title: Pediatric Invasive Pneumococcal Disease in Guatemala City: Importance of Serotype 2.
abstract: BACKGROUND
  To inform estimations of the potential impact of recently introduced pneumococcal conjugate vaccine (PCV), we report results of 11 years of pre-PCV surveillance for invasive pneumococcal disease (IPD) among children in Guatemala City.
  
  
  METHODS
  Cases of IPD in children younger than 5 years were identified by active surveillance at 3 referral hospitals in Guatemala City from October 1996 through 2007. Clinical and demographic data were obtained, and isolates of Streptococcus pneumoniae from normally sterile sites were serotyped using latex agglutination and confirmed by Quellung reaction.
  
  
  RESULTS
  Four hundred fifty-two cases of IPD were identified with a case fatality rate of 21%. Meningitis was the most common cause of death (77% of all deaths) and occurred more often in infancy (median age 5 months) than other clinical syndromes. Of the 137 isolates serotyped, type 1 (26 cases, 17%), type 2 (25 cases, 16%) and type 5 (18 cases, 12%) were the most common. Serotype 2 was associated with a higher case fatality rate (28%), higher rate of meningitis (68%) and occurred in younger infants (median age, 3.5 months) than other common serotypes. Recently introduced PCV13 includes 73% of observed serotypes in the study.
  
  
  CONCLUSIONS
  Infants with IPD presented at a young age. Serotype 2, rarely reported as a significant cause of IPD and not included in available PCVs, was a common cause of disease in this population. PCV13 introduction in Guatemala, begun in 2013, may not have as great an impact in disease reduction as has been observed in other countries.
authors.affiliation: From the *Division of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado; †Center for Global Health, Colorado School of Public Health, Aurora, Colorado; ‡Department of Pediatrics, Denver Health Hospital Authority, Denver, Colorado; §Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; ¶Department of Pediatrics, University Francisco Marroquin, Guatemala City, Guatemala; and ‖Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: James T
authors.initials: JT
authors.lastname: Gaensbauer
authors.forename: Edwin J
authors.initials: EJ
authors.lastname: Asturias
authors.forename: Monica
authors.initials: M
authors.lastname: Soto
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Holt
authors.forename: Daniel
authors.initials: D
authors.lastname: Olson
authors.forename: Neal A
authors.initials: NA
authors.lastname: Halsey
mesh_terms: D002675:Child, Preschool; D002947:Cities / Q000453:epidemiology; D005260:Female; D006166:Guatemala / Q000453:epidemiology; D006761:Hospitals; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000517:prevention & control; D022242:Pneumococcal Vaccines / Q000008:administration & dosage / Q000276:immunology; D065288:Serogroup; D013296:Streptococcus pneumoniae / Q000145:classification* / Q000302:isolation & purification*; D014505:Urban Population
chemical_list: C538862:13-valent pneumococcal vaccine; D022242:Pneumococcal Vaccines