Pneumococcal Pneumonia

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pneumonia EDITORIAL TEAM Editorial Board Professor Michael Alpers, Australia Dr Antonio Anzueto, United States Dr Steven Black, United States Dr Debby Bogaert, The Netherlands Professor Allan Cripps, Australia Dr Burke A Cunha, United States Professor Ron Dagan, Israel Dr Iris De Schutter, Belgium Professor Bob Douglas, Australia Professor Stephen B Gordon, United Kingdom Professor Brian Greenwood, United Kingdom Professor Keith Klugman, United States Associate Professor Amanda Leach, Australia Associate Professor Deborah Lehmann, Australia Dr Orin S Levine, United States Dr Carlos Luna, Argentina Professor Shabir Ahmed Madhi, South Africa Professor Kim Mulholland, Australia Professor Daniel Musher, United States Associate Professor Carlos Orihuela, United States Dr William Pomat, Papua New Guinea Professor Jordi Rello, Spain Dr Ger Rijkers, The Netherlands Professor Ian Riley, Australia Professor Antoni Torres, Spain Professor Grant Waterer, Australia

Editorial Office Professor Allan Cripps, Editor-in-Chief, Australia Dr Diana Otczyk, Senior Editor, Australia Penny Chapman, Managing Editor, Australia

Disclaimer “This special issue of pneumonia has been produced from abstracts that were reviewed and forwarded to the journal by the organisers of the 9th International Symposium on Pneumococci and Pneumococcal Diseases (ISPPD-9). The abstracts have been ordered in the sections as received from the organisers of the meeting. Abstracts, tables and figures have been reproduced largely as received from the authors. Minor editorial changes have been made for consistency and to be more compliant with pneumonia’s style guidelines. In some instances, figure and table quality is poor. These figures and tables were provided at a resolution less than the journal sets as a minimum standard.” Suggested citation Abstracts should be cited as follows: Flaming J, Heijmans Y, Van Laetham S, Mignon A. Importance of pneumococcal eteology in adult severe lower respiratory tract infections in primary care in Belgium. [Abstract ISPPD - 0141]. pneumonia 2014;3:290

The INCLEN Trust is an international non-governmental Organisation (NGO) registered in India and the local host organisation of ISPPD-9.

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TABLE OF CONTENTS

pneumonia Instructions to Authors

2

Pneumococcal Colonization and Carriage

5

Invited Lecture Abstracts Oral Poster Abstracts Poster Abstracts

5 6 16

New Pneumococcal Diagnostics---further ahead or more confused?

61

Invited Lecture Abstracts Oral Plenary Abstracts Oral Poster Abstracts Poster Abstracts

61 61 64 68

Man versus Microbe---who gets pneumococcal disease and why?

80

Invited Lecture Abstracts Oral Poster Abstracts Poster Abstracts

80 80 84

Next Generation Vaccines

92

Oral Plenary Abstracts Poster Abstracts

92 102

The Promiscuous Pneumococcus---Evolution and Biology

122

Invited Lecture Abstracts Oral Plenary Abstracts Oral Poster Abstracts Poster Abstracts

122 122 124 128

Controlling Pneumococcal Disease around the Globe

139

Oral Plenary Abstracts Oral Poster Abstracts Poster Abstracts

139 141 151

Antibiotic Resistance and Clonal Spread

204

Oral Poster Abstracts Poster Abstracts

204 208

Global Pneumococcal Disease and Policies for Control

222

Oral Poster Abstracts Poster Abstracts

222 228

Pneumococcal Pneumonia---Risky Business

246

Invited Lecture Abstracts Oral Plenary Abstracts Oral Poster Abstracts Poster Abstracts

246 246 248 254

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pneumonia Instructions to Authors Focus and scope

Manuscript Preparation and Organisation

pneumonia is an online, international, peer-reviewed, open access journal that publishes original research articles, case studies, reviews, commentaries, correspondence and highlights, news and activities on all aspects related to pneumonia. The focus of the journal is to establish an international forum for pneumonia, bringing together knowledge from the various specialties involved in the treatment and prevention of this disease.

Manuscript format: DOC or DOCX; typed double-spaced; 12 point font; left line numbering; pages should be numbered; consistency of writing style is required using BRITISH spelling conventions. 

pneumonia strives to follow the standards and guidelines for publication ethics as set out by the Commission on Publication Ethics (COPE: http://publicationethics.org) and the International Committee of Medical Journal Ethics (ICMJE: http://www.icmje.org). Author’s should observe pneumonia’s complete author guidelines, ethics and editorial policies at http://www.pneumonia.org.au to ensure that the review and publication of your paper is as swift and efficient as possible.

Open Access pneumonia is an open access journal. All articles published in pneumonia will be immediately and permanently freely available online for everyone to read and download. pneumonia is affiliated with Griffith University, Australia, and is published by Griffith University ePress. Griffith University is Australia’s ninth largest education provider and is currently ranked amongst the top 5% of universities in the world in the prestigious CWTS Leiden Rankings.

Copyright Creative Commons Attribution 3.0 (CC-BY) Australia License. Under the terms of the license, authors retain authorship of the copyright of their articles. However, readers are permitted unrestricted use, distribution, and reproduction in any medium, provided the original authors and the source are credited.

Submission of Manuscripts Manuscripts may be submitted online using the electronic submission tool at http://www.pneumonia.org.au. pneumonia uses CrossCheck powered by iThenticate to screen for plagiarism before publication. The CrossCheck software checks submissions against a database of current and scholarly literature.

Peer Review Process All contributions are read by two or more reviewers to ensure both accuracy and relevance and revisions to the manuscript may thus be required. pneumonia offers a fast publication schedule and reviewers are given 14 days to review a manuscript. The final editorial decision is made based on the recommendations of the reviewers and the Editor-in-Chief. Authors address all comments made by the reviewers. On acceptance, contributions are subject to editorial amendment to suit house style.

Authorship All authors, including Multicentre Groups, must meet the following criteria for authorship: 1) significant contribution to the conception, generation of hypotheses and design of the research plan; 2) substantial contribution to the acquisition of the data, its analysis and its interpretation; 3) significant contribution to either writing or revising of the manuscript prior to its submission; 4) final agreement to the version of the manuscript submitted for publication.

Covering Letter The corresponding author must communicate: the key features of the manuscript and make a case as to why pneumonia is the journal of choice for the submitted manuscript; why the results will be of interest to other members; that all co-authors and Multicentre Group participants have agreed to the final version of the manuscript and the order of authors. The authors are invited to suggest up to 5 potential reviewers.

Title page •

Title: The title should be specific to the study, avoiding specialist abbreviations. Manuscripts regarding randomised trials or a meta-analysis should have the description in the title.



Author’s names, including titles: First name, middle initial and last name of each author separated by commas. Each author’s highest academic degrees should be listed.



Author affiliations: Affiliations should be keyed to the author’s name with superscript small case letters. 



Corresponding author: Marked with an asterisk with physical address, telephone number and email address.



Short running title: Limited to 50 characters



Keywords: Up to 5 keywords must provided



Author contributions: Each author’s contribution to the study must be listed.



Funding: All sources of funding must be listed. Authors must state the role of the funder involved in the study design; collection, analysis, and interpretation of data; writing of the paper; and/or decision to submit the paper for publication.



Competing interests: For each author, potential financial, professional or personal competing interests that were present during the 5 years prior to the article being written must be listed.

Abstract The abstract should include the purpose of the research, techniques used and results and a summary of the most important findings. The format of the Abstract is unstructured without headings.

Introduction The introduction should be succinct, providing a brief background that places the research reported in context with the literature. A clear rationale and hypothesis should be stated. There should be no headings.

Material and Methods/Patients and Methods This section must provide sufficient detail to enable the research to be reproduced. The details should be either provided in full in the text or referenced to work where the methodology is provided in full. pneumonia 2014 Volume 3

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Details to be included, but not limited to (if applicable): • Details of suppliers, including name of company and country of origin and if appropriate, catalogue numbers should be provided. Identify all drugs and chemicals used, including generic name(s), dose(s), and route(s) of administration. •



Describe study participants and their selection; study design; outcome measures. An ethical statement must be provided, including: procedures followed were in accordance with the ethical standards of the Helsinki Declaration; consent procedure, name of the Institution Review Board (IRB) for human and/or animal experiments that approved the research; IRB approval number; WHO International Trials Registry Platform (ICTRP) or ClinicalTrials.gov. clinical trial registration number(s); citation of appropriate EQUATOR-listed standards for health studies. Describe statistical methods used as outlined by the  journal.

Results The results should be clearly articulated and concise and presented in logical sequence in the text. All tables and figures are to be referred to in the body of the text.

