title: Distribution of serotypes, vaccine coverage, and antimicrobial susceptibility pattern of Streptococcus pneumoniae in children living in SAARC countries: a systematic review.
abstract: BACKGROUND
  Each SAARC nation falls in the zone of high incidence of pneumococcal disease but there is a paucity of literature estimating the burden of pneumococcal disease in this region.
  
  
  OBJECTIVE
  To identify the prevalent serotypes causing invasive pneumococcal disease in children of SAARC countries, to determine the coverage of these serotypes by the available vaccines, and to determine the antibiotic resistance pattern of Streptococcus pneumoniae.
  
  
  METHODS
  We searched major electronic databases using a comprehensive search strategy, and additionally searched the bibliography of the included studies and retrieved articles till July 2014. Both community and hospital based observational studies which included children aged ≤12 years as/or part of the studied population in SAARC countries were included.
  
  
  RESULTS
  A total of 17 studies were included in the final analysis. The period of surveillance varied from 12-96 months (median, 24 months). The most common serotypes country-wise were as follows: serotype 1 in Nepal; serotype 14 in Bangladesh and India; serotype 19F in Sri Lanka and Pakistan. PCV-10 was found to be suitable for countries like India, Nepal, Bangladesh, and Sri Lanka, whereas PCV-13 may be more suitable for Pakistan. An increasing trend of non-susceptibility to antibiotics was noted for co-trimoxazole, erythromycin and chloramphenicol, whereas an increasing trend of susceptibility was noted for penicillin.
  
  
  CONCLUSIONS
  Due to paucity of recent data in majority of the SAARC countries, urgent large size prospective studies are needed to formulate recommendations for specific pneumococcal vaccine introduction and usage of antimicrobial agents in these regions.
authors.affiliation: ICMR Advanced Centre for evidence based Child Health, Department of Pediatrics, Post-Graduate Institute of Medical Education & Research, Chandigarh, India.
authors.forename: Nishant
authors.initials: N
authors.lastname: Jaiswal
authors.affiliation: Department of Pediatrics, Post-Graduate Institute of Medical Education & Research, Chandigarh, India.
authors.forename: Meenu
authors.initials: M
authors.lastname: Singh
authors.affiliation: Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, India.
authors.forename: Rashmi Ranjan
authors.initials: RR
authors.lastname: Das
authors.affiliation: ICMR Advanced Centre for evidence based Child Health, Department of Pediatrics, Post-Graduate Institute of Medical Education & Research, Chandigarh, India.
authors.forename: Ishita
authors.initials: I
authors.lastname: Jindal
authors.affiliation: ICMR Advanced Centre for evidence based Child Health, Department of Pediatrics, Post-Graduate Institute of Medical Education & Research, Chandigarh, India.
authors.forename: Amit
authors.initials: A
authors.lastname: Agarwal
authors.affiliation: ICMR Advanced Centre for evidence based Child Health, Department of Pediatrics, Post-Graduate Institute of Medical Education & Research, Chandigarh, India.
authors.forename: Kiran Kumar
authors.initials: KK
authors.lastname: Thumburu
authors.affiliation: Department of Ophthalmology, Wayne State University, Detroit, Michigan, United States of America.
authors.forename: Ajay
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Department of Pediatrics, Post-Graduate Institute of Medical Education & Research, Chandigarh, India.
authors.forename: Anil
authors.initials: A
authors.lastname: Chauhan
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001211:Asia, Western / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D002701:Chloramphenicol / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial; D004917:Erythromycin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D022242:Pneumococcal Vaccines / Q000008:administration & dosage / Q000276:immunology*; D011018:Pneumonia, Pneumococcal / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D065288:Serogroup; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000187:drug effects / Q000235:genetics / Q000276:immunology* / Q000302:isolation & purification; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D014611:Vaccination / Q000706:statistics & numerical data*; D018074:Vaccines, Conjugate
chemical_list: D000900:Anti-Bacterial Agents; D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate; D004917:Erythromycin; D002701:Chloramphenicol; D015662:Trimethoprim, Sulfamethoxazole Drug Combination