Hospital-based surveillance of invasive pneumococcal disease among young children in urban Nepal.
BACKGROUND
Streptococcus pneumoniae is a leading cause of pneumonia and meningitis in young children. Before implementation of the pneumococcal conjugate vaccine in developing countries, there is an urgent need to provide regional epidemiological data on pneumococcal disease. The aims of this study were to determine the prevalence and serotype distribution of invasive pneumococcal disease among young children hospitalized in urban Nepal.


METHODS
Children aged 2 months to 5 years who were admitted to Patan Hospital, Kathmandu, with fever and/or suspected pneumonia, meningitis, or bacteremia were recruited. Blood culture specimens were collected from all participants. In cases of suspected meningitis, cerebrospinal fluid specimens were cultured and were tested for S. pneumoniae antigen.


RESULTS
A total of 885 children were recruited during the 21-month study period. Of these, 76 (9%) had meningitis and 498 (56%) had pneumonia, on the basis of clinical criteria. Radiographically confirmed pneumonia occurred in 354 (40%), and probable or definite meningitis occurred in 47 (5%). S. pneumoniae was isolated in specimens from 17 (2%) of the children. Serotypes 1 and 12A were isolated most frequently, and only 1 of 17 isolates had a serotype contained in the currently available 7-valent pneumococcal conjugate vaccine.


CONCLUSIONS
More than 60% of children aged <5 years who were admitted with fever and/or suspected invasive bacterial disease in urban Nepal had the clinical syndromes of meningitis and/or pneumonia. A new generation of pneumococcal vaccines that prevent infection with a broader range of serotypes may be necessary to most effectively control pneumococcal disease in young children in Kathmandu.
Williams
Eleri J
EJ
Department of Paediatrics, University of Oxford, Oxford, United Kingdom. dreleri.williams@btinternet.com
Thorson
Stephen
S
Maskey
Mitu
M
Mahat
Sandeep
S
Hamaluba
Mainga
M
Dongol
Sabina
S
Werno
Anja M
AM
Yadav
Bharat K
BK
Shah
Aparna Singh
AS
Kelly
Dominic F
DF
Adhikari
Neelam
N
Pollard
Andrew J
AJ
Murdoch
David R
DR
D000942:Antigens, Bacterial / Q000097:blood / Q000134:cerebrospinal fluid; D001769:Blood / Q000382:microbiology; D002555:Cerebrospinal Fluid / Q000382:microbiology; D002673:Child, Hospitalized; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008586:Meningitis, Pneumococcal / Q000453:epidemiology; D009390:Nepal / Q000453:epidemiology; D011008:Pneumococcal Infections / Q000453:epidemiology*; D011018:Pneumonia, Pneumococcal / Q000453:epidemiology; D015995:Prevalence; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification / Q000302:isolation & purification*; D014505:Urban Population
D000942:Antigens, Bacterial