Discussion The discussion should begin by briefly summarising the main findings of the study.  It should then follow that possible mechanisms or explanations for the findings are discussed and related to the current literature. Link the conclusions with the goals of the study.

Units and Abbreviations The international system of units (SI) should be followed. Units should have a single space between the number and the unit. Thousands should be separated by commas. Unusual units or abbreviations should be defined. Abbreviations must be clearly defined in full on first use and used consistently throughout the text.

Figures Figures must NOT be included in the main text.  They should be submitted as separate supplementary files.   Figures must: be numbered consecutively using Arabic numerals (Figure 1, Figure 2, etc); have footnotes to explain abbreviations using superscript lowercase letters to indicate them. Multi-panel figures (e.g. parts A, B, C, D) should be assembled into one image file. Format: Figures should be provided in high resolution EPS or TIFF. Graphic software packages capable of creating high quality graphics include: Adobe Photoshop and Illustrator; Microsoft PowerPoint and GIMP (free at www.gimp.org). TIFF files with multiple layers are not an accepted format for figures and must be provided in a flattened version of your file.

People who do not meet all the criteria for authorship should be listed in the Acknowledgements along with their contributions. Those people noted in the Acknowledgements should agree to being named in the manuscript. Large multi-author groups and their affiliations should be named in the Acknowledgements.

Resolution (minimum) and colour mode: • Line art figures (no tonal or shaded areas): 300 ppi • Grayscale figures (varying tones of black and white): 300 ppi • Halftone images such as photographs (no text / RGB or grayscale mode): 300 ppi. • Combination figures (combination of halftone and line art or text): 300 ppi • Low resolution (72 ppi, web-like resolution) is NOT acceptable, however screen resolution output from analytical tools will be accepted.

Reference Style

Colour images should be in RGB mode (bit depth 8 bits per channel)

Acknowledgements

The standard reference style of the journal is “VANCOUVER” style.  References are to be numbered consecutively in the text and should be identified using numbers in square brackets [ ]. Where there are more than 6 authors, the first 6 should be followed by “et al.” Journal names are to be abbreviated according to Index Medicus journal abbreviation via the NLM catalog. Examples of references from a journal (1), book (2) and web (3). 1.

Skinner JM, Indrawati L, Cannon J, Blue J, Winters M, Macnair J, et al. Pre-clinical evaluation of a 15-valent pneumococcal conjugate vaccine (PCV15-CRM197) in an infant-rhesus monkey immunogenicity model. Vaccine. 2011 Nov 8;29(48):8870-6.

2.

Hoffman GJ, Nellson JP, Alfred Z, Crow CA, Gull AM, Hognett ED et al. A Cochrane pocketbook: Childhood Preumonia. Chichester, West Sussex, England: John Wiley & Sons Ltd; 2008.

3.

World Health Organization. Number of countries having introduced pneumococcal conjugate vaccines to date. 2012 [cited 2012 Nov 20]; Available from: www.who.int/nuvi/ pneumococcus/decision_implementation/en/index1.html

Sizing: Figures will be sized to fit 1 (7.5 cm), 1.5 (11.5 cm), or 2 (15.5 cm) columns of the final printable PDF of the article. Fonts and size: Figure text must be in Arial font, between 8 and 12 point.

Tables Tables must NOT: be included in the main text - they should be submitted as separate supplementary files; have vertical lines; use returns or tabs within a cell; include empty columns, rows or cells to create spacing. Tables must: be numbered consecutively using Arabic numerals (Table 1, Table 2, etc); have columns with explanatory headings and units where appropriate; have explanatory information and definitions as footnotes to the table indicated by superscript lowercase letters; be cell-based (e.g. preferably created in Word with tables tool or in Excel).

Figure Legends and Table Captions Figure legends and table captions should be typed on separate pages. They should provide a brief description of the figure and table and contain enough information without the reader having to refer to the main text.

