Staphylococcus aureus are common inhabitants of the upper respiratory tract in children and are responsible for common infections. Carriage of S aureus and S pneumoniae can result in bacterial spread and endogenous infections. [1][2][3] Streptococcus pneumoniae is carried in the nasopharynx by most children at least once during early childhood 1 but not frequently by adults. 4 Staphylococcus aureus is carried by 10% to 35% of children [5][6][7] and by approximately 35% of the general adult population. 3 Staphylococcus aureus is carried most consistently in the nares.Various studies have explored bacterial interference-the suppression of one species by another. [8][9][10][11] However, studies examining possible interference between S aureus and S pneumoniae are noticeably absent. An association between these 2 pathogens may suggest epidemiologic changes that could follow widespread vaccination with pneumococcal conjugate vaccines.We investigated the possible association between the 2 pathogens by studying their prevalence and risk factors for carriage in young children in a region where pneumococcal conjugate vaccination is not practiced. METHODSThe study was approved by the Sheba Medical Center Ethics Committee, Ramat-Gan, Israel. Informed consent was obtained from all parents. Study PopulationDuring February 2002, children aged 40 months or younger seen for any rea-son in 53 participating primary care pediatric clinics of a major health maintenance organization (Maccabi Healthcare Services, Tel-Aviv) were enrolled. The clinics were located in 4 large cities in the central district of Israel, inhabited by a middle-class Jew-

The rate of Streptococcus pneumoniae carriage among adults was compared with that among children (age, < or =6 years) in the same population. Nasopharyngeal culture results for 1300 adults and 404 children were analyzed. S. pneumoniae was carried by only 4% of the adults, compared with 53% of children in the same community. Young age, day care center attendance, having young siblings, and no antibiotic use during the month before screening were associated with the high carriage rate among children, whereas the only risk factor associated with carriage among adults was the presence of a respiratory infection on the screening day. S. pneumoniae serotype distribution and antibiotic resistance patterns differed between adults and children. Isolates of the same serotype--even of the same clone--differed in their antibiotic susceptibility patterns between children and adults. In a subanalysis of 151 pairs of children and their parents and of 32 pairs of siblings, intrafamilial transmission of S. pneumoniae could not be demonstrated.

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Diagnosis of celiac disease frequently depends upon serology assays. We set out to prospectively assess the diagnostic value of five serology tests: an enzyme-linked immunosorbent assay (ELISA) for tissue transglutaminase (tTG)-immunoglobulin A (IgA) and tTG-IgG, a chemiluminescence assay for tTG-IgA, an ELISA for deamidated gliadin peptide (DGP) IgG and IgA screening, and detection of endomysial antibodies (Abs) by indirect immunofluorescence. One hundred sixteen children at high risk for developing celiac disease were evaluated clinically and underwent small bowel biopsies and blood serology tests. We examined differences between younger and older children in terms of clinical presentation, test performance, and the ability of high Ab levels to correctly predict diagnosis of celiac disease. Celiac disease was diagnosed for 85 (73%) children. No significant clinical differences were observed between the biopsy-positive and biopsy-negative groups. Children <3 years of age revealed higher concentrations of tTG-IgA and DGP Abs than children >3 years old (P ‫؍‬ 0.017 and 0.007, respectively). High Ab concentrations were predictive of villous atrophies, with sensitivities ranging from 92.8% to 97.9%, depending on the assay and the cutoff points applied. Sensitivities, specificities, positive predictive values, and negative predictive values varied among assays and improved after correction for best cutoff points. Assay specificities obtained in the clinical setting were lower than expected. The new tTG-IgA chemiluminescence assay demonstrated high throughput but low specificity (74.2%). The tTG-IgA ELISA exhibited the highest test efficiency, and the tTG-IgA chemiluminescence assay was suitable for large-scale screening, with reduced specificity. High concentrations of celiac disease-specific Abs bring into question the need for performance of biopsies on children at high risk.