Abstract
Although Streptococcus pneumoniae is a leading cause of childhood disease in South East Asia, little has previously been reported regarding the epidemiology of invasive pneumococcal disease in Malaysia and very few studies have explored pneumococcal epidemiology using multilocus sequence typing (MLST). Here we describe serotype, multilocus sequence type (ST), and penicillin susceptibility of thirty pneumococcal invasive disease isolates received by the University of Malaya Medical Centre between February 2000 and January 2007 and relate this to the serotypes included in current pneumococcal conjugate vaccines. A high level of diversity was observed; fourteen serotypes and 26 sequence types (ST), (11 of which were not previously described) were detected from 30 isolates. Penicillin non-susceptible pneumococci accounted for 33% of isolates. The extent of molecular heterogeneity within carried and disease-causing Malaysian pneumococci remains unknown. Larger surveillance and epidemiological studies are now required in this region to provide robust evidence on which to base future vaccine policy.
Highlights
Streptococcus pneumoniae remains a leading cause of pneumonia and invasive disease worldwide and cause significant morbidity and mortality, in young children and the elderly
Even with small numbers we show that pneumococcal multi-locus sequence types (ST) causing disease in this study are heterogeneous and differ from those ST commonly observed in the USA and Europe
Of the 30 invasive pneumococcal disease (IPD) isolates included in the study, eleven were from children aged less than 15 years and seventeen were from adults
Summary
Streptococcus pneumoniae (the pneumococcus) remains a leading cause of pneumonia and invasive disease worldwide and cause significant morbidity and mortality, in young children and the elderly. There is little recent data on the epidemiology of invasive pneumococcal disease (IPD) in Malaysia; the majority of the few studies published to date have addressed serotype and/or antibiotic susceptibility [6,7,8,9,10,11]. The heptavalent conjugate vaccine (Prevnar, PCV7, Pfizer) is effective against seven serotypes (4, 6B, 9V, 14, 18C, 19F and 23F) responsible for much paediatric IPD in many western countries and elsewhere [13,14]. PCV7 was licensed in Malaysia in 2006, and 13-valent vaccine (Prevnar-13, PCV13, Pfizer) containing additional polysaccharides against serotypes 1, 3, 5, 7F, 18F and 19A was licensed in 2010. A 10-valent vaccine in which pneumococcal polysaccharides are conjugated to a Haemophilus influenzae surface protein has recently been licensed (PHiD-CV, Synflorix, GSK). No pneumococcal conjugate vaccine (PCV) is currently included in the Malaysian national immunisation programme (NIP)
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