Background: Little is known about nasopharyngeal carriage and the patterns of antibiotic resistance of pneumococci
in Pacific nations. We set out to document pneumococcal nasopharyngeal carriage and associated risk factors,
antimicrobial resistance and serotypes in healthy children in Fiji.
Methods: A cross-sectional survey of healthy children aged 3–13 months was conducted. Nasopharyngeal (NP)
swabs were collected from each child and processed according to standard methods. Antimicrobial resistance was
determined by disk diffusion and confirmed by E-testing. Serotyping was performed by the Quellung reaction.
Results: Of 440 consecutive NP swabs taken, 195 were S. pneumoniae-positive (carriage rate 44.3%). Higher rates
were found in the indigenous Fijian population. Penicillin non-susceptibility was found in 11.4% of isolates, with
one isolate demonstrating high-level resistance. Cotrimoxazole resistance was common (20.3%) and no isolates
were chloramphenicol-resistant. Multi-drug resistance was uncommon. The commonest serotypes were 6A
(13.2%), 23F (8.3%), 19F (7.4%) and 6B (6.2%). Thirty per cent were included in the 7-valent pneumococcal
conjugate vaccine (PCV), 54.3% if cross-reacting strains were included. Being indigenous Fijian or having
symptoms of acute respiratory infection were independent risk factors for carriage.
Conclusions: Pneumococcal NP carriage is common in Fijian children. Penicillin resistance has been documented
for the first time in Fiji and, as a result, first-line treatment for meningitis has been altered. Being indigenous Fijian
is a risk factor for disease, although the reasons for this are unclear. A low proportion of carriage serotypes are
covered by the existing 7-valent PCV.