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Commonly used Abbreviations and Acronyms AE aOR ART BSA CAP CDC CFU CI CLSI EPI GMC GMP GMT IPD MDR MIC MLST MLVA NIP OPA OPK OR PCR PCV PCV7, 7vPCV PCV10, 10vPCV PCV13, 13vPCV PHiD-CV, PHiD-CV10 Pn23V, 23VPPS, PPSV23 RBC STGG VT WHO

Adverse event Adjusted odds ratio Antiretroviral therapy Bovine serum albumin Community-acquired pneumonia Center for Disease Control Colony forming units Confidence interval Clinical Laboratory Standards Institute Expanded Program on Immunization Geometric mean concentration Good Manufacturing Practice Geometric mean titers Invasive pneumococcal disease Multidrug resistant Minimum inhibitory concentrations Multi-locus sequence typing Multiple-Locus Variable number tandem repeat Analysis National Immunisation Program Opsonophagocytic assay Opsonophagocytic killing Odds ratio Polymerase chain reaction Pneumococcal conjugate vaccine 7-valent pneumococcal conjugate vaccine 10-valent pneumococcal conjugate vaccine 13-valent pneumococcal conjugate vaccine 10-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine 23-valent pneumococcal polysaccharide vaccine Red blood cell Skimmed milk, tryptone, glucose, glycerol broth Vaccine types World Health Organization

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Pneumococcal Colonization and Carriage Invited Lecture Abstracts ISPPD-0534 Pneumococcal Colonization and Carriage GENOMICS AND PNEUMOCOCCAL EPIDEMIOLOGY IN THE NASOPHARYNX C. Chewapreecha1, S.R. Harris1, N.J. Croucher2, C. Turner3, P. Marttinen4, L. Cheng5, A. Pessia5, D. Aanensen6, S.J. Salter1, A.E. Mather1, A.J. Page1, D. Harris1, F. Nosten7, D. Goldblatt8, J. Corander5, J. Parkhill1, P. Turner3, S.D. Bentley1 1

Pathogen genomics, The Wellcome Trust Sanger Institute, Cambridge, United Kingdom; 2Center for Communicable Disease Dynamics, Harvard School of Public Health, Boston, USA; 3Cambodia-Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia 4 Department of Information and Computer Science, Aalto University, Helsinki, Finland; 5Department of Mathematics and Statistics, University of Helsinki, Helsinki, Finland; 6Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom; 7Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Tak, Thailand; 8Immunobiology Unit, Institute of Child Health University College London, London, United Kingdom

Homologous recombination is one of the main evolutionary forces affecting Streptococcus pneumoniae. The highly recombinogenic nature of this species allows introduction of genetic material with selective advantages in carriage, the state that is a prerequisite for the development of pneumococcal invasive diseases. To study the impact of recombination on the evolution of a carriage pneumococcal population, whole genome sequencing was used to characterize 3,085 pneumococcal carriage isolates from a 2.4 km2 Thai refugee camp collected over a 3-year period. This high sampling density allowed us to characterized genetic exchanges in the pneumococcal population at a high resolution. Recombination ‘hotspots’ showed remarkable consistency between lineages, some of which were associated with drug resistance. Temporal trends in recombination at these sites reflected changes in antibiotic consumption, suggesting recombination facilitates adaptation to changing selection pressures. The highest frequencies of receipt and donation of DNA fragments exchanged through homologous recombination were observed in non-encapsulated lineages, implying a potential role in diversification and adaptation of the overall population played by these non-vaccine target lineages. These findings expand our understanding of pneumococcal population in carriage and help inform the design of future intervention strategies.  No conflict of interest ISPPD-0550 Pneumococcal Colonization and Carriage INTERACTIONS BETWEEN STREPTOCOCCUS PNEUMONIAE AND THE RESPIRATORY MICROBIOME IN RELATION TO RESPIRATORY HEALTH D. Bogaert1 1

The Netherlands

Individuals differ markedly in their susceptibility to and clinical presentation of respiratory infections, despite that most young children and many adults are colonized with potential bacterial pathogens like Streptococcus pneumoniae. The reasons for these individual differences are not yet fully understood, but clearly multifactorial. Besides pathogen-related (virulence)-factors, host-related factors like immune-status and genetic background and environmental factors, a possible fourth factor might be of relevance, i.e. the commensal community of bacteria ‘hosting’ these potential pathogens. The collective genomes of these commensal inhabitants are referred to as the human microbiome. This microbiome contains highly complexity communities of bacteria, which differ between individuals and even more between niches. The human microbiome in general has shown crucial for an appropriate development of our immune system and our mucosal barriers, and for prevention of pathogen adherence and expansion. We studied the development and composition of microbiota of the upper respiratory tract in different age-groups and in relation to environmental and disease characteristics. We observed highly complex and nichespecific communities of bacteria. Even within the upper respiratory tract, the microbiota composition differs depending on the exact anatomical location. Furthermore, the composition of respiratory microbiota varies with host and environmental factors like age, season, infant feeding, and viral presence. Moreover, our data suggest a correlation between the presence and abundance of specific bacteria and stability of microbiota, as well as susceptibility to respiratory infections. Finally, clear evidence has been found for patterns of bacterial interactions within the respiratory microbiota, with a central role played by Streptococci. No conflict of interest

