title: Serotype distribution and antimicrobial resistance of Streptococcus pneumoniae in children with acute bacterial meningitis in Mozambique: implications for a national immunization strategy.
abstract: S. pneumoniae is the leading cause of acute bacterial meningitis (ABM) in children. Vaccination using the 10-valent conjugate vaccine (PCV-10) was recently introduced into the National Immunization Program in Mozambique, but data on serotype coverage of this vaccine formulation are scarce. In this study, we investigated the serotype distribution and antimicrobial resistance of isolates of S. pneumoniae causing ABM in children < 5 years at the two largest hospitals in Mozambique.
  
  
  
  Between March 2013 and March 2014, a total of 352 cerebrospinal fluid (CSF) samples were collected from eligible children, of which 119 (33.8 %) were positive for S. pneumoniae. Of these, only 50 samples met the criteria for serotyping and were subsequently serotyped using sequential multiplex PCR (SM-PCR), but 15 samples were non-typable.
  
  
  
  The most common serotypes of S. pneumoniae were 1 (18.2 %), 5 (15.2 %), 14 (12.1 %), 9 V (12.1 %), 23 F (9.1 %), 6A (9.1 %), 4 (9.1 %) and 6B (6.1 %). Serotypes 1, 5, 9 V, 6A and 12 were mostly prevalent in Northern Mozambique, while serotypes 23 F, 4, 6B, 3 and 15B were predominant in Southern. Serotype coverage of PCV-10 and PCV-13 vaccine formulations were 81.8 % and 93.9 %, respectively. Serotypes 1, 3, 4, 6B, 14, 23 F were resistant to penicillin and sensitive to ceftriaxone.
  
  
  
  Our findings shows that changing the current in use PCV-10 vaccine formulation to PCV-13 formulation might increase substantially the protection against invasive strains of S. pneumoniae as the PCV-10 vaccine formulation does not cover the serotypes 3 and 6A, which are prevalent in Mozambique.
authors.affiliation: Laboratório Nacional de Referência de Microbiologia, Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique. aquinoalbinonhantumbo@yahoo.com.br.|Laboratório Nacional de Referência de Microbiologia, Instituto Nacional de Saúde, Av Eduardo Mondlane 1008, PO Box 264, Maputo, Mozambique. aquinoalbinonhantumbo@yahoo.com.br.
authors.forename: Aquino Albino
authors.initials: AA
authors.lastname: Nhantumbo
authors.affiliation: Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique.
authors.forename: Eduardo Samo
authors.initials: ES
authors.lastname: Gudo
authors.affiliation: Universidade Federal de Ciências de Saúde de Porto Algre (UFCSPA), Porto Alegre, Brazil.
authors.forename: Juliana
authors.initials: J
authors.lastname: Caierão
authors.affiliation: Laboratório Nacional de Referência de Microbiologia, Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique.
authors.forename: Alcides Moniz
authors.initials: AM
authors.lastname: Munguambe
authors.affiliation: Laboratório Nacional de Referência de Microbiologia, Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique.
authors.forename: Charlotte Elizabeth
authors.initials: CE
authors.lastname: Comé
authors.affiliation: Departamento de Medicina at the Hospital Central de Maputo, Maputo, Mozambique.
authors.forename: Tomás Francisco
authors.initials: TF
authors.lastname: Zimba
authors.affiliation: Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
authors.forename: Milton Ozório
authors.initials: MO
authors.lastname: Moraes
authors.affiliation: Universidade Federal de Ciências de Saúde de Porto Algre (UFCSPA), Porto Alegre, Brazil.
authors.forename: Cícero
authors.initials: C
authors.lastname: Dias
authors.affiliation: Universidade Feevale, Rio Sul, Brazil.|Universidade Federal de Ciências de Saúde de Porto Algre (UFCSPA), Porto Alegre, Brazil.
authors.forename: Vlademir Vicente
authors.initials: VV
authors.lastname: Cantarelli
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D002443:Ceftriaxone / Q000494:pharmacology; D002675:Child, Preschool; D004269:DNA, Bacterial / Q000032:analysis; D024901:Drug Resistance, Multiple, Bacterial; D062665:Epidemiological Monitoring; D005260:Female; D006801:Humans; D017589:Immunization Programs; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016920:Meningitis, Bacterial / Q000134:cerebrospinal fluid* / Q000453:epidemiology / Q000382:microbiology* / Q000517:prevention & control; D008826:Microbial Sensitivity Tests; D009073:Mozambique / Q000453:epidemiology; D010406:Penicillins / Q000494:pharmacology; D011008:Pneumococcal Infections / Q000276:immunology / Q000382:microbiology; D022242:Pneumococcal Vaccines / Q000008:administration & dosage; D016133:Polymerase Chain Reaction; D015995:Prevalence; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification* / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification
chemical_list: C586648:10-valent pneumococcal conjugate vaccine; C538862:13-valent pneumococcal vaccine; D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D010406:Penicillins; D022242:Pneumococcal Vaccines; D002443:Ceftriaxone
keywords: Mozambique; Pneumococcal meningitis