The Enigmatic Voyage of Pneumococcal Carriage: Unraveling the Risk Factors in Pediatric Populations -- A Scoping Review.

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Vaishnavi Naik, Subhangini Chakraborty, Krishnamurthy Jayanna, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4020518/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Pneumococcal infections are a major cause of morbidity and mortality globally, especially among children in low- and middle-income countries (LMICs). Although considerable research has been done on the frequency of pneumococcal infections and their risk factors, there are still many unanswered questions. The objective of this study is to offer fresh perspectives through systematic literature review on the shifting prevalence of and associated risk factors for pneumococcal carriage. Studies from 41 different countries are included in the evaluation, which focuses on pediatrics patients who are most vulnerable to pneumococcal infections. The most frequent risk variables for pneumococcal carriage were having siblings, daycare centers, passive smoking, household characteristics, age, comorbidities, and vaccination status. The frequency of pneumococcal carriage was greatest among LMICs, which may be related to inadequate pneumococcal vaccination programs, densely populated areas, and a lack of knowledge about basic sanitation and hygiene. The study emphasizes how crucial it is to monitor serotype prevalence to direct vaccination campaigns in these regions. For creating efficient pneumococcal disease prevention and control strategies, it is essential to understand the risk factors connected to pneumococcal carriage. The risk of pneumococcal carriage, transmission, and disease may be decreased by public health initiatives that are aimed at a particular age group to reduce transmission, such as improved hygiene and sanitation, addressing socioeconomic disparities and social determinants of health thus reducing transmission of the bacteria. The review highlights the value of vaccination campaigns in lowering the prevalence of pneumococcal illness, to completely understand the relationship between immunization, serotype carriage, and the risk of pneumococcal carriage, more study is required especially in LIC and LMIC region. Streptococcus pneumoniae carriage risk factors pediatric transmission vaccination Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 A. Background Pneumococcal infections are a major public health burden on a global scale. Streptococcus pneumoniae (Pneumococcus, S. pneumoniae ) became the most common cause of lower respiratory tract infection-related morbidity and mortality worldwide in 2019 (2.5 million deaths), accounting for more fatalities than all other causes put together. It is the leading cause of death for children under 5 years, accounting for approximately one-third of all casualties, despite being avoidable with the use of an effective vaccine [ 1 ]. Pneumococcus is an opportunistic gram-positive extracellular pathogen that colonizes the mucosal surface of the human upper respiratory tract (URT). Although colonization at this site appears to be asymptomatic, an inflammatory reaction occurs if the organism enters the normally sterile regions of the airway, leading to invasive pneumococcal disease (IPD), such as pneumonia, meningitis, and febrile bacteremia. More frequent but less serious symptoms of non-IPD include bronchitis, sinusitis, and otitis media [ 2 – 4 ]. Children under 5 years and adults over 60 years are the most vulnerable populations. [ 5 ] According to reports from 2017, pneumonia was the greatest cause of death for children, accounting for 15% of all child fatalities, and it also contributed to 1.13 million deaths among the elderly [ 1 ]. The polysaccharide capsule of bacteria is an essential component of pathogenicity. The classification of disease invasiveness and the development of pneumococcal vaccines are based on the vastly heterogeneous capsular polysaccharides [ 6 ]. There are over one hundred different pneumococcal serotypes known to exist (until 2020); however, only a few of these serotypes are responsible for the infection. Recent research indicates that IPD is more likely to be caused by serotypes 19F, 9 V, 23F, 6B, 11A, 13, 34, 10A, 19A and 6A [ 7 , 8 ]. The distribution of disease-causing serotypes fluctuates throughout time, with variations according to age, illness syndrome, disease severity, geographical location, and the existence of genes for antibiotic resistance [ 9 ]. There are two types of vaccines available globally: pneumococcal conjugate vaccines (PCV13, PCV10, PCV15, PCV20, PCV24) and pneumococcal polysaccharide vaccines (PPSV23). The WHO suggests that all children between the ages of 2 and 59 months should receive PCV13 or PCV10 (PCV13 has an added advantage in regions where infection caused by serotype 19A or 6C is prevalent)[ 10 ]), and adults 65 and older should receive PPSV23. It is estimated that between 60 and 70 percent of invasive diseases are prevented by vaccination with serotypes found in the vaccine [ 11 ]. Vaccination works by reducing severity brought on by vaccine serotypes. They also lessen colonization by the same serotypes, which explains the notable herd immunity. impact observed in older age groups who have not had vaccinations [ 12 ]. Pneumococcal infections continue to be a concern worldwide despite the availability of these vaccinations because nonvaccine serotypes (NVTs) have replaced vaccine serotypes (VTs), frequently in connection with the emergence of multidrug-resistant serotypes [ 13 ]. The colonization of the nasopharynx by S. pneumoniae is a prerequisite for invasive illness and plays a significant role in pathogen transmission to other people. The local microbiota is expected to have an influence on both initial colonization and subsequent dynamics through a process known as colonization resistance, which can be either direct or immunologically mediated, resulting in pathogen spread in the community, carried by up to 27–85% of children and 10–30% of adults [ 14 ]. Studies over the past few decades have increasingly demonstrated a link between pneumococcal carriage and invasive and mucosal infections as a result of socioeconomic factors [ 15 – 17 ], missed or incomplete immunization [ 6 , 18 , 19 ], asthma or respiratory allergies [ 20 , 21 ], smoking and alcoholism [ 22 , 23 ] and malnutrition [ 24 ]. There has been a significant decline in mortality from invasive pneumococcal illness over the past two decades because of enhanced immunization[ 25 ]. However, overall pneumonia rates have remained the same[ 26 ]. Invasive pneumococcal illness caused by the 13 serotypes covered by PCV13 dropped by 98% in children under the age of five [ 27 ]. It is interesting to note that bacterial carriage prevalence has stayed between 38% and 68% despite a decline in infection burden [ 28 ]. A critical area of inquiry is why the pneumococcal infection burden has decreased with vaccination, although the bacterial carriage prevalence has remained stable. Understanding this problem will be essential for forecasting the outcomes of future pneumococcal immunization campaigns, especially in underdeveloped nations. These pneumococcal carriage investigations are crucial because pneumococcal illness and pneumococcal dissemination are strongly influenced by carriage. We examined multiple studies that looked at the relationship between distinct characteristics and the possibility of harboring the bacteria in our thorough analysis of S. pneumoniae carriage risk factors. We looked at the study designs used, sample sizes, and any confounding variables when assessing potential biases in the data. It was vital to detect any restrictions that would compromise the validity and generalizability of the results. We examined the biological and epidemiological variations in virulence, antibiotic resistance patterns, and geographic distribution of S. pneumoniae serotypes. We wanted to know how these differences would affect the severity of the disease and the efficiency of treatments such as immunization. We evaluated the relative contributions of vaccination and other variables to address the growth of NVTs. Analyzing data on serotype distribution before and after pneumococcal vaccine introduction, keeping track of the incidence of NVTs in various groups, and looking into putative processes causing serotype replacement were all part of this process. To create efficient preventative measures and public health policies, it is crucial to understand the risk factors related to pneumococcal disease. Certain risk variables have been clarified by prior research, but to fill any information gaps, more recent and thorough studies are needed. This review aims to provide a comprehensive analysis of recent studies included in this study, presenting the most up-to-date data on risk factors associated with pneumococcal carriage and common serotypes. The aim is to highlight the importance of immunization, alterations in living conditions, addressing socioeconomic inequalities, and lowering tobacco use as significant efforts to reduce the prevalence of pneumococcal carriage. This research intends to direct the creation and execution of efficient pneumococcal vaccination programs and other public health initiatives by detecting these gaps and providing insightful information. Results Search Results Screening from two databases resulted in a total of 768 studies, and 150 duplicates were removed from the collection. After screening the titles and abstracts of the remaining 618 articles, 267 studies were then excluded because the articles were not relevant to this review based on the inclusion criteria. A total of 280 studies were further excluded from 351 selected articles during full-text screening where prevalence was not mentioned, leaving 71 studies in the review that fulfilled the inclusion and exclusion criteria of this study (Fig. 1 ). Characteristics of the study : The 71 studies included in the review were reported from 41 countries around the globe. Most of the studies were reported from high-income countries (HIC) (19/71; 26.7%), followed by low-income countries (LIC) (18/71; 25.3%). The age group of the participants ranged from 0 to 10 years. Similar statistical analysis was used across the studies, most commonly logistic regression reporting adjusted odds ratios. Selection of variables as associated risk factors was driven by P values ranging from < 0.1 -<0.5 as significant. Prevalence and Serotypes Figure 2 depicts the overall number of daily articles published between January 2012 and December 2023. The overall prevalence reported globally from 2012 to 2022 ranged from 24.98 to 49.45, with the highest prevalence documented in 2021 (Fig. 3 ). The highest prevalence of pneumococci carriage among children was documented in a study in Kenya in 2017 (prevalence 90%) [ 29 ], followed by Malawi in 2022 (prevalence 86%) [ 30 ] and New Guinea in 2023 (prevalence 83%) [ 31 ]. The bubble chart (Figure S1 ) depicts the yearly prevalence of pneumococcal carriage across various countries. Serotype 6A is one of the common serotypes reported across countries. The common serotypes observed among the ten countries