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Fletcher MA, Daigle D, Siapka M, Baay M, Hanquet G, del Carmen Morales G. Serotype distribution of invasive pneumococcal disease from countries of the WHO Africa, Americas, Eastern Mediterranean, South-East Asia, and Western Pacific regions: a systematic literature review from 2010 to 2021. Front Public Health 2024; 12:1402795. [PMID: 39050608 PMCID: PMC11266301 DOI: 10.3389/fpubh.2024.1402795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 06/20/2024] [Indexed: 07/27/2024] Open
Abstract
Background Most publications on invasive pneumococcal disease (IPD) serotype distribution are from about 20 countries (Australia, Canada, China, European Union members, Japan, New Zealand, South Korea, and USA). Here, we reviewed the literature among underrepresented countries in the Americas (AMRO), Africa (AFRO), Eastern Mediterranean (EMRO), South-East Asia (SEARO), and Western Pacific (WPRO) WHO regions. Methods We performed a systematic review of the most recent IPD serotype surveillance publications (from 01/01/2010 to 31/12/2021, Medline/Embase) in those WHO regions. Selection criteria were delineated by contemporality, within-country geographical scope, and number of samples. Reported serotype distributions for each country were stratified by age group, pneumococcal conjugate vaccine (PCV) serotype category (considering undifferentiated serotypes), and PCV program period (pre-PCV, intermediate, or PCVhv [higher valency PCV formulation]). Pre-PCV period pooled data estimated PCV serotype category distribution by age group across WHO regions, while for the PCVhv period, country-level dataset tables were prepared. Results Of 2,793 publications screened, 107 were included (58 pediatric, 11 adult, 37 all ages, and one comprising every age group). One-third of eligible countries (51/135) published serotype distribution, ranging from 30 to 43% by WHO region. Considering number of samples per WHO region, a few countries prevailed: AMRO (Brazil), AFRO (South Africa, Malawi, and Burkina Faso), and WPRO (Taiwan). In the pre-PCV period, PCV13 formulation serotypes predominated: ranging from 74 to 85% in children and 58-86% in adults in the different WHO regions. The PCVhv period represented half of the most recent IPD surveillance by countries (26/51). Undifferentiated serotypes represented >20% of IPD from most countries (34/51). Conclusion Ubiquity of undifferentiated serotypes among the publications could constrain estimates of PCV program impact and of serotype coverage for newer PCVhv formulations; consequently, we recommend that countries favor techniques that identify serotypes specifically and, rather than reporting PCV formulation serotype distributions, provide serotype results individually. Systematic review registration The protocol has been prospectively registered at PROSPERO, identifier: CRD42021278501. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=278501.
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Affiliation(s)
- Mark A. Fletcher
- Pfizer Vaccines Emerging Markets, Medical Affairs, Paris, France
| | - Derek Daigle
- Pfizer Vaccines Emerging Markets, Medical Affairs, New York, NY, United States
| | | | - Marc Baay
- P95 Epidemiology & Pharmacovigilance, Leuven, Belgium
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Bardach A, Ruvinsky S, Palermo MC, Alconada T, Sandoval MM, Brizuela ME, Wierzbicki ER, Cantos J, Gagetti P, Ciapponi A. Invasive pneumococcal disease in Latin America and the Caribbean: Serotype distribution, disease burden, and impact of vaccination. A systematic review and meta-analysis. PLoS One 2024; 19:e0304978. [PMID: 38935748 PMCID: PMC11210815 DOI: 10.1371/journal.pone.0304978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 04/09/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Invasive pneumococcal diseases (IPD) are associated with high morbidity, mortality, and health costs worldwide, particularly in Latin America and the Caribbean (LAC). Surveillance about the distribution of serotypes causing IPD and the impact of pneumococcal vaccination is an important epidemiological tool to monitor disease activity trends, inform public health decision-making, and implement relevant prevention and control measures. OBJECTIVES To estimate the serotype distribution for IPD and the related disease burden in LAC before, during, and after implementing the pneumococcal vaccine immunization program in LAC. METHODS Systematic literature review following Cochrane methods of studies from LAC. We evaluated the impact of the pneumococcal vaccine on hospitalization and death during or after hospitalizations due to pneumococcal disease and serotype-specific disease over time. We also analyzed the incidence of serotyped IPD in pneumococcal conjugate vaccine PCV10 and PCV13. The protocol was registered in PROSPERO (ID: CRD42023392097). RESULTS 155 epidemiological studies were screened and provided epidemiological data on IPD. Meta-analysis of invasive diseases in children <5 years old found that 57%-65% of causative serotypes were included in PCV10 and 66%-84% in PCV13. After PCV introduction, vaccine serotypes declined in IPD, and the emergence of non-vaccine serotypes varied by country. CONCLUSIONS Pneumococcal conjugate vaccines significantly reduced IPD and shifted serotype distribution in Latin America and the Caribbean. PCV10/PCV13 covered 57-84% of serotypes in children under 5, with marked decline in PCV serotypes post-vaccination. Continuous surveillance remains crucial for monitoring evolving serotypes and informing public health action.
