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Childhood Invasive Bacterial Disease in Kathmandu, Nepal (2005-2013)
Michael J Carter1,2,3, Meeru Gurung2, Bhishma Pokhrel2
1From the Department of Women and Children's Health, School of Life Course Sciences, King's College London, United Kingdom.
Insights
Invasive bacterial disease in children is a major health issue in low-income countries. This study found Salmonella Typhi and Streptococcus pneumoniae were common pathogens, with most pneumococcal serotypes covered by vaccines.
Area of Science:
- Pediatric infectious diseases
- Microbiology
- Vaccinology
Background:
- Invasive bacterial disease (IBD), including pneumonia, meningitis, and sepsis, significantly contributes to child morbidity and mortality in low-income nations.
- Understanding the epidemiology of IBD is crucial for developing effective prevention and control strategies, particularly in regions with limited healthcare resources.
Purpose of the Study:
- To analyze the serotype distribution of invasive pneumococcal disease (IPD) in children before the introduction of pneumococcal conjugate vaccines (PCV) in Kathmandu, Nepal.
- To evaluate the effectiveness of enhanced surveillance methods, including antigen and PCR testing, for identifying IBD pathogens in cerebrospinal fluid (CSF).
Main Methods:
- Data from a surveillance study of suspected community-acquired IBD in children under 15 years in Kathmandu, Nepal (2005-2013) were analyzed.
- Cerebrospinal fluid (CSF) and blood samples were cultured, and antigen and PCR testing were incorporated for enhanced pathogen detection.
- Serotype-specific distribution of invasive pneumococcal disease (IPD) was detailed.
Main Results:
- Salmonella enterica serovar Typhi (28%) and Streptococcus pneumoniae (16%) were the most prevalent pathogens isolated from blood or CSF cultures.
- The majority of identified pneumococcal serotypes were covered by 10-valent and 13-valent PCVs (73% and 78%, respectively).
- Combined antigen and PCR testing of CSF increased the identification of key pathogens (pneumococci, Haemophilus influenzae type b, meningococci) from 33 to 68 cases.
Conclusions:
- Salmonella Typhi and Streptococcus pneumoniae were the primary bacterial pathogens causing invasive disease in children in this study cohort.
- The findings indicate that current pneumococcal conjugate vaccines likely cover a significant proportion of circulating pneumococcal serotypes.
- Enhanced diagnostic methods, such as antigen and PCR testing of CSF, significantly improve the sensitivity for detecting IBD pathogens.
Background:
Invasive bacterial disease (IBD; including pneumonia, meningitis, sepsis) is a major cause of morbidity and mortality in children in low-income countries.
Methods:
We analyzed data from a surveillance study of suspected community-acquired IBD in children <15 years of age in Kathmandu, Nepal, from 2005 to 2013 before introduction of pneumococcal conjugate vaccines (PCV). We detailed the serotype-specific distribution of invasive pneumococcal disease (IPD) and incorporated antigen and PCR testing of cerebrospinal fluid (CSF) from children with meningitis.
Results:
Enhanced surveillance of IBD was undertaken during 2005-2006 and 2010-2013. During enhanced surveillance, a total of 7956 children were recruited of whom 7754 had blood or CSF culture results available for analysis, and 342 (4%) had a pathogen isolated. From 2007 to 2009, all 376 positive culture results were available, with 259 pathogens isolated (and 117 contaminants). Salmonella enterica serovar Typhi was the most prevalent pathogen isolated (167 cases, 28% of pathogens), followed by Streptococcus pneumoniae (98 cases, 16% pathogens). Approximately, 73% and 78% of pneumococcal serotypes were contained in 10-valent and 13-valent PCV, respectively. Most cases of invasive pneumococcal disease (IPD) were among children ≥5 years of age from 2008 onward. Antigen and PCR testing of CSF for pneumococci, Haemophilus influenzae type b and meningococci increased the number of these pathogens identified from 33 (culture) to 68 (culture/antigen/PCR testing).
Conclusions:
S. enterica serovar Typhi and S. pneumoniae accounted for 44% of pathogens isolated. Most pneumococcal isolates were of serotypes contained in PCVs. Antigen and PCR testing of CSF improves sensitivity for IBD pathogens.
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