{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T03:07:29Z","timestamp":1775790449410,"version":"3.50.1"},"reference-count":19,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2023,1,26]],"date-time":"2023-01-26T00:00:00Z","timestamp":1674691200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,1,26]],"date-time":"2023-01-26T00:00:00Z","timestamp":1674691200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1117653"],"award-info":[{"award-number":["OPP1117653"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004440","name":"Wellcome","doi-asserted-by":"publisher","award":["206545\/Z\/17\/Z"],"award-info":[{"award-number":["206545\/Z\/17\/Z"]}],"id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["203919\/Z\/16\/Z"],"award-info":[{"award-number":["203919\/Z\/16\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Infect Dis"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Introduction<\/jats:title>\n                <jats:p>The introduction of PCV13 to the Malawi infant immunization schedule in 2011 has been associated with reduced disease from <jats:italic>Streptococcus pneumoniae<\/jats:italic>. Improved understanding of serotypes with high invasive potential can guide future vaccination interventions. We aimed to estimate pneumococcal serotypes associated with acute respiratory infection (ARI) and invasive pneumococcal disease (IPD) in hospitalized children in Blantyre, Malawi.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We analysed data from healthy children under 5\u00a0years in the community in Blantyre and children admitted to Queen Elizabeth Central Hospital with ARI between 2015 and 2018. Nasopharyngeal swabs from children were tested for <jats:italic>S. pneumoniae<\/jats:italic> and serotyped by latex agglutination if positive. We analysed culture-positive blood and cerebrospinal fluid samples from admitted children between 2012 and 2018 to identify cases of IPD after the introduction of PCV13. We calculated the age-adjusted odds ratio (OR) of carriage for <jats:italic>S. pneumoniae<\/jats:italic> vaccine serotypes (VT) comparing those with ARI to healthy children. We also calculated age-adjusted ORs comparing serotypes causing IPD to carriage in the community with OR\u2009&gt;\u20091 indicating high invasive potential.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Serotypes 5 (OR 24.73 [95% CI 7.90\u201378.56] p\u2009&lt;\u20090.001), 1 (OR 23.38 [95% CI 9.75\u201356.06] p\u2009&lt;\u20090.001), and 6B (OR 4.73 [95% CI 1.66\u201311.64] p\u2009=\u20090.001) had high invasive potential. Serotype 6B was no longer significant (OR 1.34 [95% CI 0.07\u20136.87] p\u2009=\u20090.777) in a sensitivity analysis accounting for year of recruitment. The prevalence of <jats:italic>S. pneumoniae<\/jats:italic> carriage in the community was 72.6% [95% CI 71.3\u201374.0] (3078\/4238) and 23.4% (719\/3078) of positive community samples were VT. The carriage prevalence in those hospitalised with ARI was 45.5% [95% CI 42.1\u201348.9] (389\/855) and 43.8% of hospital attendees reported antibiotic use prior to admission. We did not identify significant associations with carriage of any serotypes in those with ARI.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Pneumococcal serotypes 5 and 1 are associated with high invasive potential. Despite high community pneumococcal carriage, pre-hospital antibiotic usage likely reduces pneumococcal detection among children admitted in this setting and further research is needed to investigate serotypes associated with ARI. Data from this study can guide future preventative vaccination strategies in Malawi.\n<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12879-023-08022-4","type":"journal-article","created":{"date-parts":[[2023,1,26]],"date-time":"2023-01-26T14:03:58Z","timestamp":1674741838000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Invasiveness potential of pneumococcal serotypes in children after introduction of PCV13 in Blantyre, Malawi"],"prefix":"10.1186","volume":"23","author":[{"given":"Amir","family":"Kirolos","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Todd D.","family":"Swarthout","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew A.","family":"Mataya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Farouck","family":"Bonomali","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Comfort","family":"Brown","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacquline","family":"Msefula","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naor","family":"Bar-Zeev","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pui-Ying","family":"Iroh Tam","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maaike","family":"Alaerts","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sithembile","family":"Bilima","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert S.","family":"Heyderman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neil","family":"French","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2023,1,26]]},"reference":[{"key":"8022_CR1","doi-asserted-by":"publisher","first-page":"e47","DOI":"10.1016\/s2214-109x(18)30408-x","volume":"7","author":"DA McAllister","year":"2019","unstructured":"McAllister DA, et al. Global, regional, and national estimates of pneumonia morbidity and mortality in children younger than 5 years between 2000 and 2015: a systematic analysis. Lancet Glob Health. 2019;7:e47\u201357. https:\/\/doi.org\/10.1016\/s2214-109x(18)30408-x.","journal-title":"Lancet Glob Health"},{"key":"8022_CR2","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1186\/s12916-019-1450-2","volume":"17","author":"J Louren\u00e7o","year":"2019","unstructured":"Louren\u00e7o J, et al. Determinants of high residual post-PCV13 pneumococcal vaccine-type carriage in Blantyre, Malawi: a modelling study. BMC Med. 2019;17:219. https:\/\/doi.org\/10.1186\/s12916-019-1450-2.","journal-title":"BMC Med"},{"key":"8022_CR3","doi-asserted-by":"publisher","first-page":"757","DOI":"10.1016\/s0140-6736(19)30721-4","volume":"394","author":"Pneumonia Etiology Research for Child Health (PERCH) Study Group","year":"2019","unstructured":"Pneumonia Etiology Research for Child Health (PERCH) Study Group. Causes of severe pneumonia requiring hospital admission in children without HIV infection from Africa and Asia: the PERCH multi-country case-control study. Lancet. 2019;394:757\u201379. https:\/\/doi.org\/10.1016\/s0140-6736(19)30721-4.","journal-title":"Lancet"},{"key":"8022_CR4","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0017765","volume":"6","author":"DB Everett","year":"2011","unstructured":"Everett DB, et al. Ten years of surveillance for Invasive Streptococcus pneumoniae during the era of antiretroviral scale-up and cotrimoxazole prophylaxis in Malawi. PLoS ONE. 2011;6: e17765. https:\/\/doi.org\/10.1371\/journal.pone.0017765.","journal-title":"PLoS ONE"},{"key":"8022_CR5","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1016\/s1473-3099(04)00938-7","volume":"4","author":"D Bogaert","year":"2004","unstructured":"Bogaert D, De Groot R, Hermans PW. Streptococcus pneumoniae colonisation: the key to pneumococcal disease. 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All methods described in this study were performed in accordance with the Declaration of Helsinki. Parents\/guardians of child participants provided written informed consent when participating in the study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent from parents\/guardians of child participants included consent for publication.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests. The study funders had no role in study design, data collection, data analysis, data interpretation, decision to submit for publication, or writing of the report.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"56"}}