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Affiliation(s)
- Ariel Bardach
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
- Centro de Investigaciones Epidemiológicas y Salud Pública (CIESP-IECS), CONICET, Buenos Aires, Argentina
| | - Silvina Ruvinsky
- Departamento de Investigación, Hospital Garrahan, Buenos Aires, Argentina
- Departamento de Evaluación de Tecnologías Sanitarias y Economía de la Salud, Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - M. Carolina Palermo
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Tomás Alconada
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - M. Macarena Sandoval
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Martín E. Brizuela
- Unidad de Pediatría, Hospital General de Agudos Vélez Sarsfield, Buenos Aires, Argentina
| | | | - Joaquín Cantos
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Paula Gagetti
- Servicio Antimicrobianos, Instituto Nacional de Enfermedades Infecciosas (INEI)-ANLIS ‘‘Dr. Carlos G. Malbrán”, Buenos Aires, Argentina
| | - Agustín Ciapponi
- Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
- Centro de Investigaciones Epidemiológicas y Salud Pública (CIESP-IECS), CONICET, Buenos Aires, Argentina
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Agudelo CI, Castañeda-Orjuela C, Brandileone MCDC, Echániz-Aviles G, Almeida SCG, Carnalla-Barajas MN, Regueira M, Fossati S, Alarcón P, Araya P, Duarte C, Sánchez J, Novas M, Toraño-Peraza G, Rodríguez-Ortega M, Chamorro-Cortesi G, Kawabata A, García-Gabarrot G, Camou T, Spadola E, Payares D, Andrade AL, Di Fabio JL, Castañeda E. The direct effect of pneumococcal conjugate vaccines on invasive pneumococcal disease in children in the Latin American and Caribbean region (SIREVA 2006-17): a multicentre, retrospective observational study. THE LANCET. INFECTIOUS DISEASES 2020; 21:405-417. [PMID: 32986996 DOI: 10.1016/s1473-3099(20)30489-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 04/02/2020] [Accepted: 04/24/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Streptococcus pneumoniae isolated from patients with invasive pneumococcal disease has been subjected to laboratory-based surveillance in Latin American and Caribbean countries since 1993. Invasive pneumococcal diseases remain a major cause of death and disability worldwide, particularly in children. We therefore aimed to assess the direct effect of pneumococcal conjugate vaccines (PCVs) on the distribution of pneumococcal serotypes causing invasive pneumococcal disease in children younger than 5 years before and after PCV introduction. METHODS We did a multicentre, retrospective observational study in eight countries that had introduced PCV (ie, PCV countries) in the Latin American and Caribbean region: Argentina, Brazil, Chile, Colombia, Dominican Republic, Mexico, Paraguay, and Uruguay. Cuba and Venezuela were also included as non-PCV countries. Isolate data for Streptococcus pneumoniae were obtained between 2006 and 2017 from children younger than 5 years with an invasive pneumococcal disease from local laboratories or hospitals. Species' confirmation and capsular serotyping were done by the respective national reference laboratories. Databases from the Sistema Regional de Vacunas (SIREVA) participating countries were managed and cleaned in a unified database using Microsoft Excel 2016 and the program R (version 3.6.1). Analysis involved percentage change in vaccine serotypes between pre-PCV and post-PCV periods and the annual reporting rate of invasive pneumococcal diseases per 100 000 children younger than 5 years, which was used as a population reference to calculate percentage vaccine type reduction. FINDINGS Between 2006 and 2017, 12 269 isolates of invasive pneumococcal disease were collected from children younger than 5 years in the ten Latin American and Caribbean countries. The ten serotypes included in ten-valent pneumococcal conjugate vaccine (PCV10) decreased significantly (p<0·0001) after any PCV introduction, except for the Dominican Republic. The percentage change for the ten vaccine serotypes in PCV10 countries was -91·6% in Brazil (530 [72·9%] of 727 before, 27 [6·1%] of 441 after); -85·0% in Chile (613 [72·6%] of 844 before, 44 [10·9%] of 404] after); -84·7% in Colombia (231 [63·1%] of 366 before, 34 [9·7%] of 352 after); and -73·8% in Paraguay (127 [77·0%] of 165 before, 22 [20·2%] of 109 after). In the 13-valent pneumococcal conjugate vaccine (PCV13) countries, the percentage change for the 13 vaccine serotypes was -59·6% in Argentina (853 [85·0%] of 1003 before, 149 [34·3%] of 434 after); -16·5% in the Dominican Republic (95 [80·5%] of 118 before, 39 [67·2%] of 58 after); -43·7% in Mexico (202 [73·2%] of 276 before, 63 [41·2%] of 153 after); and -45·9% in Uruguay (138 [80·7%] of 171 before, 38 [43·7%] of 87 after). Annual reporting rates showed a reduction from -82·5% (6·21 before vs 1·09 after per 100 000, 95% CI -61·6 to -92·0) to -94·7% (1·15 vs 0·06 per 100 000, -89·7 to -97·3) for PCV10 countries, and -58·8% (2·98 vs 1·23 per 100 000, -21·4 to -78·4) to -82·9% (7·80 vs 1·33 per 100 000, -76·9 to -87·4) for PCV13 countries. An increase in the amount of non-vaccine types was observed in the eight countries after PCV introduction together with an increase in their percentage in relation to total invasive strains in the post-PCV period. INTERPRETATION SIREVA laboratory surveillance was able to confirm the effect of PCV vaccine on serotypes causing invasive pneumococcal disease in the eight PCV countries. Improved monitoring of the effect and trends in vaccine type as well as in non-vaccine type isolates is needed, as this information will be relevant for future decisions associated with new PCVs. FUNDING None. TRANSLATIONS For the Portuguese and Spanish translations of the abstract see Supplementary Materials section.
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Affiliation(s)
| | | | | | - Gabriela Echániz-Aviles
- Centro de Investigaciones Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | | | - María Noemí Carnalla-Barajas
- Centro de Investigaciones Sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - Mabel Regueira
- Departamento Bacteriología, INEI-ANLIS Dr Carlos G Malbrán, Buenos Aires, Argentina
| | - Sofia Fossati
- Departamento Bacteriología, INEI-ANLIS Dr Carlos G Malbrán, Buenos Aires, Argentina
| | - Pedro Alarcón
- Sección Bacteriología, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Pamela Araya
- Sección Bacteriología, Instituto de Salud Pública de Chile, Santiago, Chile
| | - Carolina Duarte
- Grupo de Microbiología, Instituto Nacional de Salud, Bogotá, Colombia
| | - Jacqueline Sánchez
- Laboratorio de Microbiología-DEI, Hospital Infantil Dr Robert Reid Cabral, Santo Domingo, Dominican Republic
| | - Mirna Novas
- Laboratorio de Microbiología-DEI, Hospital Infantil Dr Robert Reid Cabral, Santo Domingo, Dominican Republic
| | - Gilda Toraño-Peraza
- Departamento de Bacteriología y Micología, Instituto Pedro Kouri, La Habana, Cuba
| | | | - Gustavo Chamorro-Cortesi
- Departamento de Bacteriología y Micología, Laboratorio Central de Salud Pública, Asunción, Paraguay
| | - Anibal Kawabata
- Departamento de Bacteriología y Micología, Laboratorio Central de Salud Pública, Asunción, Paraguay
| | | | - Teresa Camou
- Departamento de Laboratorios, Ministerio de Salud, Montevideo, Uruguay
| | - Enza Spadola
- Sección de Aislamiento e Identificación Bacteriana, Instituto Nacional de Higiene Rafael Rangel, Caracas, Venezuela
| | - Daisy Payares
- Sección de Aislamiento e Identificación Bacteriana, Instituto Nacional de Higiene Rafael Rangel, Caracas, Venezuela
| | - Ana Lucía Andrade
- Instituto de Patología Tropical e Saúde Pública, Universidade Federal de Goias, Goiania, Goias, Brazil
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Di Fabio JL, Agudelo CI, Castañeda E. [Regional System for Vaccines (SIREVA), laboratory surveillance and vaccine development for Streptococcus pneumoniae: bibliometric analysis, 1993-2019]. Rev Panam Salud Publica 2020; 44:e80. [PMID: 32774349 PMCID: PMC7406127 DOI: 10.26633/rpsp.2020.80] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/14/2020] [Indexed: 01/30/2023] Open
Abstract
