title: Enhanced determination of Streptococcus pneumoniae serotypes associated with invasive disease in Laos by using a real-time polymerase chain reaction serotyping assay with cerebrospinal fluid.
abstract: A prospective hospital-based study was undertaken to define the incidence of invasive pneumococcal disease (IPD) and circulating serotypes in Laos. Of 10,799 patients with hemocultures and 353 patients with cerebrospinal fluid samples, 0.21% and 5.4%, respectively, were positive for Streptococcus pneumoniae, giving a total of 35 IPD patients. We developed a real-time polymerase chain reaction to detect serotypes represented in the 13-valent pneumococcal vaccine. A blinded evaluation comparing serotype as defined by the Quellung reaction versus the polymerase chain reaction demonstrated 100% concordance. The most frequent serotype (n = 33 patients) was 1 (n = 6), followed by serotypes 5, 6A/B/C, 14, and 23F. Serotypes represented in the 7-valent polysaccharide-protein conjugate vaccine (PCV-7) infected 39% of patients, with 73% coverage for the PCV-10 and PCV-13 vaccines. Although the sample size is small, these data suggest that the PCV-7 vaccine may have relatively low efficacy in Laos. Further studies are urgently needed to guide pneumococcal vaccine policy in Laos.
authors.affiliation: Wellcome Trust-Mahosot Hospital-Oxford Tropical Medicine Research Collaboration, Mahosot Hospital, Vientiane, Laos. catrin@tropmedres.ac
authors.forename: Catrin E
authors.initials: CE
authors.lastname: Moore
authors.forename: Amphone
authors.initials: A
authors.lastname: Sengduangphachanh
authors.forename: Thaksinaporn
authors.initials: T
authors.lastname: Thaojaikong
authors.forename: Joy
authors.initials: J
authors.lastname: Sirisouk
authors.forename: Dona
authors.initials: D
authors.lastname: Foster
authors.forename: Rattanaphone
authors.initials: R
authors.lastname: Phetsouvanh
authors.forename: Lesley
authors.initials: L
authors.lastname: McGee
authors.forename: Derrick W
authors.initials: DW
authors.lastname: Crook
authors.forename: Paul N
authors.initials: PN
authors.lastname: Newton
authors.forename: Sharon J
authors.initials: SJ
authors.lastname: Peacock
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001483:Base Sequence; D017931:DNA Primers; D006801:Humans; D007812:Laos / Q000453:epidemiology; D008826:Microbial Sensitivity Tests; D022242:Pneumococcal Vaccines / Q000008:administration & dosage; D016133:Polymerase Chain Reaction / Q000379:methods*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013290:Streptococcal Infections / Q000134:cerebrospinal fluid / Q000453:epidemiology / Q000382:microbiology* / Q000517:prevention & control; D013296:Streptococcus pneumoniae / Q000145:classification / Q000187:drug effects / Q000235:genetics / Q000472:pathogenicity*
chemical_list: D000900:Anti-Bacterial Agents; D017931:DNA Primers; D022242:Pneumococcal Vaccines
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