Epidemiology and Infection

Estimating the transmission parameters of pneumococcal carriage in households

A. MELEGARO a1a2c1, N. J. GAY a1 and G. F. MEDLEY a2
a1 Modelling and Economics Unit, Communicable Disease Surveillance Centre, Health Protection Agency, London NW9 5EQ, UK
a2 Department of Biological Sciences, University of Warwick, Coventry CV4 7AL, UK

Article author query
melegaro a   [PubMed][Google Scholar] 
gay n   [PubMed][Google Scholar] 
medley g   [PubMed][Google Scholar] 


This paper analyses Streptococcus pneumoniae transmission dynamics in households using longitudinal data on pneumococcal (Pnc) carriage in the United Kingdom. Ten consecutive swabs were taken at 4-week intervals from all members of 121 households. The family status is derived from the observed Pnc carriage status of each family member. Transition matrices are built for each family size and composition containing the observed frequency of transitions between family statuses over a 28-day interval. A density-dependent transmission model is fitted to derive maximum-likelihood estimates of the duration of carriage and acquisition rates from the community and from infected individuals within the household. Parameter values are estimated for children (<5 years) and adults (5+ years). The duration of carriage is longer in children <5 years of age than in older family members (51 vs. 19 days). Children are 3–4 times more likely than adults to acquire Pnc infection from the community. Transmission rates within the household suggest that adults are more infectious but less susceptible than children. Transmission within the household is most important in large families. The proportion of household-acquired infection ranges from 29 to 46% in households of three persons to 38–50% in larger households. Evidence of density-dependent within-household transmission is found, although the strength of this relationship is not clear from the model estimates.

(Accepted December 22 2003)

c1 A. Melegaro, Modelling and Economics Unit, Communicable Disease Surveillance Centre, Health Protection Agency, 61 Colindale Avenue, London NW9 5EQ, UK.