title: Invasive pneumococcal infections among hospitalized children in Bamako, Mali.
abstract: BACKGROUND
  Prevention of invasive pneumococcal disease (IPD) in children is a global public health priority, and determination of the most common serotypes is crucial for vaccine development and implementation.
  
  
  METHODS
  We performed prospective surveillance for IPD in hospitalized children in Bamako, Mali. All febrile children and others suspected to have invasive bacterial disease had an admission blood culture and cultures of additional anatomic sites when indicated. Standard microbiologic methods were used to identify, serotype and determine antibiograms for pneumococcal isolates.
  
  
  RESULTS
  Of 2,049 children enrolled, 106 (5%) had an IPD, including 47 cases of meningitis and 44 bacteremic pneumonias. The incidence was highest in infants (84/100,000/year). The overall IPD case fatality rate was 24%. Only 2 of 96 isolates were nonsusceptible to penicillin. The serotypes isolated were 5 (54%), 2 (14%), 7F (10%), 19F (8%), 6A/B (3%), 9V (3%), 1 (2%) and 14 (1%).
  
  
  CONCLUSIONS
  IPD is common and frequently fatal among hospitalized children in Mali, but surprisingly little resistance has occurred. Notably, 91% of the serotypes causing IPD in Bamako children are found in the 11-valent pneumococcal conjugate vaccine.
authors.affiliation: University of Maryland School of Medicine, Center for Vaccine Development, Baltimore, MD 21201, USA. jcampbel@medicine.umaryland.edu
authors.forename: James D
authors.initials: JD
authors.lastname: Campbell
authors.forename: Karen L
authors.initials: KL
authors.lastname: Kotloff
authors.forename: Samba O
authors.initials: SO
authors.lastname: Sow
authors.forename: Milagritos
authors.initials: M
authors.lastname: Tapia
authors.forename: Mamadou Marouf
authors.initials: MM
authors.lastname: Keita
authors.forename: Tatiana
authors.initials: T
authors.lastname: Keita
authors.forename: Souleymane
authors.initials: S
authors.lastname: Diallo
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Hormazabal
authors.forename: Patrick
authors.initials: P
authors.lastname: Murray
authors.forename: Myron M
authors.initials: MM
authors.lastname: Levine
mesh_terms: D000293:Adolescent; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008302:Mali / Q000453:epidemiology; D008826:Microbial Sensitivity Tests; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D011159:Population Surveillance; D011446:Prospective Studies; D014505:Urban Population