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Invasive pneumococcal disease in a pediatric population, Auckland, New Zealand
L Voss1, D Lennon, K Okesene-Gafa
1Department of Pediatrics, School of Medicine, Auckland, New Zealand.
Insights
Invasive pneumococcal disease is a significant childhood threat, particularly in infants. Local epidemiology is crucial for developing effective vaccines against penicillin-resistant Streptococcus pneumoniae strains.
Area of Science:
- Pediatric Infectious Diseases
- Vaccinology
- Epidemiology
Background:
- Streptococcus pneumoniae is a leading cause of invasive childhood infections.
- Rising penicillin resistance complicates treatment and highlights the need for vaccines.
- Current vaccines have limited efficacy in young children.
Purpose of the Study:
- To determine the epidemiology of invasive pneumococcal disease (IPD) in Auckland, New Zealand, from 1984 to 1992.
- To inform vaccine development and public health strategies for IPD prevention in pediatric populations.
Main Methods:
- Population-based retrospective study.
- Analysis of laboratory records and hospital discharge codes.
- Review of 413 isolates from 407 patients over a 9-year period.
Main Results:
- Overall IPD incidence was 22.0/100,000 for children <15 years, and 56.0/100,000 for children <5 years.
- Maori and Pacific Island children had higher IPD rates than Caucasian children.
- Serotypes 14, 6, and 19 were most common; the 23-valent vaccine covers most serotypes, but efficacy is limited in children under 2 years.
Conclusions:
- Invasive pneumococcal disease disproportionately affects young children, especially Maori and Pacific Islanders.
- Existing polysaccharide vaccines are less effective in infants due to poor immunogenicity.
- Conjugated pneumococcal vaccines are needed to address the burden of IPD in young children.
Abstract:
Streptococcus pneumoniae is one of the major invasive pathogens in childhood. The increasing worldwide prevalence of penicillin-resistant strains makes management of invasive infections difficult and underscores the need for effective vaccines. Currently available vaccines are of limited value in the pediatric age group. Trials are taking place to evaluate conjugated pneumococcal vaccines and in view of this it is important to establish local epidemiology of pneumococcal disease. The aims of this population-based study were to review all of the cases of invasive pneumococcal disease occurring during a 9-year period (1984 to 1992) in Auckland, New Zealand. Through the use of laboratory records and hospital discharge codes, 413 isolates from 407 patients were found. Age-specific incidence for all invasive disease was 22.0/100,000 for children less than 15 years old but 56.0/100,000 for children less than 5 years old (chi 2 Yates corrected 18.20; P = 0.001). Two-thirds were less than 2 years old. The rates were higher in Maori and Pacific Island children than in Caucasian children. A total of 70 isolates from 68 patients with meningitis occurred. The majority were less than 5 years old (incidence of meningitis was 10.0/100,000) and 84% were less than 2 years old. The overall mortality from meningitis was 4.3%. Of the 129 isolates serogrouped or serotyped, 14, 6 and 19 accounted for 23%, 16% and 16%, respectively, of cases. Although 98% of serotypes identified would be covered by the currently available 23-valent vaccine, two-thirds of the children affected by these isolates would be unprotected because of poor immunogenicity of polysaccharide vaccines in children less than 2 years old.