Abstract
BackgroundStreptococcus pneumoniae is a leading cause of invasive infection in young children causing morbidity and mortality. Active surveillance systems of invasive pneumococcal disease (IPD) are recommended worldwide. The aim of this study was to estimate the current incidence of IPD and to describe the serotype distribution and the antimocrobial susceptibility of S. pneumoniae isolates in children aged less than 5 years residing in North-West Lombardy, Italy.MethodsA twelve-month prospective active surveillance system recruited all children aged less than 5 years admitted for suspicion of IPD at emergency room of ten hospitals located in the monitored area. Blood samples were taken in all participants for confirmation of IPD based on isolation of S. pneumoniae from blood. Pneumococcal meningitis and sepsis were additionally confirmed by cerebrospinal fluid analysis. Serotyping and antimicrobial susceptibility testing were performed on isolates from blood.ResultsA total of 15 confirmed cases of IPD were detected among 135 recruited children, including pneumonia (n = 8), bacteremia (n = 4), sepsis (n = 2) and meningitis (n = 1). The annual IPD incidence rate was 50.0/100,000 (95%CI, 30.5-82.5/100,000). Incidence was 58.3/100,000 (28.8-120.1/100,000) among children aged less than 2 years and 44.4/100,000 (22.9-87.5/100,000) among children aged 2–4 years. Thirteen isolates were typified. The most common serotype was 19A (23.1%) that together with serotypes 1, 7F and 19F accounted for 69.2% of typified isolates. Serotypes 14, 23F, 12B and 15C were also identified. The 7- and 13-valent pneumococcal conjugate vaccines covered respectively 30.8% and 84.6% of typified IPD cases. One isolate (serotype 15C) was penicillin-resistant and caused meningitis.ConclusionsThe inclusion of the 13-valent pneumococcal conjugate vaccine in immunization programs of young children might be considered to reduce incidence and morbidity of invasive pneumococcal disease in this surveilled population.
Highlights
Streptococcus pneumoniae is a leading cause of invasive infection in young children causing morbidity and mortality
The main objectives of this study were to estimate the current incidence of invasive pneumococcal disease (IPD) in children aged less than 5 years in North-West Lombardy, Italy, and to describe the serotype distribution of S. pneumoniae isolates and antimicrobial susceptibility
The study involved 10 hospitals representatively distributed in the territorial area delimited by four Reference Local Health Authorities districts serving at the beginning of the study around 3,500,000 people and comprising 130,000 children aged less than 5 years of whom 30,000 (12,000 younger than 2 years of age) linked to the participant hospitals
Summary
Streptococcus pneumoniae is a leading cause of invasive infection in young children causing morbidity and mortality. The aim of this study was to estimate the current incidence of IPD and to describe the serotype distribution and the antimocrobial susceptibility of S. pneumoniae isolates in children aged less than 5 years residing in North-West Lombardy, Italy. Recent estimates of deaths caused by S. pneumoniae in children younger than 5 years range from 700,000 to 1 million every year worldwide [1,2,3], with a Decline in the number of cases of invasive pneumococcal disease (IPD) has been observed among children, especially in infants, both in USA and European countries which introduced the hepta-valent pneumococcal conjugate vaccine (PCV) in their immunization programs [5,6,7,8], with higher reduction in USA, where reduction in IPD mortality occurred [9]. There is lack of longitudinal data in Lombardy, a crucial region with around 9,000,000 resident people
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