reporting the highest prevalence are depicted in Table 1 . We also assessed the rate of common serotypes reported among the studies used in the PCV7, PCV10 and PCV13 vaccines. The highest number of carriages with serotypes used in PCV 13 vaccines was reported in 2021. The graph below (Fig. 4 ) shows the year wise distribution of the serotypes used in the PCV7, PCV10 and PCV13 vaccines. The highest prevalence of pneumococci carriage was observed in low- and Middle-income Countries (LMICs), followed by upper middle-income countries (UMICs) (Fig. 5 ). Table 1 Common serotypes reported from the top ten countries reporting the highest prevalence of pneumococci carriage. SL. NO. Country Year Prevalence % Serotype 1 Kenya 2012 65.8 1, 5, 7F 2012 63.17 4, 6B, 9 V, 14, 18C, 19F, and 23F 2017 90 19F, 3, 7F,15B,19B,11A,23F,6A &6B 2 Malawi 2022 86 3, 6A, 19A 3 New Guinea 2023 83 3, 6A, 19A, 1,5 ,7F,6C 4 Bangladesh 2021 54.8 3, 6A, 19A, 35B, 15B, 34, 6A, 6B, 19A 5 South Africa 2023 70 3, 6A, 19A, 1,5 ,7F,6C 6 Ecuadorian 2021 67 3, 6A, 19A, 1,5 ,7F,6C 7 Dominican Republic 2021 62 3, 6A, 19A 8 Nigeria 2018 61.6 1, 7F & 5 9 Greenland 2016 60 6B, 6C,15B,16 F, 19A, 22 F, 23 F, 33 F and 35 F 10 Vietnam 2021 60 1, 5, 7F Risk Factors : Factors assessed for association with pneumococcal nasopharyngeal carriage varied by study (Table S1 ). Among the seventy one studies included in the review, the most common risk factors reported were the child being a sibling (25/71; 35.2%), attending day care (24/71; 33.8%), age of less than 2 years (24/71; 33.8%) and passive smoking (19/71; 26.7%). Higher odds ratios were observed among tobacco and alcohol consumption in the family, having siblings and attending day care Antibiotic usage in the past was reported as a risk factor in a few studies, whereas other studies reported it as a protective factor. Materials and Methods The present scoping review was written following the updated Preferred Reporting Items for Systematic Review and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines [ 32 ]. a. Search Strategy : A systematic exploration of the literature spanned from January 2012 to December 2023, while the study period encompassed April 2004 to 2023. This inquiry was conducted across two prominent databases, namely, PubMed and Scopus, using lists of keywords. These keywords were combined using the Boolean operators OR (within key concepts) and AND (between key concepts) as follows: (‘ Streptococcus pneumoniae ’’ OR ‘S pneumoniae’ OR pneumococci) AND ‘risk’ AND (‘carriage’ OR ‘colonization’). An additional search was conducted by manually screening the references of the retrieved literature. b. Selection of Study : Studies were excluded if (i) they did not report the prevalence and risk factors for pneumococcal carriage; (ii) they were studies on adult pneumococcal carriage; (iii) they were studies published in languages other than English; or (iv) they were case series or reports, clinical studies on pneumococcal infections, qualitative studies, conference papers, proceedings, abstract-only articles, editorial reviews, letters of communications, or commentaries. The retrieved literature was downloaded into Mendeley, and duplicates were identified and removed from this review. The references were distributed to two authors (V.N., S.C.) who independently reviewed all the articles for title and abstract screening. Satisfactory agreement for the screening process was assessed between the authors. Discrepancies between the authors were solved through a discussion with another author (T.S.). c. Data Extraction : The full text screening was performed independently by three authors (V.N., T.S. and S.C.), and the findings were summarized in an Excel worksheet. The data included the year of study, study location, sample size, prevalence/incidence, risk factor with odds ratio and commonly identified serotypes. Another author verified the results and scoping review (K.J.). Discussion The current review offers new insights into the changing prevalence of and risk factors for pneumococcal disease. This research was conducted throughout 41 nations, demonstrating the broad interest in and attempts to comprehend the risk variables connected to S. pneumoniae carriage. It is remarkable that the bulk of studies came from high-income nations, which reflects the availability of resources and the research infrastructure in these areas. In contrast, the incidence of pneumococcal carriage was highest among LMICs, which could be due to the absence of proper vaccination programs against pneumococci, the dense population residing in close proximity, and a lack of awareness of proper sanitation and hygiene. Participants' ages in the studies that were included ranged from 0 to 10, emphasizing the focus on kids who are known to be especially prone to pneumococcal infections. This age range must be thoroughly investigated since it is a population that needs specialized preventative measures. The inclusion of research from other nations improves the generalizability of the results by giving us a more complete picture of the prevalence of pneumococcal illness worldwide and the risk factors that contribute to it. Additionally, the inclusion of both high- and low-income nations emphasizes the necessity of addressing pneumococcal illness in various socioeconomic contexts. This study emphasizes the important risk factors for pneumococcal carriage, such as having siblings, daycare attendance, passive smoking, household characteristics, age, comorbidities, and vaccination status. One significant risk factor for children carrying Streptococcus pneumoniae was having siblings. Children with siblings are more likely to develop S. pneumoniae colonization [ 33 – 49 ]. For instance, Abaye et al. 2019 [ 50 ] discovered that kids with siblings were considerably more likely to have S. pneumoniae colonization (odds ratio = 16.06, 95% confidence interval). Similarly, Haile et al. 2019 [ 51 ] found that children who have elder siblings are more likely to have S. pneumoniae (odds ratio = 2.9, 95% confidence interval [CI]. Sibling relationships are regularly linked to a higher incidence of Streptococcus pneumoniae carriage in kids. Numerous studies have shown that children with siblings are more likely to develop S. pneumoniae colonization than children without siblings. Bacterial transmission might happen because of close contact and shared living quarters[ 37 ]. One factor that raises the likelihood of colonization is the presence of an older sibling. Within families and communities, siblings may act as reservoirs for pneumococcal transmission[ 40 ]. The second most reported risk factor was children who attended day care facilities. Numerous investigations [ 17 , 34 – 36 , 38 , 42 , 45 , 47 – 49 , 51 – 69 ] carried out in various geographic places have consistently shown that children who attend day care have a higher frequency of S. pneumoniae . An odds ratio = 13.73 was recorded by Neves et al. 2017 [ 17 ] Children on day-care centers spend more time together and interact more, which makes it easier for respiratory diseases to spread [ 67 ]. The increased exposure to respiratory secretions, sharing of toys, and poor hand hygiene practices all contribute to the greater colonization rates seen in these environments [ 56 ]. An increased diversity of pneumococcal serotypes is also caused by the presence of more kids in day-care facilities, which raises the risk of introducing novel pneumococcal strains into the community. An age of less than two years has been noted in several studies as a significant risk factor for S. pneumoniae carriage [ 6 , 16 , 18 , 30 , 35 , 36 , 38 , 39 , 41 , 42 , 44 , 45 , 54 – 56 , 60 – 62 , 66 , 69 – 81 ]. Due to their undeveloped immune systems and limited exposure to pathogens, infants and young children in this age range are more susceptible to pneumococcal infections. According to Tilahun et al.’s 2022 [ 66 ] study performed in a low-income nation, babies under the age of two years had a greater frequency of pneumococcal carriage than older children. Similar findings were found in research conducted in a high-income nation, which found that children under the age of two had a greater risk of pneumococcal colonization [ 38 , 62 ]. Passive smoking has become a major risk factor for pneumococcal illness. According to studies [ 35 , 37 , 43 , 54 , 57 , 66 – 68 , 80 , 82 , 83 ], second-hand smoke exposure puts children at risk for pneumococcal carriage. These results underline how crucial it is to promote smoke-free surroundings and tobacco control policies to lower the incidence of pneumococcal illness. Crowded housing, which is defined as having more people living there, increases the chances of transmission and promotes the spread of the bacteria [ 19 , 30 , 35 , 40 , 47 , 48 , 50 , 61 , 70 , 73 , 75 , 78 , 84 – 86 ]. The likelihood of S. pneumoniae infections is enhanced by socioeconomic variables. The lack of access to healthcare, substandard housing, and uneducated parents are major contributing causes. People at a low socioeconomic level people have difficulties getting healthcare, especially immunizations. Living in cramped quarters and having poor sanitation helps the germs spread. Parents with less education are less likely to be aware of preventative actions. increases the danger even further. Individuals with partial vaccination status have insufficient defenses against the pneumococcal strains included in the vaccine, leaving them more vulnerable to colonization and illness. Family members who use tobacco and alcohol have weakened immune systems, making them more susceptible to pneumococcal infections. As children can act as reservoirs for germs, living in a home with two or more small children increases the risk of exposure to S. pneumoniae [ 16 ]. Shared beds increase the likelihood of pneumococcal transmission because they bring numerous people into close, ongoing contact [ 46 , 85 , 87 ]. The prevention of smoke exposure [ 29 , 51 , 54 , 57 , 65 , 67 , 73 ] is an environmental risk factor for pneumococcal carriage and transmission that needs to be addressed. Understanding the causes of pneumococcal carriage in certain settings could help inform other public health initiatives that might be necessary. Although age, living with small children, and ethnicity are risk factors that cannot be changed, public health programs and policies that target specific age groups to reduce transmission, such as increased access to enhanced hygiene and sanitation, or which are intended to tackle socioeconomic differences and social determinants of health that promote transmission, may reduce the risk of pneumococcal carriage, transmission, and disease. The WHO's integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhea [ 88 ] includes several of these modifiable variables. Programs to address these issues would also aid in preventing other infectious illnesses, which frequently cause infant morbidity as well as mortality in LMICs. The most common serotypes recorded from the listed countries were serotype 6A cases recorded from New Guinea (2023)[ 31 ],Thailand (2023)[ 80 ],Nigeria (2023)[ 81 ],Bangladesh & India (2021)[ 46 ], Ecuador (2021)[ 70 ], and the Dominican Republic (2021)[ 70 ]; serotype 