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Oral Poster Abstracts ISPPD-0085 Pneumococcal Colonization and Carriage THE ADULT NASOPHARYNGEAL MICROBIOME AS A DETERMINANT OF PNEUMOCOCCAL CARRIAGE A.J.H. Cremers1, A.L. Zomer1, J.F. Gritzfeld2, J.G. Ferwerda1, S.A.F.T. van Hijum3, M.I. de Jonge1, K.P. Klugman4, J. Boekhorst3, H.M. Timmerman5, S.B. Gordon2, P.W.M. Hermans1 Dept of Pediatrics, Radboud University Medical Centre, Nijmegen, Netherlands; 2Dept of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; 3Centre for Molecular and Biomolecular Informatics (CMBI) Bacterial Genomics, Radboud University Medical Centre, Nijmegen, Netherlands; 4The Rollins School of Public Health, Emory University, Atlanta, USA; 5Dept of Health, NIZO food research B.V., Ede, Netherlands

1

Although cohort studies have indicated associations between Streptococcus pneumoniae and other microbes in the nasopharynx, they do not allow statements on causality. Here a unique experimental human pneumococcal carriage model is used to study whether the nasopharyngeal microbiome is perturbed by pneumococcal exposure and whether a specific composition determines subsequent establishment of pneumococcal carriage. Healthy adult volunteers were assessed for pneumococcal carriage by culture of nasal wash samples (NWS). Those without naturally acquired pneumococcal carriage received an experimental intranasal pneumococcal challenge with serotype 6B or 23F. The composition of the nasopharyngeal microbiome was longitudinally studied by 16S rDNA pyrosequencing on NWS collected before and 2, 7 and 14 days after challenge. Among the 40 selected volunteers 10 were natural carriers and 30 were experimentally challenged. Microbiome composition data were attained for 117 NWS. By principal component analysis of the individual nasopharyngeal communities before challenge we identified 5 distinct microbiome profiles. Natural pneumococcal carriage was particularly common in one of these profiles (p = 0.005). A more diverse microbiome (p = 0.034) and low presence of Corynebacterium spp. (p = 0.046) prior to challenge were associated with establishment of pneumococcal carriage. Whereas the nasopharyngeal microbiome was not perturbed after exposure to serotype 6B, its diversity increased upon exposure to serotype 23F (p = 0.004). Five nasopharyngeal microbiome profiles were identified with different natural pneumococcal carriage rates. A more diverse microbiome and low presence of Corynebacterium spp. prior to challenge were associated with establishment of pneumococcal carriage. Perturbation of the nasopharyngeal microbiome upon pneumococcal exposure seems to be strain dependent. No conflict of interest ISPPD-0060 Pneumococcal Colonization and Carriage MACROPHAGE MIGRATION INHIBITORY FACTOR (MIF) IS IMPORTANT FOR CLEARANCE OF PNEUMOCOCCAL COLONIZATION R. Das1, M. LaRose1, R. Bucala2, J.N. Weiser1 Internal Medicine, University of Pennsylvania School of Medicine, Philadelphia, USA; 2Internal Medicine, Yale School of Medicine, New Haven, USA

1

Human genetic polymorphisms associated with reduced expression of macrophage migration inhibitory factor (MIF) have been linked to the risk of community-acquired pneumonia (CAP).  Since Streptococcus pneumoniae is a leading cause of CAP and nasal carriage is a precursor to invasive disease, we explored the role of MIF in pneumococcal colonization using a mouse model.  Pneumococcal colonization led to local and systemic MIF production.  Mice deficient in MIF (Mif-/-) were prone to higher density and more prolonged colonization compared to wild-type.  The delayed clearance in Mif-/- mice correlated with reduced recruitment of nasopharyngeal macrophages.  The upregulation and positive feedback provided by monocyte chemotactic protein-1 (MCP-1 or CCL2) was impaired in the Mif-/- mice.  In vitro, pneumococcal infection of macrophages induced transcription and release of MIF, processes dependent on bacterial expression of the pore-forming toxin, pneumolysin, and induction of MAP kinase phosphorylation.  A point mutation in pneumolysin, which eliminates pore-formation, was sufficient to abrogate macrophage production of MIF.  Correspondingly, nasal colonization with pneumolysin-deficient bacteria led to decreased local MIF upregulation and reduced macrophage recruitment.  Prior work has demonstrated that pneumolysin-deficient bacteria show delayed clearance of colonization; this effect was eliminated in Mif-/animals.  Downstream of primary clearance, Mif-/- animals also demonstrated reduced anti-pneumococcal antibody production and reduced ability to clear secondary colonization.  Finally, delivery of MIF to the nasopharynx restored macrophage recruitment and pneumococcal clearance.  Our work suggests that MIF is important for innate and adaptive immunity to pneumococcal colonization and could be a contributing factor in the genetic susceptibility to CAP. No conflict of interest

