Thesis for scientific degree of candidate of medical sciences in specialty 14.01.10 - pediatrics. - National Medical University after O. O. Bogomolets, Kiev, 2016. Dissertation is devoted to improving the prevention and treatment of diseases caused by S. pneumonia by examining the prevalence of carriage, and medical and social factors contributing to it, serotype distribution and stability of pneumococci to antimicrobial agents. The theoretical summarization and new solution of scientific and practical problems of pneumococcal disease in children under 5 years old are reported in the dissertation; the procedure for immunization with current pneumococcal vaccines and specific advice on the choice of starting empiric antibiotic therapy was founded and developed. In a prospective observational multicenter (12 centers) study the prevalence of nasopharyngeal carriage S. pneumoniae in a large cohort of children (n = 900) aged between 6 months to 5 years by the classical bacteriological method of polymerase chain reaction in real time was determined, and it was 50,4 % (95 % CI: 47,4-53,4). The value of social activity of children and their siblings, as well as other medical and social factors in the formation of pneumococcal nasopharyngeal colonization and the development of diseases associated with them (community-acquired pneumonia and acute otitis media) were found out. Thus, the carrier frequency of the "home" children was the lowest (37,3 %), and it increased from 60,9 % of children attending pre-school education to 95,6 % of institutionalized children with an increasing in the duration of social contacts. For the first time the distribution of serotypes of S. pneumoniae with nasopharyngeal carriage of healthy children aged between 6 months and 5 years using multiplex PCR has been studied in Ukraine. Among isolated pneumococcal 88,9 % were capsular, and the 14 different serotypes were identified (3, 4, 5, 6A, 6B, 6C, 7F, 9V, 14, 18C, 19A, 19F, 20, 23F), with a predominance of 19F (26,1 %), 6A / B (18,2 %), 14 (11,4 %) and 23F (5,7 %). The serotypes distribution depends essentially on the social activity and the age of child. The vaccinal serotypes consist 65,53 % of capsular pneumococci. There is serotype 19A (which has a high potential for development of antibiotic resistance) occurs in Ukraine, even before the introduction of pneumococcal conjugate vaccine in National Immunization Program. Pneumococci, isolated from the nasopharynx, characterized by increased resistance to antimicrobial agents. The resistance was extensive to ciprofloxacin, co-trimoxazole, erythromycin, and azithromycin, amoxicillin / clavulanate (from 100 % to 32,7 %, respectively), less - to penicillin, cefuroxime, levofloxacin, chloramphenicol and vancomycin (from 20 % to 67 %, respectively), and the lowest - to cefotaxime, ceftriaxone, and meropenem (from 2,2 % to 0,6 %, respectively). About one-third (33,8 %) of the isolates were multiresistant. The results can serve as a bench mark for further epidemiological studies in other regions of Ukraine and for assessment of the effectiveness of mass immunoprophylaxis of pneumococcal disease after it implementation.
