalences of the most common serotypes prior to and following the introduction of the heptavalent pneumococcal capsular polysaccharide vaccine (PCV-7). It provides thoughts about the selection of serotypes for future-generation conjugate vaccines. A remarkable feature of the global epidemiology of pneumococcal carriage is the consistency of the dominant carriage serotypes in very different environments and at different times. Invasive disease potential, or invasiveness, is a measure of the ability of pneumococci to progress from nasopharyngeal carriage to invasive disease in humans. It differs from virulence in that the latter is often used to describe the ability of a pathogen to cause disease in laboratory animals. The 11-valent formulation prevented vaccine-related otitis media and was also shown to elicit antibodies with functional immunogenicity (opsonophagocytic activity) against 6A comparable to that seen with PCV-7. The incidence of invasive pneumococcal disease (IPD) due to vaccine serotypes has decreased substantially since the introduction of PCV-7 in the United States, in vaccinated children as well as all other age groups, indicating that pneumococcal transmission was interrupted as a result of the reduction in carriage in the vaccinated pediatric population. For mucosal disease, otitis media and nonbacteremic pneumonia, it is less clear which serotypes it would be most valuable to add since there appear to be less clearcut differences in invasiveness among serotypes. The only certain way of preventing mucosal disease is to sterilize the nasopharynx with respect to pneumococci.

Citation: Hausdorff W, Brueggemann A, Hackell J, Scott J. 2008. Pneumococcal Serotype Epidemiology, p 139-160. In Siber G, Klugman K, Mäkelä P (ed), Pneumococcal Vaccines. ASM Press, Washington, DC. doi: 10.1128/9781555815820.ch10
Highlighted Text: Show | Hide
Loading full text...

Full text loading...

Figures

Pneumococcal Serotype Epidemiology
[com.pub2web.rdf.cci.facet.ContentItem[id=http://asm.metastore.ingenta.com/content/author/10.1128/9781555815820.ch10-1,webId=/content/author/10.1128/9781555815820.ch10-1,properties={foaf_givenname=William P., foaf_name=William P. Hausdorff, foaf_surname=Hausdorff, pub_isAffiliatedWith=[com.pub2web.rdf.cci.facet.ContentItem[id=http://asm.metastore.ingenta.com/content/affiliation/10.1128/9781555815820.ch10-aff1]]}], com.pub2web.rdf.cci.facet.ContentItem[id=http://asm.metastore.ingenta.com/content/author/10.1128/9781555815820.ch10-2,webId=/content/author/10.1128/9781555815820.ch10-2,properties={foaf_givenname=Angela B., foaf_name=Angela B. Brueggemann, foaf_surname=Brueggemann, pub_isAffiliatedWith=[com.pub2web.rdf.cci.facet.ContentItem[id=http://asm.metastore.ingenta.com/content/affiliation/10.1128/9781555815820.ch10-aff2]]}], com.pub2web.rdf.cci.facet.ContentItem[id=http://asm.metastore.ingenta.com/content/author/10.1128/9781555815820.ch10-3,webId=/content/author/10.1128/9781555815820.ch10-3,properties={foaf_givenname=Jill G., foaf_name=Jill G. Hackell, foaf_surname=Hackell, pub_isAffiliatedWith=[com.pub2web.rdf.cci.facet.ContentItem[id=http://asm.metastore.ingenta.com/content/affiliation/10.1128/9781555815820.ch10-aff3]]}], com.pub2web.rdf.cci.facet.ContentItem[id=http://asm.metastore.ingenta.com/content/author/10.1128/9781555815820.ch10-4,webId=/content/author/10.1128/9781555815820.ch10-4,properties={foaf_givenname=J. Anthony G., foaf_name=J. Anthony G. Scott, foaf_surname=Scott, pub_isAffiliatedWith=[com.pub2web.rdf.cci.facet.ContentItem[id=http://asm.metastore.ingenta.com/content/affiliation/10.1128/9781555815820.ch10-aff4]]}]]
Citation: Hausdorff W, Brueggemann A, Hackell J, Scott J. 2008. Pneumococcal Serotype Epidemiology, p 139-160. In Siber G, Klugman K, Mäkelä P (ed), Pneumococcal Vaccines. ASM Press, Washington, DC. doi: 10.1128/9781555815820.ch10
/content/10.1128/9781555815820.ch10.ch10fig01
Figure 1
Percentages of IPD isolates represented in the PCV-7 formulation and recovered from children <5 years of age. As indicated in the figure, shading refers to the percentages of all IPD isolates identified as serotypes 4, 6A, 6B, 9V, 14, 18C, 19F, and 23F. Data sources are references cited in reference and references .
10.1128/9781555815820/f0144-01_thmb.gif
10.1128/9781555815820/f0144-01.gif
Image of Figure 1
Figure 1

Percentages of IPD isolates represented in the PCV-7 formulation and recovered from children <5 years of age. As indicated in the figure, shading refers to the percentages of all IPD isolates identified as serotypes 4, 6A, 6B, 9V, 14, 18C, 19F, and 23F. Data sources are references cited in reference and references .

Citation: Hausdorff W, Brueggemann A, Hackell J, Scott J. 2008. Pneumococcal Serotype Epidemiology, p 139-160. In Siber G, Klugman K, Mäkelä P (ed), Pneumococcal Vaccines. ASM Press, Washington, DC. doi: 10.1128/9781555815820.ch10
Permissions and Reprints Request Permissions
Download as Powerpoint
/content/10.1128/9781555815820.ch10.ch10fig02
Figure 2
Percentages of IPD isolates represented in the PHiD CV-10 formulation and recovered from children <5 years of age. As indicated in the figure, shading refers to the percentages of all IPD isolates identified as serotypes 1, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19F, and 23F. Countries marked with two shades correspond to percentage of serotype coverage exactly intermediate between the percentages represented by the two shades. Data sources are those cited in the legend to Fig. 1 .
10.1128/9781555815820/f0145-01_thmb.gif
10.1128/9781555815820/f0145-01.gif
Image of Figure 2
Figure 2

Percentages of IPD isolates represented in the PHiD CV-10 formulation and recovered from children <5 years of age. As indicated in the figure, shading refers to the percentages of all IPD isolates identified as serotypes 1, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19F, and 23F. Countries marked with two shades correspond to percentage of serotype coverage exactly intermediate between the percentages represented by the two shades. Data sources are those cited in the legend to Fig. 1 .

Citation: Hausdorff W, Brueggemann A, Hackell J, Scott J. 2008. Pneumococcal Serotype Epidemiology, p 139-160. In Siber G, Klugman K, Mäkelä P (ed), Pneumococcal Vaccines. ASM Press, Washington, DC. doi: 10.1128/9781555815820.ch10
Permissions and Reprints Request Permissions
Download as Powerpoint
/content/10.1128/9781555815820.ch10.ch10fig03
Figure 3
Percentages of IPD isolates represented in the PCV-7 formulation and recovered from children <5 years of age. As indicated in the figure, shading refers to the percentages of all IPD isolates identified as serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, and 23F. Data sources are those cited in the legend to Fig. 1 .
10.1128/9781555815820/f0146-01_thmb.gif
10.1128/9781555815820/f0146-01.gif
Image of Figure 3
Figure 3

Percentages of IPD isolates represented in the PCV-7 formulation and recovered from children <5 years of age. As indicated in the figure, shading refers to the percentages of all IPD isolates identified as serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, and 23F. Data sources are those cited in the legend to Fig. 1 .

Citation: Hausdorff W, Brueggemann A, Hackell J, Scott J. 2008. Pneumococcal Serotype Epidemiology, p 139-160. In Siber G, Klugman K, Mäkelä P (ed), Pneumococcal Vaccines. ASM Press, Washington, DC. doi: 10.1128/9781555815820.ch10
Permissions and Reprints Request Permissions
Download as Powerpoint

References

/content/book/10.1128/9781555815820.ch10
1. Abdullahi, O.,, P. Lewa,, J. Nyiro, and, J. A. G. Scott. 2006. Can isolates of Streptococcus pneumoniae carried by healthy children or children with mild or severe pneumonia predict serotypes and resistance patterns of invasive isolates? abstr. PO7.24. Fifth Int. Symp. Pneumococci Pneumococcal Dis., Alice Springs, Australia, 3 to 6 April 2006.
2. Abdullahi, O.,, J. Nyiro,, P. Lewa, and, J. A. G. Scott. The descriptive epidemiology of Streptococcus pneumoniae and Haemophilus influenzae nasopharyngeal carriage in children and adults in Kilifi District, Kenya. Pediatr. Infect. Dis. J., in press.
3. Adegbola, R. A.,, P. C. Hill,, O. Secka,, U. N. Ikumapayi,, G. Lahai,, B. M. Greenwood, and, T. Corrah. 2006. Serotype and antimicrobial susceptibility patterns of isolates of Streptococcus pneumoniae causing invasive disease in The Gambia, 1996–2003. Trop. Med. Int. Health 11 : 1128– 1135.
4. Agudelo, C. I.,, J. Moreno,, O. M. Sanabria,, M. V. Ovalle,, J. L. Di Fabio,, E. Castaneda, and Grupo Colombiano de Trabajo en Streptococcus pneumoniae. 2006. Streptococcus pneumoniae: serotype evolution and patterns of antimicrobial susceptibility in invasive isolates from 11 years' surveillance (1994–2004) in Colombia. Biomedica 26 : 234– 249. (In Spanish.)
5. Alanee, S. R. J.,, L. McGee,, D. Jackson,, C. C. Chiou,, C. Feldman,, A. Morris,, A. Ortqvist,, J. Rello,, C. M. Luna, L. M. Baddour,, M. Ip,, V. L. Yu, and, K. P. Klugman for the International Pneumococcal Study Group. 2007. Association of serotypes of Streptococcus pneumoniae with disease severity and outcome in adults: an international study. Clin. Infect. Dis. 45 : 52– 54.
