title: Population-based surveillance for invasive pneumococcal disease and pneumonia in infants and young children in Goiânia, Brazil.
abstract: BACKGROUND
  Streptococcus pneumoniae is the leading cause of vaccine-preventable death in children <5 years of age globally. We determined incidence rates of invasive pneumococcal disease (IPD), clinical and chest X-ray-confirmed pneumonia (CXR+Pn), S. pneumoniae serotype distribution, and antimicrobial susceptibility in children in Goiânia, Brazil.
  
  
  METHODS
  Prospective, population-based surveillance was conducted from May 2007 to May 2009 in children 28 days to <36 months of age presenting to all 33 pediatric healthcare services (outpatient departments, emergency rooms, hospitals) in Goiânia. Eligibility criteria were temperature ≥39.0 °C in the previous 24h and/or clinical suspicion of pneumonia or IPD.
  
  
  RESULTS
  14,509 subjects were enrolled. Median age was 14.0 months. S. pneumoniae was detected in 64 samples from 62 subjects: 58 (90.6%) blood; 4 (6.3%) cerebrospinal fluid; and 2 (3.1%) pleural fluid. Incidence rate of IPD (culture- and polymerase chain reaction-positive) for all children aged 28 days to <36 months was 57.5/100,000; overall incidence for culture-positive only was 54.9/100,000. Age stratification of culture-positive-only subjects found the highest rates were, 114.6/100,000 and 69.8/100,000, respectively, for the 6 months to <12 months and 12 months to <24 months age groups. The overall incidence of invasive pneumonia and pneumococcal meningitis was 37.2/100,000 and 5.3/100,000, respectively. The most common IPD serotypes were 14 (45.0%), 6B (13.3%), 18C (6.7%), and 23F (5.0%). Eight isolates (13.3%) were penicillin nonsusceptible. The cumulative percentages of serotypes included in 7-valent, 10-valent, and 13-valent pneumococcal conjugate vaccines were 78.3%, 80.0%, and 88.3%, respectively. The overall incidence of clinical pneumonia and CXR+Pn was, 9598/100,000 and 3428/100,000, respectively. CXR+Pn rates for hospitalized and non-hospitalized subjects were 1751/100,000 and 1677/100,000, respectively.
  
  
  CONCLUSIONS
  The burden of IPD and pneumonia is considerable in children in a large Brazilian city, and is seen in hospitalized as well as ambulatory subjects. Vaccination with pneumococcal conjugate vaccines has the potential to decrease this burden.
authors.affiliation: Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Brazil.
authors.forename: Ana Lucia
authors.initials: AL
authors.lastname: Andrade
authors.forename: Renato
authors.initials: R
authors.lastname: Oliveira
authors.forename: Maria A
authors.initials: MA
authors.lastname: Vieira
authors.forename: Ruth
authors.initials: R
authors.lastname: Minamisava
authors.forename: Vicente
authors.initials: V
authors.lastname: Pessoa
authors.forename: Maria Cristina C
authors.initials: MC
authors.lastname: Brandileone
authors.forename: Sueli L A
authors.initials: SL
authors.lastname: Alves
authors.forename: Fernando
authors.initials: F
authors.lastname: Alfieri
authors.forename: Rosana
authors.initials: R
authors.lastname: Pagliarini
authors.forename: José Cassio
authors.initials: JC
authors.lastname: Moraes
authors.forename: Sharon
authors.initials: S
authors.lastname: Gray
authors.forename: Gail L
authors.initials: GL
authors.lastname: Rodgers
mesh_terms: D001938:Brazil / Q000453:epidemiology; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D011008:Pneumococcal Infections / Q000453:epidemiology*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage; D018410:Pneumonia, Bacterial / Q000453:epidemiology*; D011159:Population Surveillance; D011446:Prospective Studies
chemical_list: D022242:Pneumococcal Vaccines