1477. Streptococcus pneumoniae Serotypes in Guatemalan Children:  Incidence, Severity and Distribution before Introduction of PCV-13 Vaccine
Session: Poster Abstract Session: Global Health
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • James Gaensbauer IDWeek Poster PDF.pdf (536.3 kB)
  • Background: Invasive pneumococcal disease (IPD) in children results in high rates of severe morbidity and mortality in the developing world.  We characterize the factors associated with IPD in Guatemala City, including bacterial serotype, to inform public health programs and predict the impact of the introduction of pneumococcal vaccination.

    Methods: Active surveillance cases of pediatric (<60 months) invasive bacterial infection presenting to the three major referral hospitals in Guatemala City was carried out over an 11 year period from 1996 to 2007.  Demographic, clinical, and laboratory data were collected.  Cases of IPD were defined as a discharge diagnosis of invasive infection (meningitis, sepsis, pneumonia, septic arthritis, facial or orbital cellulitis) associated with identification by culture or latex agglutination of Streptococcus pneumoniae from blood, cerebrospinal fluid or other sterile site.  Serotyping of  positive cultures was done by latex agglutination.

    Results: A total of 441 cases of IPD were identified.  Pneumonia was the most common diagnosis (42% of cases), followed by sepsis (27%) and meningitis (25%).  The overall case fatality rate (CFR) from IPD was 22%, with highest rates in infants less than 6 months (CFR 35%) and in cases of meningitis (CFR 39%).  Serotype was available for 145 positive samples.  Of these, 63% are serotypes present in the 10 valent pneumococcal vaccine in use in some Latin American countries, and 74% are included in the 13 valent pneumococcal conjugate vaccine, which was introduced in Guatemala in late 2012.  A notable exception was serotype 2, which was responsible for 15% of invasive IPD cases with serotype available.

    Conclusion: Implementation of universal PCV13 vaccination in Guatemala would be expected to result in a significant reduction in pediatric invasive pneumococcal disease.  However, non-vaccine serotypes, notably type 2, are likely to be a cause of persistent disease.

     

     Diagnosis

    Vaccine

    Meningitis

    (n=64)

    Sepsis

    (n=25)

    Pneumonia

    (n=55)

    Facial/Orbital Cellulitis

    (n=1)

    Total

    (n=145)

    PCV 13

    64%

    76%

    85%

    100%

    74%

    PCV10

    55%

    60%

    75%

    0

    63%

    Table.  Percent of pediatric invasive pneumococcal infections resulting from serotypes covered in 10 and 13-valent pneumococcal conjugate vaccines, by clinical syndrome.

    James Gaensbauer, MD, MScPH1, Edwin J Asturias, MD1,2, Monica Soto, MD3, Elizabeth Holt, DrPH MSPH4 and Neal Halsey, MD4, (1)Pediatrics, Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, (2)Center for Global Health, University of Colorado, School of Public Health, Aurora, CO, (3)Pathology, Hospital General San Juan De Dios, Guatemala City, Guatemala, (4)Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

    Disclosures:

    J. Gaensbauer, None

    E. J. Asturias, None

    M. Soto, None

    E. Holt, None

    N. Halsey, Pfizer: Scientific Advisor, Consulting fee

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