6. The Albert B. Sabin Vaccine Institute. 2007. Proceedings of the Second Regional Pneumococcal Symposium, São Paulo, Brazil, 13– 14 December 2006. Session IV: Pneumococcal vaccine development: uptake and issues. The Albert B. Sabin Vaccine Institute, Washington, DC.
7. Al-Mazrou, A.,, K. Twum-Danso,, F. Al Zamil, and, A. Kamba. 2005. Streptococcus pneumoniae serotypes/serogroups causing invasive disease in Riyadh, Saudi Arabia: extent of coverage by pneumococcal vaccines. Ann. Saudi Med. 25 : 94– 99.
8. Arguedas, A.,, R. Dagan,, S. Guevara,, N. Porat,, C. Soley,, A. Perez, and, R. Brilla. 2005. Middle ear fluid Streptococcus pneumoniae serotype distribution in Costa Rican children with otitis media. Pediatr. Infect. Dis. J. 24 : 631– 634.
9. Barker, J.,, M. Gratten,, I. Riley,, D. Lehmann,, J. Montgomery,, M. Kajoi,, H. Gratten,, D. Smith,, T. F. Marshall, and, M. P. Alpers. 1989. Pneumonia in children in the Eastern Highlands of Papua New Guinea: a bacteriologic study of patients selected by standard clinical criteria. J. Infect. Dis. 159 : 348– 352.
10. Beall, B.,, M. C. McEllistrem,, R. E. J. Gertz,, S. Wedel,, D. J. Boxrud,, A. L. Gonzalez,, M. J. Medina,, R. Pai,, T. A. Thompson,, L. H. Harrison,, L. McGee, and, C. G. Whitney. 2006. Pre- and postvaccination clonal compositions of invasive pneumococcal serotypes for isolates collected in the United States in 1999, 2001, and 2002. J. Clin. Microbiol. 44 : 999– 1017.
11. Bentley, S. D.,, D. M. Aanensen,, A. Mavroidi,, D. Saunders,, E. Rabbinowitsch,, M. Collins,, K. Donohoe,, D. Harris,, L. Murphy,, M. A. Quail,, G. Samuel,, I. C. Skovsted,, M. S. Kaltoft,, B. Barrell,, P. R. Reeves,, J. Parkhill, and, B. G. Spratt., 2006. Genetic analysis of the capsular biosynthetic locus from all 90 pneumococcal serotypes. PLoS Genet. 2: e31.
12. Berg, S.,, B. Trollfors,, E. Persson,, E. Backhaus,, P. Larsson,, E. Ek,, B. E. Claesson,, L. Jonsson,, G. Radberg,, S. Johansson,, T. Ripa,, M. S. Kaltoft, and, H. B. Konradsen. 2006. Serotypes of Streptococcus pneumoniae isolated from blood and cerebrospinal fluid related to vaccine serotypes and to clinical characteristics. Scand. J. Infect. Dis. 38 : 427– 432.
13. Berkley, J. A.,, B. S. Lowe,, M. Phil,, I. Mwangi,, T. Williams,, E. Bauni,, S. Mwarumba,, C. Ngetsa,, M. P. E. Slack,, S. Njenga,, C. A. Hart,, K. Maitland,, M. English,, K. Marsh, and, A. G. Scott. 2005. Bacteremia among children admitted to a rural hospital in Kenya. N. Engl. J. Med. 352 : 39– 47.
14. Black, S. B.,, H. R. Shinefield,, S. Ling,, J. Hansen,, B. Fireman,, D. Spring,, J. Noyes,, E. Lewis,, P. Ray,, J. Lee, and, J. Hackell. 2002. Effectiveness of heptavalent pneumococcal conjugate vaccine in children younger than five years of age for prevention of pneumonia. Pediatr. Infect. Dis. J. 21 : 810– 815.
15. Bogaert, D.,, M. N. Engelen,, A. J. Timmers-Reker,, K. P. Elzenaar,, P. G. Peerbooms,, R. A. Coutinho,, R. de Groot, and, P. W. Hermans. 2001. Pneumococcal carriage in children in The Netherlands: a molecular epidemiological study. J. Clin. Microbiol. 39 : 3316– 3320.
16. Borrow, R., and, E. Miller. 2006. Long-term protection in children with meningococcal C conjugate vaccination: lessons learned. Expert Rev. Vaccines 5 : 851– 857.
17. Brandileone, M. C.,, A. L. de Andrade,, J. L. Di Fabio,, M. L. Guerra, and, R. Austrian. 2003. Appropriateness of a pneumococcal conjugate vaccine in Brazil: potential impact of age and clinical diagnosis, with emphasis on meningitis. J. Infect. Dis. 187 : 1206– 1212.
18. Brooks, W. A.,, D. Goswami,, A. Hossain,, K. Alam,, K. Nahar,, S. Saha,, S. E. Arifeen,, A. Naheed,, R. F. Breiman,, D. A. Sack, and, S. Luby. 2006. Population based surveillance for invasive pneumococcal disease among children in urban Bangladesh: 2004–2006, abstr. PO3.10. Fifth Int. Symp. Pneumococci Pneumococcal Dis. Alice Springs, Australia, 3 to 6 April 2006.
19. Brueggemann, A. B.,, T. E. Peto,, D. W. Crook,, J. C. Butler,, K. G. Kristinsson, and, B. G. Spratt. 2004. Temporal and geographic stability of the serogroup-specific invasive disease potential of Streptococcus pneumoniae in children. J. Infect. Dis. 190 : 1203– 1211.
20. Brueggemann, A. B.,, D. T. Griffiths,, E. Meats,, T. Peto,, D. W. Crook, and, B. G. Spratt. 2003. Clonal relationships between invasive and carriage Streptococcus pneumoniae and serotype- and clone-specific differences in invasive disease potential. J. Infect. Dis. 187 : 1424– 1432.
21. Brueggemann, A. B.,, R. Pai,, D. W. Crook, and, B. Beall. 2006. Nature's experiment: vaccine escape recombinants emerge after pneumococcal vaccination, abstr. SY5.05. Fifth Int. Symp. Pneumococci Pneumococcal Dis., Alice Springs, Australia, 3 to 6 April 2006.
22. Brueggemann, A. B., and, B. G. Spratt. 2003. Geographic distribution and clonal diversity of Streptococcus pneumoniae serotype 1 isolates. J. Clin. Microbiol. 41 : 4966– 4970.
23. Buie, K. A.,, K. P. Klugman,, A. von Gottberg,, O. Perovic,, A. Karstaedt,, H. Crewe-Brown,, S. A. Madhi, and, C. Feldman. 2004. Gender as a risk factor for both antibiotic resistance and infection with pediatric serogroups/serotypes, in HIV-infected and -uninfected adults with pneumococcal bacteremia. J. Infect. Dis. 189 : 1996– 2000.
24. Butler, J. C.,, R. F. Breiman,, H. B. Lipman,, J. Hofmann, and, R. R. Facklam. 1995. Serotype distribution of Streptococcus pneumoniae infections among preschool children in the United States, 1978–1994: implications for development of a conjugate vaccine. J. Infect. Dis. 171 : 885– 889.
25. Byington, C. L.,, K. Korgenski,, J. Daly,, K. Ampofo,, A. Pavia, and, E. O. Mason. 2006. Impact of the pneumococcal conjugate vaccine on pneumococcal parapneumonic empyema. Pediatr. Infect. Dis. J. 25 : 250– 254.
26. Calbo, E.,, A. Diaz,, E. Canadell,, J. Fabrega,, S. Uriz,, M. Xercavins,, M. A. Morera,, E. Cuchi,, M. Rodriguez-Carballeira,, J. Garau, and the Spanish Pneumococcal Infection Study Network. 2006. Invasive pneumococcal disease among children in a health district of Barcelona: early impact of pneumococcal conjugate vaccine. Clin. Microbiol. Infect. 12 : 867– 872.
27. Camou, T.,, R. Palacio,, J. L. DiFabio, and, M. Hortal. 2003. Invasive pneumococcal diseases in Uruguayan children: comparison between serotype distribution and conjugate vaccine formulations. Vaccine 21 : 2093– 2096.
28. Campbell, J. D.,, K. L. Kotloff,, S. O. Sow,, M. Tapia,, M. M. Keita,, T. Keita,, S. Diallo,, J. C. Hormazabal,, P. Murray, and, M. M. Levine. 2004. Invasive pneumococcal infections among hospitalized children in Bamako, Mali. Pediatr. Infect. Dis. J. 23 : 642– 649.
29. Capeding, M. R.,, L. T. Sombrero,, G. A. Esparar, and, A. G. Taclibon. Pneumococcal serotypes among Filipino children admitted to a tertiary care center for infectious diseases in 2000–2005, abstr. PO3.48. Fifth Int. Symp. Pneumococci Pneumococcal Dis., Alice Springs, Australia, 3 to 6 April 2006.
30. Casado Flores, J.,, A. Fenoll,, J. Aristegui Fernandez,, C. Rodrigo De Liria,, J. M. Martinon Sanchez,, S. Berron,, C. Fernandez Perez, and Grupo para el Estudio de la Meningitis Neumococica. 2002. Pneumococcal meningitis in Spanish children: incidence, serotypes and antibiotic resistance. Prospective and multicentre study. An. Esp. Pediatr. 57 : 295– 300. (In Spanish.)
31. Centers for Disease Control and Prevention. 2005. Direct and indirect effects of routine vaccination of children with PCV-7 pneumococcal conjugate vaccine on incidence of invasive pneumococcal disease, United States, 1998–2003. Morb. Mortal. Wkly. Rep. 54 : 893– 897.
