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Koenraads M, Swarthout TD, Bar-Zeev N, Brown C, Msefula J, Denis B, Dube Q, Gordon SB, Heyderman RS, Gladstone MJ, French N. Changing Incidence of Invasive Pneumococcal Disease in Infants Less Than 90 Days of Age Before and After Introduction of the 13-Valent Pneumococcal Conjugate Vaccine in Blantyre, Malawi: A 14-Year Hospital Based Surveillance Study. Pediatr Infect Dis J 2022; 41:764-768. [PMID: 35703302 PMCID: PMC9359774 DOI: 10.1097/inf.0000000000003606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/06/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Invasive pneumococcal disease (IPD) in young infants is uncommon but associated with high morbidity and mortality. Accurate data on the burden of IPD in young infants in low-income countries are lacking. We examined the burden of IPD in infants <90 days old in Blantyre, Malawi over a 14-year period and evaluated the indirect impact of the 13-valent pneumococcal conjugate vaccine (PCV13) on vaccine-serotype IPD (VT-IPD) in this population. METHODS We conducted laboratory-based prospective IPD surveillance in infants <90 days of age admitted to Queen Elizabeth Central Hospital in Blantyre between 2005 and 2018, including 7 years pre-PCV13 and 7 years post-PCV13 introduction. IPD was defined as Streptococcus pneumoniae identified by culture from blood or cerebrospinal fluid. Serotypes were determined by multiplex polymerase chain reaction and latex agglutination testing. RESULTS We identified 130 cases of culture-confirmed IPD in infants <90 days old between 2005 and 2018. Total IPD incidence was declining before PCV13 introduction. The mean incidence of IPD was significantly lower in the post-PCV13 era. Serotypes 5 (27.8%) and 1 (15.6%) were most prevalent. Even after PCV13 introduction, VTs remained the primary cause of IPD, with serotype 5 accounting for 17.4% and serotype 1 for 13.0% of cases in young infants. CONCLUSION Vaccine serotypes 1 and 5 were the main cause of IPD in neonates and young infants, both before and after PCV13 introduction. This suggests incomplete indirect protection with persisting VT carriage across the population despite vaccination in this setting. Alternative vaccine schedules and other vaccine introduction approaches need to be considered to protect this vulnerable population.
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Affiliation(s)
- Marianne Koenraads
- From the Department of Women and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Todd D. Swarthout
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
- NIHR Global Health Research Unit on Mucosal Pathogens, Research Department of Infection, Division of Infection and Immunity, University College London, London, United Kingdom
| | - Naor Bar-Zeev
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection Veterinary and Ecological Science, University of Liverpool, Liverpool, United Kingdom
- International Vaccine Access Center, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Comfort Brown
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Jacquline Msefula
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Brigitte Denis
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Queen Dube
- Department of Paediatrics, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Stephen B. Gordon
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Robert S. Heyderman
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
- NIHR Global Health Research Unit on Mucosal Pathogens, Research Department of Infection, Division of Infection and Immunity, University College London, London, United Kingdom
| | - Melissa J. Gladstone
- From the Department of Women and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Neil French
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection Veterinary and Ecological Science, University of Liverpool, Liverpool, United Kingdom
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Aldana-Valenzuela C, Rodriguez-López AM, Blancas EG. Fulminant early-onset neonatal sepsis due to Streptococcus pneumoniae: Case report and review of the literature. Pediatr Rep 2019; 11:7953. [PMID: 31001404 PMCID: PMC6452222 DOI: 10.4081/pr.2019.7953] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 03/06/2019] [Indexed: 11/22/2022] Open
Abstract
Streptococcus pneumoniae is a rare cause of neonatal sepsis, and it is associated with significant morbidity and a very high fatality rate. The infection is usually acquired intrapartum, from the colonization of the maternal genital tract. Most affected neonates have an early-onset presentation of symptoms, usually within the first 48 hours after birth, which is similar to other causes of neonatal sepsis such as Streptococcus Agalactiae or Escherichia Coli. However, the virulence seems to be higher for Streptococcus pneumoniae, which has in addition a higher infant invasion/ maternal colonization ratio than Streptococcus Agalactiae. Pneumococcal vaccination has not resulted in a significant decline of neonatal cases. Many cases included ours, involved serotypes not present in the vaccine. Other strategies to protect these infants are necessary. We describe a late preterm infant with a fatal, early-onset sepsis caused by Streptococcus Pneumoniae serotype 28 A. Maternal vaginal culture grew the same bacteria.