19A cases reported from the Nigeria (2023)[ 31 , 81 ], Thailand (2023) [ 80 ],New Guinea (2023)[ 31 ],Dominican Republic (2021), Bangladesh (2021)[ 46 ], India (2021)[ 46 ], Ecuador (2021)[ 70 ], and Malawi (2022); serotype 1 cases reported from Kenya (2012 [ 89 , 90 ], 2017 (52,83)) and Nigeria (2018); serotype 5 cases reported from Nigeria (2018)[ 75 ], Vietnam (2021), Germany (2021)[ 67 ], and Kenya (2012[ 89 , 90 ], 2017[ 29 ]); and serotype 7F cases reported from Vietnam (2021)[ 77 ], Germany (2021)[ 67 ], and Kenya (2012 [ 89 , 90 ], 2017) [ 89 , 90 ]. There is a considerable increase in PCV13 serotype numbers in 2020 and 2021. This implies that some pneumococcal bacteria may have evolved over time to circumvent the protection provided by the PCV13 vaccination. The persisting problem of pneumococcal bacteria shifting and evolving in response to vaccination is highlighted by the rising numbers of PCV13 serotypes in recent years. These results illustrate geographical differences in pneumococcal serotype distribution and emphasize the significance of tracking serotype prevalence to guide immunization programs. For the creation and use of efficient vaccinations that can specifically target circulating strains, an understanding of the common serotypes in each nation is essential. The burden of pneumococcal illness can be decreased by tailoring vaccination programs to target the strains that provide the highest risk on the basis of the serotypes that are most often identified. One of the most important methods for avoiding pneumococcal illness is vaccination with PCVs. In certain studies, persons without a vaccine [ 38 , 40 , 46 , 83 , 85 , 91 – 94 ] or with partial immunizations [ 31 , 36 , 42 , 45 , 47 , 52 – 62 , 79 , 81 ] had a higher frequency of the disease than those who were vaccinated. This highlights the importance of vaccination initiatives in reducing the incidence of pneumococcal disease. Although PCVs have been successful in lowering vaccine serotype infections, some research has revealed that vaccination may be linked to a higher risk of carrying Streptococcus pneumoniae [ 36 , 42 , 45 , 47 , 52 – 62 ], which indicates that a) the presence of nonvaccine serotypes and serotype switching[ 95 ] and b) vaccination can only prevent invasive pneumococcal disease and not carriage[ 96 ] To fully comprehend the connection between vaccination serotype carriage and the risk of pneumococcal carriage, further research is needed. Evaluation of PCV vaccination efficacy in lowering pneumococcal carriage and serotype prevalence is also crucial. The creation of effective preventive and control measures for pneumococcal illness can be aided by an understanding of the risk factors connected to pneumococcal carriage. In addition, advanced technologies in vaccine development need to be employed to identify other potential antigen candidates for pneumococcal vaccination. The thorough analysis of the selected papers offers important latest information on the risk factors for pneumococcal illness. The results highlight the value of immunization, improving living circumstances, addressing socioeconomic inequities, and encouraging smoke-free surroundings as key tactics in lowering the incidence of pneumococcal illness. Overall, this study's findings offer significant information on the incidence of pneumococcal carriage worldwide and the distribution of prevalent serotypes. These results can be used to guide the creation and execution of pneumococcal vaccination programs, among other public health policies. It is crucial to remember that the included studies and nations may not be typical of all populations; therefore, it is possible that the prevalence rates presented in this study may not accurately reflect the whole global burden of pneumococcal carriage. To obtain a deeper knowledge of the worldwide epidemiology of pneumococcal carriage, further study and monitoring efforts are needed. Conclusion The analysis of current research revealed that household characteristics, age, comorbidities, passive smoking, and partial immunization as major risk factors linked to the occurrence of carriage. To lessen the burden of pneumococcal illness, our findings emphasize the value of immunization programs, improving living circumstances, reducing socioeconomic gaps, and encouraging smoke-free surroundings. This review can potentially inform public health policy and programs in low- and middle-income countries to develop efficient preventive and control measures to tackle the burden of pneumococcal illness. Abbreviations URT - Upper Respiratory Tract IPD - Invasive Pneumococcal Disease PCV - Pneumococcal Conjugate Vaccines PPSV - Pneumococcal Polysaccharide Vaccines NVTs – Non-Vaccine serotypes VT - Vaccine serotypes LICs - Low-income countries LMICs - Lower middle-income countries UMICs - Upper middle-income countries HICs - High income countries Declarations Ethics approval and consent to participate – Not applicable. Consent for publication- Not applicable Availability of data and materials - Not applicable Competing interests - “The authors declares that they have no competing interests”. Funding - Not applicable Authors' contributions Vaishnavi Vishram Naik – screening of review papers and manuscript writing. 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RESEARCH FUND FOR THE CONTROL OF INFECTIOUS DISEASES 24:4–7 Toledo ME, Casanova MF, Linares-Pérez N, et al (2017) Prevalence of Pneumococcal Nasopharyngeal Carriage among Children 2-18 Months of Age: Baseline Study Pre Introduction of Pneumococcal Vaccination in Cuba. Pediatric Infectious Disease Journal 36:e22–e28 Usuf E, Bojang A, Camara B, Jagne I, Oluwalana C, Bottomley C, D’Alessandro U, Roca A (2018) Maternal pneumococcal nasopharyngeal carriage and risk factors for neonatal carriage after the introduction of pneumococcal conjugate vaccines in The Gambia. Clinical Microbiology and Infection 24:389–395 NAVNE JE, BØRRESEN ML, SLOTVED HC, ANDERSSON M, MELBYE M, LADEFOGED K, KOCH A (2016) Nasopharyngeal bacterial carriage in young children in Greenland: a population at high risk of respiratory infections. Epidemiol Infect 144:3226–3236 Kovács E, Sahin-Tóth J, Tóthpál A, van der Linden M, Tirczka T, Dobay O (2020) Co-carriage of Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis among three different age categories of children in Hungary. PLoS One 15:e0229021 Chang B, Akeda H, Nakamura Y, Hamabata H, Ameku K, Toma T, Miyagi M, Ohnishi M (2020) Impact of thirteen-valent pneumococcal conjugate vaccine on nasopharyngeal carriage in healthy children under 24 months in Okinawa, Japan. Journal of Infection and Chemotherapy 26:465–470 Wroe PC, Lee GM, Finkelstein JA, et al (2012) Pneumococcal Carriage and Antibiotic Resistance in Young Children Before 13-valent Conjugate Vaccine. Pediatric Infectious Disease Journal 31:249–254 Wróbel-Pawelczyk I, Ronkiewicz P, Wanke-Rytt M, et al (2022) Pneumococcal carriage in unvaccinated children at the time of vaccine implementation into the national immunization program in Poland. Sci Rep 12:5858 Lindstrand A, Galanis I, Darenberg J, Morfeldt E, Naucler P, Blennow M, Alfvén T, Henriques-Normark B, Örtqvist Å (2016) Unaltered pneumococcal carriage prevalence due to expansion of non-vaccine types of low invasive potential 8 years after vaccine introduction in Stockholm, Sweden. Vaccine 34:4565–4571 Arvas A, Çokuğraş H, Gür E, Gönüllü N, Taner Z, Tokman HB (2017) Pneumococcal Nasopharyngeal Carriage in Young Healthy Children After Pneumococcal Conjugate Vaccine in Turkey. Balkan Med J. https://doi.org/10.4274/balkanmedj.2016.1256 Kanık Yüksek S, Tezer H, Gülhan B, et al (2020) Nasopharyngeal pneumococcal carriage in healthy Turkish children after 13-valent conjugated pneumococcal vaccine implementation in the national immunization program. J Infect Public Health 13:266–274 Kaya Gursoy B, Beyazova U, Oguz MM, Demirel F, Ozkan S, Sultan N, Nar Otgun S (2019) Impact of PCV7 vaccination on nasopharyngeal carriage and antimicrobial resistance among children in Turkey. The Journal of Infection in Developing Countries 13:227–232 Lee GM, Kleinman K, Pelton SI, Hanage W, Huang SS, Lakoma M, Dutta-Linn M, Croucher NJ, Stevenson A, Finkelstein JA (2014) Impact of 13-valent pneumococcal conjugate vaccination on Streptococcus pneumoniae carriage in young children in Massachusetts. J Pediatric Infect Dis Soc 3:23–32 Apte A, Dayma G, Naziat H, et al (2021) Nasopharyngeal pneumococcal carriage in South Asian infants: Results of observational cohort studies in vaccinated and unvaccinated populations. J Glob Health 11:04054 Lee GM, Kleinman K, Pelton S, Lipsitch M, Huang SS, Lakoma M, Dutta-Linn M, Rett M, Hanage WP, Finkelstein JA Immunization, Antibiotic Use, and Pneumococcal Colonization Over a 15-Year Period. Fortuna LBDP, Miranda FM, Antunes IMF, Silva AB, Cabral AS, Dolores ÍM, Cardoso-Marques NT, Teixeira LM, Neves FPG (2023) Prevalence, capsular types, antimicrobial resistance and risk factors associated with pneumococcal carriage among children after long-term 10-valent pneumococcal conjugate vaccine use in Brazil. Vaccine 41:3111–3118 Tiley KS, Ratcliffe H, Voysey M, et al (2023) Nasopharyngeal Carriage of Pneumococcus in Children in England up to 10 Years After 13-Valent Pneumococcal Conjugate Vaccine Introduction: Persistence of Serotypes 3 and 19A and Emergence of 7C. J Infect Dis 227:610–621 Abaye G, Fekadu H, Haji K, Alemu D, Anjulo AA, Yadate DT (2019) Prevalence and risk factors of pneumococcal nasopharyngeal carriage in healthy children attending kindergarten, in district of Arsi Zone, South East, Ethiopia. BMC Res Notes 12:253 Haile AA, Gidebo DD, Ali MM (2019) Colonization rate of Streptococcus pneumoniae, its associated factors and antimicrobial susceptibility pattern among children attending kindergarten school in Hawassa, southern Ethiopia. BMC Res Notes 12:344 Brandileone M-C de C, Zanella RC, Almeida SCG, et al (2016) Effect of 10-valent pneumococcal conjugate vaccine on nasopharyngeal carriage of Streptococcus pneumoniae and Haemophilus influenzae among children in São Paulo, Brazil. Vaccine 34:5604–5611 Birindwa AM, Emgård M, Nordén R, et al (2018) High rate of antibiotic resistance among pneumococci carried by healthy children in the eastern part of the Democratic Republic of the Congo. BMC Pediatr 18:361 Koliou MG, Andreou K, Lamnisos D, Lavranos G, Iakovides P, Economou C, Soteriades ES (2018) Risk factors for carriage of Streptococcus pneumoniae in children. BMC Pediatr 18:144 Gebre T, Tadesse M, Aragaw D, Feye D, Beyene H, Seyoum D, Mekonnen M (2017) Nasopharyngeal Carriage and Antimicrobial Susceptibility Patterns of Streptococcus pneumoniae among Children under Five in Southwest Ethiopia. Children 4:27 Hussen S, Asnake S, Wachamo D, Tadesse BT (2020) Pneumococcal nasopharyngeal carriage and antimicrobial susceptibility profile in children under five in southern Ethiopia. F1000Res 9:1466 Negash AA, Asrat D, Abebe W, Hailemariam T, Gebre M, Verhaegen J, Aseffa A, Vaneechoutte M (2019) Pneumococcal Carriage, Serotype Distribution, and Risk Factors in Children With Community-Acquired Pneumonia, 5 Years After Introduction of the 10-Valent Pneumococcal Conjugate Vaccine in Ethiopia. Open Forum Infect