32. Centre National de Référence des Pneumocoques. 2006. Rapport d'activite 2006: Epidemiologie 2005. Centre National de Référence des Pneumocoques, Paris, France. http://www.invs.sante.fr/surveillance/cnr/rapport_cnr_pneumo_2006.pdf.
33. Chen, J. Y.,, C. P. Fung,, C. C. Wang,, M. L. Chu, and, L. K. Siu. 2003. In vitro susceptibility of six fluoroquinolones against invasive Streptococcus pneumoniae isolated from 1996 to 2001 in Taiwan. Microb. Drug Resist. 9 : 211– 217.
34. Chen, Y. Y.,, S. M. Yao,, C. Y. Chou,, Y. C. Chang,, P. W. Shen,, C. T. Huang,, H. P. Su, and, S. Y. Li. 2006. Surveillance of invasive Streptococcus pneumoniae in Taiwan, 2002–2003. J. Med. Microbiol. 55 : 1109– 1114.
35. Chiba, N.,, R. Kobayashi,, K. Hasegawa,, M. Morozumi,, E. Nakayama,, T. Tajima,, S. Iwata,, K. Ubukata, and the Acute Respiratory Diseases Study Group. 2005. Antibiotic susceptibility according to genotype of penicillin-binding protein and macrolide resistance genes, and serotype of Streptococcus pneumoniae isolates from community-acquired pneumonia in children. J. Antimicrob. Chemother. 56 : 756– 760.
36. Choi, E. H., and, H. J. Lee. 1998. Clinical outcome of invasive infections by penicillin-resistant Streptococcus pneumoniae in Korean children. Clin. Infect. Dis. 26 : 1346– 1354.
37. Chong, C.-Y.,, Y. H. Mok, and, N. Tee. 2006. Invasive pneumococcal disease in Singapore children, abstr. PO3.09. Fifth Int. Symp. Pneumococci Pneumococcal Dis., Alice Springs, Australia, 3 to 6 April 2006.
38. Clarke, S. C.,, J. M. Jefferies,, A. J. Smith,, J. McMenamin,, T. J. Mitchell, and, G. F. Edwards. 2006. Pneumococci causing invasive disease in children prior to the introduction of pneumococcal conjugate vaccine in Scotland. J. Med. Microbiol. 55 : 1079– 1084.
39. Coffey, T. J.,, M. Daniels,, M. C. Enright, and, B. G. Spratt. 1999. Serotype 14 variants of the Spanish penicillin-resistant serotype 9V clone of Streptococcus pneumoniae arose by large recombinational replacements of the cpsA-pbp1a region. Microbiology 145 : 2023– 2031.
40. Coffey, T. J.,, M. C. Enright,, M. Daniels,, J. K. Morona,, R. Morona,, W. Hryniewicz,, J. C. Paton, and, B. G. Spratt. 1998. Recombinational exchanges at the capsular polysaccharide biosynthetic locus lead to frequent serotype changes among natural isolates of Streptococcus pneumoniae. Mol. Microbiol. 27 : 73– 83.
41. Coffey, T. J.,, M. C. Enright,, M. Daniels,, P. Wilkinson,, S. Berron,, A. Fenoll, and, B. G. Spratt. 1998. Serotype 19A variants of the Spanish serotype 23F multiresistant clone of Streptococcus pneumoniae. Microb. Drug Resist. 4 : 51– 55.
42. Converse, G. M., and, H. C. J. Dillon. 1977. Epidemiological studies of Streptococcus pneumoniae in infants: methods of isolating pneumococci. J. Clin. Microbiol. 5 : 293– 296.
43. Crewe-Brown, H. H.,, A. S. Karsteidt,, G. L. Saunders,, M. Khoosal,, N. Jones,, A. Wasas, and, K. P. Klugman. 1997. Streptococcus pneumoniae blood culture isolates from patients with and without human immunodeficiency virus infection: alterations in penicillin susceptibilities and in serogroups or serotypes. Clin. Infect. Dis. 25 : 1165– 1172.
44. Cruickshank, R. 1933. Pneumococcal infections. II. Lobar pneumonia in the community. Lancet i : 621– 626.
45. Cutts, F. T.,, S. M. Zaman,, G. Enwere,, S. Jaffar,, O. S. Levine,, J. B. Okoko,, C. Oluwalana,, A. Vaughan,, S. K. Obaro,, A. Leach,, K. P. McAdam,, E. Biney,, M. Saaka,, U. Onwuchekwa,, F. Yallop,, N. F. Pierce,, B. M. Greenwood,, R. A. Adegbola, and the Gambian Pneumococcal Vaccine Trial Group. 2005. Efficacy of nine-valent pneumococcal conjugate vaccine against pneumonia and invasive pneumococcal disease in The Gambia: randomised, double-blind, placebo-controlled trial. Lancet 365 : 1139– 1146.
46. Dagan, R.,, R. Melamed,, M. Muallem,, L. Piglansky,, D. Greenberg,, O. Abramson,, P. M. Mendelman,, N. Bohidar, and, P. Yagupsky. 1996. Reduction of nasopharyngeal carriage of pneumococci during the second year of life by a heptavalent conjugate pneumococcal vaccine. J. Infect. Dis. 174 : 1271– 1278.
47. Dagan, R.,, O. Shriker,, I. Hazan,, E. Leibovitz,, D. Greenberg,, F. Schlaeffer, and, R. Levy. 1998. Prospective study to determine clinical relevance of detection of pneumococcal DNA in sera of children by PCR. J. Clin. Microbiol. 36 : 669– 673.
48. Dagan, R.,, N. Givon-Lavi,, O. Zamir,, M. Sikuler-Cohen,, L. Guy,, J. Janco,, P. Yagupsky, and, D. Fraser. 2002. Reduction of nasopharyngeal carriage of Streptococcus pneumoniae after administration of a 9-valent pneumococcal conjugate vaccine to toddlers attending day care centers. J. Infect. Dis. 185 : 927– 936.
49. Dagan, R.,, N. Givon-Lavi,, J. Bar-Ziv, and, N. Porat. 2004. The association of nasopharyngeal (NP) S. pneumoniae (Pnc) serotypes with community-acquired alveolar pneumonia (CAAP) determined by WHO standardisation of interpretation of chest radiographs in children (WHO-SICR), abstr. 44. Fourth Int. Symp. Pneumococci Pneumococcal Dis., Helsinki, Finland, 9 to 13 May 2004.
50. Di Fabio, J. L.,, E. Castaneda,, C. I. Agudelo,, F. De La Hoz,, M. Hortal,, T. Camou,, G. Echaniz-Aviles,, M. Noemi,, C. Barajas,, I. Heitmann,, J. C. Hormazabal,, M. C. Brandileone,, V. S. Dias Vieira,, M. Regueira,, R. Ruvinski,, A. Corso,, M. Lovgren,, J. A. Talbot,, C. De Quadros, et al. 2001. Evolution of Streptococcus pneumoniae serotypes and penicillin susceptibility in Latin America, Sireva-Vigia Group, 1993 to 1999. Pediatr. Infect. Dis. J. 20 : 959– 967.
51. Dochez, A. R., and, O. T. Avery. 1915. The occurrence of carriers of disease-producing types of pneumococcus. J. Exp. Med. 22 : 105– 113.
52. Douglas, R. M.,, J. C. Paton,, S. J. Duncan, and, D. J. Hansman. 1983. Antibody response to pneumococcal vaccination in children younger than five years of age. J. Infect. Dis. 148 : 131– 137.
53. Dowell, S. F.,, R. L. Garman,, G. Liu,, O. S. Levine, and, Y. H. Yang. 2001. Evaluation of Binax NOW, an assay for the detection of pneumococcal antigen in urine samples, performed among pediatric patients. Clin. Infect. Dis. 32 : 824– 825.
54. Enright, M. C., and, B. G. Spratt. 1998. A multilocus sequence typing scheme for Streptococcus pneumoniae: identification of clones associated with serious invasive disease. Microbiology 144 : 3049– 3060.
55. Eskola, J.,, T. Kilpi,, A. Palmu,, J. Jokinen,, J. Haapakoski,, E. Herva,, A. Takala,, H. Kayhty,, P. Karma,, R. Kohberger,, G. Siber, and, P. H. Makela. 2001. Efficacy of a pneumococcal conjugate vaccine against acute otitis media. N. Engl. J. Med. 344 : 403– 409.
56. Esposito, S.,, R. Droghetti,, N. Faelli,, A. Lastrico,, C. Tagliabue,, L. Cesati,, C. Bianchi, and, N. Principi. 2003. Serum concentrations of pneumococcal anticapsular antibodies in children with pneumonia associated with Streptococcus pneumonia infection. Clin. Infect. Dis. 37 : 1261– 1264.
57. Factor, S. H. 2005. Streptococcus pneumoniae and Haemophilus influenzae type b carriage, Central Asia. Emerg. Infect. Dis. 11 : 1476– 1479.
58. Feikin, D. R., and, K. P. Klugman. 2002. Historical changes in pneumococcal serogroup distribution: implications for the era of pneumococcal conjugate vaccines. Clin. Infect. Dis. 35 : 547– 555.
59. Feikin, D. R.,, M. Davis,, O. C. Nwanyanwu,, P. N. Kazembe,, L. M. Barat,, A. Wasas,, P. B. Bloland,, C. Ziba,, T. Capper,, R. E. Huebner,, B. Schwartz,, K. P. Klugman, and, S. F. Dowell. 2003. Antibiotic resistance and serotype distribution of Streptococcus pneumoniae colonizing rural Malawian children. Pediatr. Infect. Dis. J. 22 : 564– 567.
60. Feikin, D. R.,, K. P. Klugman,, R. R. Facklam,, E. R. Zell,, A. Schuchat,, C. G. Whitney, and the Active Bacterial Core Surveillance/Emerging Infections Program Network. 2005. Increased prevalence of pediatric pneumococcal serotypes in elderly adults. Clin. Infect. Dis. 41 : 481– 487.
