title: Establishment of population-based surveillance for invasive pneumococcal disease in Bangalore, India.
abstract: BACKGROUND
  Invasive pneumococcal disease (IPD) is vaccine-preventable but few data on the incidence of PD exist for Indian children.
  
  
  OBJECTIVE
  To assess the feasibility of implementing prospective, population-based surveillance for PD among children less than five years of age. Settings and Design :Hospitals and health agencies, Bangalore, India. Retrospective review and analysis of hospitalization records as well as public health and demographic data.
  
  
  METHODS
  Records for 2006 hospitalizations for pneumococcal disease-associated syndromes (meningitis, pneumonia and sepsis) were identified at three pediatric referral hospitals (Indira Gandhi Institute of Child Health, Kempegowda Institute of Child Health and Vani Vilas Hospital) in Bangalore using International Classification of Diseases, 9th revision codes. Hospital microbiology laboratory records were assessed to ensure capacity for identifying S. pneumoniae. Population data were identified from national census and polio surveillance data.
  
  
  RESULTS
  The Bangalore city southern zone includes 33 wards occupying 51 Km 2 with 150,945 children between 0-5 years of age served by three referral pediatric hospitals. From January--December 2006, records of these three hospitals showed 2,219 hospitalizations of children less than five years of age (967 pneumonia, 768 sepsis, and 484 meningitis) with PD-associated diagnoses (southern zone area incidence: 0.15/100,000 PD-associated hospitalizations, less than five years of age). There were 178 deaths in children less than five years of age, of which 87 were attributable to sepsis, 56 to pneumonia and 35 to meningitis.
  
  
  CONCLUSIONS
  Our analysis suggests that the PD-associated disease burden in Bangalore is high and local institutions have capacity for population-based surveillance. In a prospective study, systematic attention to potential barriers in identifying children with pneumococcal infections will improve estimation of IPD incidence in India.
authors.affiliation: Division of Translational Research, International Vaccine Institute, Seoul, South Korea. rajuladi@yahoo.com
authors.forename: Aparna S
authors.initials: AS
authors.lastname: Shah
authors.forename: Ramnilinga
authors.initials: R
authors.lastname: Nisarga
authors.forename: K L
authors.initials: KL
authors.lastname: Ravi Kumar
authors.forename: Robin
authors.initials: R
authors.lastname: Hubler
authors.forename: Guillermo
authors.initials: G
authors.lastname: Herrera
authors.forename: Paul E
authors.initials: PE
authors.lastname: Kilgore
mesh_terms: D000367:Age Factors; D002675:Child, Preschool; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008586:Meningitis, Pneumococcal / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D011008:Pneumococcal Infections / Q000453:epidemiology / Q000517:prevention & control; D011018:Pneumonia, Pneumococcal / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D012189:Retrospective Studies; D018571:Sentinel Surveillance; D018805:Sepsis / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D013296:Streptococcus pneumoniae / Q000302:isolation & purification*