Dis. https://doi.org/10.1093/ofid/ofz259 Esposito S, Terranova L, Patria MF, et al (2015) Streptococcus pneumoniae colonisation in children and adolescents with asthma: impact of the heptavalent pneumococcal conjugate vaccine and evaluation of potential effect of thirteen-valent pneumococcal conjugate vaccine. BMC Infect Dis 16:12 Fortunato F, Martinelli D, Cappelli MG, Cozza V, Prato R (2015) Impact of Pneumococcal Conjugate Universal Routine Vaccination on Pneumococcal Disease in Italian Children. J Immunol Res 2015:1–6 Ueno M, Ishii Y, Tateda K, et al (2013) Prevalence and Risk Factors of Nasopharyngeal Carriage of Streptococcus pneumoniae in Healthy Children in Japan. Jpn J Infect Dis 66:22–25 Chan J, Mungun T, Batsaixan P, et al (2021) Direct and indirect effects of 13-valent pneumococcal conjugate vaccine on pneumococcal carriage in children hospitalised with pneumonia from formal and informal settlements in Mongolia: an observational study. Lancet Reg Health West Pac 15:100231 Choe YJ, Han MS, Choi YY, et al (2021) Trend change of nasopharyngeal colonization with Streptococcus pneumoniae and non-typeable Haemophilus influenzae in children attending daycare centres: nationwide population-based study, South Korea 2014 and 2019. International Journal of Infectious Diseases 111:328–332 Coulibaly B, Sié A, Kiemde D, et al (2020) Pneumococcal Carriage and Antibiotic Resistance in Children Younger than 5 Years in Nouna District, Burkina Faso. Am J Trop Med Hyg 103:684–688 Pan H, Cui B, Huang Y, Yang J, Ba-Thein W (2016) Nasal carriage of common bacterial pathogens among healthy kindergarten children in Chaoshan region, southern China: a cross-sectional study. BMC Pediatr 16:161 Hadjipanayis A, Efstathiou E, Alexandrou M, Panayiotou L, Zachariadou C, Petrou P, Papaevangelou V (2016) Nasopharyngeal pneumococcal carriage among healthy children in Cyprus post widespread simultaneous implementation of PCV10 and PCV13 vaccines. PLoS One. https://doi.org/10.1371/journal.pone.0163269 Tilahun M, Fiseha M, Ebrahim E, Ali S, Belete MA, Seid A, Demsiss W, Gedefie A, Tadesse S, Belayhun C (2022) High Prevalence of Asymptomatic Nasopharyngeal Carriage Rate and Multidrug Resistance Pattern of Streptococcus pneumoniae Among Pre-School Children in North Showa Ethiopia. Infect Drug Resist Volume 15:4253–4268 Rose MA, Laurenz M, Sprenger R, Imöhl M, van der Linden M (2021) Nasopharyngeal Carriage in Children After the Introduction of Generalized Infant Pneumococcal Conjugate Vaccine Immunization in Germany. Front Med (Lausanne). https://doi.org/10.3389/fmed.2021.719481 Mirzaei H, Kalayeh G, Moniri R, Gholam S, Moosavi A, Rezaei M, Yasini M, Valipour M (2014) Serotyping, Antibiotic Susceptibility and Related Risk Factors Aspects of Nasopharyngeal Carriage of Streptococcus pneumoniae in Healthy School Students. Nguyen HAT, Fujii H, Vu HTT, Parry CM, Dang AD, Ariyoshi K, Yoshida L-M (2019) An alarmingly high nasal carriage rate of Streptococcus pneumoniae serotype 19F non-susceptible to multiple beta-lactam antimicrobials among Vietnamese children. BMC Infect Dis 19:241 Regalado L D, Rivera-Olivero IA, Garcia-Bereguiain MA, Tana L, Hernandez I, Zurita J, Vidal JE, Terán E, de Waard JH (2021) Pneumococcal Carriage Among Indigenous Kichwa Children From the Ecuadorian Andes After the 10-Valent Pneumococcal Vaccine Introduction. Pediatric Infectious Disease Journal 40:e427–e433 Bojang A, Jafali J, Egere UE, Hill PC, Antonio M, Jeffries D, Greenwood BM, Roca A (2015) Seasonality of Pneumococcal Nasopharyngeal Carriage in Rural Gambia Determined within the Context of a Cluster Randomized Pneumococcal Vaccine Trial. PLoS One 10:e0129649 Raman R, Sankar J, Putlibai S, Raghavan V (2017) Demographic Profile of Healthy Children with Nasopharyngeal Colonisation of Streptococcus pneumoniae: A Research Paper. Indian J Med Microbiol 35:607–609 Fadlyana E, Dunne EM, Rusmil K, et al (2018) Risk factors associated with nasopharyngeal carriage and density of Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus in young children living in Indonesia. Pneumonia 10:14 Paudel G, Amatya N, Saud B, Wagle S, Shrestha V, Adhikari B (2022) Nasal colonization by potential bacterial pathogens in healthy kindergarten children of Nepal: a prevalence study. Germs 12:86–98 Adetifa IMO, Adamu AL, Karani A, Waithaka M, Odeyemi KA, Okoromah CAN, Bello MM, Abubakar IS, Inem V, Scott JAnthonyG (2018) Nasopharyngeal Pneumococcal Carriage in Nigeria: a two-site, population-based survey. Sci Rep 8:3509 Skosana Z, Von Gottberg A, Olorunju S, Mohale T, Du Plessis M, Adams T, Mbelle N (2021) Non-vaccine serotype pneumococcal carriage in healthy infants in South Africa following introduction of the 13-valent pneumococcal conjugate vaccine. South African Medical Journal 111:143 Higgins RA, Temple B, Dai VTT, et al (2021) Immunogenicity and impact on nasopharyngeal carriage of a single dose of PCV10 given to vietnamese children at 18 months of age. Lancet Reg Health West Pac 16:100273 Qian G, Toizumi M, Clifford S, et al (2022) Association of pneumococcal carriage in infants with the risk of carriage among their contacts in Nha Trang, Vietnam: A nested cross-sectional survey. PLoS Med. https://doi.org/10.1371/journal.pmed.1004016 Olwagen CP, Izu A, Mutsaerts EAML, et al (2023) Single priming and booster dose of ten-valent and 13-valent pneumococcal conjugate vaccines and Streptococcus pneumoniae colonisation in children in South Africa: a single-centre, open-label, randomised trial. Lancet Child Adolesc Health 7:326–335 Sanchez Picot V, Keovichith I, Paboriboune P, Flaissier B, Saadatian-Elahi M, Rudge JW (2023) Epidemiology and serotype distribution of Streptococcus pneumoniae carriage among influenza-like illness cases in metropolitan Vientiane, Lao PDR: a community-based cohort study. Front Public Health. https://doi.org/10.3389/fpubh.2023.1124016 Adamu AL, Ojal J, Abubakar IA, et al (2023) The impact of introduction of the 10-valent pneumococcal conjugate vaccine on pneumococcal carriage in Nigeria. Nat Commun 14:2666 Gudnason T, Hrafnkelsson B, Laxdal B, Kristinsson KG (2014) Risk factors for nasopharyngeal carriage of Streptococcus pneumoniae and effects of a hygiene intervention: repeated cross-sectional cohort study at day care centres. Scand J Infect Dis 46:493–501 von Mollendorf C, Dunne EM, La Vincente S, et al (2019) Pneumococcal carriage in children in Ulaanbaatar, Mongolia before and one year after the introduction of the 13-valent pneumococcal conjugate vaccine. Vaccine 37:4068–4075 Kelly MS, Surette MG, Smieja M, et al (2018) Pneumococcal Colonization and the Nasopharyngeal Microbiota of Children in Botswana. Pediatric Infectious Disease Journal 37:1176–1183 Menezes AP de O, Azevedo J, Leite MC, et al (2016) Nasopharyngeal carriage of Streptococcus pneumoniae among children in an urban setting in Brazil prior to PCV10 introduction. Vaccine 34:791–797 Francois Watkins LK, Milucky JL, McGee, L, et al (2021) Nasopharyngeal Carriage of Streptococcus pneumoniae among Young Children in Haiti before Pneumococcal Conjugate Vaccine Introduction. Journal of Infectious Diseases 224:S248–S257 Hernandez-Bou S, Garcia-Garcia JJ, Gene A, Esteva C, del Amo E, Muñoz-Almagro C (2012) Pneumococcal carriage in children attending a hospital outpatient clinic in the era of pneumococcal conjugate vaccines in Barcelona. Diagn Microbiol Infect Dis 74:258–262 World Health Organization., UNICEF. (2013) Ending preventable child deaths from pneumonia and diarrhoea by 2025 : the integrated Global Action Plan for Pneumonia and Diarrhoea (GAPPD). World Health Organization Abdullahi O, Karani A, Tigoi CC, Mugo D, Kungu S, Wanjiru E, Jomo J, Musyimi R, Lipsitch M, Scott JAG (2012) The Prevalence and Risk Factors for Pneumococcal Colonization of the Nasopharynx among Children in Kilifi District, Kenya. PLoS One 7:e30787 Tigoi CC, Gatakaa H, Karani A, et al (2012) Rates of Acquisition of Pneumococcal Colonization and Transmission Probabilities, by Serotype, Among Newborn Infants in Kilifi District, Kenya. Clinical Infectious Diseases 55:180–188 Egere U, Townend J, Roca A, Akinsanya A, Bojang A, Nsekpong D, Greenwood B, Adegbola RA, Hill PC (2012) Indirect Effect of 7-Valent Pneumococcal Conjugate Vaccine on Pneumococcal Carriage in Newborns in Rural Gambia: A Randomised Controlled Trial. PLoS One 7:e49143 Navne JE, Koch A, Slotved H-C, Andersson M, Melbye M, Ladefoged K, Børresen M (2017) Effect of the 13-valent pneumococcal conjugate vaccine on nasopharyngeal carriage by respiratory pathogens among Greenlandic children. Int J Circumpolar Health 76:1309504 Shahid S, Khan A, Nisar MI, et al (2022) Pneumococcal Carriage in Infants Post-PCV10 Introduction in Pakistan: Results from Serial Cross-Sectional Surveys. Vaccines (Basel) 10:971 Dunn MG, Lessa FC, Sánchez J, Cordero R, Feris-Iglesias J, Cedano D, Carvalho M da G, Fernández J, Feemster KA (2021) Impact of 13-Valent Pneumococcal Conjugate Vaccine on Nasopharyngeal Carriage Rates of Streptococcus pneumoniae in a Rural Community in the Dominican Republic. J Infect Dis 224:S237–S247 Neal EFG, Chan J, Nguyen CD, Russell FM (2022) Factors associated with pneumococcal nasopharyngeal carriage: A systematic review. PLOS Global Public Health 2:e0000327 Berical AC, Harris D, Dela Cruz CS, Possick JD (2016) Pneumococcal Vaccination Strategies. An Update and Perspective. Ann Am Thorac Soc 13:933–44 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4020518","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":280883006,"identity":"c02e3c31-d13b-4606-a8dd-a58bccb3cf1c","order_by":0,"name":"Vaishnavi Naik","email":"","orcid":"","institution":"Ramaiah University of Applied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Vaishnavi","middleName":"","lastName":"Naik","suffix":""},{"id":280883007,"identity":"3a221540-e157-42d0-9d20-6dd96b9f846e","order_by":1,"name":"Subhangini Chakraborty","email":"","orcid":"","institution":"Al Futtaim Health","correspondingAuthor":false,"prefix":"","firstName":"Subhangini","middleName":"","lastName":"Chakraborty","suffix":""},{"id":280883008,"identity":"03564a84-7c96-45a4-94a6-a44886984049","order_by":2,"name":"Krishnamurthy Jayanna","email":"","orcid":"","institution":"Ramaiah University of Applied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Krishnamurthy","middleName":"","lastName":"Jayanna","suffix":""},{"id":280883009,"identity":"32c072fc-4ee3-4ad8-9aae-9bfd3ee01815","order_by":3,"name":"Tushar Shaw","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/0lEQVRIiWNgGAWjYHACNhCRwMDA2Pjgg4ENA4hxAJ96HoQW5mbDGRVpIC0NxGphb5PmOXMYLIpXi71E+rMHP/fU5fHPSGyT5m07b7e2/TDQlhqbaJy2SOSYG/Y8O1wscSOx2XJu2+3kbWcSgVqOpeU24NbCJsFz4EBiw+3ExhtvgVrMgOwDjA2H8WhJfyb550Bd4vzbiQ0SvG3nks3OPySkJcFMmucAc+KG24lNkjxnDtiZ3SBky5k3ZtIyBw4nbrz/EBTIyQlmN4C2JODxC3s70GFvgA6bd+b4Q2BU2tmbnU8HMmpscGrBAIlglQnEKgcBe1IUj4JRMApGwcgAABvIa+Hp/7OAAAAAAElFTkSuQmCC","orcid":"","institution":"Ramaiah University of Applied Sciences","correspondingAuthor":true,"prefix":"","firstName":"Tushar","middleName":"","lastName":"Shaw","suffix":""}],"badges":[],"createdAt":"2024-03-06 10:53:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4020518/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4020518/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":53011565,"identity":"09838e1f-c524-466c-81c9-bdfcc30440e5","added_by":"auto","created_at":"2024-03-19 15:36:46","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":74312,"visible":true,"origin":"","legend":"\u003cp\u003ePRISMA-ScR flow diagram showing the process of selecting studies.