Surveillance of bacterial pneumonia and other invasive bacterial diseases among under-five children in India, 2016–2018

Abstract

Background: Bacterial pneumonia and other invasive bacterial diseases (IBDs) are leading causes of morbidity and mortality in under-five children globally. Common etiological agents include Streptococcus pneumoniae, Haemophilus influenzae type b (Hib) and Neisseria meningitidis. Vaccination against Hib is already covered in the national immunization program (NIP) in India and a phased introduction of Pneumococcal Conjugate Vaccine (PCV-13) was started in 2017. Towards understanding the trends in common etiologies of bacterial pneumonia/IBDs and serotype distribution of S. Pneumoniae in pre and post-vaccination scenario, a hospital based surveillance network was established in 2016. Preliminary findings from the surveillance network are herein reported. Methods & Materials: Children aged 1–59 months admitted to six pediatric hospitals with suspected pneumonia, meningitis and sepsis were enrolled between 2016 and 2018. At the hospital site, blood, cerebrospinal fluid (CSF), and other normally sterile body fluids samples were collected and processed following conventional microbiological procedures. CSF was additionally screened by latex-agglutination (Wellcogen). PCR, serotyping (Quellung reaction) and antimicrobial susceptibility testing of pneumococcal isolates at the network's reference laboratory. Results: A total of 2008 blood, 730 CSF and 81 other samples were collected from 2297 enrolled children. In CSF, S. pneumoniae (35.1%), N. meningitidis (21.6%) and Hib (16.2%) were the major etiology. Staphylococcus aureus (32.9%) was the commonest blood isolate and S. pneumoniae was identified from 26 blood samples (9.3%). Overall, S. pneumoniae was the major pathogen among children <2 years of age (61.9%). Among the 24 pneumococcal isolates, 12 different serotypes were detected and the commonest were 14 (20.8%), 19F (16.7%), 6B (8.3%), 1 (8.3%), 10A (8.3%), 9V (8.3%) and 5 (8.3%). Seventy five percent of identified serotypes were covered by PCV-13. Antibiotic resistance was highest to co-trimoxazole (100%) followed by erythromycin (54.2%). Conclusion: Study documented S. pneumoniae as the major cause of bacterial pneumonia and IBDs in India among under-five children. With over two-thirds of pneumococcal serotypes covered by the current PCV-13, continued surveillance will document trends in pneumococcal disease burden and serotype distribution. Data thus generated will aid in assessing the effectiveness of PCV-13 in India and inform the program managers for decision making regarding sustenance of PCV and reconjugation.