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Pneumococcal carriage is a prerequisite for invasive and non-invasive infections, where children and elderly are the most vulnerable age groups. Jordan is known as a middle-income country with 44.3% of the population under the age of 19 years, and there is no PCVs available in the National Immunization Program (NIP) of the country. In the history of Jordan, there is no data available on the pneumococcal infections or serotypes of IPD, although parts of some publications have described infections with the pneumococci. Furthermore, pneumococcal conjugate vaccine PCV7 is available in the private market of Jordan since year 2000, followed by PCV13 in the year 2010. In Jordan, more than 500 meningitis infections were reported annually, and many infections of otitis media and pneumonia with no identified causative agents, therefore surveillance of the carriage due to Streptococcus pneumoniae is essential. Another serious problem for Jordan is the antibiotic consumption, where no reported data are available, and there is misuse and abuse in this regard. Aims of the chapter: Determine the carriage rate of children attending Day Care Centers (DCC) in north Jordan with the resistance rates and the possible coverage of the old and future pneumococcal conjugate vaccines (PCV). Methods: Nasopharyngeal swabs (NP) were taken from healthy Jordanian children from north Jordan with ages ranging from one month to 14 years in the period from 2008 to 2019. Swabs were cultivated on Columbia Blood Agar base supplemented with 5% sheep blood and incubated at 37˚C for 18-24 hours. Suspected alpha hemolytic isolates were tested for optochin sensitivity and bile solubility. Antimicrobial susceptibility testing was performed using the Vitek2 compact system and E-test (BioMérieux). Serotyping was done by the Neufeld Quellung method. Results: A total of 1866 NP-swabs were tested with 733 (39.3%) pneumococcal carriers. The periods 2008-2010 and 2015-2019 indicate fluctuations in carriage, resistance and coverage of available and future vaccines. For both periods, resistance rates to penicillin, clarithromycin, clindamycin, trimethoprim-sulfamethoxazole, tetracycline, and chloramphenicol was as follows: 89.3%, 64.8%, 36.3%, 73.0%, 56.6%, and 3.1%, respectively. Predominant serotypes were 19F (17.6%), 6A (8.9%), 23F (8.1%), 6B (7.9%), 11A (6%), 14 (5.6%), and 19A (5.2%), respectively. Coverage of PCV7, PCV10, PCV13 and the future PCV20 was 41.7%, 42%, 57.7%, and 73.1%, respectively. 493 cases had a previous 1-3 PCV7 injections, among which 256 (51.9%) cases were pneumococcal carriers, distributed as non-PCV vaccine serotypes (31.6%), and with PCV types (68.4%). Conclusions: The potential inclusion of the PCV vaccination program for children in Jordan would have an impact of decreasing carriage, resistance and indirectly the pneumococcal infections, especially the future PCV20.

Pneumococcal Carriage in Jordanian Children and the Importance of Vaccination