Abstract. The etiology of invasive bacterial infections was studied among 956 Filipino children less than five years old who fulfilled the World Health Organization criteria for severe or very severe pneumonia or had suspected meningitis or sepsis. The most common invasive infections were due to Streptococcus pneumoniae (12 [1.3%]) and Haemophilus influenzae (12 [1.3%]); including four cases of pneumococcal meningitis and 11 cases of H. influenzae meningitis. Type 1 was the most common (six of the 12 isolates) of the pneumococcal serotypes. Serotypes/groups 1, 6, 14, and 23 accounted for 91.7% of the invasive isolates. The majority of the H. influenzae strains from blood (10 out of 10) and cerebrospinal fluid (6 out of 7) were type b. Almost all of the invasive S. pneumoniae (9 out of 12) and H. influenzae (11 out of 12) infections were seen before one year of age, which stresses the need to investigate early immunization of children for H. influenzae type b and S. pneumoniae, as well as maternal immunization to maximize the potential of immunoprophylaxis.

Abstract. A clinical bacteriologic laboratory was established in a tertiary care government hospital in The Philippines, where expert bacteriologic laboratories do not usually exist at this level of health care. The laboratory was jointly established by the Research Institute for Tropical Medicine (RITM) (Manila, The Philippines) and the National Public Health Institute (KTL) (Helsinki, Finland). The laboratory was planned, its personnel were trained, and its functioning was continuously supported by the RITM and KTL. The following aspects were of utmost importance in establishing the laboratory and launching its work: 1) the support of the RITM bacteriologic laboratory, with backup and consultations from KTL; 2) creation and maintenance of personal contacts between clinicians and laboratory staff with an emphasis on clinical relevance and rapid reporting of laboratory results; 3) the consideration of the quality aspects of the work from the start; and 4) keen follow-up of the bacteriologic results and their clinical significance and use, of practical laboratory work, and of quality assurance aspects. In the first two years of its operation, the laboratory identified Streptococcus pneumoniae and Haemophilus influenzae as the most important causes of severe pneumonia, sepsis or meningitis in children less than two years of age, and Salmonella typhi as the most frequent significant isolate from the blood cultures, being found most often in school age children and young adults.