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Pneumococcal disease in India: The dilemma continues

This issue carries a study by Ravi Kumar et al1 on the Streptococcus pneumoniae nasopharyngeal carriage in a convenience sample of 190 apparently healthy infants and children1. They have also described the antimicrobial sensitivity pattern of the isolated bacteria. There are some methodological limitations in their study (such as small sample size, unclear recruitment criteria, hospital-based enrolment, recruitment of children presenting for vaccination, incomplete description of serotypes searched for, unclear cut-off for penicillin susceptibility, etc.). There are also some flaws in analysis and interpretation. For example, the point-prevalence in the age group 3-12 months (21/96) has been interpreted as 49.2 per cent giving the erroneous impression that there is an inverse correlation between age and pneumococcal carriage. Despite these limitations, the study adds to the Indian literature already available on the subject2,3,4,5,6,7,8. Against this backdrop, what additional value does this study provide?