Active Epidemiologic Surveillance of Pneumonia and Invasive Pneumococcal Disease in Ambulatory and Hospitalized Infants in Cordoba, Argentina

Tregnaghi, Miguel; Ceballos, Ana; Rüttimann, Ricardo; Ussher, José; Tregnaghi, Pablo; Peeters, Pascal; Hausdorff, William P.

doi:10.1097/01.inf.0000208368.67448.51

Cited by 41 publications

(33 citation statements)

References 14 publications

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“…Serotypes 14, 5 and 1 accounted for more than half of all identified serotypes, as observed in most Latin American countries. 2,5,9,13 Although serotypes 3 and 4, which are included in the PCV13, were not found in our cases, the vaccine does include most circulating serotypes related to resistance, except for 23B, which is less prevalent. Therefore, it is expected that the PCV13, recently introduced in Argentina, will achieve a major reduction in IPDs, as documented in other countries that introduced the 7-valent pneumococcal conjugate vaccine (PCV7).…”

Section: Discussionmentioning

confidence: 70%

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Nineteen-years of pneumococcal invasive disease surveillance in a children’s hospital in Mendoza, Argentina

2014

Arch Argent Pediat

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Five hundred and thirty-seven children admitted to Hospital Dr. Notti and diagnosed with invasive pneumococcal disease between 1993 and 2011 were studied. Their median age was 19 months (range= 0-192 months); 34.82% were <1 year old and 23.46%, ≥60 months old. Pneumonia with or without effusion (48.04%) and meningitis (29.05%) were the most predominant conditions, with a case fatality rate of 6.14%. Identified serotypes corresponded to 14, 5 and 1 in 56.86% of cases. Sensitivity to penicillin was observed in 99.74% of non-meningeal strains, while sensitivity to ceftriaxone was found in 98.08% of meningeal strains. Risk factors in pneumonia with effusion were associated to age ≥60 months old, RR: 1.47 (1.06-2.04), p= 0.02, to serotype 5, RR: 2.57 (1.71-3.87), p= 0.0001, and to serotype 1, RR: 1.86 (1.17-2.96), p= 0.014; in the case of meningitis, risk factors were mainly associated to age <1 year old, RR: 2.35 (1.87-3.06), p= 0.0000, and to serotype 18C, RR: 2.19 (1.3-3.7), p= 0.024. Conclusion. Streptococcus pneumonia was a major problem in infants younger than one year old, who predominantly developed meningitis which caused half of deaths, and in children older than 60 months old, who had a prevalence of pneumonia with effusion. Most cases were sensitive to penicillin and ceftriaxone. 1990 and 2006 showed that between 12 000 and 28 000 children younger than 5 years old could die every year because of this disease. 2 S e r o t y p e s t h a t c a u s e m o s t i n v a s i v e pneumococcal diseases (IPDs) show variations in terms of geographic regions and type of disease, 3 in addition to changes in antimicrobial susceptibility, specially to penicillin and thirdgeneration cephalosporins. 4 In Argentina, according to data collected by the Surveillance System for Bacterial Agents Responsible for Pneumonia and Meningitis (SIREVA), 2012, 79.2% of identified meningitis strains and 100% of nonmeningeal strains were sensitive to penicillin in children younger than 5 years old. In the case of ceftriaxone, 94.3% were sensitive in meningitis, with an intermediate sensitivity (IS) of 5.7%, while 98.5% were sensitive in non-meningeal conditions, with an IS of 1.5%. 5 In 2012 (Resolution 502/2011), Argentina introduced the 13-valent pneumococcal conjugate vaccine (PCV13) to the immunization schedule for infants as of 2 months old. 6 Knowing the epidemiology of IPD, the distribution of serotypes and antimicrobial susceptibility is essential to assess the potential impact of an immunization program. OBJECTIVESTo describe the epidemiological characteristics of hospitalized patients with IPD and to detect risk factors for IPD. POPULATION AND METHODSObservational, analytical and retrospective study conducted between January 1993 and December 2011.All patients with confirmed IPD diagnosis admitted to Hospital Pediátrico Dr. Humberto Notti, Mendoza, were selected. Confirmed IPD was defined as isolation of Spn in typically sterile liquid and a compatible clinical presentation.Medical records were reviewed using the files ...

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Section: Discussionmentioning

confidence: 70%

“…For this reason, prevalent conditions were meningitis and pneumonia with and without effusion, with a low frequency of bacteremias. 9 This was also a limitation when analyzing the relative risk of having a certain age in relation to the different clinical presentations since the study included only seriously ill children.…”

Section: Discussionmentioning

confidence: 99%

Nineteen-years of pneumococcal invasive disease surveillance in a children’s hospital in Mendoza, Argentina

2014

Arch Argent Pediat

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“…Por dicho motivo, predominaron meningitis, neumonía con y sin derrame, y se observó baja frecuencia de bacteriemias. 9 Esta situación también fue una limitante cuando analizamos el riesgo relativo que implicaba la edad para las diversas formas clínicas de presentación, ya que solo incluimos los niños con enfermedad grave. No obstante, al igual que la bibliografía de América Latina y el Caribe, 2,10 la mayor incidencia se observó en varones menores de un año, en quienes se asoció el riesgo más alto para meningitis [RR 2,35 (1,87-30,6), p 0,0000] y para serotipos 19F y 19A.…”

Section: Discussionunclassified

Diecinueve años de vigilancia de enfermedad invasiva neumocócica en un hospital pediátrico de Mendoza, Argentina

2014

Arch Argent Pediat

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“…En nuestro país, los estudios poblacionales estimaron una incidencia anual de la enfermedad invasiva similar a la de otros países antes de la implementación de la vacunación universal. 8 La incidencia informada en la bibliografía de enfermedad invasiva por S. pneumoniae es mayor en los menores de 2 años y en los pacientes inmunodeprimidos. 1 Sin embargo, en la serie del Hospital Nacional de Pediatría "Prof. Dr. Juan P. Garrahan" predominaron los mayores de 2 años, hecho probablemente relacionado con las características de la población del hospital (enfermos crónicos, pacientes con enfermedades oncohematológicas, inmunodeficiencias y cardiopatías).…”

Section: Discussionunclassified

Infecciones invasivas por Streptococcus pneumoniae en un hospital pediátrico de tercer nivel antes de la introducción de la vacuna conjugada. Características clínicas y serotipos involucrados

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Active Epidemiologic Surveillance of Pneumonia and Invasive Pneumococcal Disease in Ambulatory and Hospitalized Infants in Cordoba, Argentina

Cited by 41 publications

References 14 publications

Nineteen-years of pneumococcal invasive disease surveillance in a children’s hospital in Mendoza, Argentina

Nineteen-years of pneumococcal invasive disease surveillance in a children’s hospital in Mendoza, Argentina

Diecinueve años de vigilancia de enfermedad invasiva neumocócica en un hospital pediátrico de Mendoza, Argentina

Infecciones invasivas por Streptococcus pneumoniae en un hospital pediátrico de tercer nivel antes de la introducción de la vacuna conjugada. Características clínicas y serotipos involucrados

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