61. Feris, J.,, J. Fernandez,, J. Sanchez,, C. Pena,, G. Guzman,, M. Gonzalez,, J. Marinez,, M. Novas, and, E. Perez-Then. 2006. Streptococcus pneumoniae invasive disease in Dominican children, abstr. G-856. 46th Int. Conf. Antimicrob. Agents Chemother., San Francisco, CA, 27 to 30 Sept. 2006.
62. Fireman, B.,, S. B. Black,, H. R. Shinefield,, J. Lee,, E. Lewis, and, P. Ray. 2003. Impact of the pneumococcal conjugate vaccine on otitis media. Pediatr. Infect. Dis. J. 22 : 10– 16.
63. Flannery, B.,, R. T. Heffernan,, L. H. Harrison,, S. M. Ray,, A. L. Reingold,, J. Hadler,, W. Schaffner,, R. Lynfield,, A. R. Thomas,, J. Li,, M. Campsmith,, C. G. Whitney, and, A. Schuchat. 2006. Changes in invasive pneumococcal disease among HIV-infected adults living in the era of childhood pneumococcal immunisation. Ann. Intern. Med. 144 : 1– 9.
64. Fletcher, M.,, J. Leeming,, K. Cartwright,, A. Finn, and the South West of England Invasive Community Acquired Infection Study Group. 2006. Childhood empyema: limited potential impact of PCV-7 pneumococcal conjugate vaccine. Pediatr. Infect. Dis. J. 25 : 559– 560.
65. Foy, H. M.,, B. Wentworth,, G. E. Kenny,, J. M. Kloeck, and, J. T. Grayston. 1975. Pneumococcal isolations from patients with pneumonia and control subjects in a prepaid medical care group. Am. Rev. Respir. Dis. 111 : 595– 603.
66. Fraser, D.,, N. Givon-Lavi,, N. Bilenko, and, R. Dagan. 2001. A decade (1989–1998) of pediatric invasive pneumococcal disease in 2 populations residing in 1 geographic location: implications for vaccine choice. Clin. Infect. Dis. 33 : 421– 427.
67. Garcia, E., and, R. Lopez. 1997. Molecular biology of the capsular genes of Streptococcus pneumoniae. FEMS Microbiol. Lett. 149 : 1– 10.
68. Garcia-Suarez, M. D. M.,, R. Villaverde,, A. F. Caldevilla,, F. J. Mendez, and, F. Vazquez. 2006. Serotype distribution and antimicrobial resistance of invasive and non-invasive pneumococccal isolates in Asturias, Spain. Jpn. J. Infect. Dis. 59 : 299– 305.
69. Gene, A.,, J. J. Garcia-Garcia,, A. Domingo,, P. Wienberg, and, E. Palacin. 2004. Etiology of acute otitis media in a children's hospital and antibiotic sensitivity of the bacteria involved. Enferm. Infecc. Microbiol. Clin. 22 : 377– 380. ( In Spanish.)
70. Gonzalez, B. E.,, K. G. Hulten,, L. Lamberth,, S. L. Kaplan, and, E. O. Mason. 2006. Streptococcus pneumoniae serogroups 15 and 33: an increasing cause of pneumococcal infections in children in the United States after the introduction of the pneumococcal PCV-7 conjugate vaccine. Pediatr. Infect. Dis. J. 25 : 301– 305.
71. Gordon, S. B.,, S. Kanyanda,, A. L. Walsh,, K. Goddard,, M. Chaponda,, V. Atkinson,, W. Mulwafu,, E. M. Molyneux,, E. E. Zijlstra,, M. E. Molyneux, and, S. M. Graham. 2003. Poor potential coverage for PCV-7 pneumococcal conjugate vaccine, Malawi. Emerg. Infect. Dis. 9 : 747– 749.
72. Gratten, M.,, J. Montgomery,, G. Gerega,, H. Gratten,, H. Siwi,, A. Poli, and, G. Koki. 1989. Multiple colonisation of the upper respiratory tract of Papua New Guinea children with Haemophilus influenzae and Streptococcus pneumoniae. Southeast Asian J. Trop. Med. Public Health 20 : 501– 509.
73. Gray, B. M.,, G. M. Converse, and, H. C. Dillon. 1980. Epidemiologic studies of Streptococcus pneumoniae in infants: acquisition, carriage, and infection during the first 24 months of life. J. Infect. Dis. 142 : 923– 933.
74. Griffith, F. 1928. The significance of pneumococcal types. J. Hyg. 27 : 113– 159.
75. Hammitt, L. L.,, D. L. Bruden,, J. C. Butler,, H. C. Baggett,, D. A. Hurlburt,, A. Reasonover, and, T. W. Hennessy. 2006. Indirect effect of conjugate vaccine on adult carriage of Streptococcus pneumoniae: an explanation of trends in invasive pneumococcal disease. J. Infect. Dis. 193 : 1487– 1494.
76. Hanage, W. P.,, K. Auranen,, R. Syrjanen,, E. Herva,, P. H. Makela,, T. Kilpi, and, B. G. Spratt. 2004. Ability of pneumococcal serotypes and clones to cause AOM: implications for the prevention of otitis media by conjugate vaccines. Infect. Immun. 72 : 76– 81.
77. Hanage, W. P.,, T. H. Kaijalainen,, R. K. Syrjanen,, K. Auranen,, M. Leinonen,, P. H. Makela, and, B. G. Spratt. 2005. Invasiveness of serotypes and clones of Streptococcus pneumoniae among children in Finland. Infect. Immun. 73 : 431– 435.
78. Hansman, D.,, S. Morris,, M. Gregory, and, B. McDonald. 1985. Pneumococcal carriage amongst Australian aborigines in Alice Springs, Northern Territory. J. Hyg. ( London) 95 : 677– 684.
79. Hansman, D. 1972. Type distribution and antibiotic sensitivity of pneumococci from carriers in Kiriwina, Trobriand Islands (New Guinea). Med. J. Aust. 2 : 771– 773.
80. Hausdorff, W. P.,, J. Bryant,, P. R. Paradiso, and, G. R. Siber. 2000. Which pneumococcal serogroups cause the most invasive disease: implications for conjugate vaccine formulation and use, part I. Clin. Infect. Dis. 30 : 100– 121.
81. Hausdorff, W. P.,, J. Bryant,, C. Kloek,, P. R. Paradiso, and, G. R. Siber. 2000. The contribution of specific pneumococcal serogroups to different disease manifestations: implications for conjugate vaccine formulation and use, part II. Clin. Infect. Dis. 30 : 122– 140.
82. Hausdorff, W. P.,, D. R. Feikin, and, K. P. Klugman. 2005. Epidemiological differences among pneumococcal serotypes. Lancet Infect. Dis. 5 : 83– 93.
83. Hausdorff, W. P.,, G. Siber, and, P. R. Paradiso. 2001. Geographical differences in invasive pneumococcal disease rates and serotype frequency in young children. Lancet 357 : 950– 952.
84. Hausdorff, W. P. 2007. The roles of pneumococcal serotypes 1 and 5 in pediatric invasive disease. Vaccine 25 : 2406– 2412.
85. (Reference deleted.)
86. Hausdorff, W. P.,, G. Yothers,, R. Dagan,, T. Kilpi,, S. I. Pelton,, R. Cohen,, M. R. Jacobs,, S. L. Kaplan,, C. Levy,, E. L. Lopez,, E. O. Mason, Jr.,, V. Syriopoulou,, B. Wynne, and, J. Bryant. 2002. Multinational study of pneumococcal serotypes causing acute otitis media in children. Pediatr. Infect. Dis. J. 21 : 1008– 1016.
87. Hedlund, J.,, M. Sorberg,, B. Henriques Normark, and, G. Kronvall. 2003. Capsular types and antibiotic susceptibility of invasive Streptococcus pneumoniae among children in Sweden. Scand. J. Infect. Dis. 35 : 452– 458.
88. Heffernan, H. M.,, D. R. Martin,, R. E. Woodhouse,, J. Morgan, and, T. K. Blackmore. 17 May 2007, posting date. Invasive pneumococcal disease in New Zealand 1998–2005: capsular serotypes and antimicrobial resistance. Epidemiol. Infect. [Epub ahead of print.] doi: 10.1017/S0950268807008588.
89. Heffron, R. 1939. Pneumonia with special reference to pneumococcus lobar pneumonia. The Commonwealth Fund, New York, NY.
90. Henriques, B.,, M. Kalin,, A. Ortqvist,, B. Olsson Liljequist,, M. Almela,, T. J. Marrie,, M. A. Mufson,, A. Torres,, M. A. Woodhead,, S. B. Svenson, and, G. Kallenius. 2000. Molecular epidemiology of Streptococcus pneumoniae causing invasive disease in 5 countries. J. Infect. Dis. 182 : 833– 839.
91. Hill, P. C.,, A. Akisanya,, K. Sankareh,, Y. B. Cheung,, M. Saaka,, G. Lahai,, B. M. Greenwood, and, R. A. Adegbola. 2006. Nasopharyngeal carriage of Streptococcus pneumoniae in Gambian villagers. Clin. Infect. Dis. 43 : 673– 679.
92. Ho, P. L.,, K. F. Lam,, F. K. Chow,, Y. L. Lau,, S. S. Wong,, S. L. Cheng, and, S. S. Chiu. 2004. Serotype distribution and antimicrobial resistance patterns of nasopharyngeal and invasive Streptococcus pneumoniae isolates in Hong Kong children. Vaccine 22 : 3334– 3339.
93. Hodges, R. G.,, C. M. MacLeod, and, W. G. Bernhard. 1946. Epidemic pneumococcal pneumonia. III. Carrier studies. Am. J. Hyg. 44 : 207– 230.
