Nasopharyngeal swabs were obtained using rayon-tipped swabs and transported in Amies-charcoal media (COPAN, Italy). Swabs were inoculated on 5% sheep blood agar with gentamicin (5 mg/liter) and incubated at 35°C in 5% CO2 for 48 hours. Identification of S. pneumoniae was performed using the optochin test (Oxoid, Basingstoke, UK) and, in case of doubt, a DNA hybridization test (Accuprobe, Gen-Probe Inc., San Diego, CA, USA). Antimicrobial susceptibility tests were performed using disk diffusion method (Oxoid, UK) and E-test (bioMérieux, France) and interpreted according to EUCAST 2012. Serotyping of S.pneumoniawas done with a multiplex-PCR which covers 36 serotypes [5] , [6] (link). Control strains were included in all analyses.
Data on demography, house sanitation (crowding, smoke exposure from cigarette and mosquito coils), and water and food hygiene, were recorded using a questionnaire that was developed to identify determinants of carriage. Crowding was defined to be present when the ratio of total bedroom space to the number of family members was less than 4 m2[7] . Water hygiene was defined as poor when water other than tap or bottled water was used by the family. Food hygiene was considered poor if the family consumed street food.
Data on demography, house sanitation (crowding, smoke exposure from cigarette and mosquito coils), and water and food hygiene, were recorded using a questionnaire that was developed to identify determinants of carriage. Crowding was defined to be present when the ratio of total bedroom space to the number of family members was less than 4 m2[7] . Water hygiene was defined as poor when water other than tap or bottled water was used by the family. Food hygiene was considered poor if the family consumed street food.
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