Nasopharyngeal Carriage, Antimicrobial Resistance, and Serotype Distribution of in Children Under Five in Lebanon: Baseline Data Prior to PCV13 Introduction

Overview

Journal Antibiotics (Basel)

Specialty Pharmacology

Date 2025 Feb 26

PMID 40001412

Authors

Rayane Rafei

Mazen Zaylaa

Mohamad Diab

Issmat I Kassem

Khaled El Omari

Fatima B Halimeh

Grace El Moujaber

Afaf Achour

Bassel Ismail

Hassan Mallat

Monzer Hamze

Fouad Dabboussi

Marwan Osman

Affiliations

Soon will be listed here.

Abstract

Background: The nasopharyngeal carriage of can be the source of transmission between humans and the starting step towards invasive pneumococcal diseases. Data on the carriage of pneumococci in children before and after the pneumococcal conjugate vaccines (PCV) integration in a country are essential for monitoring any change in pneumococcal carriage serotypes and their antimicrobial-resistance profiles.

Methods: We investigated the epidemiology of carriage among children younger than five years old in Tripoli, Lebanon, in 2016, the same year of integration of PCV13 in the country's Expanded Program on Immunization.

Results: Of 104 participating children, 57 (54.8%) gave a positive culture for . Antimicrobial susceptibility testing revealed that 26.3% of isolates were multidrug-resistant. Resistance was detected mainly against oxacillin (77.2%), tetracycline (29.8%), erythromycin (22.8%), trimethoprim-sulfamethoxazole (22.8%), clindamycin (19.3%), minocycline (19.3%), and teicoplanin (1.8%). Serotyping analysis identified 14 distinct serotypes, with only 31.3% and 50% of isolates corresponding to vaccine serotypes covered by PCV13 and PCV20, respectively. The most common serotypes were 11A, 19F, 23A, and those of serogroup 24 (Sg24) accounted for 37.5% of the serotyped isolates.

Conclusions: Our findings have revealed the circulation of a pool of pneumococci isolates with high levels of antibiotic resistance and different degrees of likelihood of causing invasive diseases in children under five years old in Tripoli in 2016. The overall limited PCV13 vaccine coverage in this study highlighted the need for vaccines with greater coverage in the immunization programs in Lebanon. Longitudinal national studies investigating the carriage of pneumococci in children are required to further assess the impact of the PCV vaccine on pneumococci carriage in children and steer new vaccine development.

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