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Invasive pneumococcal disease in children aged younger than 5 years in India: a surveillance study
Anand Manoharan1, Vikas Manchanda2, Sundaram Balasubramanian3
1Pushpagiri Research Centre, Pushpagiri Institute of Medical Science and Research Centre, Tiruvalla, Kerala, India.
Insights
Invasive pneumococcal disease remains a significant threat to young children in India. This study highlights common serotypes and concerning antimicrobial resistance patterns, informing vaccine strategies.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Epidemiology
Background:
- Invasive pneumococcal disease (IPD) poses a substantial burden of illness and death in Indian children under five.
- Understanding the epidemiology of IPD, including serotype distribution and antimicrobial resistance, is crucial for public health interventions.
Purpose of the Study:
- To determine the national patterns of invasive Streptococcus pneumoniae disease in children younger than 5 years in India.
- To analyze trends in invasive pneumococcal serotypes and antimicrobial resistance patterns.
Main Methods:
- A prospective hospital-based and retrospective laboratory-based surveillance study was conducted across 11 Indian states.
- Children under 5 with suspected or confirmed IPD were enrolled, with blood and sterile body fluid cultures performed.
- Pneumococcal isolates were serotyped, and antimicrobial susceptibility testing was performed.
Main Results:
- Of 361 culture-proven IPD cases, pneumonia (58%) and meningitis (35%) were the most common presentations.
- Serotypes 14, 1, 5, and 19F were the most prevalent.
- High rates of resistance were observed for co-trimoxazole (66%) and erythromycin (37%), with multidrug resistance in 9% of isolates.
Conclusions:
- The study provides representative data on IPD epidemiology in India, identifying key serotypes and significant antimicrobial resistance.
- Continued surveillance is essential to guide the implementation of protein-conjugated vaccines.
Background:
Invasive pneumococcal disease continues to be a major cause of morbidity and mortality among children younger than 5 years of age in India. We aimed to provide nationally representative data for the pattern of disease due to Streptococcus pneumoniae, trends in the serotype of invasive pneumococci, and invasive pneumococci antimicrobial resistance patterns, in India.
Methods:
In this prospective hospital-based and retrospective laboratory-based surveillance study, we prospectively enrolled children aged younger than 5 years with suspected or proven invasive pneumococcal disease from 18 hospitals or institutional centres and retrospectively included laboratory-confirmed pneumococcal isolates from ten sentinel laboratories, together representing 11 states in India. Eligibility criteria were fever higher than 38°C without localising symptoms, clinical presentation of suspected meningitis or pneumonia, and evidence of radiographic pneumonia. We cultured blood and other normally sterile body fluids, reconfirmed and serotyped pneumococcal isolates, and established antimicrobial susceptibility using standard study protocols.
Findings:
Between Jan 1, 2011, and June 30, 2015, we enrolled 4377 patients. Among 361 (8%) patients with culture-proven pneumococcal disease, all clinical data were known for 226 (63%); among these patients, 132 (58%) presented with pneumonia, 78 (35%) presented with meningitis, and 16 (7%) had other clinical conditions. 131 (3%) died overall and 29 (8%) patients with invasive pneumococcal disease died. Serotypes 14 (52 [14%] of 361), 1 (49 [14%]), 5 (37 [10%]), and 19F (33 [9%]) were the most common. Penicillin non-susceptibility occurred in isolates from 29 (8%) patients, co-trimoxazole resistance occurred in 239 (66%), erythromycin resistance occurred in 132 (37%), and chloramphenicol resistance occurred in 33 (9%). We found multidrug resistance in 33 (9%) of 361 patients.
Interpretation:
The proportion of positive blood cultures, number of isolates, geographical representation, and data generated over the 4·5 years of the study are representative of data for most of India. Continued surveillance is warranted as the decision to introduce protein conjugated vaccine in India is made.
Funding:
GlaxoSmithKline India.
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