Invasive pneumococcal disease in Jamaican children

Morbidity, mortality and antimicrobial resistance of pneumococcal infections in the Jamaican paediatric and adult populations

BACKGROUND

Pneumococcal infections are a leading global cause of morbidity and mortality, complicated by the increasing antimicrobial resistance of pneumococcal isolates.

OBJECTIVE

To evaluate morbidity and mortality associated with both invasive pneumococcal disease (IPD) and non-IPD in Jamaica in both the paediatric and adult population. Pneumococcal isolates (n= 94) were collected over a 2-year period (2008-2009).

METHODS

Risk factors for poor clinical outcomes: death, complicated disease and length of hospitalization (LOH) were evaluated and antimicrobial resistance patterns were determined by Kirby-Bauer disc diffusion.

RESULTS

The case fatality rate was 6.8%. Independent mortality risk factors included complicated disease [OR 30.9 (3.4-276.6)] and diabetes mellitus [OR 8.3 (1.4-48.8)]. Independent risk factors for the development of complicated disease included sickle cell disease [OR 36.5 (4.2-320.3)] and sepsis [OR 3.5 (1.2-10.4)]. The LOH was increased most in patients with invasive disease (4.6-fold) and resistance to ceftriaxone (4.3-fold). Penicillin (16.0%) and erythromycin (14.9%) resistance was most prevalent, while ceftriaxone (4.3%) resistance was least prevalent.

CONCLUSIONS

The high burden of IPD in at-risk groups in our population and the associated increase in morbidity and mortality underlie the need for improved preventive and therapeutic management strategies in these patients.

Pneumococcal disease burden, clinical presentations and vaccine coverage in the Jamaican population

BACKGROUND

Pneumococcal serotypes circulating in any population vary over time and between countries and impacts the effectiveness of pneumococcal vaccination.

OBJECTIVE

This study investigated the epidemiology of pneumococcal disease in Jamaica.

METHODS

Streptococcus pneumoniae isolates (n= 349) along with demographic and clinical information were collected from patients presenting at the 4 major hospitals in Jamaica over a 2-year period. Serotyping was done using latex agglutination tests and the Quellung reaction assay.

RESULTS

Invasive pneumococcal disease (IPD) incidence was 45.4/100,000 in children under 5 yrs and 16.3/100,000 in adults over 65 yrs. Thirteen serogroups were identified among the 120 isolates subjected to grouping; the most common being serogroups: 19 (22/120,18.3%), 6 (20/120,16.7%), 14 (20/120,16.7%), 23 (18/120,15.0%), 3 (11/120,9.2%) and nontypeable (8/120,2.3%). The estimated vaccine coverage rates for the PCV7 and PCV13 vaccines in children less than 5 yrs were 82.5% and 88.7% respectively. The 23-valent PPV23 provided 100% coverage rate in adults over 65 yrs and 82.9% coverage rate for the entire population.

CONCLUSIONS

Pneumococcal vaccine coverage rates in Jamaica are comparable to those reported in certain developed countries and higher than in other developing countries. The high incidence of IPD in the paediatric population indicates that routine vaccination would be beneficial.

Pneumococcal infection among hospitalized Egyptian children

AIM

We aimed to describe the detection rate spectrum of clinical manifestations, and outcome of pneumococcal disease in children younger than 5 years admitted to the largest referral pediatric hospital in Egypt.

MATERIALS AND METHODS

This was a hospital-based study to detect laboratory-confirmed Streptococcus pneumoniae cases among children younger than 5 years. Data on demographic characteristics, clinical diagnosis, comorbidities, diagnostic tests, antibiotic resistance, and clinical outcome were collected during the study years from 2008 to 2011.

RESULTS

During the 4-year study period, 22 018 cases younger than 5 years had cultures performed at Cairo University Pediatric Hospital microbiology laboratory. We estimated the annual detection rate of total Streptococcus pneumonia infection to be 54.5/100 000. The incidence of invasive pneumococcal disease (IPD) was half the incidence of non-IPD (18.2 and 36.4/100 000, respectively). Infants of 1 year or younger were statistically more vulnerable to Streptococcus pneumonia infection compared with children between 1 and 5 years of age (annual rate: 110.5/100 000 and 21.6/100 000, respectively). The overall pneumococcal annual case fatality was 33.3% and was higher in IPD (75%) than in non-IPD (12.5%) cases. There was an obviously increasing trend of the pneumococcal detection rate throughout the 4 years of the study (P<0.0001).

CONCLUSION AND RECOMMENDATIONS

Our results confirm the substantial and increasing pneumococcal infection, the emerging of multidrug resistant isolates, and the vulnerability of the younger age group and high-risk population, which calls for a national surveillance to inform policy and decision-making before national wide vaccine introduction.

Epidemiology of pediatric pneumococcal meningitis and bacteremia in Latin America and the Caribbean: a systematic review and meta-analysis

BACKGROUND

Pneumococcal meningitis and bacteremia pose a significant disease burden in Latin America and the Caribbean (LAC).

METHODS

To perform a systematic review of studies of pediatric pneumococcal meningitis and non-pneumonia, non-meningitis pneumococcal bacteremia in LAC, we conducted an exhaustive search from 2000 to 2010 in electronic databases and grey literature. Pairs of independently selected reviewers assessed the quality and extracted the studies' data. A STROBE-based checklist was used to assess the risk of bias in observational studies. Meta-analyses were performed.

