Invasive pneumococcal disease associated with high case fatality in India

Area of Science:

• Infectious Diseases
• Epidemiology
• Microbiology

Background:

• Invasive pneumococcal disease (IPD) poses a significant public health challenge globally, particularly in developing countries.
• Streptococcus pneumoniae is a leading cause of bacterial pneumonia, meningitis, and sepsis, with a high mortality rate, especially in elderly populations.

Purpose of the Study:

• To investigate the seroepidemiology and antimicrobial resistance patterns of IPD in hospitalized adult patients in India.
• To assess the coverage of the 23-valent pneumococcal polysaccharide vaccine (23-valent PPSV) against prevalent serotypes in elderly IPD cases.

Main Methods:

• A prospective surveillance study was conducted in seven Indian academic teaching hospitals from 1993 to 2008.
• Patients over 18 years old with confirmed IPD (S. pneumoniae isolated from sterile body fluids or antigen-positive) were included.
• Serotype/group (STG) and antimicrobial susceptibility testing (AST) for key antibiotics were performed.

Main Results:

• Of 1,037 patients with suspected invasive bacterial infection, 449 (43.3%) had IPD. Meningitis and pneumonia were the most common clinical presentations.
• The overall case fatality rate was high (25-30%). Penicillin resistance was low (2.7%), but resistance to co-trimoxazole increased significantly over the study period (42.9% to 85.2%).
• Serotype 1 was the most common STG (22.9%). The 23-valent PPSV covered 83.3% of STGs causing IPD in patients over 60 years old.

Conclusions:

• IPD remains a critical issue in India, characterized by high case fatality despite hospital treatment.
• Low penicillin resistance is a positive finding, but increasing co-trimoxazole resistance is concerning.
• The 23-valent PPSV demonstrates good coverage for serotypes causing IPD in the elderly in India, suggesting its potential utility in this population.