Invasive Pneumococcal Disease among Children in Rural Bangladesh: Results from a Population-Based Surveillance
Invasive Pneumococcal Disease among Children in Rural Bangladesh: Results from a Population-Based Surveillance
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DOI：
10.1086/596543
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发表时间：
2009-03-01
影响因子：
11.8
通讯作者：
Luby, Stephen P.
中科院分区：
文献类型：
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作者：
Arifeen, Shams E.;Saha, Samir K.;Luby, Stephen P.
背景肺炎链球菌感染被认为是全球优先的公共卫生问题，结合疫苗已被证明可以预防儿童的疫苗型侵袭性肺炎球菌病（IPD）。然而，需要更好地估计疾病负担和可靠的基于人群的血清型组成的数据，以在发展中国家的疫苗开发和实施。我们在孟加拉国农村社区米尔扎布尔启动了一项基于人口的监测，覆盖人口约为144 000人。在研究地区，村保健工作者每周访问约12 000名1-59个月的儿童。报告发烧、咳嗽或呼吸困难的儿童由村卫生保健工作者使用临床算法进行评估，并在需要时转诊到医院。来自研究地区的儿童在医院接受临床检查和实验室检测，如果他们符合标准化的病例定义。血液和/或脑脊液培养结果证实了IPD。根据标准实验室方法鉴定分离株，检测对抗生素的敏感性，并进行血清分型。我们在这里介绍的结果，从第一个3年的监测（2004年7月至2007年6月）。村卫生保健工作者确定了5020例可能的严重肺炎和/或非常严重的疾病（每1 000儿童年165例）和9 411例可能的肺炎（每1000儿童年310例）以及2029例疑似脑膜炎和/或非常严重的疾病（67例/1000儿童年）和8967例高热和/或可能的菌血症（295例/1000儿童年）。在2596例住院病例中，肺炎是最常见的单一疾病形式（977例[38%]病例中发现）。我们找到了26个S肺炎分离株（25株来自6925份血培养物，1株来自41份脑脊液培养物），总体IPD发病率为86例/100，000儿童年。侵袭性肺炎球菌感染常见于婴儿期（26例中有23例为婴儿），总分离株的50%来自诊断为上呼吸道感染和发热的非住院患者。最流行的肺炎球菌血清型是血清型1、5、14、18 C、19 A和38。26株分离株中，10株对复方新诺明完全耐药，10株中度耐药。传染病是孟加拉国农村儿童发病率的主要原因。S.肺炎可引起儿童侵袭性但不严重的疾病，如果忽视此类病例，IPD发病率可能严重低估。新出现的对甲氧苄啶-磺胺甲恶唑的高度耐药性应予以解决。血清型分布数据将有助于指导适当的肺炎球菌结合疫苗配方。
Background. Streptococcus pneumoniae infection is recognized as a global priority public health problem, and conjugate vaccines have been shown to prevent vaccine-type invasive pneumococcal disease (IPD) in children. However, better estimates of the disease burden and reliable population-based data on serotype composition are needed for vaccine development and implementation in developing countries.Methods. We initiated a population-based surveillance in the rural Bangladesh community of Mirzapur, covering a population of similar to 144,000. Village health care workers made weekly visits to similar to 12,000 children 1-59 months of age in the study area. Children with reported fever, cough, or difficulty breathing were assessed by the village health care workers using a clinical algorithm and were referred to the hospital if required. Children from the study area who were seen in the hospital underwent clinical examination and laboratory testing if they met standardized case definitions. IPD was confirmed by blood and/or cerebrospinal fluid culture results. Isolates were identified, tested for susceptibility to antibiotics, and serotyped in accordance with standard laboratory methods. We present here the results from the first 3 years of the surveillance (July 2004-June 2007).Results. Village health care workers identified 5020 cases of possible severe pneumonia and/or very severe disease (165 cases per 1000 child-years) and 9411 cases of possible pneumonia (310 cases per 1000 child-years) as well as 2029 cases of suspected meningitis and/or very severe disease (67 cases per 1000 child-years) and 8967 cases of high fever and/or possible bacteremia (295 cases per 1000 child-years). Pneumonia was the single most common form of illness observed among 2596 hospitalizations (found in 977 [38%] of cases). We recovered 26 S. pneumoniae isolates (25 isolates from 6925 blood cultures and 1 isolate from 41 cerebrospinal fluid cultures), which gave an overall IPD incidence of 86 cases per 100,000 child-years. Invasive pneumococcal infection was common during infancy (with infants accounting for 23 of the 26 cases), and 50% of the total isolates were obtained from nonhospitalized patients who received a diagnosis of upper respiratory tract infection and fever. The most prevalent pneumococcal serotypes were serotypes 1, 5, 14, 18C, 19A, and 38. Ten of the 26 isolates were completely resistant to trimethoprim-sulfamethoxazole, and another 10 isolates had intermediate resistance.Conclusions. IPD contributes substantially to childhood morbidity in rural Bangladesh. S. pneumoniae can cause invasive but nonsevere disease in children, and IPD incidence can be seriously under reported if such cases are overlooked. The emerging high resistance to trimethoprim-sulfamethoxazole should be addressed. Data on serotype distribution would help to guide appropriate pneumococcal conjugate vaccine formulation.