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4020518/v1/ade5059dd457366725d0b055.png"},{"id":53011562,"identity":"c0390f72-eef7-4ca3-b420-65893423ada9","added_by":"auto","created_at":"2024-03-19 15:36:46","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":25151,"visible":true,"origin":"","legend":"\u003cp\u003eAverage number of articles published between January 2012 and December 2023.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4020518/v1/33c65f881ba6e94f10b290a7.png"},{"id":53012789,"identity":"d0ddb21f-0956-40a2-9c13-5b6f559367b7","added_by":"auto","created_at":"2024-03-19 15:44:46","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":25242,"visible":true,"origin":"","legend":"\u003cp\u003eAnnual prevalence reported globally from 2012 to 2023.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-4020518/v1/3480f66d5a649a0eabc06bc6.png"},{"id":53011563,"identity":"a1767a05-fbcf-4e7f-9c06-62eac1ce2b95","added_by":"auto","created_at":"2024-03-19 15:36:46","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":36793,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of serotype carriage used in PCV7, PCV 10 and PCV 13 vaccines from 2012 to 2023.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-4020518/v1/d807a374c2fe2e016371616c.png"},{"id":53011566,"identity":"b02cc362-ea2d-4e58-86c4-e8f20925de7b","added_by":"auto","created_at":"2024-03-19 15:36:46","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":23242,"visible":true,"origin":"","legend":"\u003cp\u003ePrevalence of pneumococcal carriage based on income class country.\u003c/p\u003e\n\u003cp\u003e(Low-income countries (LICs); lower middle-income countries (LMICs); upper middle-income countries (UMICs); and high income countries (or HICs).)\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-4020518/v1/d222615bb9d920ea5fc05769.png"},{"id":58924997,"identity":"2a8e20b4-9416-4388-acd9-4285360ee109","added_by":"auto","created_at":"2024-06-24 08:02:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":656813,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4020518/v1/c3d4af48-330d-478b-b558-afd81d64b9ac.pdf"},{"id":53011567,"identity":"6e1d1b81-a3ca-4a15-a50d-81bcae71c2ae","added_by":"auto","created_at":"2024-03-19 15:36:46","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":440606,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementary1.docx","url":"https://assets-eu.researchsquare.com/files/rs-4020518/v1/7b1351174567f36b79dfa14e.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eThe Enigmatic Voyage of Pneumococcal Carriage: Unraveling the Risk Factors in Pediatric Populations -- A Scoping Review.\u003c/p\u003e","fulltext":[{"header":"A. Background","content":"\u003cp\u003ePneumococcal infections are a major public health burden on a global scale. \u003cem\u003eStreptococcus pneumoniae\u003c/em\u003e (Pneumococcus, \u003cem\u003eS. pneumoniae\u003c/em\u003e) became the most common cause of lower respiratory tract infection-related morbidity and mortality worldwide in 2019 (2.5\u0026nbsp;million deaths), accounting for more fatalities than all other causes put together. It is the leading cause of death for children under 5 years, accounting for approximately one-third of all casualties, despite being avoidable with the use of an effective vaccine [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Pneumococcus is an opportunistic gram-positive extracellular pathogen that colonizes the mucosal surface of the human upper respiratory tract (URT). Although colonization at this site appears to be asymptomatic, an inflammatory reaction occurs if the organism enters the normally sterile regions of the airway, leading to invasive pneumococcal disease (IPD), such as pneumonia, meningitis, and febrile bacteremia. More frequent but less serious symptoms of non-IPD include bronchitis, sinusitis, and otitis media [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e–\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Children under 5 years and adults over 60 years are the most vulnerable populations. [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] According to reports from 2017, pneumonia was the greatest cause of death for children, accounting for 15% of all child fatalities, and it also contributed to 1.13\u0026nbsp;million deaths among the elderly [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe polysaccharide capsule of bacteria is an essential component of pathogenicity. The classification of disease invasiveness and the development of pneumococcal vaccines are based on the vastly heterogeneous capsular polysaccharides [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. There are over one hundred different pneumococcal serotypes known to exist (until 2020); however, only a few of these serotypes are responsible for the infection. Recent research indicates that IPD is more likely to be caused by serotypes 19F, 9 V, 23F, 6B, 11A, 13, 34, 10A, 19A and 6A [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The distribution of disease-causing serotypes fluctuates throughout time, with variations according to age, illness syndrome, disease severity, geographical location, and the existence of genes for antibiotic resistance [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. There are two types of vaccines available globally: pneumococcal conjugate vaccines (PCV13, PCV10, PCV15, PCV20, PCV24) and pneumococcal polysaccharide vaccines (PPSV23). The WHO suggests that all children between the ages of 2 and 59 months should receive PCV13 or PCV10 (PCV13 has an added advantage in regions where infection caused by serotype 19A or 6C is prevalent)[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]), and adults 65 and older should receive PPSV23. It is estimated that between 60 and 70 percent of invasive diseases are prevented by vaccination with serotypes found in the vaccine [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Vaccination works by reducing severity brought on by vaccine serotypes. They also lessen colonization by the same serotypes, which explains the notable herd immunity. impact observed in older age groups who have not had vaccinations [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Pneumococcal infections continue to be a concern worldwide despite the availability of these vaccinations because nonvaccine serotypes (NVTs) have replaced vaccine serotypes (VTs), frequently in connection with the emergence of multidrug-resistant serotypes [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe colonization of the nasopharynx by \u003cem\u003eS. pneumoniae\u003c/em\u003e is a prerequisite for invasive illness and plays a significant role in pathogen transmission to other people. The local microbiota is expected to have an influence on both initial colonization and subsequent dynamics through a process known as colonization resistance, which can be either direct or immunologically mediated, resulting in pathogen spread in the community, carried by up to 27–85% of children and 10–30% of adults [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Studies over the past few decades have increasingly demonstrated a link between pneumococcal carriage and invasive and mucosal infections as a result of socioeconomic factors [\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e–\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], missed or incomplete immunization [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], asthma or respiratory allergies [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], smoking and alcoholism [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] and malnutrition [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThere has been a significant decline in mortality from invasive pneumococcal illness over the past two decades because of enhanced immunization[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. However, overall pneumonia rates have remained the same[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Invasive pneumococcal illness caused by the 13 serotypes covered by PCV13 dropped by 98% in children under the age of five [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. It is interesting to note that bacterial carriage prevalence has stayed between 38% and 68% despite a decline in infection burden [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. A critical area of inquiry is why the pneumococcal infection burden has decreased with vaccination, although the bacterial carriage prevalence has remained stable. Understanding this problem will be essential for forecasting the outcomes of future pneumococcal immunization campaigns, especially in underdeveloped nations. These pneumococcal carriage investigations are crucial because pneumococcal illness and pneumococcal dissemination are strongly influenced by carriage. We examined multiple studies that looked at the relationship between distinct characteristics and the possibility of harboring the bacteria in our thorough analysis of \u003cem\u003eS. pneumoniae\u003c/em\u003e carriage risk factors.\u003c/p\u003e \u003cp\u003eWe looked at the study designs used, sample sizes, and any confounding variables when assessing potential biases in the data. It was vital to detect any restrictions that would compromise the validity and generalizability of the results. We examined the biological and epidemiological variations in virulence, antibiotic resistance patterns, and geographic distribution of \u003cem\u003eS. pneumoniae\u003c/em\u003e serotypes. We wanted to know how these differences would affect the severity of the disease and the efficiency of treatments such as immunization.\u003c/p\u003e \u003cp\u003eWe evaluated the relative contributions of vaccination and other variables to address the growth of NVTs. Analyzing data on serotype distribution before and after pneumococcal vaccine introduction, keeping track of the incidence of NVTs in various groups, and looking into putative processes causing serotype replacement were all part of this process.\u003c/p\u003e \u003cp\u003eTo create efficient preventative measures and public health policies, it is crucial to understand the risk factors related to pneumococcal disease. Certain risk variables have been clarified by prior research, but to fill any information gaps, more recent and thorough studies are needed. This review aims to provide a comprehensive analysis of recent studies included in this study, presenting the most up-to-date data on risk factors associated with pneumococcal carriage and common serotypes. The aim is to highlight the importance of immunization, alterations in living conditions, addressing socioeconomic inequalities, and lowering tobacco use as significant efforts to reduce the prevalence of pneumococcal carriage. This research intends to direct the creation and execution of efficient pneumococcal vaccination programs and other public health initiatives by detecting these gaps and providing insightful information.