Prospective epidemiologic surveillance of invasive pneumococcal disease and pneumonia in children in San José, Costa Rica.
BACKGROUND
Streptococcus pneumoniae (SP) is the leading cause of vaccine-preventable death in children <5 years of age, globally. This surveillance determined incidence rates of invasive pneumococcal disease (IPD), clinical and chest radiograph-confirmed pneumonia (CXR+Pn); and SP serotype distribution and antimicrobial susceptibility in children in San José, Costa Rica.


METHODS
This was a 2-year prospective, population-based surveillance conducted in 2007-2009 in children aged 28 days to 36 months presenting to participating healthcare centers. Eligibility criteria for study inclusion were as follows: temperature ≥ 39.0°C within 24h and/or clinical suspicion of IPD or pneumonia.


RESULTS
8801 subjects were enrolled. Median age: 14.5 months. A total of 25 children had invasive pneumococcal disease with S. pneumoniae isolated from nonduplicative cultures (22) or detected solely by PCR and a clinical picture consistent with IPD (3). Sources of positive cultures (some children had >1 positive culture) were: blood (20), pleural fluid (4), and cerebrospinal fluid (3). Of the 3 cases detected solely by PCR, 2 were from cerebrospinal fluid and 1 from pleural fluid. The overall IPD incidence rates for culture-positive only cases for children aged 28 days to <3 years was 33.7/100,000 per year for years 1 and 2 combined. Age stratification of culture-positive only subjects showed a peak during year 1 (106.8/100,000) in children 28 days to <6 months of age group, and in year 2 (45.5/100,000) in children 12 months to <24 months of age group. Most common serotypes were 14 (28.6%), followed by 3, 4, 6A, 19A, and 22F (9.5% each). Of 22 nonduplicative IPD isolates, 42.9% were penicillin- and trimethoprim/sulfamethoxazole nonsusceptible isolates. Consideration of PCR-positive cases increases the incidence of IPD for children aged 28 days to <3 years to 46.0/100,000. Overall incidence of clinical pneumonia and CXR+Pn was 1968/100,000 and 551/100,000, respectively.


CONCLUSIONS
There is a considerable burden of IPD and pneumonia in children in San José. These epidemiologic data serve as a baseline to evaluate the effectiveness of the incorporation of new conjugate pneumococcal vaccines into the National Immunization Program in Costa Rican children.
Instituto de Atención Pediátrica, San José, Costa Rica. aarguedas@iped.net
Adriano
A
Arguedas
Arturo
A
Abdelnour
Carolina
C
Soley
Elias
E
Jimenez
Ana Laura
AL
Jimenez
Darmendra
D
Ramcharran
Nurith
N
Porat
Ron
R
Dagan
Sharon
S
Gray
Gail L
GL
Rodgers
D000900:Anti-Bacterial Agents / Q000494:pharmacology; D002675:Child, Preschool; D003364:Costa Rica / Q000453:epidemiology; D003470:Culture Media; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D011018:Pneumonia, Pneumococcal / Q000453:epidemiology* / Q000382:microbiology; D016133:Polymerase Chain Reaction / Q000379:methods; D011159:Population Surveillance / Q000379:methods*; D011446:Prospective Studies; D013296:Streptococcus pneumoniae / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*
D000900:Anti-Bacterial Agents; D003470:Culture Media