g. optochin susceptibility) and serotyping (e.g. production of capsule) is needed. The performance of simpler storage media could be validated. There are many methods available for shipping of pneumococcal isolates. These include using STGG, silica gel desiccant sachets (stable for a fortnight at room-temperature or a month at 4 °C [66] and [131]), Dorset media, Amies transport media, chocolate or similar agar slopes, or lyophilization. There is no evidence base for preferring one method EPZ5676 datasheet over another. Any of the methods outlined

above, or others that are shown to be equally as effective are acceptable. Comparison of effectiveness of different transport methods could be undertaken, although it is likely that many would prove satisfactory. In previous sections we have provided a core methodology to perform pneumococcal NP carriage studies. We now consider the role of these carriage studies, especially in the context of pneumococcal disease control. Significant attention is being directed to whether and how NP studies of pneumococcal

ecology in communities can be used to infer or predict disease impact. As the understanding of the quantitative relationship between colonization and disease matures, the role of NP colonization outcomes as a tool for evaluating the global rollout of PCV and other pneumococcal vaccines could become more central. The gold standard for such assessments has to date been population-based surveillance of Afatinib invasive

pneumococcal disease (IPD) as exemplified by the Active Bacterial Core Surveillance of the Centers for Disease control in the USA [132]. This requires a significant clinical and diagnostic microbiology infrastructure, not present in many developing countries. Further, the collection of IPD isolates requires a clinical environment in which the great majority of suspected cases of meningitis receive a lumbar puncture, and a sufficient number of blood cultures are taken to recognize an impact of PCV, given that blood culture will detect only 2–3% of pediatric those pneumonias prevented by PCV [133]. An alternate to IPD surveillance is syndromic surveillance for changes in pneumonia hospitalization or death following PCV introduction. These types of studies have relied on large networks of electronic surveillance [134] not available in developing countries, and can measure only the aggregate effect of a reduction in vaccine type disease and replacement. While such an approach based on just one or a few hospitals may be possible, this depends on the care-seeking behavior of those most at risk for serious morbidity and mortality [135]; in many settings those are the very children with least access to the health facility study sites.