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Streptococcus pneumoniae serotype 19A in Latin America and the Caribbean: a systematic review and meta-analysis, 1990-2010.

Castañeda E, Agudelo CI, De Antonio R, Rosselli D, Calderón C, Ortega-Barria E, Colindres RE - BMC Infect. Dis. (2012)

Bottom Line: Experience in developed countries has shown that they reduce the incidence of invasive and non-invasive disease.However, there is evidence that the introduction of PCVs in universal mass vaccination programs, combined with inappropriate and extensive use of antibiotics, could be associated to changes in non-PCV serotypes, including serotype 19A.Before widespread PCV implementation in this region, serotype 19A was responsible for a relatively small number of pneumococcal disease cases.

View Article: PubMed Central - HTML - PubMed

Affiliation: Instituto Nacional de Salud Bogotá, Bogotá, Colombia. ecastaneda21@gmail.com

ABSTRACT

Background: Pneumococcal conjugate vaccines (PCVs) are in the process of implementation in Latin America. Experience in developed countries has shown that they reduce the incidence of invasive and non-invasive disease. However, there is evidence that the introduction of PCVs in universal mass vaccination programs, combined with inappropriate and extensive use of antibiotics, could be associated to changes in non-PCV serotypes, including serotype 19A. We conducted a systematic review to determine the distribution of serotype 19A, burden of pneumococcal disease and antibiotic resistance in the region.

Methods: We performed a systematic review of serotype 19A data from observational and randomized clinical studies in the region, conducted between 1990 and 2010, for children under 6 years. Pooled prevalence estimates from surveillance activities with confidence intervals were calculated.

Results: We included 100 studies in 22 countries and extracted data from 63. These data reported 19733 serotyped invasive pneumococcal isolates, 3.8% of which were serotype 19A. Serotype 19A isolates were responsible for 2.4% acute otitis media episodes, and accounted for 4.1% and 4.4% of 4,380 nasopharyngeal isolates from healthy children and in hospital-based/sick children, respectively. This serotype was stable over the twenty years of surveillance in the region. A total of 53.7% Spn19A isolates from meningitis cases and only 14% from non meningitis were resistant to penicillin.

Conclusions: Before widespread PCV implementation in this region, serotype 19A was responsible for a relatively small number of pneumococcal disease cases. With increased use of PCVs and a greater number of serotypes included, monitoring S. pneumoniae serotype distribution will be essential for understanding the epidemiology of pneumococcal disease.

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Streptococcus pneumoniae serotype 19A distribution of invasive isolates SIREVA data, 2000–2005, 2006, 2007, 2008, 2009.
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Figure 2: Streptococcus pneumoniae serotype 19A distribution of invasive isolates SIREVA data, 2000–2005, 2006, 2007, 2008, 2009.

Mentions: The prevalence of Spn19A in the region, by country and by time period is shown in Table 3. Spn19A accounted for 3.3% (CI95%: 1.8–4.9) of isolates between 1993 and 1999, 3.6% (CI95%: 2.3–4.9) between 2000 and 2005 and 4.6% (CI95%: 3.4–5.8) between 2006 and 2009 (χ2 10.8, p < 0.001). The prevalence of serotypes recorded from SIREVA data collected during the three time periods presented by vaccine type (VT) (PCV7, PCV10, PCV13) and non vaccine type (NVT), as well as Spn19A, prevalence by region (SIREVA) (Average cases by study period (2000–2005 vs. 2006 – 2009) is shown in Additional file 4. Analysis by SIREVA reports are presented in Figure 2.


Streptococcus pneumoniae serotype 19A in Latin America and the Caribbean: a systematic review and meta-analysis, 1990-2010.

Castañeda E, Agudelo CI, De Antonio R, Rosselli D, Calderón C, Ortega-Barria E, Colindres RE - BMC Infect. Dis. (2012)

Streptococcus pneumoniae serotype 19A distribution of invasive isolates SIREVA data, 2000–2005, 2006, 2007, 2008, 2009.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3475047&req=5

Figure 2: Streptococcus pneumoniae serotype 19A distribution of invasive isolates SIREVA data, 2000–2005, 2006, 2007, 2008, 2009.
Mentions: The prevalence of Spn19A in the region, by country and by time period is shown in Table 3. Spn19A accounted for 3.3% (CI95%: 1.8–4.9) of isolates between 1993 and 1999, 3.6% (CI95%: 2.3–4.9) between 2000 and 2005 and 4.6% (CI95%: 3.4–5.8) between 2006 and 2009 (χ2 10.8, p < 0.001). The prevalence of serotypes recorded from SIREVA data collected during the three time periods presented by vaccine type (VT) (PCV7, PCV10, PCV13) and non vaccine type (NVT), as well as Spn19A, prevalence by region (SIREVA) (Average cases by study period (2000–2005 vs. 2006 – 2009) is shown in Additional file 4. Analysis by SIREVA reports are presented in Figure 2.

Bottom Line: Experience in developed countries has shown that they reduce the incidence of invasive and non-invasive disease.However, there is evidence that the introduction of PCVs in universal mass vaccination programs, combined with inappropriate and extensive use of antibiotics, could be associated to changes in non-PCV serotypes, including serotype 19A.Before widespread PCV implementation in this region, serotype 19A was responsible for a relatively small number of pneumococcal disease cases.

View Article: PubMed Central - HTML - PubMed

Affiliation: Instituto Nacional de Salud Bogotá, Bogotá, Colombia. ecastaneda21@gmail.com

ABSTRACT

Background: Pneumococcal conjugate vaccines (PCVs) are in the process of implementation in Latin America. Experience in developed countries has shown that they reduce the incidence of invasive and non-invasive disease. However, there is evidence that the introduction of PCVs in universal mass vaccination programs, combined with inappropriate and extensive use of antibiotics, could be associated to changes in non-PCV serotypes, including serotype 19A. We conducted a systematic review to determine the distribution of serotype 19A, burden of pneumococcal disease and antibiotic resistance in the region.

Methods: We performed a systematic review of serotype 19A data from observational and randomized clinical studies in the region, conducted between 1990 and 2010, for children under 6 years. Pooled prevalence estimates from surveillance activities with confidence intervals were calculated.

Results: We included 100 studies in 22 countries and extracted data from 63. These data reported 19733 serotyped invasive pneumococcal isolates, 3.8% of which were serotype 19A. Serotype 19A isolates were responsible for 2.4% acute otitis media episodes, and accounted for 4.1% and 4.4% of 4,380 nasopharyngeal isolates from healthy children and in hospital-based/sick children, respectively. This serotype was stable over the twenty years of surveillance in the region. A total of 53.7% Spn19A isolates from meningitis cases and only 14% from non meningitis were resistant to penicillin.

Conclusions: Before widespread PCV implementation in this region, serotype 19A was responsible for a relatively small number of pneumococcal disease cases. With increased use of PCVs and a greater number of serotypes included, monitoring S. pneumoniae serotype distribution will be essential for understanding the epidemiology of pneumococcal disease.

Show MeSH
Related in: MedlinePlus