Surveillance of pneumococcal-associated disease among hospitalized children in Khanh Hoa Province, Vietnam.
BACKGROUND
To understand the epidemiology of childhood bacterial diseases, including invasive pneumococcal disease, prospective surveillance was conducted among hospitalized children in Nha Trang, Vietnam.


METHODS
From April 2005 through August 2006, pediatricians at the Khanh Hoa General Hospital used standardized screening criteria to identify children aged <5 years who had signs and symptoms of invasive bacterial disease. All cerebrospinal fluid (CSF) and blood specimens collected were tested by bacterial culture. Selected culture-negative specimens were tested for Streptococcus pneumoniae by antigen detection or for Haemophilus influenzae, Moraxella catarrhalis, Neisseria meningitidis, and S. pneumoniae by polymerase chain reaction (PCR).


RESULTS
A total of 987 children were enrolled (794 with pneumonia, 76 with meningitis, and 117 with other syndromes consistent with invasive bacterial disease); 84% of children were aged 0-23 months, and 57% were male. Seven (0.71%) of 987 blood cultures and 4 (15%) of 26 CSF cultures were positive for any bacterial pathogen (including 6 for H. influenzae type b and 1 for S. pneumoniae). Pneumococcal antigen testing and PCR identified an additional 16 children with invasive pneumococcal disease (12 by antigen testing and 4 by PCR). Among children aged <5 years who lived in Nha Trang, the incidence rate of invasive pneumococcal disease was at least 48.7 cases per 100,000 children (95% confidence interval, 27.9-85.1 cases per 100,000 children).


CONCLUSIONS
S. pneumoniae and H. influenzae type b were the most common causes of laboratory-confirmed invasive bacterial disease in children. PCR and antigen testing increased the sensitivity of detection and provided a more accurate estimate of the burden of invasive bacterial disease in Vietnam.
Anh
Dang Duc
DD
National Institute of Hygiene and Epidemiology, Hanoi, Vietnam.
Kilgore
Paul E
PE
Slack
Mary P E
MP
Nyambat
Batmunkh
B
Tho
Le Huu
le H
Yoshida
Lay Myint
LM
Nguyen
Hien Anh
HA
Nguyen
Cat Dinh
CD
Chong
Chia Yin
CY
Nguyen
Dong
D
Ariyoshi
Koya
K
Clemens
John D
JD
Jodar
Luis
L
D000942:Antigens, Bacterial / Q000302:isolation & purification; D001769:Blood / Q000382:microbiology; D002555:Cerebrospinal Fluid / Q000382:microbiology; D002673:Child, Hospitalized; D004269:DNA, Bacterial / Q000235:genetics; D005260:Female; D006761:Hospitals; D006801:Humans; D007118:Immunoassay; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011008:Pneumococcal Infections / Q000453:epidemiology*; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D013296:Streptococcus pneumoniae / Q000302:isolation & purification*; D014744:Vietnam / Q000453:epidemiology
D000942:Antigens, Bacterial; D004269:DNA, Bacterial