Objetivo. Medir a través del análisis bibliométrico la productividad, la visibilidad y el impacto del Sistema Regional de Vacunas (SIREVA, un proyecto de la Organización Panamericana de la Salud) en sus dos componentes, la vigilancia por laboratorio y el desarrollo de vacunas. Métodos. Se recuperaron de Scopus las publicaciones correspondientes a vigilancia por laboratorio y desarrollo de vacunas con sus referencias y citas y se aplicó la herramienta para obtener los indicadores bibliométricos. Se utilizó VOSviewer® 1.6.13 para visualizar las redes de coautoría por país y autores, y para realizar un análisis de coocurrencia de términos incluidos en los títulos y resúmenes de las publicaciones. Resultados. Cumplieron los criterios establecidos para vigilancia por laboratorio y desarrollo de vacunas 173 y 128 publicaciones, respectivamente. Diez países de la Región fueron responsables de 90,8% de las publicaciones sobre vigilancia por laboratorio y 8 países de todas las publicaciones sobre desarrollo de vacunas. Las diez publicaciones más citadas sobre vigilancia por laboratorio y sobre desarrollo de vacunas estaban incluidas en 855 y 503 artículos, respectivamente; los principales autores se encontraban en Alemania, Australia, Bélgica, Brasil, China, Estados Unidos de América y el Reino Unido. La construcción y visualización de redes por coautorías de autores y países, y la coocurrencia de términos mostraron el trabajo en red y la colaboración intrarregional, así como permitieron hacer seguimiento a las diversas áreas de estudio y su evolución en el tiempo. Conclusiones. El análisis bibliométrico permitió documentar de manera objetiva la productividad y visibilidad del Sistema Regional de Vacunas para Streptococcus pneumoniae en la Región.
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Affiliation(s)
- José Luis Di Fabio
- Consultor independiente Washington D.C. Estados Unidos de América Consultor independiente, Washington D.C., Estados Unidos de América
| | - Clara Inés Agudelo
- Instituto Nacional de Salud Bogotá Colombia Instituto Nacional de Salud, Bogotá, Colombia
| | - Elizabeth Castañeda
- Instituto Nacional de Salud Bogotá Colombia Instituto Nacional de Salud, Bogotá, Colombia
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Agudelo CI, DeAntonio R, Castañeda E. Streptococcus pneumoniae serotype 19A in Latin America and the Caribbean 2010–2015: A systematic review and a time series analysis. Vaccine 2018; 36:4861-4874. [DOI: 10.1016/j.vaccine.2018.06.068] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/28/2018] [Accepted: 06/29/2018] [Indexed: 10/28/2022]
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Carnalla-Barajas MN, Soto-Noguerón A, Sánchez-Alemán MA, Solórzano-Santos F, Velazquez-Meza ME, Echániz-Aviles G. Changing trends in serotypes of S. pneumoniae isolates causing invasive and non-invasive diseases in unvaccinated population in Mexico (2000-2014). Int J Infect Dis 2017; 58:1-7. [PMID: 28216181 DOI: 10.1016/j.ijid.2017.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 02/02/2017] [Accepted: 02/07/2017] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE Introduction of pneumococcal conjugate vaccines (PCV) targeted against a limited number of serotypes substantially decreased invasive (IPD) and non-invasive pneumococcal diseases (NIPD) but it was accompanied by non-vaccine type replacement disease. After 9 years of introduction of PCV in Mexico, we analyze the evidence of the indirect effects on IPD and NIPD serotype distribution among groups not targeted to receive the vaccine. METHODS From January 2000 to December 2014, pneumococcal strains isolated from IPD and NIPD cases from patients ≥5 years of age from participant hospitals of the SIREVA II (Sistema Regional de Vacunas) network were serotyped. A regression analysis was performed considering year and proportion of serotypes included in the different vaccine formulations (PCV7, PCV10 and PCV13). The slope was obtained for each regression line and their correspondent p-value. The proportion of each serotype in the pre-PCV7 and post-PCV7 periods was evaluated by χ2 test. RESULTS From a total of 1147 pneumococcal strains recovered, 570 corresponded to the pre-PCV7 and 577 to the post-PCV7 periods. The proportion of vaccine serotypes included in the three PCV formulations decreased by 2.4, 2.6 and 1.3%, respectively per year during the study period. A significant increase of serotype 19A was observed in the post-vaccine period in all age groups. CONCLUSIONS A percentage of annual decline of serotypes causing IPD and NIPD included in PCV was detected among groups not targeted to receive the vaccine, probably due to herd effect. Considering pneumococcal serotype distribution is a dynamic process, we highlight the importance of surveillance programs.
