Twenty year surveillance of invasive pneumococcal disease in Nottingham: serogroups responsible and implications for immunisation

Abstract

Aims: To evaluate the incidence, spectrum of clinical manifestations, and outcome of invasive pneumococcal disease (IPD) in children. To determine the major serogroups of Streptococcus pneumoniae responsible for invasive disease and the potential coverage by the new pneumococcal conjugate vaccines. Methods: Analysis of prospectively recorded information of all children admitted to two teaching hospitals in Nottingham with IPD between January 1980 and December 1999. Results: A total of 266 episodes of IPD in children were identified; 103 (39%) were aged ,1 year and 160 (60%) ,2 years. Major clinical presentations were meningitis in 86 (32%), pneumonia in 82 (31%), and bacteraemia without an obvious focus in 80 (30%). The age specific mean annual incidence rates of IPD overall among children aged ,1, ,2, and ,5 years were 47.1, 37.8, and 20 per 100 000 population, respectively. Mortality rates for children with meningitis and non-meningitic infection were 20% and 7%, respectively. Neurological sequelae following meningitis were documented in 16 (26%) of the 61 survivors assessed. The potential coverage rates in children between the ages of 6 months and 5 years are 84% by the 7-valent, 91% by the 9-valent, and 95% by the 11-valent conjugate vaccines. Conclusion: This study indicates that inclusion of a pneumococcal conjugate vaccine in the primary immunisation programme in the UK would have a considerable effect on the mortality and morbidity associated with IPD.

Implications of Streptococcus pneumoniae Penicillin Resistance and Serotype Distribution in Kuwait for Disease Treatment and Prevention

“…In a study by Fouda et al (11) from Saudi Arabia, a similar coverage rate of 55.5% was reported for the 7-valent conjugate vaccine against invasive infections. However, other studies (16,18,24,26,27) have reported variable coverage rates, ranging from low (26%) to high (95%), for invasive pneumococcal isolates.…”

Ten-year surveillance of invasive Streptococcus pneumoniae isolates in central Turkey prior to the introduction of a conjugate vaccine

“…Serotypes causing invasive diseases differ from country to country; therefore, it is of utmost importance to identify the most common serotypes causing invasive diseases and to determine which of these are resistant to antimicrobial agents. Serogroup coverage rate for the 7-valent conjugate vaccine for children has been reported as 78% in the United States of America [9], 75.3% in Greece [10], 71% in England [11], 56% in Gambia [12], and 48.4% in Scotland [13]. Serotypes 1 and 5, which are not found in the 7-valent conjugate vaccine, have been reported to be common serotypes, especially in developing countries.…”

Identification of Invasive Serotype 1 Pneumococcal Isolates That Express Nonhemolytic Pneumolysin

“…The hemolytic property of pneumolysin has also been shown to be involved in the initial stages of pneumonia, including invasion of the lung tissue and neutrophil recruitment; however, hemolytic activity is not important in facilitating pneumococcal growth in the alveoli (62,63). As serotype 1 disease is associated with pneumonia rather than meningitis in Europe and the United States (26,30) (Table 1), it may be that hemolytically active pneumolysin is not essential for the pathogenesis of certain serotype 1 sequence types, such as ST306. This may mean that there will be less selective pressure to conserve the nucleotide sequences that encode the hemolytic activity of pneumolysin and may allow the mutations we have identified to arise.…”