IPD and pneumonia are important causes of morbidity in children of Bangalore
South Zone, India.
Highest incidence of IPD o...
of 1

presented at ESPID PNEUMONET

Published on: Mar 4, 2016

Transcripts - presented at ESPID PNEUMONET

  • 1. IPD and pneumonia are important causes of morbidity in children of Bangalore South Zone, India. Highest incidence of IPD observed in our study was in children aged 6 months to <12 months (46.01 per 100,000 children). The most common IPD was pneumonia, which occurred in 12 of 17 subjects (10.67 per 100,000). ClinPn incidence and CXR+Pn incidence were highest in children aged <6 months (ClinPn 4,800.88 and CXR+Pn 1,771.32 per 100,000 children, respectively). Overall incidence was 2,107.87 and 983.25 per 100,000 children. Salmonella sp. was the most frequently isolated pathogen in children aged <5 years. There were some limitations in the calculation of the at-risk population (denominator for incidence rates calculation) used in this study that may lead to an underestimation of the incidence rates. Continuing surveillance is crucial to evaluating the pneumococcal disease burden, and the evolution of SP serotype distribution and antibiotic resistance in children aged <5 years in India. CONCLUSIONS Presented at the 29th Annual Meeting of the European Society for Paediatric Infectious Diseases (ESPID), 7–11 June 2011, The Hague, Netherlands. Prospective, Multinational, Active, Hospital-Based Epidemiologic Surveillance for IPD and Pneumonia Burden Among Children in Bangalore South Zone, Bangalore, India Ramalinge Gowda Nisarga1 , Ivana Balter2 , Ramaswamy Premalatha3 , Munirathnam Govindaraj4 , Ranjith Batuwanthudawe5 , Michele Moscariello6 , Robin Hubler6 , Jian Ye7 , Paul Kilgore5 , Seok Woo Kim5 Kadahalli Lingegowda Ravikumar1 , Usha Shivappa1 1 Kempegowda Institute of Medical Sciences Hospital, Bangalore, India; 2 3 Vani Vilas Hospital, Bangalore, India; 4 Indira Gandhi Institute of Child Health, Bangalore, India; 5 International Vaccine Institute, Seoul, Korea; 6 7 Cambridge Group, On Assignment, Westport, CT, USA To estimate incidence rates of IPD and pneumonia, as well as serotype distribution and antibiotic susceptibility of SP in children 28 days to <60 months in a target population in India, served by 3 hospitals in Bangalore South Zone (Kempegowda Institute of Medical Sciences Hospital, Vani Villas Hospital, and Indira Gandhi Institute of Child Health). Streptococcus pneumoniae (SP) is a major cause of invasive pneumococcal disease (IPD) in children worldwide. Data on IPD in India are scarce, with most studies based on the passive microbiology laboratory surveillance of hospitalized patients. This study, Pneumonet (Pan Asia Epidemiologic surveillance network to assess the burden of invasive pneumococcal disease), was conducted to estimate the incidence of IPD and pneumonia, and the pneumococcal serotype distribution and antibiotic susceptibility in 4 Asian countries – India, Thailand, Indonesia, and the Philippines. OBJECTIVE INTRODUCTION A total of 5,249 subjects were enrolled into the study from the calculated at-risk population of 112,483 children aged between 28 days and <60 months who resided within the catchment area in Bangalore South Zone, India. Mean age was 19.8 months and 66.5% of subjects were aged 28 days to <24 months (Table 1). Overall, 17 children were diagnosed with IPD. Prior pneumococcal conjugate vaccination occurred in 0.3% of all enrolled subjects and none of the IPD cases. Hospitalization was required for 17.5% of the subjects enrolled and occurred more commonly in those aged Incidence rates 17 subjects with IPD resulted in an overall estimated incidence rate for IPD of 15.11 per 100,000 children. Six of the 17 cases occurred in subjects aged 6 months to <12 months, resulting in an estimated incidence rate of 46.01 per 100,000 for this age group (Table 2). Final IPD cases observed were pneumonia in 12 subjects, meningitis in 3 subjects, and bacteraemia in 2 subjects. The overall estimated incidence rates for pneumonia, meningitis, and bacteraemia were 10.67, 2.67, and 1.78 per 100,000 children, respectively The estimated incidence rates by age group for ClinPn and CXR+Pn are shown in Table 4. Highest estimated incidence rates observed were for children aged 28 days to <6 months in both groups. Risk factors and population characteristic observations Exposure to smoke from cooking: 7/41.2% of subjects with IPD and 1283/24.5% overall.* Breastfed for <2 months: 3/17.6% of subjects with IPD and 654/12.5% overall. Antibiotic use within prior 7 days: 2/12.5% of subjects with IPD and 1060/20.4% overall. Urban residence:17/100.0% of subjects with IPD and 5,227/99.6% of all enrolled. Bacteriology Overall, positive culture growth was obtained in 432 (8.2%) of the 5,249 enrolled subjects. Percentages of total growth were as follows: Salmonella sp. 60 (13.9%); SP 27 (6.3%); Staphylococcus hominis 41 (9.5%); Micrococcus sp. 32 (7.4%); Staphylococcus epidermidis 24 (5.6%); Staphylococcus aureus 19 (4.4%). SP was detected and serotype information obtained in 17 subjects (N=18 serotypes). In 1 subject isolates grown from CSF and blood were of 2 different serotypes (CSF=6A and blood=3). The distribution of the serotypes isolated is shown in Table 3; 6A and 5 were seen most frequently. 