Distribution of serotypes, vaccine coverage, and antimicrobial susceptibility pattern of Streptococcus pneumoniae in children living in SAARC countries: a systematic review.

Nishant Jaiswal,Anil Chauhan,Meenu Singh,Ishita Jindal,Rashmi Ranjan Das,Kiran Kumar Thumburu,Amit Agarwal,Ajay Kumar,Eliane Namie Miyaji

doi:10.1371/journal.pone.0108617

Abstract

IntroductionEach SAARC nation falls in the zone of high incidence of pneumococcal disease but there is a paucity of literature estimating the burden of pneumococcal disease in this region.ObjectiveTo identify the prevalent serotypes causing invasive pneumococcal disease in children of SAARC countries, to determine the coverage of these serotypes by the available vaccines, and to determine the antibiotic resistance pattern of Streptococcus pneumoniae.MethodsWe searched major electronic databases using a comprehensive search strategy, and additionally searched the bibliography of the included studies and retrieved articles till July 2014. Both community and hospital based observational studies which included children aged ≤12 years as/or part of the studied population in SAARC countries were included.ResultsA total of 17 studies were included in the final analysis. The period of surveillance varied from 12–96 months (median, 24 months). The most common serotypes country-wise were as follows: serotype 1 in Nepal; serotype 14 in Bangladesh and India; serotype 19F in Sri Lanka and Pakistan. PCV-10 was found to be suitable for countries like India, Nepal, Bangladesh, and Sri Lanka, whereas PCV-13 may be more suitable for Pakistan. An increasing trend of non-susceptibility to antibiotics was noted for co-trimoxazole, erythromycin and chloramphenicol, whereas an increasing trend of susceptibility was noted for penicillin.ConclusionDue to paucity of recent data in majority of the SAARC countries, urgent large size prospective studies are needed to formulate recommendations for specific pneumococcal vaccine introduction and usage of antimicrobial agents in these regions.

Highlights

Each SAARC nation falls in the zone of high incidence of pneumococcal disease but there is a paucity of literature estimating the burden of pneumococcal disease in this region
For every 1 child that dies of pneumonia in a developed country, more than 2000 children die of pneumonia in developing countries [3]
The SAARC nations fall in the zone with high incidence of pneumococcal disease [1], but there is a dearth of studies reporting prevalent serotypes in these regions

Summary

Introduction

Each SAARC nation falls in the zone of high incidence of pneumococcal disease but there is a paucity of literature estimating the burden of pneumococcal disease in this region. The SAARC (The South Asian Association for Regional Cooperation) includes 8 countries: India, Pakistan, Bangladesh, Sri Lanka, Nepal, Bhutan, Maldives, and Afghanistan. The share of under-five deaths due to pneumonia in these regions is as follows: 20.4% in Afghanistan; 15% in India, 14.6% in Pakistan, 13.6% each in Nepal and Bhutan; 11% in Bangladesh, 8.8% in Maldives, and 5.7% in Sri Lanka [2,4]. The SAARC nations fall in the zone with high incidence of pneumococcal disease [1], but there is a dearth of studies reporting prevalent serotypes in these regions

Methods

Results

Discussion

Conclusion