\u003c/p\u003e "},{"header":"Results","content":"\u003cp\u003e \u003cb\u003eSearch Results\u003c/b\u003e \u003c/p\u003e\u003cp\u003eScreening from two databases resulted in a total of 768 studies, and 150 duplicates were removed from the collection. After screening the titles and abstracts of the remaining 618 articles, 267 studies were then excluded because the articles were not relevant to this review based on the inclusion criteria. A total of 280 studies were further excluded from 351 selected articles during full-text screening where prevalence was not mentioned, leaving 71 studies in the review that fulfilled the inclusion and exclusion criteria of this study (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e \u003cb\u003eCharacteristics of the study\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eThe 71 studies included in the review were reported from 41 countries around the globe. Most of the studies were reported from high-income countries (HIC) (19/71; 26.7%), followed by low-income countries (LIC) (18/71; 25.3%). The age group of the participants ranged from 0 to 10 years. Similar statistical analysis was used across the studies, most commonly logistic regression reporting adjusted odds ratios. Selection of variables as associated risk factors was driven by P values ranging from \u0026lt; 0.1 -\u0026lt;0.5 as significant.\u003c/p\u003e\u003cp\u003e \u003cb\u003ePrevalence and Serotypes\u003c/b\u003e \u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e2\u003c/span\u003e depicts the overall number of daily articles published between January 2012 and December 2023. The overall prevalence reported globally from 2012 to 2022 ranged from 24.98 to 49.45, with the highest prevalence documented in 2021 (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The highest prevalence of pneumococci carriage among children was documented in a study in Kenya in 2017 (prevalence 90%) [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], followed by Malawi in 2022 (prevalence 86%) [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] and New Guinea in 2023 (prevalence 83%) [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. The bubble chart (Figure \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e) depicts the yearly prevalence of pneumococcal carriage across various countries. Serotype 6A is one of the common serotypes reported across countries. The common serotypes observed among the ten countries reporting the highest prevalence are depicted in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. We also assessed the rate of common serotypes reported among the studies used in the PCV7, PCV10 and PCV13 vaccines. The highest number of carriages with serotypes used in PCV 13 vaccines was reported in 2021. The graph below (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e4\u003c/span\u003e) shows the year wise distribution of the serotypes used in the PCV7, PCV10 and PCV13 vaccines. The highest prevalence of pneumococci carriage was observed in low- and Middle-income Countries (LMICs), followed by upper middle-income countries (UMICs) (Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCommon serotypes reported from the top ten countries reporting the highest prevalence of pneumococci carriage.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSL. NO.\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCountry\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYear\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePrevalence %\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSerotype\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eKenya\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2012\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65.8\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1, 5, 7F\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2012\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63.17\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4, 6B, 9 V, 14, 18C, 19F, and 23F\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2017\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19F, 3, 7F,15B,19B,11A,23F,6A \u0026amp;6B\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMalawi\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3, 6A, 19A\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNew Guinea\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3, 6A, 19A, 1,5 ,7F,6C\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBangladesh\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54.8\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3, 6A, 19A, 35B, 15B, 34, 6A, 6B, 19A\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSouth Africa\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3, 6A, 19A, 1,5 ,7F,6C\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEcuadorian\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3, 6A, 19A, 1,5 ,7F,6C\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDominican Republic\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3, 6A, 19A\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNigeria\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2018\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61.6\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1, 7F \u0026amp; 5\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGreenland\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2016\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6B, 6C,15B,16 F, 19A, 22 F, 23 F, 33 F and 35 F\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVietnam\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1, 5, 7F\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e \u003cb\u003eRisk Factors\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eFactors assessed for association with pneumococcal nasopharyngeal carriage varied by study (Table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e). Among the seventy one studies included in the review, the most common risk factors reported were the child being a sibling (25/71; 35.2%), attending day care (24/71; 33.8%), age of less than 2 years (24/71; 33.8%) and passive smoking (19/71; 26.7%). Higher odds ratios were observed among tobacco and alcohol consumption in the family, having siblings and attending day care Antibiotic usage in the past was reported as a risk factor in a few studies, whereas other studies reported it as a protective factor.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eThe present scoping review was written following the updated Preferred Reporting Items for Systematic Review and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e \u003cb\u003ea. Search Strategy\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eA systematic exploration of the literature spanned from January 2012 to December 2023, while the study period encompassed April 2004 to 2023. This inquiry was conducted across two prominent databases, namely, PubMed and Scopus, using lists of keywords. These keywords were combined using the Boolean operators OR (within key concepts) and AND (between key concepts) as follows: (‘\u003cem\u003eStreptococcus pneumoniae\u003c/em\u003e’’ OR ‘S pneumoniae’ OR pneumococci) AND ‘risk’ AND (‘carriage’ OR ‘colonization’). An additional search was conducted by manually screening the references of the retrieved literature.\u003c/p\u003e\u003cp\u003e \u003cb\u003eb. Selection of Study\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eStudies were excluded if (i) they did not report the prevalence and risk factors for pneumococcal carriage; (ii) they were studies on adult pneumococcal carriage; (iii) they were studies published in languages other than English; or (iv) they were case series or reports, clinical studies on pneumococcal infections, qualitative studies, conference papers, proceedings, abstract-only articles, editorial reviews, letters of communications, or commentaries. The retrieved literature was downloaded into Mendeley, and duplicates were identified and removed from this review. The references were distributed to two authors (V.N., S.C.) who independently reviewed all the articles for title and abstract screening. Satisfactory agreement for the screening process was assessed between the authors. Discrepancies between the authors were solved through a discussion with another author (T.S.).\u003c/p\u003e\u003cp\u003e \u003cb\u003ec. Data Extraction\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eThe full text screening was performed independently by three authors (V.N., T.S. and S.C.), and the findings were summarized in an Excel worksheet. The data included the year of study, study location, sample size, prevalence/incidence, risk factor with odds ratio and commonly identified serotypes. Another author verified the results and scoping review (K.J.).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe current review offers new insights into the changing prevalence of and risk factors for pneumococcal disease. This research was conducted throughout 41 nations, demonstrating the broad interest in and attempts to comprehend the risk variables connected to \u003cem\u003eS. pneumoniae\u003c/em\u003e carriage. It is remarkable that the bulk of studies came from high-income nations, which reflects the availability of resources and the research infrastructure in these areas. In contrast, the incidence of pneumococcal carriage was highest among LMICs, which could be due to the absence of proper vaccination programs against pneumococci, the dense population residing in close proximity, and a lack of awareness of proper sanitation and hygiene.\u003c/p\u003e\u003cp\u003eParticipants' ages in the studies that were included ranged from 0 to 10, emphasizing the focus on kids who are known to be especially prone to pneumococcal infections. This age range must be thoroughly investigated since it is a population that needs specialized preventative measures.\u003c/p\u003e\u003cp\u003eThe inclusion of research from other nations improves the generalizability of the results by giving us a more complete picture of the prevalence of pneumococcal illness worldwide and the risk factors that contribute to it. Additionally, the inclusion of both high- and low-income nations emphasizes the necessity of addressing pneumococcal illness in various socioeconomic contexts.\u003c/p\u003e\u003cp\u003eThis study emphasizes the important risk factors for pneumococcal carriage, such as having siblings, daycare attendance, passive smoking, household characteristics, age, comorbidities, and vaccination status. One significant risk factor for children carrying \u003cem\u003eStreptococcus pneumoniae\u003c/em\u003e was having siblings. Children with siblings are more likely to develop \u003cem\u003eS. pneumoniae\u003c/em\u003e colonization [\u003cspan additionalcitationids=\"CR34 CR35 CR36 CR37 CR38 CR39 CR40 CR41 CR42 CR43 CR44 CR45 CR46 CR47 CR48\" citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e–\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. For instance, Abaye et al. 2019 [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e] discovered that kids with siblings were considerably more likely to have \u003cem\u003eS. pneumoniae\u003c/em\u003e colonization (odds ratio = 16.06, 95% confidence interval). Similarly, Haile et al. 2019 [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e] found that children who have elder siblings are more likely to have \u003cem\u003eS. pneumoniae\u003c/em\u003e (odds ratio = 2.9, 95% confidence interval [CI].