Childhood pneumococcal disease in Africa – A systematic review and meta-analysis of incidence, serotype distribution, and antimicrobial susceptibility

Abstract

Background Determining the incidence, disease-associated serotypes and antimicrobial susceptibility of invasive pneumococcal disease (IPD) among children in Africa is essential in order to monitor the impact of these infections prior to widespread introduction of the pneumococcal conjugate vaccine (PCV). Methods To provide updated estimates of the incidence, serotype distribution, and antimicrobial susceptibility profile of Streptococcus pneumoniae causing disease in Africa, we performed a systematic review of articles published from 2000–2015 using Ovid Medline and Embase. We included prospective and surveillance studies that applied predefined diagnostic criteria. Meta-analysis for all pooled analyses was based on random-effects models. Results We included 38 studies consisting of 386,880 participants in 21 countries over a total of 350,613 person-years. The pooled incidence of IPD was 62.6 (95% CI 16.9, 226.5) per 100,000 person-years, including meningitis which had a pooled incidence of 24.7 (95% CI 11.9, 51.6) per 100,000 person-years. The pooled prevalence of penicillin susceptibility was 78.1% (95% CI 61.9, 89.2). Cumulatively, PCV10 and PCV13 included 66.9% (95% CI 55.9, 76.7) and 80.6% (95% CI 66.3, 90.5) of IPD serotypes, respectively. Conclusions Our study provides an integrated and robust summary of incidence data, serotype distribution and antimicrobial susceptibility for S. pneumoniae in children ≤5 years of age in Africa prior to widespread introduction of PCV on the continent. The heterogeneity of studies and wide range of incidence rates across the continent indicate that surveillance efforts should be intensified in all regions of Africa to improve the integrity of epidemiologic data, vaccine impact and cost benefit. Although the incidence of IPD in young children in Africa is substantial, currently available conjugate vaccines are estimated to cover the majority of invasive disease-causing pneumococcal serotypes. These data provide a reliable baseline from which to monitor the impact of the broad introduction of PCV.

Nasopharyngeal Pneumococcal Carriage in Nigeria: a two-site, population-based survey

“…Despite expanded testing for serogroup 6 serotypes, we did not find any pneumococci of serotype C. This is consistent with our earlier survey. Serotypes 1 and 5 are commonly isolated in disease in Africa 41 – 44 where they cause about 13% and 10% of meningitis and other IPD respectively 45 . However, we found carriage of these serotypes was very low in our study population similar to other reports 17 , 25 , 30 , 44 .…”

Detection of Streptococcus pneumoniae from culture-negative dried blood spots by real-time PCR in Nigerian children with acute febrile illness

“…Acute febrile illness is a common cause of hospital admission, and its associated infectious causes contribute to substantial morbidity and mortality worldwide. A key bacterial causative agent is Streptococcus pneumoniae , and in Africa rates of invasive pneumococcal disease (IPD) are estimated to be the highest of any continent, with recent pooled incidence rates of 62.6 per 100,000 person-years for children ≤ 5 years of age [ 1 ]. The lack of robust surveillance systems in low- and middle-income countries (LMICs) has made it challenging to diagnose the etiology of disease in acute febrile illness.…”

23-valent pneumococcal polysaccharide vaccine elicits hierarchical antibody and cellular responses in healthy and tuberculosis-cured elderly, and HIV-1-infected subjects

“…When the bacteria disseminate to other parts of the body, it can lead to severe health problems such pneumonia, bacteremia, and meningitis [3]. Populations at high risks for PD include elderly > 60 years old, people with chronic health conditions, and people whose immune systems are compromised [4,5]. Immunization with pneumococcal vaccine is the best way to prevent pneumococcal disease.…”