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ISPPD-0093 Pneumococcal Colonization and Carriage MULTIPLE SEROTYPE COLONIZATION OF STREPTOCOCCUS PNEUMONIAE IS ASSOCIATED WITH ACUTE RESPIRATORY INFECTIONS IN CHILDREN B.G. Dhoubhadel1, L. Yoshida2, H.A. Nguyen3, L.N. Minh1, H.T. Le4, M. Yasunami1, M. Suzuki1, K. Morimoto1, D.A. Dang3, K. Ariyoshi1 1 Department of Clinical Medicine, Institute of Tropical Medicine Nagasaki University, Nagasaki, Japan; 2Department of Pediatric Infectious Diseases, Institute of Tropical Medicine Nagasaki University, Nagasaki, Japan; 3Department of Bacteriology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam; 4Khanh Hoa Health Service Centre, Khanh Hoa Provincial Health Department, NhaTrang, Vietnam

Background and Aims: Although prevalence of multiple serotype colonization is reported, its association with a clinical outcome and inter-relationship among the serotypes are not known. By applying the newly developed assay based on nanofluidic real time PCR system, we aimed to examine the association of multiple serotype colonization with acute respiratory infections (ARI) and the inter-relationship of the serotypes in terms of bacterial load. Methods: Nasopharyngeal samples from 595 hospital admitted ARI cases and 350 healthy controls from Nha Trang, Veitnam were screened for Streptococcus pneumoniae by culture and lytA PCR. Samples positive for culture and lytA were subjected to the nanofluidic real time PCR system that can identify 50 serotypes in 29 groups, and it can detect minor population in the multiple serotype colonization, with the minimum level of detection of 30 to 300 copies. Results: The prevalence of multiple serotype colonization was 2.5 times higher in cases than controls, 18.5 % versus 7.1 % (odd ratio (OR) 2.96, 95% CI: 1.37-6.93, p = 0.002). Among serotypes of multiple serotype colonization, one serotype dominated over the other serotypes by contributing more than 99% of the total pneumococcal load (p < 0.001). Serotypes covered by conjugate vaccines: PCV7, PCV10 and PCV13 were similar, 75% in cases and 52% in controls. Conclusion: Multiple serotype colonization is associated with ARI cases; one serotype that is dominant over the other, seems to be the causal pathogen. Introduction of PCV will reduce the burden of ARI cases in Vietnam. No conflict of interest ISPPD-0502 Pneumococcal Colonization and Carriage MECHANISMS OF PNEUMOCOCCAL TRANSMISSION: COLONISATION IS ASSOCIATED WITH RHINITIS IN HEALTHY PRESCHOOL CHILDREN A. Finn1, E. Nicoli2, B. Morales-Aza1, R. Holland1, L. Januario3, B. Vipond4, P. Muir4, F. Rodrigues3 1

Cellular and Molecular Medicine, University of Bristol, Bristol, United Kingdom; 2Social and Community Medicine, University of Bristol, Bristol, United Kingdom; 3Infectious Diseases Unit & Emergency Service, Hospital Pediatrico de Coimbra, Coimbra, Portugal; 4South West Regional Virology Laboratory, Public Health England, Bristol, United Kingdom

Background and Aims: We recently reported a significant association between picornavirus (rhinovirus) infection and both rates and density of pneumococcal (Sp) carriage in pre-school children. Methods: In a further cross-sectional study in 586 children attending nurseries in Coimbra Portugal we took nasal swabs (into STGG) and recorded symptoms and demographics in March 2010. Samples underwent bacterial culture and RT-PCR for common respiratory viruses. Multivariate logistic regression analysis was done to find associations that were independent of age. Differences described were statistically significant p