Incidence of pneumococcal bacteremia requiring hospitalization in rural Thailand.
BACKGROUND
Population-based estimates of the incidence of invasive pneumococcal disease are unavailable for Thailand and other countries in Southeast Asia. We estimated the incidence of pneumococcal bacteremia cases requiring hospitalization in rural Thailand.


METHODS
Blood cultures were performed on samples from hospitalized patients in 2 rural provinces where active, population-based surveillance of community-acquired pneumonia is conducted. Blood cultures were performed at clinician discretion and were encouraged for all patients with suspected pneumonia and all children aged <5 years with suspected sepsis. Pneumococcal antigen testing was performed on positive blood culture specimens that failed to grow organisms on subculture.


RESULTS
From May 2005 through June 2007, 23,853 blood culture specimens were collected overall, and 7319 were collected from children aged <5 years, which represented 66% and 47% of target patients, respectively. A total of 72 culture-confirmed pneumococcal bacteremia cases requiring hospitalization were identified. An additional 44 patients had media from positive blood cultures that yielded no growth on subculture but that had positive results of pneumococcal antigen testing. Of the 116 confirmed cases of bacteremia, 27 (23%) occurred in children aged <5 years; of these, 9 (33%) were confirmed by antigen testing only. The incidence of pneumococcal bacteremia cases requiring hospitalization among children aged <5 years had a range of 10.6-28.9 cases per 100,000 persons (incidence range if cases detected by antigen are excluded, 7.5-14.0 cases per 100,000 persons).


CONCLUSIONS
Invasive pneumococcal disease is more common than was previously suspected in Thailand, even on the basis of estimates limited to hospitalized cases of bacteremia. These estimates, which are close to estimates of the incidence of hospitalized cases of pneumococcal bacteremia in the United States before introduction of pneumococcal conjugate vaccine, provide important data to guide public health care policy and to inform discussions about vaccine introduction in Thailand and the rest of Southeast Asia.
Baggett
Henry C
HC
International Emerging Infections Program, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Sa Kaeo, Thailand. hbaggett@cdc.gov
Peruski
Leonard F
LF
Olsen
Sonja J
SJ
Thamthitiwat
Somsak
S
Rhodes
Julia
J
Dejsirilert
Surang
S
Wongjindanon
Wanna
W
Dowell
Scott F
SF
Fischer
Julie E
JE
Areerat
Peera
P
Sornkij
Denchai
D
Jorakate
Possawat
P
Kaewpan
Anek
A
Prapasiri
Prabda
P
Naorat
Sathapana
S
Sangsuk
Leelawadee
L
Eampokalap
Boonchuay
B
Moore
Matthew R
MR
Carvalho
Gloria
G
Beall
Bernard
B
Ungchusak
Kumnuan
K
Maloney
Susan A
SA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000942:Antigens, Bacterial / Q000097:blood; D016470:Bacteremia / Q000453:epidemiology*; D001769:Blood / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012424:Rural Population; D013785:Thailand / Q000453:epidemiology; D055815:Young Adult
D000942:Antigens, Bacterial