title: Burden of pneumonia and meningitis caused by Streptococcus pneumoniae in China among children under 5 years of age: a systematic literature review.
abstract: METHODS
  To understand the burden and epidemiology of Streptococcus pneumoniae disease among children between 1 and 59 months of age in China, we conducted a review of literature published between 1980 and 2008 applying standardized algorithms. Because of the absence of population-based surveillance for pneumococcal disease (PD), we identified all-cause pneumonia, bacteremia and meningitis burden, syndromes most commonly associated with S. pneumoniae, and applied the proportion of disease attributable to S. pneumoniae from studies that determined the etiology of these three syndromes to calculate PD burden. Because of the microbiologic difficulties in identifying S. pneumoniae-attributable pneumonia which likely underestimates the pneumonia burden, we also used the proportion obtained from vaccine efficacy trials.
  
  
  RESULTS
  Between 1980 and 2008, there were 12,815 cases/100,000/year of all-cause pneumonia among children between 1 month and 59 months, with 526 deaths/100,000 annually. There were 14 meningitis cases/100,000/year. We estimate that as of 2000, there were 260,768 (113,000 to 582,382) and 902 (114-4,463) cases of pneumococcal pneumonia and meningitis, respectively with 10,703 (4,638-23,904) and 75 (9-370) pneumococcal pneumonia and meningitis deaths, respectively. Pneumococcal pneumonia cases and deaths were more than two-fold higher, 695,382 (173,845-1,216,918) and 28,542 (7,136-49,949), respectively, when parameters from efficacy trials were used. Serotypes 19F, 19A and 14 were the most common serotypes obtained from pneumonia/meningitis patients. Currently available vaccines are expected to cover 79.5% to 88.4% of the prevalent serotypes. With high antibiotic resistance, introducing pneumococcal vaccines to the routine immunization program should be considered in China. Population-based studies are warranted.
authors: Institutes of Biomedical Sciences, Fudan University, Shanghai, People's Republic of China.
authors: Ying
authors: Y
authors: Chen
authors: Wei
authors: W
authors: Deng
authors: Song-Mei
authors: SM
authors: Wang
authors: Qi-Mei
authors: QM
authors: Mo
authors: Huan
authors: H
authors: Jia
authors: Qun
authors: Q
authors: Wang
authors: Song-Guang
authors: SG
authors: Li
authors: Xiang
authors: X
authors: Li
authors: Bao-Dong
authors: BD
authors: Yao
authors: Cheng-Jun
authors: CJ
authors: Liu
authors: Yi-Qiang
authors: YQ
authors: Zhan
authors: Chen
authors: C
authors: Ji
authors: Anna Lena
authors: AL
authors: Lopez
authors: Xuan-Yi
authors: XY
authors: Wang
mesh_terms: D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D024881:Drug Resistance, Bacterial; D006801:Humans; D008586:Meningitis, Pneumococcal / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D011018:Pneumonia, Pneumococcal / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D013045:Species Specificity; D013296:Streptococcus pneumoniae / Q000145:classification / Q000187:drug effects / Q000472:pathogenicity*