title: Clinical presentation of invasive pneumococcal disease in Spain in the era of heptavalent conjugate vaccine.
abstract: BACKGROUND
  The aim of this study was to analyze the rate of incidence, clinical presentation, serotype, and clonal distribution of invasive pneumococcal disease (IPD) in the era of heptavalent pneumococcal conjugate vaccine (PCV7) in Barcelona, Spain.
  
  
  METHODS
  This was a prospective study comprising all children <5 years with IPD who were managed in 2 tertiary-care, pediatric hospitals between January 2007 and December 2009. IPD was defined as the presence of clinical findings of infection together with isolation or detection of DNA of Streptococcus pneumoniae in a sterile fluid sample.
  
  
  RESULTS
  In this study, 319 patients (53.3% male), mean age 29.6 months, were included. Comparing rates in 2007 and 2009 (76.2 and 109.9 episodes/100,000 population, respectively), an increase of 44% (95% confidence interval, 10%-89%) was observed. The main clinical presentation was pneumonia (254 episodes, 79.6%), followed by meningitis (29, 9.1%), and bacteremia (25, 7.8%).The diagnosis was made by positive culture in 123 (38.6%) patients and in 196 (61.4%) by real-time polymerase chain reaction. Serotype study was performed in 300 episodes, and 273 (91%) were non-PCV7 serotypes. The most frequent serotypes were 1 (20.7%), 19A (15.7%), and 3 (12.3%). A minimal inhibitory concentration ≥0.12 μg/mL to penicillin was detected in 34.4% of isolates. Sequence type 306 expressing serotype 1 was the most frequent clonal type detected (20.3% of studied strains).
  
  
  CONCLUSIONS
  IPD continues to increase in Barcelona, and the rate is higher than previously reported as a result of low sensitivity of bacterial culture. Non-PCV7 serotypes were responsible for 91% of episodes and pneumonia was the main clinical presentation.
authors.affiliation: Hospital Universitari Sant Joan de Déu, Barcelona, Spain.
authors.forename: Maria F
authors.initials: MF
authors.lastname: de Sevilla
authors.forename: Juan-José
authors.initials: JJ
authors.lastname: García-García
authors.forename: Cristina
authors.initials: C
authors.lastname: Esteva
authors.forename: Fernando
authors.initials: F
authors.lastname: Moraga
authors.forename: Sergi
authors.initials: S
authors.lastname: Hernández
authors.forename: Laura
authors.initials: L
authors.lastname: Selva
authors.forename: Francisco
authors.initials: F
authors.lastname: Coll
authors.forename: Pilar
authors.initials: P
authors.lastname: Ciruela
authors.forename: Ana Maria
authors.initials: AM
authors.lastname: Planes
authors.forename: Gemma
authors.initials: G
authors.lastname: Codina
authors.forename: Luis
authors.initials: L
authors.lastname: Salleras
authors.forename: Iolanda
authors.initials: I
authors.lastname: Jordan
authors.forename: Angela
authors.initials: A
authors.lastname: Domínguez
authors.forename: Carmen
authors.initials: C
authors.lastname: Muñoz-Almagro
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology / Q000473:pathology; D002675:Child, Preschool; D005260:Female; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008586:Meningitis, Pneumococcal / Q000453:epidemiology / Q000382:microbiology / Q000473:pathology; D008826:Microbial Sensitivity Tests; D058889:Molecular Typing; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage* / Q000276:immunology; D011018:Pneumonia, Pneumococcal / Q000453:epidemiology / Q000382:microbiology / Q000473:pathology; D011446:Prospective Studies; D012703:Serotyping; D013030:Spain / Q000453:epidemiology; D013296:Streptococcus pneumoniae / Q000145:classification* / Q000302:isolation & purification*
chemical_list: D000900:Anti-Bacterial Agents; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D022242:Pneumococcal Vaccines