\u003c/p\u003e\u003cp\u003eSibling relationships are regularly linked to a higher incidence of \u003cem\u003eStreptococcus pneumoniae\u003c/em\u003e carriage in kids. Numerous studies have shown that children with siblings are more likely to develop \u003cem\u003eS. pneumoniae\u003c/em\u003e colonization than children without siblings. Bacterial transmission might happen because of close contact and shared living quarters[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. One factor that raises the likelihood of colonization is the presence of an older sibling. Within families and communities, siblings may act as reservoirs for pneumococcal transmission[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. The second most reported risk factor was children who attended day care facilities. Numerous investigations [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan additionalcitationids=\"CR35\" citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e–\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan additionalcitationids=\"CR48\" citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e–\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan additionalcitationids=\"CR52 CR53 CR54 CR55 CR56 CR57 CR58 CR59 CR60 CR61 CR62 CR63 CR64 CR65 CR66 CR67 CR68\" citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e–\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e] carried out in various geographic places have consistently shown that children who attend day care have a higher frequency of \u003cem\u003eS. pneumoniae\u003c/em\u003e. An odds ratio = 13.73 was recorded by Neves et al. 2017 [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] Children on day-care centers spend more time together and interact more, which makes it easier for respiratory diseases to spread [\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e]. The increased exposure to respiratory secretions, sharing of toys, and poor hand hygiene practices all contribute to the greater colonization rates seen in these environments [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]. An increased diversity of pneumococcal serotypes is also caused by the presence of more kids in day-care facilities, which raises the risk of introducing novel pneumococcal strains into the community.\u003c/p\u003e\u003cp\u003eAn age of less than two years has been noted in several studies as a significant risk factor for \u003cem\u003eS. pneumoniae\u003c/em\u003e carriage [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan additionalcitationids=\"CR55\" citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e–\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e, \u003cspan additionalcitationids=\"CR61\" citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e–\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e, \u003cspan additionalcitationids=\"CR70 CR71 CR72 CR73 CR74 CR75 CR76 CR77 CR78 CR79 CR80\" citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e–\u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e]. Due to their undeveloped immune systems and limited exposure to pathogens, infants and young children in this age range are more susceptible to pneumococcal infections. According to Tilahun et al.’s 2022 [\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e] study performed in a low-income nation, babies under the age of two years had a greater frequency of pneumococcal carriage than older children. Similar findings were found in research conducted in a high-income nation, which found that children under the age of two had a greater risk of pneumococcal colonization [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e].\u003c/p\u003e\u003cp\u003ePassive smoking has become a major risk factor for pneumococcal illness. According to studies [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan additionalcitationids=\"CR67\" citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e–\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e, \u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e, \u003cspan citationid=\"CR82\" class=\"CitationRef\"\u003e82\u003c/span\u003e, \u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e], second-hand smoke exposure puts children at risk for pneumococcal carriage. These results underline how crucial it is to promote smoke-free surroundings and tobacco control policies to lower the incidence of pneumococcal illness.\u003c/p\u003e\u003cp\u003eCrowded housing, which is defined as having more people living there, increases the chances of transmission and promotes the spread of the bacteria [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e, \u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e, \u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e, \u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e, \u003cspan additionalcitationids=\"CR85\" citationid=\"CR84\" class=\"CitationRef\"\u003e84\u003c/span\u003e–\u003cspan citationid=\"CR86\" class=\"CitationRef\"\u003e86\u003c/span\u003e]. The likelihood of \u003cem\u003eS. pneumoniae\u003c/em\u003e infections is enhanced by socioeconomic variables. The lack of access to healthcare, substandard housing, and uneducated parents are major contributing causes. People at a low socioeconomic level people have difficulties getting healthcare, especially immunizations. Living in cramped quarters and having poor sanitation helps the germs spread. Parents with less education are less likely to be aware of preventative actions. increases the danger even further. Individuals with partial vaccination status have insufficient defenses against the pneumococcal strains included in the vaccine, leaving them more vulnerable to colonization and illness.\u003c/p\u003e\u003cp\u003eFamily members who use tobacco and alcohol have weakened immune systems, making them more susceptible to pneumococcal infections. As children can act as reservoirs for germs, living in a home with two or more small children increases the risk of exposure to \u003cem\u003eS. pneumoniae\u003c/em\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Shared beds increase the likelihood of pneumococcal transmission because they bring numerous people into close, ongoing contact [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e, \u003cspan citationid=\"CR87\" class=\"CitationRef\"\u003e87\u003c/span\u003e]. The prevention of smoke exposure [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e, \u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e] is an environmental risk factor for pneumococcal carriage and transmission that needs to be addressed.\u003c/p\u003e\u003cp\u003eUnderstanding the causes of pneumococcal carriage in certain settings could help inform other public health initiatives that might be necessary. Although age, living with small children, and ethnicity are risk factors that cannot be changed, public health programs and policies that target specific age groups to reduce transmission, such as increased access to enhanced hygiene and sanitation, or which are intended to tackle socioeconomic differences and social determinants of health that promote transmission, may reduce the risk of pneumococcal carriage, transmission, and disease. The WHO's integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhea [\u003cspan citationid=\"CR88\" class=\"CitationRef\"\u003e88\u003c/span\u003e] includes several of these modifiable variables. Programs to address these issues would also aid in preventing other infectious illnesses, which frequently cause infant morbidity as well as mortality in LMICs.\u003c/p\u003e\u003cp\u003eThe most common serotypes recorded from the listed countries were serotype 6A cases recorded from New Guinea (2023)[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e],Thailand (2023)[\u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e],Nigeria (2023)[\u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e],Bangladesh \u0026amp; India (2021)[\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e], Ecuador (2021)[\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e], and the Dominican Republic (2021)[\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e]; serotype 19A cases reported from the Nigeria (2023)[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e], Thailand (2023) [\u003cspan citationid=\"CR80\" class=\"CitationRef\"\u003e80\u003c/span\u003e],New Guinea (2023)[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e],Dominican Republic (2021), Bangladesh (2021)[\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e], India (2021)[\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e], Ecuador (2021)[\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e], and Malawi (2022); serotype 1 cases reported from Kenya (2012 [\u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e89\u003c/span\u003e, \u003cspan citationid=\"CR90\" class=\"CitationRef\"\u003e90\u003c/span\u003e], 2017 (52,83)) and Nigeria (2018); serotype 5 cases reported from Nigeria (2018)[\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e], Vietnam (2021), Germany (2021)[\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e], and Kenya (2012[\u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e89\u003c/span\u003e, \u003cspan citationid=\"CR90\" class=\"CitationRef\"\u003e90\u003c/span\u003e], 2017[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]); and serotype 7F cases reported from Vietnam (2021)[\u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e], Germany (2021)[\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e], and Kenya (2012 [\u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e89\u003c/span\u003e, \u003cspan citationid=\"CR90\" class=\"CitationRef\"\u003e90\u003c/span\u003e], 2017) [\u003cspan citationid=\"CR89\" class=\"CitationRef\"\u003e89\u003c/span\u003e, \u003cspan citationid=\"CR90\" class=\"CitationRef\"\u003e90\u003c/span\u003e]. There is a considerable increase in PCV13 serotype numbers in 2020 and 2021. This implies that some pneumococcal bacteria may have evolved over time to circumvent the protection provided by the PCV13 vaccination. The persisting problem of pneumococcal bacteria shifting and evolving in response to vaccination is highlighted by the rising numbers of PCV13 serotypes in recent years. These results illustrate geographical differences in pneumococcal serotype distribution and emphasize the significance of tracking serotype prevalence to guide immunization programs. For the creation and use of efficient vaccinations that can specifically target circulating strains, an understanding of the common serotypes in each nation is essential. The burden of pneumococcal illness can be decreased by tailoring vaccination programs to target the strains that provide the highest risk on the basis of the serotypes that are most often identified.