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Pediatric Invasive Pneumococcal Disease in Guatemala City: Importance of Serotype 2
James T Gaensbauer1, Edwin J Asturias, Monica Soto
1From the *Division of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; †Center for Global Health, Colorado School of Public Health, Aurora, Colorado; ‡Department of Pediatrics, Denver Health Hospital Authority, Denver, Colorado; §Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; ¶Department of Pediatrics, University Francisco Marroquin, Guatemala City, Guatemala; and ‖Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Insights
Invasive pneumococcal disease (IPD) surveillance in Guatemala revealed that Streptococcus pneumoniae serotype 2, not included in current vaccines, was a significant cause of infant illness and death. PCV13 introduction may have limited impact due to this serotype prevalence.
Area of Science:
- Pediatrics
- Infectious Diseases
- Vaccinology
Background:
- Pneumococcal conjugate vaccines (PCV) aim to reduce invasive pneumococcal disease (IPD).
- Understanding pre-vaccine IPD epidemiology is crucial for assessing vaccine impact.
- This study presents 11 years of pre-PCV IPD surveillance data in Guatemalan children.
Purpose of the Study:
- To characterize the epidemiology of invasive pneumococcal disease (IPD) in children younger than 5 years in Guatemala City before the introduction of pneumococcal conjugate vaccine (PCV).
- To identify common Streptococcus pneumoniae serotypes causing IPD and their associated clinical outcomes.
- To inform estimations of the potential impact of PCV introduction in the region.
Main Methods:
- Active surveillance for IPD cases in children under 5 years at three referral hospitals in Guatemala City (1996-2007).
- Collection of clinical and demographic data.
- Serotyping of Streptococcus pneumoniae isolates from sterile sites using latex agglutination and Quellung reaction.
Main Results:
- 452 IPD cases were identified with a 21% case fatality rate.
- Meningitis was the most frequent cause of death (77%), particularly in infants (median age 5 months).
- Serotypes 1, 2, and 5 were most common. Serotype 2 was associated with higher fatality (28%), meningitis (68%), and younger infant age (median 3.5 months).
Conclusions:
- Infants are particularly vulnerable to severe IPD at a young age.
- Serotype 2, a significant cause of IPD in this population, is not included in current PCVs.
- The introduction of PCV13 in Guatemala may have a reduced impact on disease reduction compared to other regions due to the prevalence of non-vaccine serotypes like serotype 2.
Introduction:
To inform estimations of the potential impact of recently introduced pneumococcal conjugate vaccine (PCV), we report results of 11 years of pre-PCV surveillance for invasive pneumococcal disease (IPD) among children in Guatemala City.
Methods:
Cases of IPD in children younger than 5 years were identified by active surveillance at 3 referral hospitals in Guatemala City from October 1996 through 2007. Clinical and demographic data were obtained, and isolates of Streptococcus pneumoniae from normally sterile sites were serotyped using latex agglutination and confirmed by Quellung reaction.
Results:
Four hundred fifty-two cases of IPD were identified with a case fatality rate of 21%. Meningitis was the most common cause of death (77% of all deaths) and occurred more often in infancy (median age 5 months) than other clinical syndromes. Of the 137 isolates serotyped, type 1 (26 cases, 17%), type 2 (25 cases, 16%) and type 5 (18 cases, 12%) were the most common. Serotype 2 was associated with a higher case fatality rate (28%), higher rate of meningitis (68%) and occurred in younger infants (median age, 3.5 months) than other common serotypes. Recently introduced PCV13 includes 73% of observed serotypes in the study.
Conclusion:
Infants with IPD presented at a young age. Serotype 2, rarely reported as a significant cause of IPD and not included in available PCVs, was a common cause of disease in this population. PCV13 introduction in Guatemala, begun in 2013, may not have as great an impact in disease reduction as has been observed in other countries.
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