Abstract
While pneumococcal conjugate vaccines have been implemented in most countries worldwide, use in Asia has lagged in part because of a lack of data on the amount of disease that is vaccine preventable in the region. We describe pneumococcal serotypes elicited from 111 episodes of invasive pneumococcal disease (IPD) from 2005 to 2013 among children and adults in Pakistan. Seventy-three percent (n = 81) of 111 IPD episodes were cases of meningitis (n = 76 in children 0–15 years and n = 5 among adults). Serotypes were determined by target amplification of DNA extracted from pneumococcal isolates (n = 52) or CSF specimens (n = 59). Serogroup 18 was the most common serogroup causing meningitis in children <5 years, accounting for 21% of cases (n = 13). The 10-valent pneumococcal conjugate vaccine (PCV 10) or PCV10- related serotypes were found in 61% (n = 47) of childhood (age 0–15 years) meningitis episodes. PCV-13 increased this coverage to 63% (one additional serotype 19A; n = 48). Our data indicate that use of PCVs would prevent a large proportion of serious pneumococcal disease.
Highlights
IntroductionThe World Health Organization estimates that approximately 0.5 million deaths among HIV-negative children ,5 years were attributed to pneumococcal disease in 2008 [1]
Streptococcus pneumoniae is a major cause of childhood mortality worldwide
Current PCV10 and PCV13 formulations include the most common serotypes causing invasive pneumococcal disease (IPD) among children worldwide [3], complex epidemiology and variation of strains among geographical regions suggest that gaps may exist in vaccine coverage for prevalent pneumococcal serotypes circulating in some populations [4]
Summary
The World Health Organization estimates that approximately 0.5 million deaths among HIV-negative children ,5 years were attributed to pneumococcal disease in 2008 [1]. With the advent of pneumococcal conjugate vaccines (PCV), invasive pneumococcal disease (IPD) and pneumococcal pneumonia in children are preventable illnesses. Reduction in rates of IPD is dependent on the proportion of disease caused by vaccine serotypes. Current PCV10 and PCV13 formulations include the most common serotypes causing IPD among children worldwide [3], complex epidemiology and variation of strains among geographical regions suggest that gaps may exist in vaccine coverage for prevalent pneumococcal serotypes circulating in some populations [4]. Limited recent data from South East Asia suggests that the proportion of IPD covered by PCV might be lower in this region than elsewhere [5]. IPD surveillance in Bangladesh has shown that from 2004 to 2007 only 38% of meningitis and 42% of nonmeningitis infections were covered by PCV10 [6]
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