EID Journal Home > Volume 17, Number 6–June 2011
Volume 17, Number 6–June 2011
Invasive Streptococcus pneumoniae in Children, Malawi, 2004–2006
Jennifer E. Cornick, Dean B. Everett, Caroline Broughton, Brigitte B. Denis, Daniel L. Banda, Enitan D. Carrol, and Christopher M. Parry
Author affiliations: Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi (J.E. Cornick, D.B. Everett, B.B. Denis, D.L. Banda, E.D. Carrol); University of Liverpool, Liverpool, UK (J.E. Cornick, D.B. Everett, C. Broughton, E.D. Carrol, C.M. Parry); University of Malawi College of Medicine, Blantyre (D.L. Banda); and Angkor Hospital for Children, Siem Reap, Cambodia (C.M. Parry)
Suggested citation for this article
Of 176 invasive Streptococcus pneumoniae isolates from children in Malawi, common serotypes were 1 (23%), 6A/B (18%), 14 (6%), and 23F (6%). Coverage with the 7-valent pneumococcal conjugate vaccine (PCV) was 39%; PCV10 and PCV13 increased coverage to 66% and 88%, respectively. We found chloramphenicol resistance in 27% of isolates and penicillin nonsusceptibility in 10% (by using meningitis breakpoints); all were ceftriaxone susceptible.
Streptococcus pneumoniae causes a spectrum of disease, ranging from relatively mild otitis media to life-threatening pneumonia, meningitis, and septicemia. Recent estimates suggest that pneumococcal disease is responsible for 1 million deaths annually, >800,000 of which are in children <5 years of age in the developing world (1). Developing countries have the highest incidence of pneumococcal disease, and the spread of HIV, which increases the risk for pneumococcal disease up to 40-fold, has exacerbated the situation (2). In Malawi, in southern Africa, S. pneumoniae is 1 of the most common organisms isolated from blood and cerebrospinal fluid (CSF) cultures of children admitted to the hospital, and the case-fatality rate for invasive pneumococcal disease (IPD), pneumonia, septicemia, and meningitis is ≈25% (3,4).
The successful introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) in several industrialized nations has led to plans to extend its use to sub-Saharan Africa (2). PCV7 contains the most commonly isolated 7 serotypes from IPD in children in the United States before vaccine implementation. However, these 7 serotypes account for <50% of IPD isolates from children in Africa (5). Surveillance of circulating serotypes is therefore essential information for developing policy about vaccine introduction.
In the United States, PCV7 has successfully reduced the incidence of IPD and antimicrobial drug resistance in vaccine serotypes; however, this decrease paralleled an increase in the incidence of IPD caused by nonvaccine serotypes, among which antimicrobial drug resistance is increasing (6). Resistance to penicillin and other antimicrobial agents in pneumococci complicates clinical management (7). Previous data from Malawi suggest that penicillin resistance in IPD is relatively low (8–11).
We report the serotypes of pneumococcal isolates from febrile children admitted to the largest hospital in Blantyre, Malawi, during April 2004–October 2006. We also report susceptibilities to antimicrobial drugs used to treat IPD.
Invasive Streptococcus pneumoniae in Children | CDC EID
Suggested Citation for this Article
Cornick JE, Everett DB, Broughton C, Denis BB, Banda DL, Carrol ED, et al. Invasive Streptococcus pneumoniae in children, Malawi, 2004–2006. Emerg Infect Dis [serial on the Internet]. 2011 Jun [date cited]. http://www.cdc.gov/EID/content/17/6/1107.htm
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Jennifer E. Cornick, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, PO Box 30096, Chichiri, Blantyre 3, Malawi; email: email@example.com