title: Epidemiology of Invasive Pneumococcal Disease in Bangladeshi Children Before Introduction of Pneumococcal Conjugate Vaccine.
abstract: Because Bangladesh intended to introduce pneumococcal conjugate vaccine (PCV)-10 in 2015, we examined the baseline burden of invasive pneumococcal disease (IPD) to measure impact of PCV.
  
  
  
  During 2007-2013, we performed blood and cerebrospinal fluid cultures in children <5 years old with suspected IPD identified through active surveillance at 4 hospitals. Isolates were serotyped by quellung and tested for antibiotic susceptibility by disc diffusion and E-test. Serotyping of culture-negative cases, detected by Binax or polymerase chain reaction, was done by sequential multiplex polymerase chain reaction. Trends in IPD case numbers were analyzed by serotype and clinical syndrome.
  
  
  
  The study identified 752 IPD cases; 78% occurred in children <12 months old. Serotype information was available for 78% (442/568), including 197 of 323 culture-negative cases available for serotyping. We identified 50 serotypes; the most common serotypes were 2 (16%), 1 (10 %), 6B (7%), 14 (7%) and 5 (7%). PCV-10 and PCV-13 serotypes accounted for 46% (range 29%-57% by year) and 50% (range 37%-64% by year) of cases, respectively. Potential serotype coverage for meningitis and nonmeningitis cases was 45% and 49% for PCV-10, and 48% and 57% for PCV-13, respectively. Eighty-two percent of strains were susceptible to all antibiotics except cotrimoxazole.
  
  
  
  The distribution of serotypes causing IPD in Bangladeshi children is diverse, limiting the proportion of IPD cases PCV can prevent. However, PCV introduction is expected to have major benefits as the country has a high burden of IPD-related mortality, morbidity and disability.
authors.affiliation: From the *Child Health Research Foundation, Department of Microbiology, Bangladesh Institute of Child Health, Dhaka Shishu Hospital, Dhaka, Bangladesh; †Division of Neonatal and Developmental Medicine, Stanford University, Stanford, California; ‡Department of Child and Adolescent Health, ICDDR, B, Dhaka, Bangladesh; §Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; ¶Emory Global Health Institute, Emory University, Atlanta, Georgia; ‖Center for Innovation in Global Health, Stanford University, Stanford, California; and **Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Samir K
authors.initials: SK
authors.lastname: Saha
authors.forename: Belal
authors.initials: B
authors.lastname: Hossain
authors.forename: Maksuda
authors.initials: M
authors.lastname: Islam
authors.forename: Md
authors.initials: M
authors.lastname: Hasanuzzaman
authors.forename: Shampa
authors.initials: S
authors.lastname: Saha
authors.forename: Mohammad
authors.initials: M
authors.lastname: Hasan
authors.forename: Gary L
authors.initials: GL
authors.lastname: Darmstadt
authors.forename: Mrittika
authors.initials: M
authors.lastname: Chowdury
authors.forename: Shams El
authors.initials: SE
authors.lastname: Arifeen
authors.forename: Abdullah H
authors.initials: AH
authors.lastname: Baqui
authors.forename: Robert F
authors.initials: RF
authors.lastname: Breiman
authors.forename: Mathuram
authors.initials: M
authors.lastname: Santosham
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Luby
authors.forename: Cynthia G
authors.initials: CG
authors.lastname: Whitney
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001459:Bangladesh / Q000453:epidemiology; D001769:Blood / Q000382:microbiology*; D002555:Cerebrospinal Fluid / Q000382:microbiology*; D002675:Child, Preschool; D005260:Female; D006761:Hospitals; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D060885:Multiplex Polymerase Chain Reaction; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000382:microbiology*; D015995:Prevalence; D065288:Serogroup; D013296:Streptococcus pneumoniae / Q000145:classification* / Q000187:drug effects / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents