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Pneumococcal serotypes associated with invasive disease in under five children in India & implications for vaccine
V Balaji1, Ranjith Jayaraman, Valsan Philip Verghese
1Department of Microbiology, Christian Medical College & Hospital, Vellore, India.
Insights
Streptococcus pneumoniae infections are common in Indian children under five. Pneumococcal conjugate vaccines PCV-10 and PCV-13 offer significant protection against prevalent serotypes, with PCV-13 providing broader coverage.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Vaccinology
Background:
- Streptococcus pneumoniae poses a significant threat, causing substantial morbidity and mortality in children under five, particularly in India.
- Understanding serotype distribution and antibiotic resistance is crucial for effective disease management and prevention strategies.
Purpose of the Study:
- To analyze the serotype distribution of Streptococcus pneumoniae causing invasive infections in children under five.
- To determine the antibiotic resistance profile of these S. pneumoniae isolates.
- To evaluate the potential coverage of available pneumococcal vaccines.
Main Methods:
- Inclusion of children under five with suspected invasive pneumococcal disease.
- Isolation and identification of S. pneumoniae from sterile body fluids using standard microbiological tests.
- Serotyping via co-agglutination and multiplex PCR; antibiotic susceptibility testing.
Main Results:
- Serotypes 14, 19F, 5, 6A, and 6B were most prevalent in invasive infections.
- High non-susceptibility rates were observed for co-trimoxazole (96.4%), erythromycin (30%), and penicillin (5.2%).
- Low non-susceptibility to cefotaxime (0.8%) indicates retained efficacy of this antibiotic.
Conclusions:
- Pneumococcal conjugate vaccine 10 (PCV-10) could cover 64% of identified serotypes.
- Pneumococcal conjugate vaccine 13 (PCV-13) offers enhanced protection, covering up to 74.6% of serotypes.
- Integration of PCV-13 into the Universal Immunization Programme could improve protection against invasive pneumococcal disease in Southern India.
Background & Objectives:
Streptococcus pneumoniae is a major cause of morbidity and mortality especially in children less than five years, particularly in India. We present data on S.pneumoniae infections in children less than five years age group, with response to its serotype distribution, antibiotic resistance profile and available vaccines expected coverage.
Methods:
Children aged less than five, who were suspected for invasive pneumococcal disease were included in the study and their sterile body fluids were investigated for the presence of S. pneumoniae. Invasive S. pneumoniae isolates from sterile body fluids were identified by bile solubility and optochin susceptibility test. Pneumococcal serotyping was performed with co-agglutination technique and reconfirmed with multiplex PCR.
Results:
The most common pneumococcal serotypes causing invasive infections in children less than five years of age were 14, 19F, 5, 6A and 6B. Of the 114 S. pneumoniae isolates studied, 110 (96.4%) were non-susceptible to co-trimoxazole and 30 per cent were non-susceptible to erythromycin, 5.2 per cent of the isolates were non-susceptible to penicillin and only 0.8 per cent was non-susceptible to cefotaxime.
Interpretation & Conclusions:
Our results indicate that PCV-10 can protect against 64 per cent of serotypes causing invasive pneumococcal infections. Use of PCV-13 in this region can provide increase in protection upto 74.6 per cent against serotypes causing invasive pneumococcal infections. Incorporating PCV-13 in the Universal Immunization Programme may provide incremental protection against IPD serotypes in the southern region of the country.
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