Epidemiology of pediatric pneumococcal meningitis and bacteremia in Latin America and the Caribbean: a systematic review and meta-analysis.
BACKGROUND
Pneumococcal meningitis and bacteremia pose a significant disease burden in Latin America and the Caribbean (LAC).


METHODS
To perform a systematic review of studies of pediatric pneumococcal meningitis and non-pneumonia, non-meningitis pneumococcal bacteremia in LAC, we conducted an exhaustive search from 2000 to 2010 in electronic databases and grey literature. Pairs of independently selected reviewers assessed the quality and extracted the studies' data. A STROBE-based checklist was used to assess the risk of bias in observational studies. Meta-analyses were performed.


RESULTS
Of 1218 retrieved studies, 39 were included. In children <5 years, the pooled 95% confidence interval (CI) percentage of pneumococcal etiology out of cases studied with cerebrospinal fluid/blood cultures was 6.0% (95% CI: 3.3-9.5) for meningitis and 8.0% (95% CI: 5.3-12.4) for bacteremia. The incidences per 100,000 children were 4.7 (95% CI: 3.2-6.1) and 3.9 (95% CI: 2.0-5.9) for pneumococcal meningitis and non-pneumonia, non-meningitis bacteremia, respectively. The mortality was 8.3 (95% CI: 0.0-21.0) and 0.5 (95% CI: 0.3.0-0.6)/100,000 for meningitis and sepsis, respectively. The case fatality ratio was 33.2% (95% CI: 21.3-46.2) for meningitis and 29.0% (95% CI: 21.9-36.8) for sepsis. The pooled serotype distribution from SIREVA surveillance data showed that 14, 5, 6B (for meningitis) and 14, 6B, 19F (for bacteremia) were the most frequent serotypes, all included in licensed vaccines.


CONCLUSIONS
Pneumococcal meningitis and bacteremia are important causes of morbidity and mortality in LAC children <5 years of age. This systematic review provided evidence about the burden of pneumococcal disease and the serotype distribution to assess the impact the pneumococcal vaccines and to assist decision makers in the region.
From the *Institute for Clinical Effectiveness and Health Policy; and †Pediatric Infectious Disease Unit, Hospital Nacional de Pediatría J.P. Garrahan, Buenos Aires, Argentina.
Agustín
A
Ciapponi
Natalia
N
Elorriaga
Juan Ignacio
JI
Rojas
Marina
M
Romano
Sebastián García
SG
Martí
Ariel
A
Bardach
Silvina
S
Ruvinsky
D000367:Age Factors; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D017691:Caribbean Region / Q000453:epidemiology; D002675:Child, Preschool; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007843:Latin America / Q000453:epidemiology; D008586:Meningitis, Pneumococcal / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D065288:Serogroup; D013296:Streptococcus pneumoniae