\u003c/p\u003e\u003cp\u003eOne of the most important methods for avoiding pneumococcal illness is vaccination with PCVs. In certain studies, persons without a vaccine [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR83\" class=\"CitationRef\"\u003e83\u003c/span\u003e, \u003cspan citationid=\"CR85\" class=\"CitationRef\"\u003e85\u003c/span\u003e, \u003cspan additionalcitationids=\"CR92 CR93\" citationid=\"CR91\" class=\"CitationRef\"\u003e91\u003c/span\u003e–\u003cspan citationid=\"CR94\" class=\"CitationRef\"\u003e94\u003c/span\u003e] or with partial immunizations [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan additionalcitationids=\"CR53 CR54 CR55 CR56 CR57 CR58 CR59 CR60 CR61\" citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e–\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e, \u003cspan citationid=\"CR79\" class=\"CitationRef\"\u003e79\u003c/span\u003e, \u003cspan citationid=\"CR81\" class=\"CitationRef\"\u003e81\u003c/span\u003e] had a higher frequency of the disease than those who were vaccinated. This highlights the importance of vaccination initiatives in reducing the incidence of pneumococcal disease. Although PCVs have been successful in lowering vaccine serotype infections, some research has revealed that vaccination may be linked to a higher risk of carrying \u003cem\u003eStreptococcus pneumoniae\u003c/em\u003e [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan additionalcitationids=\"CR53 CR54 CR55 CR56 CR57 CR58 CR59 CR60 CR61\" citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e–\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e], which indicates that a) the presence of nonvaccine serotypes and serotype switching[\u003cspan citationid=\"CR95\" class=\"CitationRef\"\u003e95\u003c/span\u003e] and b) vaccination can only prevent invasive pneumococcal disease and not carriage[\u003cspan citationid=\"CR96\" class=\"CitationRef\"\u003e96\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eTo fully comprehend the connection between vaccination serotype carriage and the risk of pneumococcal carriage, further research is needed. Evaluation of PCV vaccination efficacy in lowering pneumococcal carriage and serotype prevalence is also crucial. The creation of effective preventive and control measures for pneumococcal illness can be aided by an understanding of the risk factors connected to pneumococcal carriage. In addition, advanced technologies in vaccine development need to be employed to identify other potential antigen candidates for pneumococcal vaccination.\u003c/p\u003e\u003cp\u003eThe thorough analysis of the selected papers offers important latest information on the risk factors for pneumococcal illness. The results highlight the value of immunization, improving living circumstances, addressing socioeconomic inequities, and encouraging smoke-free surroundings as key tactics in lowering the incidence of pneumococcal illness. Overall, this study's findings offer significant information on the incidence of pneumococcal carriage worldwide and the distribution of prevalent serotypes. These results can be used to guide the creation and execution of pneumococcal vaccination programs, among other public health policies. It is crucial to remember that the included studies and nations may not be typical of all populations; therefore, it is possible that the prevalence rates presented in this study may not accurately reflect the whole global burden of pneumococcal carriage. To obtain a deeper knowledge of the worldwide epidemiology of pneumococcal carriage, further study and monitoring efforts are needed.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe analysis of current research revealed that household characteristics, age, comorbidities, passive smoking, and partial immunization as major risk factors linked to the occurrence of carriage. To lessen the burden of pneumococcal illness, our findings emphasize the value of immunization programs, improving living circumstances, reducing socioeconomic gaps, and encouraging smoke-free surroundings. This review can potentially inform public health policy and programs in low- and middle-income countries to develop efficient preventive and control measures to tackle the burden of pneumococcal illness.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cul\u003e\n \u003cli\u003eURT - Upper Respiratory Tract\u003c/li\u003e\n \u003cli\u003eIPD - Invasive Pneumococcal Disease\u003c/li\u003e\n \u003cli\u003ePCV - Pneumococcal Conjugate\u0026nbsp;Vaccines\u003c/li\u003e\n \u003cli\u003ePPSV - Pneumococcal Polysaccharide\u0026nbsp;Vaccines\u003c/li\u003e\n \u003cli\u003eNVTs \u0026ndash; Non-Vaccine\u0026nbsp;serotypes \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eVT - Vaccine serotypes\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eLICs - Low-income countries\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eLMICs - Lower middle-income countries\u003c/li\u003e\n \u003cli\u003eUMICs - Upper middle-income countries\u003c/li\u003e\n \u003cli\u003eHICs - High income countries\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Declarations","content":"\u003cul type=\"disc\"\u003e\n \u003cli\u003eEthics approval and consent to participate \u0026ndash; Not applicable.\u003c/li\u003e\n \u003cli\u003eConsent for publication- Not applicable\u003c/li\u003e\n \u003cli\u003eAvailability of data and materials - Not applicable\u003c/li\u003e\n \u003cli\u003eCompeting interests -\u0026nbsp;\u0026ldquo;The authors declares that they have no competing interests\u0026rdquo;.\u003c/li\u003e\n \u003cli\u003eFunding - Not applicable\u003c/li\u003e\n \u003cli\u003eAuthors\u0026apos; contributions\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eVaishnavi Vishram Naik \u003csup\u003e\u0026ndash;\u0026nbsp;\u003c/sup\u003escreening of review papers\u003csup\u003e\u0026nbsp;\u003c/sup\u003eand manuscript writing.\u003c/p\u003e\n\u003cp\u003eSubhangini Chakraborty \u0026ndash; screening of review papers\u003c/p\u003e\n\u003cp\u003eKrishnamurthy Jayanna\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u0026ndash; substantively revised\u0026nbsp;the work.\u003c/p\u003e\n\u003cp\u003eTushar Shaw \u0026ndash; Full text screening of papers and\u0026nbsp;interpretation of data\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eAcknowledgements -Acknowledgement to the Indian Council of Medical Research (ICMR) for providing manpower support under grant no. OMI/16/2022/ECD.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBernadeta Dadonaite, Max Roser (2018) (2018) \u0026ldquo;Pneumonia\u0026rdquo; OurWorldInData.org. https://ourworldindata.org/pneumonia. Accessed 6 Jan 2023\u003c/li\u003e\n\u003cli\u003eKadioglu A, Weiser JN, Paton JC, Andrew PW (2008) The role of Streptococcus pneumoniae virulence factors in host respiratory colonization and disease. Nat Rev Microbiol 6:288\u0026ndash;301\u003c/li\u003e\n\u003cli\u003eHoward LM, Grijalva CG (2018) The central role of pneumococcal colonization in the pathogenesis and control of pneumococcal diseases. Future Microbiol 13:1453\u0026ndash;1456\u003c/li\u003e\n\u003cli\u003eWeiser JN, Ferreira DM, Paton JC (2018) Streptococcus pneumoniae: Transmission, colonization and invasion. Nat Rev Microbiol 16:355\u0026ndash;367\u003c/li\u003e\n\u003cli\u003eConsiderations for pneumococcal vaccination in older adults. 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PLoS Med. https://doi.org/10.1371/journal.pmed.1004016\u003c/li\u003e\n\u003cli\u003eOlwagen CP, Izu A, Mutsaerts EAML, et al (2023) Single priming and booster dose of ten-valent and 13-valent pneumococcal conjugate vaccines and Streptococcus pneumoniae colonisation in children in South Africa: a single-centre, open-label, randomised trial. Lancet Child Adolesc Health 7:326\u0026ndash;335\u003c/li\u003e\n\u003cli\u003eSanchez Picot V, Keovichith I, Paboriboune P, Flaissier B, Saadatian-Elahi M, Rudge JW (2023) Epidemiology and serotype distribution of Streptococcus pneumoniae carriage among influenza-like illness cases in metropolitan Vientiane, Lao PDR: a community-based cohort study. Front Public Health. https://doi.org/10.3389/fpubh.2023.1124016\u003c/li\u003e\n\u003cli\u003eAdamu AL, Ojal J, Abubakar IA, et al (2023) The impact of introduction of the 10-valent pneumococcal conjugate vaccine on pneumococcal carriage in Nigeria. 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Ann Am Thorac Soc 13:933\u0026ndash;44\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Streptococcus pneumoniae, carriage, risk factors, pediatric, transmission, vaccination","lastPublishedDoi":"10.21203/rs.3.rs-4020518/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4020518/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003ePneumococcal infections are a major cause of morbidity and mortality globally, especially among children in low- and middle-income countries (LMICs). Although considerable research has been done on the frequency of pneumococcal infections and their risk factors, there are still many unanswered questions. The objective of this study is to offer fresh perspectives through systematic literature review on the shifting prevalence of and associated risk factors for pneumococcal carriage. Studies from 41 different countries are included in the evaluation, which focuses on pediatrics patients who are most vulnerable to pneumococcal infections. The most frequent risk variables for pneumococcal carriage were having siblings, daycare centers, passive smoking, household characteristics, age, comorbidities, and vaccination status. The frequency of pneumococcal carriage was greatest among LMICs, which may be related to inadequate pneumococcal vaccination programs, densely populated areas, and a lack of knowledge about basic sanitation and hygiene. The study emphasizes how crucial it is to monitor serotype prevalence to direct vaccination campaigns in these regions. For creating efficient pneumococcal disease prevention and control strategies, it is essential to understand the risk factors connected to pneumococcal carriage. The risk of pneumococcal carriage, transmission, and disease may be decreased by public health initiatives that are aimed at a particular age group to reduce transmission, such as improved hygiene and sanitation, addressing socioeconomic disparities and social determinants of health thus reducing transmission of the bacteria. The review highlights the value of vaccination campaigns in lowering the prevalence of pneumococcal illness, to completely understand the relationship between immunization, serotype carriage, and the risk of pneumococcal carriage, more study is required especially in LIC and LMIC region.\u003c/p\u003e","manuscriptTitle":"The Enigmatic Voyage of Pneumococcal Carriage: Unraveling the Risk Factors in Pediatric Populations -- A Scoping Review.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-19 15:36:41","doi":"10.21203/rs.3.rs-4020518/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d6eb13b4-d0bb-4a06-b9c3-cb4abdfdbaca","owner":[],"postedDate":"March 19th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-06-24T07:54:03+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-19 15:36:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4020518","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4020518","identity":"rs-4020518","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}