Hypervirulent pneumococci display high levels of nasopharyngeal shedding and rapid onward transmission

Streptococcus pneumoniae serotype 1 is a major cause of invasive pneumococcal disease. Despite its high attack rate, serotype 1 exhibits a low carriage prevalence within the population, which raises important questions about the relationship between carriage and transmission of hypervirulent pneumococcal strains between individuals. We compared the transmission dynamics of serotype 1 sequence type ST217 to serotype 2 strain D39 using a novel model of transmission in young adult mice. Donor index mice were intranasally infected with ST217, D39 or isogenic pneumolysin-deficient mutants and co-housed with recipient naive contact mice. Three days later, all mice were infected with influenza A virus (IAV). Pneumococcal transmission was analysed during colonisation alone and co-infection with IAV by quantification of shedding and nasal colonisation in index and contact mice. The role of the toxin pneumolysin in shedding, transmission and colonisation, and the host nasopharyngeal immune response were investigated. We show that ST217 was shed in index mice at significantly greater levels compared to D39. Upon viral co-infection, ST217 was shed and transmitted at a faster rate to contact mice and displayed higher transmission levels compared to D39. Interestingly, the toxin pneumolysin did not play a role in shedding. However, upon acquisition by contact mice, pneumolysin-dependent macrophage recruitment was observed in the nasopharynx. Our results show that the rapid and high transmission rate of serotype 1 is a key factor in its ability to disseminate quickly within the population and cause disease outbreaks.