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Affiliation(s)
| | - Araceli Soto-Noguerón
- Instituto Nacional de Salud Pública, Av. Universidad 655, Cuernavaca, Morelos 62100, Mexico
| | | | - Fortino Solórzano-Santos
- Unidad Médica de Alta Especialidad, Hospital de Pediatría Centro Médico Nacional SXXI, Instituto Mexicano del Seguro Social, Av. Cuauhtemoc 330, Col. Doctores, CP 06720 Mexico City
| | | | - Gabriela Echániz-Aviles
- Instituto Nacional de Salud Pública, Av. Universidad 655, Cuernavaca, Morelos 62100, Mexico.
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Cui YA, Patel H, O'Neil WM, Li S, Saddier P. Pneumococcal serotype distribution: A snapshot of recent data in pediatric and adult populations around the world. Hum Vaccin Immunother 2017; 13:1-13. [PMID: 28125317 DOI: 10.1080/21645515.2016.1277300] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
S. pneumoniae infection remains a serious public health concern despite the availability of vaccines covering up to 23 of more than 94 known serotypes. The purpose of the present study was to monitor recent serotype distribution data. PubMed, EMBASE, Cochrane Reviews and Ingenta databases were searched. Serotype data covering invasive pneumococcal disease (IPD) and non-IPD were extracted from articles published from March 2014 to March 2015. Fifty-nine studies presented pneumococcal serotype prevalence by specific age categories. Most prevalent serotypes not covered by pneumococcal conjugate vaccines (PCV) were as follows: 15B, 22F, 15A, 23A among children under the age of 7 y with IPD; among adults with IPD: 22F, 11A, 10A, 38 in the 65 y and older age group; 12F, 9N, 8 in the 50-64 year-old age group and 12F, 8, 6C, 16F in the 15-59 age group. Geographic variations in serotype distribution highlight the importance of monitoring evolving pneumococcal serotype prevalence after pneumococcal vaccine implementation.
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Affiliation(s)
| | | | | | - Se Li
- a Merck & Co Inc. , Kenilworth , NJ , USA
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Soto-Noguerón A, Carnalla-Barajas MN, Solórzano-Santos F, Arrendondo-García JL, Arzate-Barbosa P, Tinoco-Favila JC, Anzurez-Gutiérrez A, Echániz-Aviles G. Streptococcus pneumoniae as cause of infection in infants less than 60 days of age: serotypes and antimicrobial susceptibility. Int J Infect Dis 2015; 42:69-73. [PMID: 26673859 DOI: 10.1016/j.ijid.2015.12.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 11/26/2015] [Accepted: 12/02/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of this study was to determine the distribution of serotypes and the antimicrobial susceptibilities of Streptococcus pneumoniae clinical isolates causing invasive and non-invasive disease in children aged ≤60 days in hospitals in Mexico. METHODS A 15-year retrospective study was conducted for the period 2000 to 2014. Pneumococcal clinical isolates were serotyped by Quellung reaction, and antimicrobial susceptibility testing was performed with the broth microdilution method. RESULTS A total of 126 pneumococcal isolates were collected. Pneumonia was the most frequent diagnosis (40.5%), followed by meningitis (29.4%), septicemia (16.7%), and other clinical entities, including otitis media and conjunctivitis (13.5%). The most frequent serotypes before the introduction of heptavalent pneumococcal conjugate vaccine (PCV7) were 19F, 23F, 7F, and 35B. Serotypes 3, 6A, 10A, 12F, and 15A/B increased after the introduction of PCV7. Serotype 19A was isolated most frequently in the pneumonia and meningitis cases only after the introduction of PCV7, and it displayed a high resistance to penicillin. CONCLUSIONS Although the number of infections in infants aged ≤60 days was low, such infections were not unusual events. New vaccination strategies should be evaluated to limit the risks in this age group.
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Affiliation(s)
- Araceli Soto-Noguerón
- Instituto Nacional de Salud Pública, Avenida Universidad 655, Cuernavaca, Morelos 62100, Mexico
| | | | - Fortino Solórzano-Santos
- Unidad Médica de Alta Especialidad, Hospital de Pediatría Centro Médico Nacional SXXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | | | | | | | | | - Gabriela Echániz-Aviles
- Instituto Nacional de Salud Pública, Avenida Universidad 655, Cuernavaca, Morelos 62100, Mexico.
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Pneumococcal vaccination and Streptococcus pneumoniae serotypes. Arch Med Res 2015; 46:514. [PMID: 26135633 DOI: 10.1016/j.arcmed.2015.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 06/24/2015] [Indexed: 11/22/2022]
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