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Colonization rates increased in areas lacking in-home running water
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Increased invasive pneumococcal disease rates in areas lacking in-home water services could be explained by higher colonization rates, according to recent study findings published in the Journal of the Pediatric Infectious Diseases Society.
Jonathan S. Reisman, MD, a research scientist in the department of health policy and management at Harvard School of Public Health and pediatrics newborn services at Massachusetts General Hospital was lead author and described work done by colleagues at the CDC Arctic Investigations Program in Anchorage. They collected 12,535 nasopharyngeal swabs from 4,980 participants aged 4 days to 92 years from eight rural Alaskan villages to determine risk factors for colonization.
"Clinicians should have a high index of suspicion for invasive pneumococcal infections in children coming from crowded home environments or living without running water," Reisman told Infectious Diseases in Children. "The results of the study also emphasize the need for on-time pneumococcal vaccinations in children."
One-third (n=4,155) of the swabs grew pneumococcus. Increased colonization in children younger than 10 years was significantly associated with lack of in-home running water (OR=1.35; 95% CI, 1.08-1.69). Household crowding was associated with increased colonization odds among all age groups, as well as having more than three children younger than 10 years living in one household.
There was a reduced risk of colonization if the participant had received antibiotics within the past 90 days.
“The main findings of this study highlight the importance of improving living standards for [Alaska Native] populations,” the researchers wrote. “Providing universal in-home water service may be a way to improve hygiene and reduce pneumococcal colonization and infection, especially in younger children. For villages with water services limited by technical geographic difficulties, this process may require experimentation with individual household water purifiers that allow recycling of waste water. Reducing crowding through education and housing innovations may also reduce colonization rates.”
Jonathan S. Reisman, MD, can be reached at reisman.jonathan@gmail.com.
Disclosure: The study was funded in part by Pfizer and the CDC. Reisman reports financial ties with Partners Healthcare.
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