title: Prospective surveillance study of invasive pneumococcal disease among urban children in the Philippines.
abstract: BACKGROUND
  Worldwide, invasive pneumococcal disease (IPD) causes considerable morbidity and mortality among children, but incidence data in Asia are lacking. This 2-year hospital-based, prospective, surveillance study was conducted at 3 study sites in urban areas of the Philippines to estimate IPD and pneumonia incidence in children and describe the serotype distribution of invasive Streptococcus pneumoniae isolates.
  
  
  METHODS
  Children aged 28 days to <60 months residing within the 3 surveillance areas presenting with possible IPD were enrolled. Initial diagnosis, history of pneumococcal vaccine receipt and previous antimicrobial treatment were recorded. Blood specimens were collected for S. pneumoniae identification and serotyping. Final diagnosis was determined for hospitalized subjects, subjects whose culture yielded S. pneumoniae and subjects with clinically suspected meningitis.
  
  
  RESULTS
  A total of 5940 subjects were enrolled, 47 IPD cases identified. IPD site rates were 33.49 per 100,000, 25.38 per 100,000 and 25.85 per 100,000. Chest radiograph-confirmed pneumonia incidence ranged from 633.74 to 1683.59 per 100,000. Highest chest radiograph-confirmed pneumonia incidence occurred in those 28 days to <6 months of age at 2 sites (2166.16 and 3891.94 per 100,000) and those 6-12 months of age at the third site (3847.52 per 100,000). Thirty-five S. pneumoniae isolates were serotyped; most commonly identified were serotypes 1, 2, 5, 6B, 14 and 18F. One serotype 14 isolate was erythromycin resistant. Previous antibiotic therapy was documented in 17-53% of subjects; 2 subjects had received pneumococcal vaccine. At 2 sites, one-third of IPD subjects died.
  
  
  CONCLUSIONS
  IPD is an important cause of morbidity and mortality among urban children in the Philippines. Our data support the expectation that widespread immunization would decrease IPD disease burden.
authors: From the *Medical Department, Research Institute for Tropical Medicine, Muntinlupa City, Philippines; †Department of Pediatrics, Philippine General Hospital and National Institutes of Health, University of Philippines Manila, Manila, Philippines; ‡Infectious Diseases Section, Philippine Children's Medical Center, Quezon City, Philippines; §Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy, Detroit, MI; ¶Translational Research Divison, International Vaccine Institute, Seoul, Republic of Korea; Former Employee of Pfizer Global Research and Development, Paris, France; **Vaccines Clinical Research, ††Clinical Affairs, Specialty Care Business Unit, Pfizer Inc, Collegeville, PA; and ‡‡Former Employee of On Assignment Inc. contracted to Pfizer Inc, Collegeville, PA.
authors: Maria Rosario
authors: MR
authors: Capeding
authors: Lulu
authors: L
authors: Bravo
authors: Jaime
authors: J
authors: Santos
authors: Paul E
authors: PE
authors: Kilgore
authors: Soon Ae
authors: SA
authors: Kim
authors: Ivana
authors: I
authors: Balter
authors: Robin
authors: R
authors: Hubler
authors: Jian
authors: J
authors: Ye
authors: Michele
authors: M
authors: Moscariello
mesh_terms: D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010679:Philippines / Q000453:epidemiology; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality / Q000517:prevention & control; D022242:Pneumococcal Vaccines / Q000008:administration & dosage; D011446:Prospective Studies; D013296:Streptococcus pneumoniae / Q000145:classification / Q000276:immunology / Q000302:isolation & purification*; D014505:Urban Population / Q000706:statistics & numerical data; D014611:Vaccination / Q000706:statistics & numerical data
chemical_list: D022242:Pneumococcal Vaccines