title: Invasive pneumococcal disease in children<5 years of age in rural Mozambique.
abstract: OBJECTIVE
  To estimate the incidence and epidemiological characteristics of invasive pneumococcal disease (IPD) in children<5 years of age living in a rural area of southern Mozambique.
  
  
  METHODS
  As part of the clinical management of children admitted to Manhiça District Hospital, prospective surveillance for invasive bacterial disease was conducted from June 2001 to May 2003. The level of antibiotic resistance of the isolates was also analysed.
  
  
  RESULTS
  Pneumococcus was the most commonly isolated bacterium, accounting for 212 episodes. The estimated crude incidence rate of IPD in the study area among children<5 years of age was 416/100,000 per child-year at risk. The youngest age group (<3 months) had the highest incidence (779/100,000). Cases were detected during both rainy and dry seasons. The most common clinical diagnosis was pneumonia, made in 146/212 (69%) of the episodes of IPD. The overall case fatality rate was 10%, being highest among children with pneumococcal meningitis (5/9=56%). Pneumococcal isolates were highly susceptible to penicillin (86% susceptible and 14% with intermediate resistance) and chloramphenicol (98% susceptible). In contrast, up to 37% of the isolates tested were non-susceptible to cotrimoxazole.
  
  
  CONCLUSIONS
  Incidence rates of IPD and associated mortality shown in this study highlight the need for pneumococcal vaccines in rural Africa, which must be effective in infants and young children.
authors.affiliation: Centre de Salut Internacional, Hospital Clínic/IDIBAPS, Universitat de Barcelona, Barcelona, Spain. anna.roca@manhica.net
authors.forename: A
authors.initials: A
authors.lastname: Roca
authors.forename: B
authors.initials: B
authors.lastname: Sigaúque
authors.forename: Ll
authors.initials: L
authors.lastname: Quintó
authors.forename: I
authors.initials: I
authors.lastname: Mandomando
authors.forename: X
authors.initials: X
authors.lastname: Vallès
authors.forename: M
authors.initials: M
authors.lastname: Espasa
authors.forename: F
authors.initials: F
authors.lastname: Abacassamo
authors.forename: J
authors.initials: J
authors.lastname: Sacarlal
authors.forename: E
authors.initials: E
authors.lastname: Macete
authors.forename: A
authors.initials: A
authors.lastname: Nhacolo
authors.forename: M
authors.initials: M
authors.lastname: Levine
authors.forename: P
authors.initials: P
authors.lastname: Alonso
mesh_terms: D017677:Age Distribution; D000890:Anti-Infective Agents / Q000627:therapeutic use; D002675:Child, Preschool; D002701:Chloramphenicol / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008586:Meningitis, Pneumococcal / Q000188:drug therapy / Q000453:epidemiology; D009073:Mozambique / Q000453:epidemiology; D010406:Penicillins / Q000627:therapeutic use; D011008:Pneumococcal Infections / Q000188:drug therapy / Q000453:epidemiology*; D011014:Pneumonia / Q000188:drug therapy / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods; D011446:Prospective Studies; D012307:Risk Factors; D012423:Rural Health; D017678:Sex Distribution; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
chemical_list: D000890:Anti-Infective Agents; D010406:Penicillins; D002701:Chloramphenicol; D015662:Trimethoprim, Sulfamethoxazole Drug Combination