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Aguirre-Quiñonero A, Muro FC, Torrecilla B, Blasco A. Early-Onset Neonatal Pneumococcal Sepsis and Meningitis. J Clin Neonatol 2019. [DOI: 10.4103/jcn.jcn_43_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Piastra M, Tempera A, Luca E, Buffone E, Cafforio C, Briganti V, Genovese O, Marano M, Rigante D. Kidney injury owing to Streptococcus pneumoniae infection in critically ill infants and children: report of four cases. Paediatr Int Child Health 2016; 36:282-287. [PMID: 26365297 DOI: 10.1179/2046905515y.0000000055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Streptococcus pneumoniae sepsis has high morbidity, particularly if complicated by renal injury. Four patients with S. pneumonia invasive infections complicated by renal disorders are presented. The first case was an 18-month-old girl with pneumococcal empyema complicated by haemolytic uraemic (HUS) syndrome. She made a full recovery after mechanical ventilation, inotropic support and haemodiafiltration. The second was a 4-year-old boy who presented with acute post-infectious glomerulonephritis associated with bilateral pneumococcal pneumonia. He too made a complete recovery. The third was a newborn girl with pneumococcal meningitis complicated by acute respiratory distress syndrome and acute renal failure. The fourth patient was an 8-month-old boy with pneumococcal pneumonia and meningitis complicated by HUS and with fulminant thrombotic thrombocytopenic purpura. Despite full support including mechanical ventilation and haemodiafiltration, he died 4 days after admission. On follow-up, all three survivors recovered completely from their pulmonary symptoms and had normal renal function and cardio-circulatory status in the mid-term.
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Affiliation(s)
- M Piastra
- a PICU, Emergency Department and Institute of Anaesthesia/Intensive CareM , Catholic University Medical School UCSC , Rome ; Neonatal ICU
| | - A Tempera
- b S. Camillo-Forlanini Hospital Rome ; Department of Paediatrics , Catholic University Medical School , Rome
| | - E Luca
- a PICU, Emergency Department and Institute of Anaesthesia/Intensive CareM , Catholic University Medical School UCSC , Rome ; Neonatal ICU
| | - E Buffone
- b S. Camillo-Forlanini Hospital Rome ; Department of Paediatrics , Catholic University Medical School , Rome
| | - C Cafforio
- b S. Camillo-Forlanini Hospital Rome ; Department of Paediatrics , Catholic University Medical School , Rome
| | - V Briganti
- b S. Camillo-Forlanini Hospital Rome ; Department of Paediatrics , Catholic University Medical School , Rome
| | - O Genovese
- a PICU, Emergency Department and Institute of Anaesthesia/Intensive CareM , Catholic University Medical School UCSC , Rome ; Neonatal ICU
| | - M Marano
- d Infectious Diseases Unit and ICU Bambino Gesù Paediatric Hospital , Rome , Italy
| | - D Rigante
- c Department of Paediatric Sciences , Catholic University Medical School , Rome
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Abstract
BACKGROUND Streptococcus pneumoniae (SP) is an uncommon cause of neonatal sepsis. AIMS To report on the spectrum of morbidity associated with SP infections in the neonatal period. METHODS A case series of SP infection in the neonatal period was studied. Maternal and neonatal outcomes were noted. RESULTS Four cases of neonatal SP infection are reported, one of which was due to a strain with reduced susceptibility to penicillin. All four cases had very early onset of severe clinical disease with bacteremia and pneumonia. In one case a retrospective diagnosis of meningitis was made as well. Maternal illness was a feature in one of these infants. CONCLUSIONS Although less common now than in the pre-antibiotic era, Streptococcus pneumoniae remains a rare but important cause of neonatal sepsis and can mimic early onset Group B streptococcal sepsis. It is unclear whether current infant or adult pneumococcal immunisation programs might influence its incidence in the neonatal period. The potential for strains with reduced susceptibility to β-lactam antibiotics to cause neonatal infection needs to be considered in relevant settings.
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Affiliation(s)
- Atul Malhotra
- Monash Newborn, Royal Children's Hospital, Melbourne, Victoria, Australia.
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Abstract
Neonatal septic shock is a devastating condition associated with high morbidity and mortality. Definitions for the sepsis continuum and treatment algorithms specific for premature neonates are needed to improve studies of septic shock and assess benefit from clinical interventions. Unique features of the immature immune system and pathophysiologic responses to sepsis, particularly those of extremely preterm infants, necessitate that clinical trials consider them as a separate group. Keen clinical suspicion and knowledge of risk factors will help to identify those neonates at greatest risk for development of septic shock. Genomic and proteomic approaches, particularly those that use very small sample volumes, will increase our understanding of the pathophysiology and direct the development of novel agents for prevention and treatment of severe sepsis and shock in the neonate. Although at present antimicrobial therapy and supportive care remain the foundation of treatment, in the future immunomodulatory agents are likely to improve outcomes for this vulnerable population.
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