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The epidemiology of pneumococcal infection in children in the developing world
1Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, UK.
Insights
Streptococcus pneumoniae causes millions of childhood deaths globally, particularly in developing nations. New conjugate vaccines offer hope against this leading bacterial pathogen, but antibiotic resistance is a growing concern.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Pneumonia and meningitis caused by Streptococcus pneumoniae (pneumococcus) result in millions of child deaths annually, predominantly in developing countries.
- Invasive pneumococcal disease incidence is significantly higher in developing nations compared to industrialized ones, potentially due to socio-economic and genetic factors.
- Risk factors for invasive pneumococcal disease include sickle cell disease and human immunodeficiency virus (HIV) infection, with rising incidence expected due to perinatal HIV transmission.
Purpose of the Study:
- To highlight the significant global burden of Streptococcus pneumoniae infections in children.
- To discuss the challenges posed by increasing antibiotic resistance to pneumococcal infections.
- To introduce the development and potential impact of novel pneumococcal vaccines.
Main Methods:
- Literature review and analysis of epidemiological data on pneumococcal disease burden.
- Examination of factors contributing to disease incidence and severity.
- Assessment of current treatment challenges and the role of emerging vaccines.
Main Results:
- Streptococcus pneumoniae is a primary cause of childhood pneumonia and meningitis, with disproportionately high mortality in developing countries.
- Penicillin resistance in pneumococci is increasing, complicating treatment and increasing healthcare costs.
- Polysaccharide-protein conjugate vaccines show promise for preventing pneumococcal disease and are currently in field trials.
Conclusions:
- Urgent need for effective interventions against Streptococcus pneumoniae, especially in resource-limited settings.
- The rise of antibiotic resistance necessitates alternative prevention strategies like vaccination.
- Further research is needed to understand the impact of vaccines on disease dynamics and carriage.
Abstract:
Pneumonia causes about three million deaths a year in young children, nearly all of which are in developing countries. Streptococcus pneumoniae (the pneumococcus) is the most important bacterial cause of pneumonia in young children and so is likely to be responsible for a high proportion of these deaths. The pneumococcus is also responsible for a substantial proportion of the 100,000-500,000 deaths that occur from meningitis in children each year. The incidence of invasive pneumococcal disease in children in the developing world is several times higher than in industrialized countries. This discrepancy may, in part, be due to socio-economic differences but genetic factors may also play a role. Children with sickle cell disease have a substantially increased risk of invasive pneumococcal infection and a search is being made for other possible genetic risk factors. Infection with human immunodeficiency virus (HIV) also predisposes to invasive pneumococcal disease and so the incidence of this disease in young children is expected to rise as increasing numbers of African and Asian children are born with a perinatally acquired HIV infection. Until recently, pneumococcal infections could be treated effectively with penicillin, a cheap and safe antibiotic. However, pneumococci that are resistant to penicillin are becoming prevalent in many countries, necessitating a change to more costly antibiotics which may be beyond the reach of the health services of poor, developing countries. The spread of antibiotic resistance has provided an added stimulus to the development of vaccines that might be able to prevent pneumococcal disease in infants. Recently developed polysaccharide-protein conjugate vaccines show promise and are now undergoing field trials. How deployment of these vaccines will influence the balance between invasive pneumococcal infections and asymptomatic nasopharyngeal carriage of pneumococci is uncertain.