Differences in bacterial colonization and mucosal responses between high and low SES children in Indonesia

BACKGROUND Nasopharyngeal carriage of pathogenic bacteria precedes invasive disease and higher rates are found in low socioeconomic-status (SES) settings. Local immune responses are important for controlling colonization, but whether SES affects these responses is currently unknown. OBJECTIVE Examining bacterial colonization and cytokine response in nasal mucosa of children from high and low SES. METHODS Twenty-five cytokines were measured in nasal fluid. qPCR was performed to determine carriage and density of Haemophilus influenzae (H. influenzae), Streptococcus pneumoniae (S. pneumoniae), Moraxella catarrhalis (M. catarrhalis) and Staphylococcus aureus (S. aureus). RESULTS The densities of H. influenzae and S. pneumoniae were increased in low compared to the high SES ( p =0.006, p =0.026), with respectively 6 and 67 times higher median densities. Densities of H. influenzae and S. pneumoniae were positively associated with levels of IL-1beta ( p =0.002, p =0.008) and IL-6 ( p <0.001, p =0.006). After correcting for bacterial density, IL-6 levels were increased in colonized children from high compared to low SES for both H. influenzae and S. pneumoniae (both p =0.039). CONCLUSION Increased density of H. influenzae and S. pneumoniae was observed in low SES children, while IL-6 levels associated with colonization were reduced in these children, indicating that immune responses to bacterial colonization were altered by SES.