Five year burden of Streptococcus pneumoniae infection in under-five children: Observations from Meningitis Surveillance Network, India

Abstract

Background: Streptococcus pneumoniae is an important cause for pneumonia, meningitis, bacteremia and sepsis among under-five children. Hospital Based Sentinel Surveillance for Bacterial Meningitis Network was established in India to generate baseline data on epidemiology of S. pneumoniae before introduction of Pneumococcal Conjugate Vaccine (PCV). The prevalence of S. pneumoniae, its serotype distribution and antimicrobial susceptibility profile are presented. Methods & Materials: Children aged between one and 59 months meeting the standard definition of meningitis from 11 sentinel hospital sites across India were included. CSF and other specimens were collected for biochemistry, culture and latex agglutination tests at sentinel site laboratories. Confirmation of S. pneumoniae in CSF by PCR, and serotyping by Quellung method and antimicrobial susceptibility tests were done in reference laboratory. Results: Totally 12,941 children with suspected meningitis between March 2012 and September 2016 were recruited. Of these, 438 cases were confirmed to be S. pneumoniae by one or more methods. Among them, S. pneumoniae was isolated by culture from blood, CSF and/or other sterile body fluids in 141 samples; 148 and 265 samples were positive by LAT and PCR respectively. Highest prevalence was observed among children aged between 1 and <2 years (82.7%). Serotyping was done in 110/141 isolates. The commonest circulating serotypes were 14 (16.4%), 19F (12.7%), 6B (11.8%), 6A (6.4%), 4 (5.5%) and 23F (5.5%). Antimicrobial resistance to cotrimoxazole and erythromycin was 100% and 47% respectively. Non- susceptible to penicillin and cefotaxime was 28% and 9% respectively. Conclusion: S. pneumoniae continues to be an important cause of bacterial meningitis among under-five children. In 2017, Government of India introduced PCV 13 vaccine in universal immunization program in high-burden districts and is expected to offer 73% protection against currently circulating serotypes of S. pneumoniae. In view of documented high prevalence of S. pneumoniae in bacterial meningitis in children, we recommend expansion of PCV 13 coverage for possible dual benefit against childhood pneumonias and bacterial meningitis. It is critical to continue surveillance to generate documented evidence of patterns of serotype distribution and pneumococcal prevalence following the introduction of PCV. This will help to inform policy on altering serotype composition of PCV for immunization in the programme.