title: Identifying an appropriate PCV for use in Senegal, recent insights concerning Streptococcus pneumoniae NP carriage and IPD in Dakar.
abstract: BACKGROUND
  Since 2000, the Global Alliance for Vaccines and Immunization (GAVI) and WHO have supported the introduction of the Pneumococcal Conjugate Vaccine (PCV) in the immunization programs of developing countries. The highest pneumococcal nasopharyngeal carriage rates have been reported (40-60%) in these countries, and the highest incidence and case fatality rates of pneumococcal infections have been demonstrated in Africa.
  
  
  METHODS
  Studies concerning nasopharyngeal pneumococcal carriage and pneumococcal infection in children less than 5 years old were conducted in Dakar from 2007 to 2008. Serotype, antibiotic susceptibility and minimum inhibitory concentrations were determined. In addition, among 17 overall publications, 6 manuscripts of the Senegalese literature published from 1972 to 2013 were selected for data comparisons.
  
  
  RESULTS
  Among the 264 children observed, 132 (50%) children generated a nasopharyngeal (NP) positive culture with Streptococcus pneumoniae. The five most prevalent serotypes, were 6B (9%), 19 F (9%), 23 F (7.6%), 14 (7.6%) and 6A (6.8%). Fifteen percent of the strains (20/132) showed reduced susceptibility to penicillin and 3% (4/132) showed reduced susceptibility to anti-pneumococcal fluoroquinolones. Among the 196 suspected pneumococcal infections, 62 (31.6%) Streptococcus pneumoniae were isolated. Serogroup 1 was the most prevalent serotype (21.3%), followed by 6B (14.9%), 23 F (14.9%) and 5 (8.5%). Vaccine coverage for PCV-7, PCV-10 and PCV-13, were 36.2% (17/47), 66% (31/47) and 70.2% (33/47) respectively. Reduced susceptibility to penicillin and anti-pneumococcal fluoroquinolones was 6.4% and 4.3%, respectively, and the overall lethality was 42.4% (14/33).
  
  
  CONCLUSIONS
  This study confirms a high rate of carriage and disease caused by Streptococcus pneumoniae serotypes contained within the current generation of pneumococcal conjugate vaccines and consistent with reports from other countries in sub-Saharan Africa prior to PCV introduction. Antimicrobial resistance in this small unselected sample confirms a low rate of antibiotic resistance. Case-fatality is high. Introduction of a high valency pneumococcal vaccine should be a priority for health planners with the establishment of an effective surveillance system to monitor post vaccine changes.
authors.affiliation: Medical Laboratory, Pasteur Institute, Dakar, Senegal. lafatiz@gmail.com.
authors.forename: Fatim
authors.initials: F
authors.lastname: Ba
authors.affiliation: Medical Laboratory, Pasteur Institute, Dakar, Senegal. seck@pasteur.sn.
authors.forename: Abdoulaye
authors.initials: A
authors.lastname: Seck
authors.affiliation: Pediatric Unit, Albert Royer Hospital, Dakar, Senegal. madouba@gmail.com.
authors.forename: Mamadou
authors.initials: M
authors.lastname: Bâ
authors.affiliation: Pediatric Unit, Albert Royer Hospital, Dakar, Senegal. thionaliou79@yahoo.fr.
authors.forename: Aliou
authors.initials: A
authors.lastname: Thiongane
authors.affiliation: Pediatric Unit, Albert Royer Hospital, Dakar, Senegal. moussafafa@hotmail.sn.
authors.forename: Moussa Fafa
authors.initials: MF
authors.lastname: Cissé
authors.affiliation: Medina Health Center, Dakar, Senegal. didi_seck03@yahoo.fr.
authors.forename: Khady
authors.initials: K
authors.lastname: Seck
authors.affiliation: Saint Martin Health Center, Dakar, Senegal. stmartin@sentoo.sn.
authors.forename: Madeleine
authors.initials: M
authors.lastname: Ndour
authors.affiliation: Epidemiology Units, Pasteur Institute, Yaounde, Cameroun. boisierpas@gmail.com.
authors.forename: Pascal
authors.initials: P
authors.lastname: Boisier
authors.affiliation: Medical Laboratory, Pasteur Institute, Dakar, Senegal. benoitgarin@gmail.com.|Bacteriology Laboratory, Pasteur Institute, Antananarivo, Madagascar. benoitgarin@gmail.com.
authors.forename: Benoit
authors.initials: B
authors.lastname: Garin
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D002353:Carrier State / Q000453:epidemiology / Q000382:microbiology*; D002675:Child, Preschool; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008826:Microbial Sensitivity Tests; D009305:Nasopharynx / Q000382:microbiology; D011008:Pneumococcal Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D022242:Pneumococcal Vaccines; D012675:Senegal; D013296:Streptococcus pneumoniae / Q000187:drug effects / Q000276:immunology* / Q000302:isolation & purification; D014611:Vaccination; D018074:Vaccines, Conjugate
chemical_list: D000900:Anti-Bacterial Agents; D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate