{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T19:06:07Z","timestamp":1789239967414,"version":"build-2803163510"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,5,26]],"date-time":"2025-05-26T00:00:00Z","timestamp":1748217600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Infections due to <jats:italic>Streptococcus pneumoniae<\/jats:italic>, including pneumonia and meningitis, are a leading cause of morbidity and mortality, especially in low-and lower middle-income countries (LMICs) worldwide. Most reviews highlight the geographical differences in serotype replacement and antibiotic resistance observed through invasive pneumococcal disease (IPD) surveillance, predominantly in high-income countries; however, data from many LMICs remain limited or poorly characterized. This study was conducted among healthy children aged 2\u201359\u202fmonths and adults living in the same household, to determine pneumococcal carriage rates, serotype distribution, and the serotypes associated with antibiotic resistance profiles, following the introduction of PCV10\/PCV13.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Nasopharyngeal samples (NP) were obtained from 420 child\/adult pairs between September 2018 and October 2019. Detection, serotyping, pneumococcal isolation and antibiotic susceptibility testing were performed using standardized protocols. Additionally, vaccine impact on serotype prevalence was assessed by comparison with a group of 100 healthy carriers under 5\u202fyears of age, recruited at the same hospital between 2010 and 2014, prior to vaccine introduction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We observed higher pneumococcal carriage in children (39%) than in adults (20%) and limited intrafamilial transmission. Vaccine serotypes continue to circulate among children despite vaccination, accompanied by a rise in non-vaccine serotypes. Almost 11% of fully vaccinated children still carried vaccine serotypes. Antibiotic resistance to beta-lactams and macrolides has increased; nearly one-third of the isolates were multidrug resistant while multi-drug resistant pediatric isolates were predominantly associated with serotypes 19F and 19A.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Our findings reveal worrying trends in the epidemiology of <jats:italic>S. pneumoniae<\/jats:italic> in Paraguay, including the persistence of vaccine-type serotypes among vaccinated children and an increasing resistance to antibiotics of isolated strains. Given the critical role of carriage studies in monitoring the impact of PCV in LMICs, the public health community should explore ways to improve their feasibility and cost-effectiveness and better integrate these efforts into routine vaccine preventable disease surveillance systems.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2025.1584857","type":"journal-article","created":{"date-parts":[[2025,5,26]],"date-time":"2025-05-26T06:03:56Z","timestamp":1748239436000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Streptococcus pneumoniae carriage, antimicrobial resistance, and serotype distribution in children and adults from Paraguay in the post-vaccinal era"],"prefix":"10.3389","volume":"13","author":[{"given":"Graciela","family":"Russomando","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norma","family":"Fari\u00f1a","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Selilah","family":"Amour","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorena","family":"Grau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa","family":"Guillen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonia","family":"Abente","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monserrat","family":"Aldama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingrid","family":"Hahn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hector","family":"Castro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00e9lina","family":"Messaoudi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zunilda","family":"Sanchez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Picot","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florence","family":"Komurian-Pradel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milen","family":"Milenkov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,5,26]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1055\/s-0029-1202938","article-title":"Streptococcus pneumoniae: epidemiology, risk factors, and strategies for prevention","volume":"30","author":"Lynch","year":"2009","journal-title":"Semin Respir Crit Care Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"338","DOI":"10.12688\/f1000research.22341.1","article-title":"Recent advances in the epidemiology and prevention of Streptococcus pneumoniae infections","volume":"9","author":"Feldman","year":"2020","journal-title":"F1000Res"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1016\/S1473-3099(04)00938-7","article-title":"Streptococcus pneumoniae colonisation: the key to pneumococcal disease","volume":"4","author":"Bogaert","year":"2004","journal-title":"Lancet Infect Dis"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"ofad098","DOI":"10.1093\/ofid\/ofad098","article-title":"Trends in Streptococcus pneumoniae antimicrobial resistance in US children: a multicenter evaluation. Open forum","volume":"10","author":"Mohanty","year":"2023","journal-title":"Infect Dis"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"866186","DOI":"10.3389\/fcimb.2022.866186","article-title":"Increase of macrolide-resistance in Streptococcus pneumoniae strains after the introduction of the 13-Valent pneumococcal conjugate vaccine in Lima","volume":"12","author":"Gonzales","year":"2022","journal-title":"Peru Front Cell Infect Microbiol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1128\/microbiolspec.gpp3-0019-2018","article-title":"Streptococcus pneumoniae capsular polysaccharide","volume":"7","author":"Paton","year":"2019","journal-title":"Microbiol Spectr"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"e00937","DOI":"10.1128\/mbio.00937-20","article-title":"A new pneumococcal capsule type, 10D, is the 100th serotype and has a large cps fragment from an Oral Streptococcus. McDaniel LS, editor","volume":"11","author":"Ganaie","year":"2020","journal-title":"MBio"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"132","DOI":"10.3390\/vaccines8010132","article-title":"Development of next generation Streptococcus pneumoniae vaccines conferring broad protection","volume":"8","author":"Masomian","year":"2020","journal-title":"Vaccine"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1038\/s41541-023-00715-w","article-title":"Emerging vaccine strategies against the incessant pneumococcal disease","volume":"8","author":"Duke","year":"2023","journal-title":"NPJ Vaccines"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"127","DOI":"10.5415\/apallergy.0000000000000114","article-title":"Evaluating immune responses to pneumococcal vaccines","volume":"13","author":"Thong","year":"2023","journal-title":"Asia Pac Allergy"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"38","DOI":"10.18004\/mem.iics\/1812-9528\/2020.018.01.38-046","article-title":"Frecuencia de Streptococcus pneumoniae aislados de enfermedad invasiva en Paraguay, serotipos y perfil de sensibilidad (2010-2018)","volume":"18","author":"Le\u00f3n","year":"2020","journal-title":"Mem Inst Investig Cienc Salud"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1021","DOI":"10.1128\/JCM.39.3.1021-1024.2001","article-title":"Evaluation of a medium (STGG) for transport and optimal recovery of Streptococcus pneumoniae from nasopharyngeal secretions collected during field studies","volume":"39","author":"O\u2019Brien","year":"2001","journal-title":"J Clin Microbiol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"2460","DOI":"10.1128\/JCM.02498-06","article-title":"Evaluation and improvement of real-time PCR assays targeting lyt a, ply, and psaA genes for detection of pneumococcal DNA","volume":"45","author":"Carvalho","year":"2007","journal-title":"J Clin Microbiol"},{"key":"ref14","unstructured":"Liofilchem\n          \n          2024"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"e0151428","DOI":"10.1371\/journal.pone.0151428","article-title":"The relevance of a novel quantitative assay to detect up to 40 major Streptococcus pneumoniae serotypes directly in clinical nasopharyngeal and blood specimens","volume":"11","author":"Messaoudi","year":"2016","journal-title":"PLoS One"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"604","DOI":"10.1093\/cid\/cix378","article-title":"Microorganisms associated with pneumonia in children <5 years of age in developing and emerging countries: The GABRIEL pneumonia multicenter, prospective, case-control study","volume":"65","author":"B\u00e9net","year":"2017","journal-title":"Clinical Infectious Dis"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"S161","DOI":"10.1097\/INF.0000000000000084","article-title":"Systematic review of the indirect effect of pneumococcal conjugate vaccine dosing schedules on pneumococcal disease and colonization","volume":"33","author":"Loo","year":"2014","journal-title":"Pediatr Infect Dis J"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"e0297767","DOI":"10.1371\/journal.pone.0297767","article-title":"Nasopharyngeal carriage of Streptococcus pneumoniae in Latin America and the Caribbean: a systematic review and meta-analysis","volume":"19","author":"Brizuela","year":"2024","journal-title":"PLoS One"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1016\/j.diagmicrobio.2007.05.012","article-title":"Nasal carriage of Streptococcus pneumoniae in healthy children and adults in northern Taiwan","volume":"59","author":"Chen","year":"2007","journal-title":"Diagn Microbiol Infect Dis"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"632","DOI":"10.1086\/381547","article-title":"Nasopharyngeal carriage of Streptococcus pneumoniae by adults and children in community and family settings","volume":"38","author":"Regev-Yochay","year":"2004","journal-title":"Clin Infect Dis"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"e79578","DOI":"10.1371\/journal.pone.0079578","article-title":"Nasopharyngeal carriage and transmission of Streptococcus pneumoniae in American Indian households after a decade of pneumococcal conjugate vaccine use","volume":"9","author":"Mosser","year":"2014","journal-title":"PLoS One"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"791","DOI":"10.1016\/j.vaccine.2015.12.042","article-title":"Nasopharyngeal carriage of Streptococcus pneumoniae among children in an urban setting in Brazil prior to PCV10 introduction","volume":"34","author":"Menezes","year":"2016","journal-title":"Vaccine"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1489","DOI":"10.1007\/s10096-011-1247-5","article-title":"Carriage and invasive isolates of Streptococcus pneumoniae in Caracas, Venezuela: the relative invasiveness of serotypes and vaccine coverage","volume":"30","author":"Rivera-Olivero","year":"2011","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"34888","DOI":"10.1038\/srep34888","article-title":"Molecular surveillance on Streptococcus pneumoniae carriage in non-elderly adults; little evidence for pneumococcal circulation independent from the reservoir in children","volume":"6","author":"Wyllie","year":"2016","journal-title":"Sci Rep"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.ijid.2021.11.021","article-title":"Pneumococcal carriage among children in low and lower-middle-income countries: a systematic review","volume":"115","author":"Tvedskov","year":"2022","journal-title":"Int J Infect Dis"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"6577","DOI":"10.1038\/s41467-024-50944-3","article-title":"Effect of pneumococcal conjugate vaccine six years post-introduction on pneumococcal carriage in Ulaanbaatar, Mongolia","volume":"15","author":"Von Mollendorf","year":"2024","journal-title":"Nat Commun"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1293","DOI":"10.1016\/j.vaccine.2017.01.035","article-title":"The rise and fall of pneumococcal serotypes carried in the PCV era","volume":"35","author":"Devine","year":"2017","journal-title":"Vaccine"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1093\/jpids\/piac117","article-title":"Serotype 19A and 6C account for one-third of pneumococcal carriage among Belgian day-care children four years after a shift to a lower-Valent PCV","volume":"12","author":"Ekinci","year":"2023","journal-title":"J Pediatric Inf Dis Soc"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1700","DOI":"10.1099\/jmm.0.001700","article-title":"Serotypes and antimicrobial resistance of Streptococcus pneumoniae in children under 5 years of age pre-and post-pneumococcal conjugate vaccine introduction in Paraguay","volume":"72","author":"Le\u00f3n","year":"2023","journal-title":"J Med Microbiol"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1244357","DOI":"10.3389\/fpubh.2023.1244357","article-title":"Antimicrobial resistance in Streptococcus pneumoniae: a retrospective analysis of emerging trends in the United Arab Emirates from 2010 to 2021","volume":"11","author":"Senok","year":"2023","journal-title":"Front Public Health"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"1418","DOI":"10.1128\/AAC.05658-11","article-title":"Changing trends in antimicrobial resistance and serotypes of Streptococcus pneumoniae isolates in Asian countries: an Asian network for surveillance of resistant pathogens (ANSORP) study","volume":"56","author":"Kim","year":"2012","journal-title":"Antimicrob Agents Chemother"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1916","DOI":"10.1111\/apa.15795","article-title":"Multi-drug resistance in Streptococcus pneumoniae among children in rural Vietnam more than doubled from 1999 to 2014","volume":"110","author":"Larsson","year":"2021","journal-title":"Acta Paediatr"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1584857\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,26]],"date-time":"2025-05-26T06:03:59Z","timestamp":1748239439000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1584857\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,26]]},"references-count":32,"alternative-id":["10.3389\/fpubh.2025.1584857"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1584857","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,26]]},"article-number":"1584857"}}