AUTHOR=Miellet Willem R. , Almeida Sónia T. , Trzciński Krzysztof , Sá-Leão Raquel 

TITLE=Streptococcus pneumoniae carriage studies in adults: Importance, challenges, and key issues to consider when using quantitative PCR-based approaches

JOURNAL=Frontiers in Microbiology

VOLUME=14

YEAR=2023

URL=https://www.frontiersin.org/journals/microbiology/articles/10.3389/fmicb.2023.1122276

DOI=10.3389/fmicb.2023.1122276

ISSN=1664-302X

ABSTRACT=<p><italic>Streptococcus pneumoniae</italic> causes significant morbidity and mortality among older adults. Detection of pneumococcal carriage is an accepted endpoint in pneumococcal conjugate vaccine studies. However, low sensitivity of culture-based approaches and nasopharyngeal samples have hampered adult <italic>S. pneumoniae</italic> carriage studies in the past. In contrast, detection of adult <italic>S. pneumoniae</italic> carriers with qPCR-based approaches can achieve high sensitivity and specificity and qPCR-based testing of oral samples improves accuracy of adult carriage detection. In this Viewpoint we outline a strategy for accurate qPCR-based testing. We recommend a dual-target approach for <italic>S. pneumoniae</italic> qPCR detection as no genetic target is universally present among or solely unique to it. Furthermore, we advise the evaluation of concordance among quantified qPCR targets to improve the accuracy of <italic>S. pneumoniae</italic> testing and qPCR-based serotyping. We do not recommend omission of qPCR-based oral sample testing as it will likely result in an underestimation of true adult carrier rates.</p>