94. Hsieh, Y. C.,, P. R. Hsueh,, C. Y. Lu,, P. I. Lee,, C. Y. Lee, and, L. M. Huang. 2004. Clinical manifestations and molecular epidemiology of necrotizing pneumonia and empyema caused by Streptococcus pneumoniae in children in Taiwan. Clin. Infect. Dis. 38 : 830– 835.
95. Huebner, R. E.,, A. D. Wasas, and, K. P. Klugman. 2000. Trends in antimicrobial resistance and serotype distribution of blood and cerebrospinal fluid isolates of Streptococcus pneumoniae in South Africa, 1991–1998. Int. J. Infect. Dis. 4 : 214– 218.
96. Hussain, M.,, A. Melegaro,, R. G. Pebody,, R. George,, W. J. Edmunds,, R. Talukdar,, S. A. Martin,, A. Efstratiou, and, E. Miller. 2005. A longitudinal household study of Streptococcus pneumoniae nasopharyngeal carriage in a UK setting. Epidemiol. Infect. 133 : 891– 898.
97. International Centre for Diarrhoeal Disease Research, Bangladesh. 2006. Surveillance for pneumococcal disease: implications for prevention Bangladesh. Health Sci. Bull. 4 : 7– 11.
98. Jefferson, T.,, E. Ferroni,, F. Curtale,, P. Giorgi Rossi, and, P. Borgia. 2006. Streptococcus pneumoniae in western Europe: serotype distribution and incidence in children less than 2 years old. Lancet Infect. Dis. 6 : 405– 410.
99. Jette, L. P.,, G. Delage,, L. Ringuette,, R. Allard,, P. De Wals,, F. Lamothe,, V. Loo, et al. 2001. Surveillance of invasive Streptococcus pneumoniae infection in the province of Quebec, Canada, from 1996 to 1998: serotype distribution, antimicrobial susceptibility, and clinical characteristics. J. Clin. Microbiol. 39 : 733– 737.
100. Jiang, S. M.,, L. Wang, and, P. R. Reeves. 2001. Molecular characterisation of Streptococcus pneumoniae type 4, 6B, 8, and 18C capsular polysaccharide gene clusters. Infect. Immun. 69 : 1244– 1255.
101. Kaltoft, M. S.,, N. Zeuthen, and, H. B. Konradsen. 2000. Epidemiology of invasive pneumococcal infections in children aged 0–6 years in Denmark: a 19-year nationwide surveillance study. Acta Paediatr. Suppl. 89 : 3– 10.
102. Kaplan, S. L.,, E. O. Mason, Jr.,, E. R. Wald,, G. E. Schutze,, J. S. Bradley,, T. Q. Tan,, J. A. Hoffman,, L. B. Givner,, R. Yogev, and, W. J. Barson. 2004. Decrease of invasive pneumococcal infections in children among 8 children's hospitals in the United States after the introduction of the PCV-7 pneumococcal conjugate vaccine. Pediatrics 113 : 443– 449.
103. Katosova, L. K. 1994. The features of Haemophilus influenzae and Streptococcus pneumoniae carriage and the comparative characteristics of strains isolated from healthy children and from patients with acute and chronic respiratory infections. Zh. Mikrobiol. Epidemiol. Immunobiol. 1994(Suppl. 1) : 55– 60. (In Russian.)
104. Klugman, K. P.,, S. A. Madhi,, R. E. Huebner,, R. Kohberger,, N. Mbelle, and, N. Pierce. 2003. A trial of a 9-valent pneumococcal conjugate vaccine in children with and those without HIV infection. N. Engl. J. Med. 349 : 1341– 1348.
105. Kostyukova, N. N.,, M. O. Volkova,, V. V. Ivanova, and, A. S. Kvetnaya. 1995. A study of pathogenic factors of Streptococcus pneumoniae strains causing meningitis. FEMS Immunol. Med. Microbiol. 10 : 133– 137.
106. Kronenberg, A.,, P. Zucs,, S. Droz, and, K. Muhlemann. 2006. Distribution and invasiveness of Streptococcus pneumoniae serotypes in Switzerland, a country with low antibiotic selection pressure, from 2001 to 2004. J. Clin. Microbiol.. 44 : 2032– 2038.
107. Kyaw, M. H.,, R. Lynfield,, W. Schaffner,, A. S. Craig,, J. Hadler,, A. Reingold,, A. R. Thomas,, L. H. Harrison,, N. M. Bennett,, M. M. Farley,, R. R. Facklam,, J. H. Jorgensen,, J. Besser,, E. R. Zell,, M. Stat,, A. Schuchat, and, C. Whitney. 2006. Effect of introduction of the pneumococcal conjugate vaccine on drug-resistant Streptococcus pneumoniae. N. Engl. J. Med. 354 : 1455– 1463.
108. Ladesma, P. E. A.,, S. Lupisan,, E. A. F. Simoes,, L. Sombrero,, B. Quiambao,, M. Lucero,, L. Gozum,, J. Arcay,, E. Herva, and, P. Ruutu. 2006. Invasive S. pneumoniae infections in infants and children less than 5 years old admitted to a tertiary hospital in central Philippines, abstr. PO2.18. Fifth Int. Symp. Pneumococci Pneumococcal Dis., Alice Springs, Australia, 3 to 6 April 2006.
109. Lagos,, R. A. Muñoz,, O. San Martín,, I. Heitmann,, H. Loyola, and, M. Levine. Secular variations in age incidence (Inc) and serotypes (St) causing invasive pneumococcal disease (IPD) in children 0 to 59 months of age (MoA) in the metropolitan region (MR), Chile, abstr. PO3.34. Fifth Int. Symp. Pneumococci Pneumococcal Dis., Alice Springs, Australia, 3 to 6 April 2006.
110. Latorre, C.,, A. Gene,, T. Juncosa,, C. Munoz-Almagro, and, A. Gonzalez-Cuevas. 2004. Characterisation of invasive pneumococcal isolates in Catalan children up to 5 years of age, 1989–2000. Clin. Microbiol. Infect. 10 : 177– 181.
111. Lauderdale, T. L.,, M. M. Wagener,, H. M. Lin,, I. F. Huang,, W. Y. Lee,, K. S. Hsieh,, J. F. Lai, and, C. C. Chiou. 2006. Serotype and antimicrobial resistance patterns of Streptococcus pneumoniae isolated from Taiwanese children: comparison of nasopharyngeal and clinical isolates. Diagn. Microbiol. Infect. Dis. 56 : 421– 426.
112. Leimkugel, J.,, A. A. Forgor,, S. Gagneux,, V. Pfluger,, C. Flierl,, E. Awine,, M. Naegeli,, J. P. Dangy,, T. Smith,, A. Hodgson, and, G. Pluschke. 2005. An outbreak of serotype 1 Streptococcus pneumoniae meningitis in northern Ghana with features that are characteristic of Neisseria meningitidis meningitis epidemics. J. Infect. Dis. 192 : 192– 199.
113. Le Monnier, A.,, E. Carbonnelle,, J. R. Zahar,, M. Le Bourgeois,, E. Abachin,, G. Quesne,, E. Varon,, P. Descamps,, J. De Blic,, P. Scheinmann,, P. Berche, and, A. Ferroni. 2006. Microbiological diagnosis of empyema in children: comparative evaluations by culture, polymerase chain reaction, and pneumococcal antigen detection in pleural fluids. Clin. Infect. Dis. 42 : 1135– 1140.
114. Levidiotou, S.,, G. Vrioni,, G. Tzanakaki,, C. Pappa,, H. Gesouli,, C. Gartzonika,, D. Papamichail, and, J. Kremastinou. 2006. Serotype distribution of Streptococcus pneumoniae in north-western Greece and implications for a vaccination programme. FEMS Immunol. Med. Microbiol. 48 : 179– 182.
115. Levine, O. S.,, K. L. O'Brien,, M. Knoll,, R. A. Adegbola,, S. Black,, T. Cherian,, R. Dagan,, D. Goldblatt,, A. Grance,, B. Greenwood,, T. Hennessy,, K. P. Klugman,, S. A. Madhi,, K. Mulholland,, H. Nohynek,, M. Santosham,, S. K. Saha,, J. A. Scott,, S. Sow,, C. G. Whitney, and, F. Cutts. 2006. Pneumococcal vaccination in developing countries. Lancet 367 : 1880– 1882.
116. Levine, S.,, S. Dejsirilert,, L. Sangsuk,, S. Chantra,, D. R. Feikin,, S. F. Dowell, and, S. J. Olsen. 2006. Serotypes and antimicrobial resistance of Streptococcus pneumoniae in Thailand 2002–2004. Pediatr. Infect. Dis. J. 25 : 176– 178.
117. Lexau, C. A.,, R. Lynfield,, R. Danila,, T. Pilishvili,, R. Facklam,, M. M. Farley,, L. H. Harrison,, W. Schaffner,, A. Reingold,, N. M. Bennett,, J. Hadler,, P. R. Cieslak, and, C. G. Whitney. 2005. Changing epidemiology of invasive pneumococcal disease among older adults in the era of pediatric pneumococcal conjugate vaccine. JAMA 294 : 2043– 2051.
118. Lin, W. J.,, W. T. Lo,, C. Y. Chou,, Y. Y. Chen,, S. Y. Tsai,, M. L. Chu, and, C. C. Wang. 2006. Antimicrobial resistance patterns and serotype distribution of invasive Streptococcus pneumoniae isolates from children in Taiwan from 1999 to 2004. Diagn. Microbiol. Infect. Dis. 56 : 189– 196.
119. Lipsitch, M.,, J. K. Dykes,, S. E. Johnson,, E. W. Ades,, J. King,, D. E. Briles, and, G. M. Carlone. 2000. Competition among Streptococcus pneumoniae for intranasal colonisation in a mouse model. Vaccine 18 : 2895– 2901.
