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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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a Serotype 19A meta-analysis of invasive isolates. b Serotype 19A meta-analysis of AOM isolates. c Serotype 19A meta-analysis healthy nasopharyngeal carriers. d Serotype 19A meta-analysis sick carriers.
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Figure 3: a Serotype 19A meta-analysis of invasive isolates. b Serotype 19A meta-analysis of AOM isolates. c Serotype 19A meta-analysis healthy nasopharyngeal carriers. d Serotype 19A meta-analysis sick carriers.

Mentions: For invasive disease, our analysis of the data shows 1% prevalence overall for this serotype, ranging from 0.03% in Argentina to 9.2% in Mexico [27-33] (Figure 3a).


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)

a Serotype 19A meta-analysis of invasive isolates. b Serotype 19A meta-analysis of AOM isolates. c Serotype 19A meta-analysis healthy nasopharyngeal carriers. d Serotype 19A meta-analysis sick carriers.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: a Serotype 19A meta-analysis of invasive isolates. b Serotype 19A meta-analysis of AOM isolates. c Serotype 19A meta-analysis healthy nasopharyngeal carriers. d Serotype 19A meta-analysis sick carriers.
Mentions: For invasive disease, our analysis of the data shows 1% prevalence overall for this serotype, ranging from 0.03% in Argentina to 9.2% in Mexico [27-33] (Figure 3a).

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