RESULTS

Of 1218 retrieved studies, 39 were included. In children <5 years, the pooled 95% confidence interval (CI) percentage of pneumococcal etiology out of cases studied with cerebrospinal fluid/blood cultures was 6.0% (95% CI: 3.3-9.5) for meningitis and 8.0% (95% CI: 5.3-12.4) for bacteremia. The incidences per 100,000 children were 4.7 (95% CI: 3.2-6.1) and 3.9 (95% CI: 2.0-5.9) for pneumococcal meningitis and non-pneumonia, non-meningitis bacteremia, respectively. The mortality was 8.3 (95% CI: 0.0-21.0) and 0.5 (95% CI: 0.3.0-0.6)/100,000 for meningitis and sepsis, respectively. The case fatality ratio was 33.2% (95% CI: 21.3-46.2) for meningitis and 29.0% (95% CI: 21.9-36.8) for sepsis. The pooled serotype distribution from SIREVA surveillance data showed that 14, 5, 6B (for meningitis) and 14, 6B, 19F (for bacteremia) were the most frequent serotypes, all included in licensed vaccines.

CONCLUSION

Pneumococcal meningitis and bacteremia are important causes of morbidity and mortality in LAC children <5 years of age. This systematic review provided evidence about the burden of pneumococcal disease and the serotype distribution to assess the impact the pneumococcal vaccines and to assist decision makers in the region.

Streptococcus pneumoniae serotype 19A in Latin America and the Caribbean: a systematic review and meta-analysis, 1990-2010

BACKGROUND

Pneumococcal conjugate vaccines (PCVs) are in the process of implementation in Latin America. Experience in developed countries has shown that they reduce the incidence of invasive and non-invasive disease. However, there is evidence that the introduction of PCVs in universal mass vaccination programs, combined with inappropriate and extensive use of antibiotics, could be associated to changes in non-PCV serotypes, including serotype 19A. We conducted a systematic review to determine the distribution of serotype 19A, burden of pneumococcal disease and antibiotic resistance in the region.

METHODS

We performed a systematic review of serotype 19A data from observational and randomized clinical studies in the region, conducted between 1990 and 2010, for children under 6 years. Pooled prevalence estimates from surveillance activities with confidence intervals were calculated.

RESULTS

We included 100 studies in 22 countries and extracted data from 63. These data reported 19733 serotyped invasive pneumococcal isolates, 3.8% of which were serotype 19A. Serotype 19A isolates were responsible for 2.4% acute otitis media episodes, and accounted for 4.1% and 4.4% of 4,380 nasopharyngeal isolates from healthy children and in hospital-based/sick children, respectively. This serotype was stable over the twenty years of surveillance in the region. A total of 53.7% Spn19A isolates from meningitis cases and only 14% from non meningitis were resistant to penicillin.

CONCLUSIONS

Before widespread PCV implementation in this region, serotype 19A was responsible for a relatively small number of pneumococcal disease cases. With increased use of PCVs and a greater number of serotypes included, monitoring S. pneumoniae serotype distribution will be essential for understanding the epidemiology of pneumococcal disease.

Epidemiology of invasive pneumococcal infection in children aged five years and under in Saudi Arabia: a five-year retrospective surveillance study

BACKGROUND

The epidemiology of invasive pneumococcal disease (IPD) in children aged <or=5 years in Saudi Arabia has not been described. We conducted a retrospective surveillance study to describe the epidemiology of IPD in the population of children aged <or=5 years served by the National Guard Health Affairs hospitals in central and western regions of Saudi Arabia.

METHODS

We reviewed the medical records of children <or=5 years old admitted to the King Abdulaziz Medical City hospitals in Riyadh and Jeddah with pneumococcal infections for the period January 1999 through December 2003. Only microbiologically confirmed IPD cases (meningitis or bacteremia) were included in the analysis.

RESULTS

A total of 82 IPD cases, 19 (23.2%) meningitis and 63 (76.8%) bacteremia, were diagnosed during the five-year period. Of these, 12.2% (10/82) died, with a case-fatality slightly but insignificantly higher in cases of meningitis (15.8%) than bacteremia (11.1%). The average annual IPD incidence was 17.4 per 100,000 (4.0 for meningitis and 13.4 for bacteremia). The incidence was roughly similar in males and females (18.3 and 16.6, respectively; p=0.663) and was almost 4-fold higher in the first year of life compared to the next four years (40.6 and 11.5, respectively; p<0.001). The average annual IPD mortality was 2.1 per 100,000 and was higher in the first year of life compared to the next four years (5.2 and 1.3 , respectively; p=0.043).

CONCLUSIONS

In the pre-vaccination era (1999-2003) in Saudi Arabia, IPD incidence was comparable to the pre-vaccination incidence rates from many industrialized countries, with children aged <or=1 year suffering the highest IPD risk among those aged <or=5 years.

The evidence for using conjugate vaccines to protect HIV-infected children against pneumococcal disease

Pneumococcal conjugate vaccines (PCVs) are a potentially useful complement to existing treatment strategies in HIV-infected children, for whom pneumococcal infections are common and serious. This Review summarises available data on the burden of pneumococcal disease and the safety and efficacy of PCVs in HIV-infected children. The data demonstrate that children with HIV have significantly increased risk of pneumococcal disease compared with uninfected children; the serotypes included in currently licensed or near-licensure conjugate vaccines include most serotypes that cause invasive pneumococcal disease (IPD) in HIV-infected children and adults; PCVs provide substantial protection against IPD and clinical pneumonia when given to HIV-infected infants; and HIV-infected adults gain an indirect benefit when children in the community are vaccinated. PCV should be considered as an important intervention for improving the lives of HIV-infected children.