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Epidemiology of pneumococcal infections in Swedish children
M Eriksson1, B Henriques, K Ekdahl
1Department of Infectious Diseases, Astrid Lindgren Children's Hospital, Stockholm, Sweden.
Insights
Pneumococcal infections in Swedish children are rare, but penicillin-resistant strains and serotype 7 are concerning. Current vaccines may not cover prevalent resistant strains, highlighting a need for updated vaccination strategies.
Area of Science:
- Pediatric Infectious Diseases
- Bacteriology
- Vaccinology
Background:
- Pneumococcal infections pose a significant health risk to children globally.
- Understanding the epidemiology of pneumococcal infections, including serotype distribution and antimicrobial resistance, is crucial for effective prevention and treatment strategies.
Purpose of the Study:
- To provide an overview of pneumococcal infections in Swedish children.
- To analyze the prevalence of invasive pneumococcal isolates and penicillin-resistant strains.
- To assess the disease burden of pneumococcal meningitis and its impact on children.
Main Methods:
- Utilized data from the Swedish Institute for Infectious Disease Control (SMI) for invasive pneumococcal isolates and penicillin susceptibility.
- Estimated disease burden using data from northern Stockholm and Malmöhus County.
- Conducted a 10-year review of meningitis cases in Northern Stockholm.
Main Results:
- Invasive pneumococcal isolates from children (0-15 years) accounted for only 3-6% of total isolates.
- Predominant serotypes were 7, 6, 14, and 23. Penicillin-resistant strains (MIC > or = 0.5 mg/l) were found in 3% of children, with higher prevalence in Southern Sweden.
- Meningitis incidence in Northern Stockholm was 10/100,000 (0-2 years) and 5.8/100,000 (0-5 years), with 20% experiencing severe sequelae.
Conclusions:
- Serotype 7, prevalent in invasive isolates, is not covered by current protein-conjugated vaccines under development.
- A heptavalent vaccine could cover 83% of resistant isolates in Southern Sweden.
- Findings underscore the need for vaccine strategies that address prevalent and resistant pneumococcal serotypes in children.
Objective:
This paper provides an overview of pneumococcal infections in Swedish children.
Method:
Data supplied by the Swedish Institute for Infectious Disease Control (SMI) provided information on invasive pneumococcal isolates and on isolates with reduced susceptibility to penicillin. Disease burden was estimated from data collected in northern Stockholm and Malmöhus County.
Results:
Only 3-6% of the total number of invasive pneumococcal isolates came from children 0-15 years of age. Predominant serotypes in descending frequency were 7, 6, 14, and 23. Strains from all sources with reduced sensitivity to penicillin (MIC > or = 0.5 mg/l) were found in 3% of children and varied between 0.2% and 11%, with the highest value found in Southern Sweden (predominating strains were 9, 19, 15, 6, and 23). A 10-year review of all cases of meningitis in Northern Stockholm reflected an incidence of 10/100,000 (0-2 years) or 5.8/100,000 (0-5 years), with severe sequelae occurring in 20% of children. This information can be used to predict an annual incidence of 30 cases of meningitis in Sweden.
Conclusion:
The large proportion of serotype 7 among invasive isolates is distressing since this serotype is not represented in the present 7- and 9-valent protein-conjugated vaccines under development. However, the heptavalent vaccine, including serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F would (at a serotype level) provide coverage against 83% of the resistant isolates in Southern Sweden.