120. Lipsitch, M. 1997. Vaccination against colonizing bacteria with multiple serotypes. Proc. Natl. Acad. Sci. USA 94 : 6571– 6576.
121. Lipsitch, M.,, K. O'Neill,, D. Cordy,, B. Bugalter,, K. Trzcinski,, C. M. Thompson,, R. Goldstein,, S. Pelton,, H. Huot,, B. Bouchet,, R. Reid,, M. Santosham, and, K. L. O'Brien. Strain characteristics of Streptococcus pneumoniae isolated from carriage and invasive disease during a cluster-randomized clinical trial of the 7-valent pneumococcal conjugate vaccine. J. Infect. Dis. 196 : 1221– 1227.
122. Lloyd-Evans, N.,, T. J. O'Dempsey,, I. Baldeh,, O. Secka,, E. Demba,, J. E. Todd,, T. F. Mcardle,, W. S. Banya, and, B. M. Greenwood. 1996. Nasopharyngeal carriage of pneumococci in Gambian children and in their families. Pediatr. Infect. Dis. J. 15 : 866– 871.
123. Loda, F. A.,, A. M. Collier,, W. P. Glezen,, K. Strangert,, W. A. J. Clyde, and, F. W. Denny. 1975. Occurrence of Diplococcus pneumoniae in the upper respiratory tract of children. J. Pediatr. 87 : 1087– 1093.
124. Lopez-Enriquez, C.,, L. E. Espinosa-Monteros,, L. V. Rojas, and, D. Gomez-Barreto. 2006. Surveillance of antimicrobial resistance of Streptococcus pneumoniae isolates in children with invasive pneumococcal infection from Mexico during 1997/2004, abstr. PO3.23. Fifth Int. Symp. Pneumococci Pneumococcal Dis., Alice Springs, Australia, 3 to 6 April 2006.
125. Madhi, S. A.,, P. Adrian,, L. Kuwanda,, W. Jassat,, S. Jones,, T. Little,, A. Soininen,, C. Cutland, and, K. P. Klugman. 2007. Long-term immunogenicity and efficacy of a 9-valent conjugate pneumococcal vaccine in human immunodeficient virus infected and non-infected children in the absence of a booster dose of vaccine. Vaccine 25 : 2451– 2457.
126. Madhi, S. A.,, L. Kuwanda,, C. Cutland, and, K. P. Klugman. 2005. The impact of a 9-valent pneumococcal conjugate vaccine on the public health burden of pneumonia in HIV-infected and -uninfected children. Clin. Infect. Dis. 40 : 1511– 1518.
127. Malley, R.,, M. Lipsitch,, A. Stack,, R. Saladino,, G. Fleisher,, S. Pelton,, C. Thompson,, D. Briles, and, P. Anderson. 2001. Intranasal immunisation with killed unencapsulated whole cells prevents colonisation and invasive disease by capsulated pneumococci. Infect. Immun. 69 : 4870– 4873.
128. Marsh, R. L.,, H. Smith-Vaughana,, J. Beissbartha,, K. Harea,, M. Kennedy,, C. Wiggera,, G. Mellona,, E. Stubbs,, J. R. Gadila,, A. Pettita,, G. Mackenzie,, P. Tipakalippa,, P. S. Morris, and, A. J. Leach. 2007. Molecular characterisation of pneumococcal serotype 16F: established predominant carriage and otitis media serotype in the 7vPCV era. Vaccine 25 : 2434– 2436.
129. Masters, P. L.,, W. Brumfitt,, R. L. Mendez, and, M. Likar. 1958. Bacterial flora of the upper respiratory tract in Paddington families 1952–4. Br. Med. J. 14 : 1200– 1205.
130. McCullers, J. A. 2006. Insights into the interaction between influenza virus and pneumococcus. Clin. Microbiol. Rev. 19 : 571– 582.
131. McEllistrem, M. C.,, J. M. Adams,, K. Patel,, A. B. Mendelsohn,, S. L. Kaplan,, J. S. Bradley,, G. E. Schutze,, K. S. Kim,, E. O. Mason, and, E. R. Wald. 2005. Acute otitis media due to penicillin-nonsusceptible Streptococcus pneumoniae before and after the introduction of the pneumococcal conjugate vaccine. Clin. Infect. Dis. 40 : 1738– 1744.
132. McGowan, J. E. J.,, L. Bratton,, J. O. Klein, and, M. Finland. 1973. Bacteremia in febrile children seen in a “walk-in” pediatric clinic. N. Engl. J. Med. 288 : 1309– 1312.
133. McIntosh, E. D.,, B. Fritzell, and, M. A. Fletcher. 2007. Burden of paediatric invasive pneumococcal disease in Europe, 2005. Epidemiol. Infect. 135 : 644– 656.
134. Meats, E.,, A. B. Brueggemann,, M. C. Enright,, K. Sleeman,, D. T. Griffiths,, D. W. Crook, and, B. G. Spratt. 2003. Stability of serotypes during nasopharyngeal carriage of Streptococcus pneumoniae. J. Clin. Microbiol. 41 : 386– 392.
135. Melegaro, A.,, W. J. Edmunds,, R. Pebody,, E. Miller, and, R. George. 2006. The current burden of pneumococcal disease in England and Wales. J. Infect. 52 : 37– 48.
136. Michel, N.,, M. Watson,, F. Baumann,, P. Perolat, and, B. Garin. 2005. Distribution of Streptococcus pneumoniae serotypes responsible for penicillin resistance and the potential role of new conjugate vaccines in New Caledonia. J. Clin. Microbiol. 43 : 6060– 6063.
137. Miller, E.,, P. Waight,, A. Efstratiou,, M. Brisson,, A. Johnson, and, R. George. 2000. Epidemiology of invasive and other pneumococcal disease in children in England and Wales, 1996–1998. Acta Paediatr. Suppl. 89 : 11– 16.
138. Montgomery, J. M.,, D. Lehmann,, T. Smith,, A. Michael,, B. Joseph,, T. Lupiwa,, C. Coakley,, V. Spooner,, B. Best, and, I. D. Riley. 1990. Bacterial colonisation of the upper respiratory tract and its association with acute lower respiratory tract infections in Highland children of Papua New Guinea. Rev. Infect. Dis. 12(Suppl. 8) :S1006–S1016.
139. Motlova, J. 2005. Distribution of Streptococcus pneumoniae serotypes and serogroups among patients with invasive pneumococcal diseases in the Czech Republic in 1996–2003: background data for vaccination strategy. Epidemiol. Mikrobiol. Imunol. 54 : 3– 10. ( In Czech.)
140. Mulholland, K. 2005. The Gambian pneumococcal vaccine trial: implications for control of childhood pneumonia. Trop. Med. Int. Health 10 : 497– 500.
141. Muller-Graf, C. D.,, A. M. Whatmore,, S. J. King,, K. Trzcinski,, A. P. Pickerill,, N. Doherty,, J. Paul,, D. Griffiths,, D. Crook, and, C. G. Dowson. 1999. Population biology of Streptococcus Pneumoniae isolated from oropharyngeal carriage and invasive disease. Microbiology 145 : 3283– 3293.
142. Nesin, M.,, M. Ramirez, and, A. Tomasz. 1998. Capsular transformation of a multidrug-resistant Streptococcus pneumoniae in vivo. J. Infect. Dis. 177 : 707– 713.
143. The Netherlands Reference Laboratory for Bacterial Meningitis. 2003. Bacterial Meningitis in The Netherlands: Annual Report, 2003. Academic Medical Center, University of Amsterdam, National Institute of Public Health and the Environment, Amsterdam, The Netherlands.
144. Normark, B. H.,, A. Ortqvist,, M. Kalin,, B. Olsson-Liljequist,, J. Hedlund,, S. B. Svenson, and, G. Kallenius. 2001. Changes in serotype distribution may hamper efficacy of pneumococcal conjugate vaccines in children. Scand. J. Infect. Dis. 33 : 848– 850.
145. Nurkka, A.,, H. Lehtonen,, A. Vuorela,, N. Ekström, and, H. Käyhty. 2006. Functionality of antibodies against serotypes 6A and 19A induced by three different pneumococcal conjugate vaccines (PCV) in infants, abstr. PO10.08. Fifth Int. Symp. Pneumococci Pneumococcal Dis., Alice Springs, Australia, 3 to 6 April 2006.
146. Obando, I.,, L. A. Arroyo,, D. Sanchez-Tatay,, D. Moreno,, W. P. Hausdorff, and, A. B. Brueggemann. 2006. Molecular typing of pneumococci causing parapneumonic empyema in Spanish children using multilocus sequence typing directly on pleural fluid samples. Pediatr. Infect. Dis. J. 25 : 962– 963.
147. O'Brien, K. L.,, J. Shaw,, R. Weatherholtz,, R. Reid,, J. Watt,, J. Croll,, R. Dagan,, A. J. Parkinson, and, M. Santosham. 2004. Epidemiology of invasive Streptococcus pneumoniae among Navajo children in the era before use of conjugate pneumococcal vaccines, 1989–1996. Am. J. Epidemiol. 160 : 270– 278.
148. O'Brien, K. L.,, R. Weatherholtz,, E. V. Millar,, J. P. Watt,, L. Moulton,, R. Reid,, A. Parkinson, and, M. Santosham. 2006. Replacement invasive pneumococcal disease 9 years after introduction of PCV among a population at high risk for IPD: the Navajo experience, abstr. PO4.17. Fifth Int. Symp. Pneumococci Pneumococcal Dis., Alice Springs, Australia, 3 to 6 April 2006.
149. O'Brien, K. L.,, M. I. Walters,, J. Sellman,, P. Quinlisk,, H. Regnery,, B. Schwartz, and, S. F. Dowell. 2000. Severe pneumococcal pneumonia in previously healthy children: the role of preceding influenza infection. Clin. Infect. Dis. 30 : 784– 789.
