title: Pneumococcal Bacteremia Requiring Hospitalization in Rural Thailand: An Update on Incidence, Clinical Characteristics, Serotype Distribution, and Antimicrobial Susceptibility, 2005-2010.
abstract: Streptococcus pneumoniae is an important cause of morbidity and mortality in Southeast Asia, but regional data is limited. Updated burden estimates are critical as pneumococcal conjugate vaccine (PCV) is highly effective, but not yet included in the Expanded Program on Immunization of Thailand or neighboring countries.
  
  
  
  We implemented automated blood culture systems in two rural Thailand provinces as part of population-based surveillance for bacteremia. Blood cultures were collected from hospitalized patients as clinically indicated.
  
  
  
  From May 2005- March 2010, 196 cases of pneumococcal bacteremia were confirmed in hospitalized patients. Of these, 57% had clinical pneumonia, 20% required mechanical ventilation, and 23% (n = 46) died. Antibiotic use before blood culture was confirmed in 25% of those with blood culture. Annual incidence of hospitalized pneumococcal bacteremia was 3.6 per 100,000 person-years; rates were higher among children aged <5 years at 11.7 and adults ≥65 years at 14.2, and highest among infants <1 year at 33.8. The median monthly case count was higher during December-March compared to the rest of the year 6.0 vs. 1.0 (p<0.001). The most common serotypes were 23F (16%) and 14 (14%); 61% (74% in patients <5 years) were serotypes in the 10-valent PCV (PCV 10) and 82% (92% in <5 years) in PCV 13. All isolates were sensitive to penicillin, but non-susceptibility was high for co-trimoxazole (57%), erythromycin (30%), and clindamycin (20%).
  
  
  
  We demonstrated a high pneumococcal bacteremia burden, yet underestimated incidence because we captured only hospitalized cases, and because pre-culture antibiotics were frequently used. Our findings together with prior research indicate that PCV would likely have high serotype coverage in Thailand. These findings will complement ongoing cost effectiveness analyses and support vaccine policy evaluation in Thailand and the region.
authors.affiliation: International Emerging Infections Program, Global Disease Detection Regional Center, Thailand Ministry of Public Health - United States Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.
authors.forename: Julia
authors.initials: J
authors.lastname: Rhodes
authors.forename: Surang
authors.initials: S
authors.lastname: Dejsirilert
authors.forename: Susan A
authors.initials: SA
authors.lastname: Maloney
authors.forename: Possawat
authors.initials: P
authors.lastname: Jorakate
authors.forename: Anek
authors.initials: A
authors.lastname: Kaewpan
authors.forename: Prasert
authors.initials: P
authors.lastname: Salika
authors.forename: Thantapat
authors.initials: T
authors.lastname: Akarachotpong
authors.forename: Prabda
authors.initials: P
authors.lastname: Prapasiri
authors.forename: Sathapana
authors.initials: S
authors.lastname: Naorat
authors.forename: Peera
authors.initials: P
authors.lastname: Areerat
authors.forename: Asadang
authors.initials: A
authors.lastname: Ruayajin
authors.forename: Pathom
authors.initials: P
authors.lastname: Sawanpanyalert
authors.forename: Pasakorn
authors.initials: P
authors.lastname: Akarasewi
authors.forename: Leonard F
authors.initials: LF
authors.lastname: Peruski
authors.forename: Henry C
authors.initials: HC
authors.lastname: Baggett
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000188:drug therapy / Q000453:epidemiology*; D012424:Rural Population / Q000706:statistics & numerical data*; D013296:Streptococcus pneumoniae / Q000145:classification* / Q000187:drug effects* / Q000502:physiology; D013785:Thailand / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents