Epidemiology of invasive pneumococcal disease in Saudi Arabian children younger than 5 years of age

Abstract

This study evaluated the incidence, serotype distribution, and antimicrobial susceptibility of invasive pneumococcal disease (IPD) in Saudi Arabian children. This multicenter, prospective, clinical surveillance study included children under 5years of age, residents of one of the seven study health areas, who were brought to a study hospital with suspicion of IPD. Bacterial isolates from sterile site samples, collected less than 24h after hospital visit/admission, were identified, serotyped, and tested for antibiotic susceptibility. Between June 2007 and January 2009, 631 episodes of suspected IPD were recorded, and 623 were included in the analysis. One child (0.2%) had previously received one dose of a pneumococcal vaccine. Forty-seven episodes were positive for Streptococcus pneumoniae and three for Haemophilus influenzae. The incidence of confirmed IPD cases was estimated to be 2.5-21.6 per 100,000 children (<5years). Among the 46 S. pneumoniae isolates serotyped and tested for antibiotic susceptibility, the most common serotypes were 5 and 23F (20% each), 6B (17%), and 1 and 14 (11% each). Sixty-three percent of isolates were multidrug-resistant. Vaccination of Saudi Arabian children with expanded-coverage conjugate pneumococcal vaccines containing serotypes 1 and 5 could have a substantial impact to prevent IPD in this population.

Molecular mechanisms and epidemiology of resistance in Streptococcus pneumoniae in the Middle East region

“…In another study conducted between 2007 and 2009, 47 cases of S. pneumoniae infection were identified as having a high level of resistance to penicillin and cotrimoxazole and a moderate resistance rate to chloramphenicol. A high multidrug resistance rate was also documented, while vancomycin tolerance was not observed [100]. It is important to note that cotrimoxazole resistance in Saudi Arabia is the highest within the region, reaching up to 100 % in patients of all ages with invasive and non-invasive diseases [101,102].…”

“…In a recent retrospective study [104], S. pneumoniae was the fourth most common keratitis-causing bacteria. In contrast to previous studies, where pneumococcal strains were isolated from sterile body sites such as cerebrospinal fluid, blood and synovial fluid [99][100][101][102], this study only included corneal isolates, and of these the pneumococcal strains expressed lower resistance rates to penicillin and erythromycin, although no resistance to FQ or vancomycin was observed.…”

Complicated pneumococcal pneumonia with pleural effusion or empyema in the 13‐valent pneumococcal conjugate vaccine era

“…Streptococcus pneumoniae is the most common cause of community‐acquired pneumonia of bacterial etiology in children aged <5 years, excluding neonates, worldwide and is frequently associated with pleural effusion (PE) or empyema . After the introduction of the 7‐valent conjugate vaccine in Spain in 2001, there was a replacement in the prevalent serotypes, with serotypes 1, 3, and 19A emerging as the most frequent cause of empyema .…”

“…Specifically, serotype 1, ST306 became the most prevalent strain in cases of empyema of pneumococcal etiology . After the introduction of the 13‐valent vaccine, which added six serotypes (1, 3, 5, 7F, 6A, and 19A) to the PCV7 (4, 6B, 9V, 14, 18C, 19F, and 23F), to the systematic vaccination schedule of the community of Madrid (Spain) in 2010, a decrease in vaccine serotypes was observed, as in other parts of the world …”

Phenotypic and molecular study of pneumococci causing respiratory tract infections

“…A new conjugate vaccine, PCV15, is currently undergoing clinical evaluation 4. In Saudi Arabia, a new 13-valent vaccine (PCV13) was introduced in 2010; it covers the 13 types of pneumococci that most commonly cause pneumococcal infections, accounting for 91% of cases as reported by the Ministry of Health The incidence of invasive pneumococcal disease5 (IPD) in children <5 years, between 2007 and 2009, was estimated to be 2.5-21.6 per 100,000 6. Due to the high risk of IPD among children <5 years and seniors >50 years, the most recent Saudi guidelines recommend that all children receive 4 doses of PCV13, to be completed before the first year of age, and that seniors be vaccinated with PCV13, followed by PPSV23 one year later 7…”