150. Ostergaard, C.,, C. Brandt,, H. B. Konradsen, and, S. Samuelsson. 2004. Differences in survival, brain damage, and cerebrospinal fluid cytokine kinetics due to meningitis caused by 3 different Streptococcus pneumoniae serotypes: evaluation in humans and in 2 experimental models. J. Infect. Dis. 190 : 1212– 1220.
151. Pai, R.,, M. R. Moore,, T. Pilishvili,, R. E. Gertz,, C. G. Whitney,, B. Beall, and the Active Bacterial Core Surveillance Team. 2005. Postvaccine genetic structure of Streptococcus pneumoniae serotype 19A from children in the United States. J. Infect. Dis. 92 : 1988– 1995.
152. Palmu, A. A.,, J. Verho,, J. Jokinen,, P. Karma, and, T. M. Kilpi. 2004. The seven-valent pneumococcal conjugate vaccine reduces tympanostomy tube placement in children. Pediatr. Infect. Dis. J. 23 : 732– 738.
153. Palmu, A. A.,, J. T. Jokinen,, T. Kaijalainen,, M. Leinonen,, P. Karma, and, T. M. Kilpi. 2005. Association of clinical signs and symptoms with pneumococcal acute otitis media by serotype: implications for vaccine effect. Clin. Infect. Dis. 40 : 52– 57.
154. Pan American Health Organization. 2007. Informe Regional de Sireva. II. Datos por Pais y por Grupos de Edad Sobre las Caracteristicas de los Aislamientos de Streptococcus pneumoniae, Haemophilus influenzae, y Neisseria meningitidis en Procesos Invasores, 2000–2005. Pan American Health Organization, Washington DC.
155. Pantosti, A.,, D. Boccia,, F. D'Ambrosio,, S. Recchia,, G. Orefici, and, M. I. Moro for the National Surveillance of Bacterial Meningitis EARSS-Italia Study. 2003. Inferring the potential success of pneumococcal vaccination in Italy: serotypes and antibiotic resistance of Streptococcus pneumoniae isolates from invasive diseases. Microb. Drug Resist. 9(Suppl. 1) :S61–S68.
156. (Reference deleted.)
157. Paragi, M.,, J. Kolman,, A. Kraigher,, M. Cizman,, M. Gubina,, H. Ribic, and the Slovenian Meningitis Study Group. 2003. Possibility of application of new pneumococcal conjugate vaccines in children in Slovenia. Vaccine 21 : 4708– 4714.
158. Parry, C. M.,, T. S. Diep,, J. Wain,, N. T. Hoa,, M. Gainsborough,, D. Nga,, C. Davies,, N. H. Phu,, T. T. Hien,, N. J. White, and, J. J. Farrar. 2000. Nasal carriage in Vietnamese children of Streptococcus pneumoniae resistant to multiple antimicrobial agents. Antimicrob. Agents Chemother. 44 : 484– 488.
159. Pedersen, M. K.,, E. A. Hoiby,, L. O. Froholm,, V. Hasseltvedt,, G. Lermark, and, D. A. Caugant. 2004. Systemic pneumococcal disease in Norway, 1995–2001: capsular serotypes and antimicrobial resistance. Epidemiol. Infect. 132 : 167– 175.
160. Perez, A.,, P. Sala,, M. Gimenez,, M. Sierra,, A. Esteve,, A. Alonso,, M. Quesada,, F. Raspall,, V. Ausina, and, C. Rodrigo. 2004. Pneumococcal bacteremia in children: an 8-year review in two hospitals in Barcelona. Eur. J. Clin. Microbiol. Infect. Dis. 23 : 677– 681.
161. Phongsamart, W.,, S. Srifeungfung,, S. Dejsirilert,, T. Chatsuwan,, P. Nunthapisud,, V. Treerauthaweeraphong,, P. Rungnobhakhun, and, K. Chokephaibulkit. 2007. Serotype distribution and antimicrobial susceptibility of S. pneumoniae causing invasive disease in Thai children younger than 5 years old, 2000–2005. Vaccine 25 : 1275– 1280.
162. Pineda, V.,, D. Fontanals,, H. Larramona,, M. Domingo,, J. Anton, and, F. Segura. 2002. Epidemiology of invasive Streptococcus pneumoniae infections in children in an area of Barcelona, Spain. Acta Paediatr. 91 : 1251– 1256.
163. Prymula, R.,, J. Motlova, and, P. Kriz. 2004. Comparison of Streptococcus pneumoniae serotypes causing acute otitis media and invasive disease in young children in the Czech Republic. Indian J. Med. Res. 119 (Suppl.): 168– 170.
164. Prymula, R.,, P. Peeters,, V. Chrobok,, P. Kriz,, E. Novakova,, E. Kaliskova,, I. Kohl,, P. Lommel,, J. Poolman,, J. P. Prieels, and, L. Schuerman. 2006. Pneumococcal capsular polysaccharides conjugated to protein D for prevention of acute otitis media caused by both Streptococcus pneumoniae and non-typable Haemophilus influenzae: a randomised double-blind efficacy study. Lancet 367 : 740– 748.
165. Ramdani-Bouguessa, N., and, K. Rahal. 2003. Serotype distribution and antimicrobial resistance of Streptococcus pneumoniae isolated in Algiers, Algeria. Antimicrob. Agents Chemother. 47 : 824– 826.
166. Ramirez, M., and, A. Tomasz. 1999. Acquisition of new capsular genes among clinical isolates of antibiotic-resistant Streptococcus pneumoniae. Microb. Drug Resist. 5: 241– 246.
167. Regev-Yochay, G.,, M. Raz,, R. Dagan,, N. Porat,, B. Shainberg,, E. Pinco,, N. Keller, and, E. Rubinstein. 2004. Nasopharyngeal carriage of Streptococcus pneumoniae by adults and children in community and family settings. Clin. Infect. Dis. 38 : 632– 639.
168. Reinert, R.,, A. Al-Lahham,, A. Siedler,, M. van der Linden,, A. M. Toschke, and, R. von Kries. 2006. Nationwide study of IPD in the pediatric population of Germany (1997-2004): incidence epidemiology of resistance, and coverage of PCV7, abstr. PO10.18. Fifth Int. Symp. Pneumococci Pneumococcal Dis., Alice Springs, Australia, 3 to 6 April 2006.
169. Reinert, R. R. 2005. Stellenwert der Pneumokokken-Impfung bei Kindern in Deutschland. Chemother. J. 14(Suppl. 23) : 1– 18.
170. Roca, A.,, B. Sigauque,, L. Quinto,, I. Mandomando,, X. Valles,, M. Espasa,, F. Abacassamo,, J. Sacarlal,, E. Macete,, A. Nhacolo,, M. Levine, and, P. Alonso. 2006. Invasive pneumococcal disease in children <5 years of age in rural Mozambique. Trop. Med. Int. Health 11 : 1422– 1431.
171. Rosenblut, A.,, M. E. Santolaya,, P. Gonzalez,, V. Corbalan,, L. F. Avendano,, M. A. Martinez, and, J. C. Hormazabal. 2001. Bacterial and viral etiology of acute otitis media in Chilean children. Pediatr. Infect. Dis. J. 20 : 501– 507.
172. Rountree, P. M.,, M. A. Beard,, W. Arter, and, A. J. Woolcock. 1967. Further studies on the nasal flora of people of Papua-New Guinea. Med. J. Aust. 1 : 967– 969.
173. Saha, S. K.,, A. H. Baqui,, G. L. Darmstadt,, M. Ruhulamin,, M. Hanif,, S. El Arifeen,, M. Santosham,, K. Oishi,, T. Nagatake, and, R. E. Black. 2003. Comparison of antibiotic resistance and serotype composition of carriage and invasive pneumococci among Bangladeshi children: implications for treatment policy and vaccine formulation. J. Clin. Microbiol. 41 : 5582– 5587.
174. Sandgren, A.,, K. Sjostrom,, B. Olsson-Liljequist,, B. Christensson,, A. Samuelsson,, G. Kronvall, and, B. Henriques Normark. 2004. Effect of clonal and serotype-specific properties on the invasive capacity of Streptococcus pneumoniae. J. Infect. Dis. 189 : 785– 796.
175. Scheifele, D.,, S. Halperin,, L. Pelletier,, J. Talbot, et al. 2000. Invasive pneumococcal infections in Canadian children, 1991–1998: implications for new vaccination strategies. Clin. Infect. Dis. 31 : 58– 64.
176. Scott, J. A.,, A. J. Hall,, A. Hannington,, R. Edwards,, S. Mwarumba,, B. Lowe,, D. Griffiths,, D. Crook, and, K. Marsh. 1998. Serotype distribution and prevalence of resistance to benzylpenicillin in three representative populations of Streptococcus pneumoniae isolates from the coast of Kenya. Clin. Infect. Dis. 27 : 1442– 1450.
177. Scott, J. A.,, A. J. Hall,, R. Dagan,, J. M. Dixon,, S. J. Eykyn,, A. Fenoll,, M. Hortal,, L. P. Jette,, J. H. Jorgensen,, F. Lamothe,, C. Latorre,, J. T. Macfarlane,, D. M. Shlaes,, L. E. Smart, and, A. Taunay. 1996. Serogroup-specific epidemiology of Streptococcus pneumoniae: associations with age, sex, and geography in 7,000 episodes of invasive disease. Clin. Infect. Dis. 22 : 973– 981.
178. Serrano, I.,, M. Ramirez,, J. Melo-Cristino, and the Portuguese Surveillance Group for the Study of Respiratory Pathogens. 2004. Invasive Streptococcus pneumoniae from Portugal: implications for vaccination and antimicrobial therapy. Clin. Microbiol. Infect. 10 : 652– 656.
179. Shouval, D. S.,, D. Greenberg,, N. Givon-Lavi,, N. Porat, and, R. Dagan. 2006. Site-specific disease potential of individual Streptococcus pneumoniae serotypes in pediatric invasive disease, acute otitis media and acute conjunctivitis. Pediatr. Infect. Dis. J. 25 : 602– 607.
180. Siedler, A.,, R. R. Reinert,, M. Toschke,, A. Al-Lahham,, R. von Kries, and the ESPED Clinic and Laboratory Study Group. 2005. Regional differences in the epidemiology of invasive pneumococcal disease in toddlers in Germany. Pediatr. Infect. Dis. J. 24 : 1114– 1115.
181. Sih, T. M. 2001. Acute otitis media in Brazilian children: analysis of microbiology and antimicrobial susceptibility. Ann. Otol. Rhinol. Laryngol. 110 : 662– 666.
182. Singleton, R. J.,, T. W. Hennessy,, L. R. Bulkow,, L. L. Hammitt,, T. Zulz,, D. A. Hurlburt,, J. C. Butler,, K. Rudolph, and, A. Parkinson. 2007. Invasive pneumococcal disease caused by nonvaccine serotypes among Alaska native children with high levels of 7-valent pneumococcal conjugate vaccine coverage. JAMA 297 : 1784– 1792.
183. Sjostrom, K.,, C. Spindler,, A. Ortqvist,, M. Kalin,, A. Sandgren,, S. Kuhlmann-Berenzon, and, B. Henriques-Normark. 2006. Clonal and capsular types decide whether pneumococci will act as a primary or opportunistic pathogen. Clin. Infect. Dis. 42 : 451– 459.
184. Sleeman, K. L.,, D. Griffiths,, F. Shackley,, L. Diggle,, S. Gupta,, M. C. Maiden,, E. R. Moxon,, D. W. Crook, and, T. E. Peto. 2006. Capsular serotype-specific attack rates and duration of carriage of Streptococcus pneumoniae in a population of children. J. Infect. Dis. 194 : 682– 688.
185. Smillie, W. G.,, G. H. Wamock, and, H. J. White. 1938. Study of a type 1 pneumococcus epidemic at the State Hospital at Worcester, Mass. Am. J. Public Health 28 : 293– 302.
186. Smillie, W. G., and, O. F. Jewett. 1940. The relationship of immediate family contact to the transmission of type-specific pneumococci. Am. J. Hyg. 32 : 79– 88.
187. Smith, T.,, D. Lehmann,, J. Montgomery,, M. Gratten,, I. D. Riley, and, M. P. Alpers. 1993. Acquisition and invasiveness of different serotypes of Streptococcus pneumoniae in young children. Epidemiol. Infect. 111 : 27– 39.
188. Sniadack, D. H.,, B. Schwartz,, H. Lipman,, J. Bogaerts,, J. C. Butler,, R. Dagan,, G. Echaniz-Aviles,, N. Lloyd-Evans,, A. Fenoll, and, N. I. Girgis. 1995 Potential interventions for the prevention of childhood pneumonia: geographic and temporal differences in serotype and serogroup distribution of sterile site pneumococcal isolates from children: implications for vaccine strategies. Pediatr. Infect. Dis. J. 14 : 503– 510.
189. Sombrero, L.,, G. Esperar,, F. Girasol,, E. Herva,, S. Lupisan,, P. Ruutu,, B. Quiambao,, L. Gozum,, M. Lucero, and, A. Nissinen. 2006. Serotype distribution and antibiotic susceptibility of invasive and respiratory pneumococcal isolates in children <5 admitted for pneumonia, suspected sepsis or meningitis in Bohol, Philippines, abstr. PO3.60. Fifth Int. Symp. Pneumococci Pneumococcal Dis., Alice Springs, Australia, 3 to 6 April 2006.
190. Song, J. H.,, S. I. Jung,, K. S. Ko,, N. Y. Kim,, J. S. Son,, H. H. Chang,, H. K. Ki,, W. S. Oh,, J. Y. Suh,, K. R. Peck,, N. Y. Lee,, Y. Yang,, Q. Lu,, A. Chongthaleong,, C. H. Chiu,, M. K. Lalitha,, J. Perera,, T. T. Yee,, G. Kumarasinghe,, F. Jamal,, A. Kamarulzaman,, N. Parasakthi,, P. H. Van,, C. Carlos,, T. So,, T. K. Ng, and, A. Shibl. 2004. High prevalence of antimicrobial resistance among clinical Streptococcus pneumoniae isolates in Asia (an AN-SORP study). Antimicrob. Agents Chemother. 48 : 2101– 2107.
191. Sow, S. O.,, J. C. Hormazabal,, M. D. Tapia,, S. Diallo,, J. D. Campbell,, K. Kotloff, and, M. Levine. 2006. Serotype distribution of Streptococcus pneumoniae among children in Bamako, Mali, abstr. PO3.57. Fifth Int. Symp. Pneumococci Pneumococcal Dis., Alice Springs, Australia, 3 to 6 April 2006.
192. Spencer, D. A.,, S. M. Iqbal,, A. Hasan, and, L. Hamilton. 2006. Empyema thoracis is still increasing in UK children. BMJ 332 : 1333.
193. Steenhoff, A. P.,, S. S. Shah,, A. J. Ratner,, S. M. Patil, and, K. L. McGowan. 2006. Emergence of vaccine-related pneumococcal serotypes as a cause of bacteremia. Clin. Infect. Dis. 42 : 907– 914.
194. Suhs, R. H., and, H. A. Feldman. 1965. Pneumococcal types detected in throat cultures from a population of “normal” families. Am. J. Med. Sci. 250 : 424– 427.
195. Syrjanen, R. K.,, T. M. Kilpi,, T. H. Kaijalainen,, E. E. Herva, and, A. K. Takala. 2001. Nasopharyngeal carriage of Streptococcus pneumoniae in Finnish children younger than 2 years old. J. Infect. Dis. 184 : 451– 459.
196. Tarallo, L.,, F. Tancredi,, G. Schito,, A. Marchese,, A. Bella, and the Italian Pneumonet Group (Societa Italiana Pediatria and Associazione Italiana Studio Antimicrobici e Resistenze). 2006. Active surveillance of Streptococcus pneumoniae bacteremia in Italian children. Vaccine 24 : 6938– 6943.
197. Torzillo, P. J.,, F. Morey,, M. Gratten,, D. Murphy,, R. Matters, and, J. Dixon. 2007. Changing epidemiology of invasive pneumococcal disease in central Australia prior to conjugate vaccine: a 16-year study. Vaccine 25 : 2375– 2378.
198. Tregnaghi, M.,, A. Ceballos,, R. Ruttimann,, J. Ussher,, P. Tregnaghi,, P. Peeters, and, W. P. Hausdorff. 2006. Active epidemiologic surveillance of pneumonia and invasive pneumococcal disease in ambulatory and hospitalized infants in Cordoba, Argentina. Pediatr. Infect. Dis. J. 25 : 370– 372.
199. Ubukata, K.,, N. Chiba,, K. Hasegawa,, R. Kobayashi,, S. Iwata, and, K. Sunakawa. 2004. Antibiotic susceptibility in relation to penicillin-binding protein genes and serotype distribution of Streptococcus pneumoniae strains responsible for meningitis in Japan, 1999 to 2002. Antimicrob. Agents Chemother. 48 : 1488– 1494.
200. Valles, X.,, B. Flannery,, A. Roca,, I. Mandomando,, B. Sigauque,, S. Sanz,, A. Schuchat,, M. Levine,, M. Soriano-Gabarro, and, P. Alonso. 2006. Serotype distribution and antibiotic susceptibility of invasive and nasopharyngeal isolates of Streptococcus pneumoniae among children in rural Mozambique. Trop. Med. Int. Health 11 : 358– 366.
201. Vergison, A.,, D. Tuerlinckx,, J. Verhaegen,, A. Malfroot, and the Belgian Invasive Pneumococcal Disease Study Group. 2006. Epidemiologic features of invasive pneumococcal disease in Belgian children: passive surveillance is not enough. Pediatrics 118 : 801– 809.
202. Waite, R. D.,, D. W. Penfold,, J. K. Struthers, and, C. G. Dowson. 2003. Spontaneous sequence duplications within capsule genes cap8E and tts control phase variation in Streptococcus pneumoniae serotypes 8 and 37. Microbiology 149 : 497– 504.
203. Wasfy, M. O.,, G. Pimentel,, M. Abdel-Maksoud,, K. L. Russell,, C. P. Barrozo,, J. D. Klena,, K. Earhart, and, R. Hajjeh. 2005. Antimicrobial susceptibility and serotype distribution of Streptococcus pneumoniae causing meningitis in Egypt, 1998–2003. J. Antimicrob. Chemother. 55 : 958– 964.
204. Watson, M.,, P. Roche,, K. Bayley,, J. M. Bell,, P. Collignon,, G. L. Gilbert,, G. Hogg,, A. D. Keil,, V. Krause,, D. Murphy,, H. V. Smith,, M. Brown,, J. Stylianopoulos, and, J. Turnidge. 2004. Laboratory surveillance of invasive pneumococcal disease in Australia, 2003: predicting the future impact of the universal childhood conjugate vaccine program. Commun. Dis. Intell. 28 : 455– 464.
205. Whitney, C. G.,, M. M. Farley,, J. Hadler,, L. H. Harrison,, N. M. Bennett,, R. Lynfield,, A. Reingold,, P. R. Cieslak,, T. Pilishvili,, D. Jackson,, R. R. Facklam,, J. H. Jorgensen,, A. Schuchat, and the Active Bacterial Core Surveillance of the Emerging Infections Program Network. 2003. Decline in invasive pneumococcal disease after the introduction of protein-polysaccharide conjugate vaccine.