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Conjunctival pneumococcal serotypes among members of a community have not been investigated well. We determined the prevalence and association of  Streptococcus pneumoniae  in the nasopharynx and conjunctiva among children in a community before pneumococcal conjugate vaccine introduction. In October 2016, conjunctival and nasopharyngeal swabs were collected from children (< 24 months old) and nasopharyngeal swabs from mothers in Nha Trang, Vietnam. Quantitative  lytA  PCR and DNA microarray were performed to detect and serotype  S. pneumoniae . The association between  S. pneumoniae  in the nasopharynx and conjunctiva was evaluated using multivariable logistic regression model. Among 698 children, 62 (8.9%, 95% CI 6.9–11.2%) were positive for  S. pneumoniae  in the conjunctiva. Non-encapsulated  S. pneumoniae  were most commonly identified, followed by serotypes 6A, 6B, and 14. Nasopharyngeal and conjunctival detection were positively associated (aOR 47.30, 95% CI 24.07–92.97). Low birth-weight, day-care attendance, and recent eye symptoms were independently associated with  S. pneumoniae  detection in the conjunctiva (aOR 11.14, 95% CI 3.76–32.98, aOR 2.19, 95% CI 1.45–3.31, and aOR 3.59, 95% CI 2.21–5.84, respectively). Serotypes and genotypes in the conjunctiva and nasopharynx matched in 87% of the children. Three mothers’ nasopharyngeal pneumococcal samples had matched serotype and genotype with their child’s in the conjunctiva and nasopharynx.  S. pneumoniae  presence in nasopharynx and conjunctiva were strongly associated. The high concordance of serotypes suggests nasopharyngeal carriage may be a source of transmission to the conjunctiva.

Prevalence of Streptococcus pneumoniae in conjunctival flora and association with nasopharyngeal carriage among children in a Vietnamese community