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S. pneumoniae a leading cause of disease among Indian children
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Streptococcus pneumoniae remained a leading cause of invasive disease among young children in India, a surveillance study revealed, with links to pneumonia and meningitis. Isolates of S. pneumoniae also showed substantial antimicrobial drug resistance.
“Data for invasive pneumococcal disease incidence in low-income countries are scarce, probably because of multiple factors, such as inadequate laboratory facilities, suboptimal specimen collection and, most importantly, prehospitalization use of antibiotics among children,” Anand Manoharan, PhD, of the Pushpagiri Institute of Medical Science and Research Centre, Tiruvalla, Kerala, India, and colleagues wrote. “With no new information available for the latest trends of prevailing pneumococcal serotypes and their resistance patterns, a pressing need exists to fill this knowledge gap to decide on the suitability and choice of vaccine.”
Manoharan and colleagues enrolled 4,377 children aged younger than 5 years who had either suspected or proven pneumococcal disease between Jan. 1, 2011 and June 30, 2015. They recruited the children from 18 hospitals or institution across 11 states in India. The researchers took blood and other fluid cultures, analyzing serotypes and testing for possible antimicrobial resistance.
Eight percent (n = 361) of the children had culture-positive pneumococcal disease, with complete clinical data available for 226 patients, the researchers reported. Of those patients, 58% (n = 132) had pneumonia, 35% (n = 78) had meningitis and 7% (n = 16) presented with other clinical conditions.
Three percent (n = 131) of the total cohort died, and 8% (n = 29) of those with pneumococcal disease died.
Among those with pneumococcal disease, serotypes 14 and 1 were the most common, Manoharan and colleagues wrote (14% for both), followed by serotypes 5 (10%) and 19F (9%).
Isolates among 8% of patients (n = 29) were penicillin non-susceptible. Researchers found co-trimoxazole resistance among 66% (n = 239) of patients and erythromycin resistance among 37% of patients (n = 132).
In an accompanying editorial, Jugesh Chhatwal, MD, of the department of pediatrics at Christian Medical College, Ludhiana, Punjab, India, described the study as “very valuable,” noting that it was the first nationally representative study of pneumococcal disease in India.
“The results of this study endorse the reports of S. pneumoniae being a substantial contributor to morbidity and mortality among children aged 5 years or younger. With effective vaccines available, the number of children dying with a vaccine-preventable disease is unfortunate and unnecessary,” Chhatwal wrote. “We still need comprehensive data, not only for policy making, but also as a surveillance network for the future once a vaccination program is initiated.”
Serotype prevalence, Chhatwal added, may not stay constant in any region. – by Andy Polhamus
Disclosure: Chhatwal reports grants to Christian Medical College from the Alliance for Surveillance of Invasive Pneumococci Study Group during Manoharan and colleagues’ study. Manoharan reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.
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