https___pneumonepal.org_the-studies_nasopharyngeal-carriage_.xml
https___pneumonepal.org_ne__E0_A4_85_E0_A4_A7_E0_A5_8D_E0_A4_AF_E0_A4_AF_E0_A4_A8_E0_A4_B9_E0_A4_B0_E0_A5_81__E0_A4_B8_E0_A4_AE_E0_A5_81_E0_A4_A6_E0_A4_BE_E0_A4_AF-_E0_A4_95_E0_A5_8D_E0_A4_AF_E0_A4_BE_E0_A4_B0_E0_A5_80_E0_A4_9C-coca__1.xml
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Prevalence of Naopharyngeal Carriage in Children in the Community Streptococcus pneumoniae bacteria (pneumococcus) is a major cause of disease and disability worldwide, and is vaccine-preventable. In 2015, the Ministry of Health of Nepal began providing a 10-valent pneumococcal conjugate vaccine to infants (PCV10) as the vaccine was introduced into its routine infant immunization schedule. Estimating the impact of PCV on transmission in the community The pneumococcus is a bacterium that is often found in the nasopharynx (i.e., the back part of the nasal cavity) of children and adults without causing disease or symptoms. Pneumococcal disease occurs when the bacteria move from this harmless location—nasopharyngeal carriage—to other more vulnerable parts of the body, including the lungs (pneumonia) or more invasive locations such as the blood (bacteremia and sepsis) or the membranes that surround and protect the brain (meningitis). Those who carry pneumococcus in their nasopharynx - regardless of whether they are sick or not - can spread the bacterium to others. For this reason, preventing carriage in a child provides protection to other members of the household including siblings and grandparents, who are at higher risk of developing pneumococcal disease than those in the general community; this type of vaccine effect is often called “indirect protection”. More than 90 distinct pneumococcal serotypes have been identified throughout the world, with a small number of these serotypes accounting for most disease in infants. The vaccine Nepali children receive, PCV10, protects against 10 pneumococcal serotypes. The COCA study is measuring whether these pneumococcal serotypes are less likely to circulate in Nepal following the introduction of PCV10, as an indicator of the vaccine's effectiveness. The study is also measuring: - The amount of pneumococcal DNA present in the nasopharynx (i.e. carriage density) of each child surveyed, - How many different serotypes each child is carrying in the nasopharynx as children are likely to be carrying more than one type, - Whether serotypes absent from the vaccine are more likely to circulate after vaccine introduction, and - Whether there are differences in carriage trends in rural versus urban households. Since 2015, we have measured carriage in thousands of healthy children up to five years of age from an urban setting in Kathmandu and a rural setting in Okhaldhunga. Preliminary results: Declines in vaccine-type carriage Preliminary results suggest that the vaccine is working to reduce vaccine-type carriage. The proportion of children carrying the type of pneumococcal bacteria included in the vaccine decreased by 66% in the first two years of vaccine use, from 28% to 10%. This indicates that PCV10 is likely having an important impact on the health of young children in Nepal. Fig. 1 In an urban setting, the proportion of children carrying vaccine-type pneumococcal bacteria has declined since the introduction of PCV10 Fig. 2 In a rural setting, the proportion of children carrying vaccine-type pneumococcal bacteria has declined since the introduction of PCV10 Carriage trends in rural versus urban households Nasopharyngeal swabs were collected from healthy children in urban (Kathmandu valley; age 6-59 months) and rural (Okhaldhunga, age 6-23 months) Nepal in 2018 and 2019, and were cultured at Patan Hospital. The number of children aged less than 15 years in the household of swabbed children was compared to nasopharyngeal carriage prevalence. Results showed that in the urban area, carriage prevalence was 67.9%(668/983), 74.8%(533/713), 81.6%(111/136) and 84.1%(37/44), respectively, for households with 0,1,2 and ≥3 other children (p<0.001). In the rural area, prevalence was 89.4% (219/245), 95.2%(220/231), 90.4%(75/83) and 91.6%(33/36), respectively, for households with 0,1,2 and ≥3 other children (p=0.121). Fig. 3 Carriage prevalence in households with 0,1,2 and ≥3 children (Urban vs Rural) Prevalence of pneumococcal nasopharyngeal carriage increased with presence of other children within the household, presumably due to increased transmission, in the urban setting, where carriage was lower. There was no association in rural setting, where prevalence was higher, possibly due to different socioeconomics and mixing patterns of children in rural Nepal. Impact of PCV10 on Younger Children In the urban sites, researchers are assessing the impact of PCV10 on infants between 0-8 weeks of age, who are too young to be immunized. The results may indicate whether PCV10 offers indirect protection by preventing carriage (and associated transmission) even in children who do not directly receive the vaccine. Preliminary findings show a statistically significant decrease in the proportion of children too young to be immunized carrying the types of pneumococcal bacteria contained in PCV10 (from 5.2% in 2014 to 2.3% in 2017). In 2019, we will assess if this decline continues. Does an accelerated vaccination schedule affect carriage? Researchers did not find evidence of a difference in carriage prevalence after immunization between to the two different vaccine schedules (6+10 vs 6+14). Read more about the accelerated schedule. Analysis of this study is ongoing. For more information, contact our study coordinator.
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समुदायमा बालबालिकाहरुमाझ नासोफ्यारिन्जिल क्यारीजको प्रभाव स्ट्रेप्टोकोकस निमोनिया जीवाणु (न्युमोकोकस) रोग तथा संसारभरको अपाङ्गताको एक प्रमुख कारण हो l यसलाई खोपद्वारा रोकथाम गर्न सकिन्छ l सन् २०१५ मा नेपालको स्वास्थ्य मन्त्रालयले शिशुहरुलाई १०-भ्यालेन्ट निमोनिया विरुद्धको खोप (PCV10) प्रदान गर्न थालनी गर्यो जुन खोप नियमित शिशु खोप तालिका अन्तर्गत दिन शुरुवात गरिएको थियो l समुदायमा सरुवाको हकमा PCV को प्रभाव आँकलन न्युमोकोकस बालबालिका तथा बयस्क मानिसहरुको न्यासोफ्यारिंक्स (नाकको पछाडीपट्टि भाग) मा प्राय: पाइने एक जीवाणु हो जुन रोग वा लक्षणहरु ननिम्त्याईकन त्यहाँ रहेको हुन्छ l जब यो जीवाणु उक्त सुरक्षित स्थान (नासोफ्यारेंजियल क्यारीज) बाट फोक्सो लगायतका शरीरका अन्य अझैँ संवेदनशील भागहरुमा जान्छ तव न्युमोकोकल रोग देखापर्दछ (जहाँ यसले निमोनिया निम्त्याउँछ) वा अझै खतरा स्थान जस्तै रगत (ब्याक्टेरेमिया तथा सेप्सिस) वा मस्तिष्कलाई झेल्ने र सुरक्षित राख्ने झिल्लीहरु (मेनेंजाईटिस) बिरामी भए पनि नभए पनि आफ्नो नासोफ्यारिंक्समा न्युमोकोकस बोक्नेहरुले अरुलाई यो जीवाणु अरुलाई सार्न सक्छन् l यसै कारण बच्चाहरुमा क्यारिज हुन नदिनाले समुदायका अन्य सदस्यहरु भन्दा पनि घरका दाजुभाई दिदी बहिनी तथा हजुरबा, हजुरआमा जस्ता उच्च जोखिममा हुन सक्ने सदस्यहरुलाई न्युमोकोकल रोगबाट बच्न मद्दत मिल्छ l यस प्रकारको खोप प्रभावलाई प्राय: “अप्रत्यक्ष सुरक्षा” भनिन्छ l संसारभरमा ९० प्रकारका फरक निमोनियाजन्य सेरोटाइपहरुको पहिचान भएको छ l तथापि शिशुहरुमा मूलत: यी मध्येका थोरै सेरोटाइपहरुले मात्र रोग निम्त्याउँछन् l नेपाली बालबालिकाहरुले पाउने PCV खोपले १० न्युमोकोकल सेरोटाइपहरुबाट बचाउने गर्दछ l COCA अध्ययनले खोपको प्रभावकारिताको सूचकका रुपमा नेपालमा PCV 10 लगाएपश्चात यी न्युमोकोकल सेरोटाइपहरु फैलन कम हुन्छन् कि भन्ने मापन गरिरहेको छ l अध्ययनले यो पनि मापन गरिरहेको छ: - सर्वेक्षण गरिएका हरेक बालबालिकाहरुको नासोफ्यारिंक्समा (क्यारीज आयतन) रहेको DNA को मात्रा - हरेक बच्चाले नासोफ्यारिंक्समा कति किसिमिका सेरोटाइपहरु बोकिरहेका छन् किनकि बच्चाहरुले एक भन्दा बढी किसिमका सेरोटाईपहरु बोक्नसक्छन् - खोप लगाएपछी हराएका सेरोटाइपहरु पुन: फर्कने सम्भावना कति रहेको छ l र - ग्रामिण र सहरी घर परिवारहरुमा क्यारीजको ट्रेण्ड फरक हुन्छ कि हुँदैन l सन् २०१५ देखि हामीले काठमाडौँको सहरी र ओखलढुंगाको ग्रामिण परिवेशबाट पाँच बर्षसम्मका हजारौं बालबालिकाहरुमा क्यारीज मापन गरेका छौं l प्रारम्भिक परिणामहरु: खोप-जन्य क्यारीज घटेको अवस्था प्रारम्भिक परिणामका अनुसार खोपले खोप-जन्य क्यारीज न्यूनीकरण गर्न काम गरिरहेको छ l यस्ता किसिमको न्युमोकोकल जीवाणु बोक्ने बालबालिकाहरुको अनुपात खोप प्रयोगको दुइ बर्षमा ६६% घटेको छ, जुन २८% देद्खी १०% हो l यसले इंगित गर्दछ कि PCV10 ले नेपालका बालबालिकाहरुको स्वास्थ्यमा महत्वपूर्ण प्रभाव पारिरहेको छ l तस्विर १ सहरी परिवेशमा PCV10 को प्रयोग संगै खोपजन्य न्युमोकोकल जीवाणु बोक्ने बालबालिकाहरुको अनुपातमा गिरावट आएको छ l तस्विर २ ग्रामिण परिवेशमा PCV10 को प्रयोग संगै खोपजन्य न्युमोकोकल जीवाणु बोक्ने बालबालिकाहरुको अनुपातमा गिरावट आएको छ l बालबालिकाहरुमा PCV10 को प्रभाव सहरी परिवेसमा शोधकर्ताहरु ०-८ हप्ताको उमेरका शिशुहरुमा PCV10 को प्रभावको मूल्यांकन गरिरहेका छन् जो खोप लगाउनका लागि अत्यन्त कम उमेरका छन् l यी परिणामहरुले यो पनि इंगित गर्छ कि PCV10 ले खोप प्राप्त नगर्ने उमेरका बालबालिकाहरुलाई पनि क्यारीज रोकथाम गरि (सम्बन्धित सरुवा) अप्रत्यक्ष सुरक्षा प्रदान गर्दछ l प्रारम्भिक परिणामले PCV10 मा रहेका न्युमोकोकल जीवाणुका किसिमहरु बोकेका खोप लगाउन नमिल्ने कम उमेरका बालबालिकाहरुको तथ्यांकीय अनुपातमा उल्लेख्य कमिआएको देखाउँछ l (२०१४ मा ५.२% बाट २०१७ मा २.३%) l २०१९ मा हामी यो गिरावट जारि रहे नरहेको मुल्यांकन गर्नेछौं l के तिब्र तुल्याईएको खोप तालिकाले क्यरिजलाई असर गर्दछ ? शोधकर्ताहरुले दुइ फरक खोप तालिकाकाबीचमा क्यारीजको प्रभाव फरक रहेको प्रमाण फेला पारेनन् l (6+10 vs 6+14) तिब्र तुल्याईएको तालिकाका बारेमा विस्तृत पढ्नुहोस् l यस अध्ययनको विश्लेषण जारि छ l विस्तृत जानकारीका लागि हाम्रो अध्ययन संयोजकलाई सम्पर्क गर्नुहोस् l