Saha Samir K, Hossain Belal, Islam Maksuda, Hasanuzzaman Md, Saha Shampa, Hasan Mohammad, Darmstadt Gary L, Chowdury Mrittika, Arifeen Shams El, Baqui Abdullah H, Breiman Robert F, Santosham Mathuram, Luby Stephen P, Whitney Cynthia G
From the *Child Health Research Foundation, Department of Microbiology, Bangladesh Institute of Child Health, Dhaka Shishu Hospital, Dhaka, Bangladesh; †Division of Neonatal and Developmental Medicine, Stanford University, Stanford, California; ‡Department of Child and Adolescent Health, ICDDR, B, Dhaka, Bangladesh; §Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; ¶Emory Global Health Institute, Emory University, Atlanta, Georgia; ‖Center for Innovation in Global Health, Stanford University, Stanford, California; and **Centers for Disease Control and Prevention, Atlanta, Georgia.
Pediatr Infect Dis J. 2016 Jun;35(6):655-61. doi: 10.1097/INF.0000000000001037.
Because Bangladesh intended to introduce pneumococcal conjugate vaccine (PCV)-10 in 2015, we examined the baseline burden of invasive pneumococcal disease (IPD) to measure impact of PCV.
During 2007-2013, we performed blood and cerebrospinal fluid cultures in children <5 years old with suspected IPD identified through active surveillance at 4 hospitals. Isolates were serotyped by quellung and tested for antibiotic susceptibility by disc diffusion and E-test. Serotyping of culture-negative cases, detected by Binax or polymerase chain reaction, was done by sequential multiplex polymerase chain reaction. Trends in IPD case numbers were analyzed by serotype and clinical syndrome.
The study identified 752 IPD cases; 78% occurred in children <12 months old. Serotype information was available for 78% (442/568), including 197 of 323 culture-negative cases available for serotyping. We identified 50 serotypes; the most common serotypes were 2 (16%), 1 (10 %), 6B (7%), 14 (7%) and 5 (7%). PCV-10 and PCV-13 serotypes accounted for 46% (range 29%-57% by year) and 50% (range 37%-64% by year) of cases, respectively. Potential serotype coverage for meningitis and nonmeningitis cases was 45% and 49% for PCV-10, and 48% and 57% for PCV-13, respectively. Eighty-two percent of strains were susceptible to all antibiotics except cotrimoxazole.
The distribution of serotypes causing IPD in Bangladeshi children is diverse, limiting the proportion of IPD cases PCV can prevent. However, PCV introduction is expected to have major benefits as the country has a high burden of IPD-related mortality, morbidity and disability.
由于孟加拉国计划在2015年引入10价肺炎球菌结合疫苗（PCV），我们调查了侵袭性肺炎球菌疾病（IPD）的基线负担，以评估PCV的影响。
在2007年至2013年期间，我们对4家医院通过主动监测确定的疑似IPD的5岁以下儿童进行了血液和脑脊液培养。分离株通过荚膜肿胀试验进行血清分型，并通过纸片扩散法和E试验检测抗生素敏感性。通过Binax或聚合酶链反应检测到的培养阴性病例的血清分型通过序列多重聚合酶链反应进行。按血清型和临床综合征分析IPD病例数的趋势。
该研究共识别出752例IPD病例；78%发生在12个月以下的儿童中。78%（442/568）的病例有血清型信息，其中323例培养阴性病例中有197例可进行血清分型。我们识别出50种血清型；最常见的血清型为2型（16%）、1型（10%）、6B型（7%）、14型（7%）和5型（7%）。PCV-10和PCV-13血清型分别占病例的46%（每年范围为29%-57%）和50%（每年范围为37%-64%）。PCV-10对脑膜炎和非脑膜炎病例的潜在血清型覆盖率分别为45%和49%，PCV-13分别为48%和57%。82%的菌株对除复方新诺明外的所有抗生素敏感。
在孟加拉国儿童中引起IPD的血清型分布多样，限制了PCV可预防的IPD病例比例。然而，由于该国IPD相关的死亡率、发病率和残疾负担较高，引入PCV预计将带来重大益处。
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