7-, 10-, and 13-valent pneumococcal vaccine serotype coverage was 27.77%, 55.55%, and 100%, respectively. Four of the 18 isolates were resistant to trimethoprim/sulfamethoxazole, 3 to erythromycin, and 1 to ceftriaxone. Antibiotic resistance was observed for serotypes 6A, 14, 1, 3, and 19A. RESULTS Study description Two-year active, prospective, hospital-based surveillance study of IPD and pneumonia in children aged 28 days to <60 months presenting at 1 of 3 hospitals in Bangalore South Zone, India. Data presented here are interim data and are from the first-calendar year of surveillance: 27 February 2009 to 26 February 2010. Calculation of the at-risk population: – only hospitals with >100 beds were included in the adjustment of at-risk population, which may result in underestimation of incidence rates. Moreover, the number of total beds may not provide an accurate estimate of healthcare utilization for children aged <5 years with pneumonia symptoms in the catchment area. – the catchment area may have different age and gender distributions than the Karnataka state and, therefore, age- and populations may be over- or underestimated. Eligibility criteria Children residing within the catchment area aged 28 days to ≤36 months with a measured temperature or history of measured temperature ≥39.0°C in prior to screening, or clinical suspicion of pneumonia, meningitis, sepsis, or other IPD regardless of temperature; or children aged >36 months to <60 months with clinical suspicion of pneumonia, meningitis, sepsis, or other IPD regardless of temperature. Samples obtained at enrollment A blood specimen was collected upon enrollment for all subjects. Cerebrospinal (CSF) was collected for culture from all subjects with suspected meningitis who did not have contraindications for lumbar puncture. Specimens from other sterile sites (e.g. pleural were collected as per routine medical practice. All samples underwent bacterial culture at the local laboratory, according to standard methodology, for identification of pathogens and reported microbiologic results as per their standard operating procedures. SP isolates were subcultured and sent to the central laboratory for confirmation of identification, serotyping and susceptibility testing. A chest radiograph (CXR) was obtained for children with clinically suspected pneumonia. Invasive pneumococcal disease = of SP from a sterile body site. pneumococcal meningitis = isolation of SP by culture from the CSF or from a blood culture of a subject with >10 white blood cells/µL on examination of CSF and CSF protein >100 mg/dL; or CSF glucose <40 mg/dL or glucose CSF–serum ratio <0.6; or a positive result from a non- culture technique for of SP in the CSF. Probable pneumococcal meningitis = CSF with gram-positive cocci and/or a positive latex agglutination test for SP in subjects with CSF compatible with meningitis; or isolation of SP in the blood by culture or non-culture technique for of SP in a subject admitted with suspected meningitis, but lacking CSF characteristics for pneumococcal meningitis or CSF not obtained. Clinical pneumonia (ClinPn) = presence of clinical signs and symptoms consistent with pneumonia. pneumonia (CXR+Pn) = presence of lobar consolidation and/or pleural effusion on CXR. Incidence Rate Calculations Incidence rates with 95% interval (CI) were determined based on numbers of cases by the current study and the at-risk population for 3 hospitals in the catchment area: – at-risk populations (denominator for incidence rates calculation) were calculated based upon data from the National Polio Surveillance Project with age and gender breakdown based on the Demographic and Health Survey for the state of Karnataka, which included the catchment area. – the at-risk population was also adjusted for the presence of other hospitals with >100 beds in the catchment area. Research reported on this poster was supported by Wyeth Pharmaceuticals, which was acquired by Inc in October 2009. Medical writing support for this poster was provided by Elaine Santiago of Excerpta Medica and funded by Inc. ACKNOWLEDGMENTS DISCLOSURES METHODS Table 4. Incidence Rates of ClinPn and CXR+Pn ClinPn CXR+Pn Age Number of cases Incidence rate per 100,000 children* (95% CI) Number of cases Incidence rate per 100,000 children* (95% CI) 28 days to <6 months 393 4,800.88 (4,337.90–5,299.81) 145 1,771.32 (1,494.75–22,084.23) 6 months to <12 months 499 3,826.69 (3,495.25–4,177.65) 214 1,641.10 (1,428.58–1,876.33) 12 months to <24 months 627 2,752.78 (2,541.50–3,976.94) 318 1,396.15 (1,246.90–1,558.34) 24 months to <36 months 384 1,708.95 (1,542.27–1,888.72) 175 778.82 (667.70–903.14) 36 months to <60 months 468 1,017.17 (927.09–1,113.64) 254 552.05 (486.24–624.29) Overall 2,371 2,107.87 (2,023.87–2,194.47) 1,106 983.26 (926.16–1,042.96 ) *Calculated using number of cases divided by number in at-risk population. Table 1. Demographics of Enrolled Children Variable N=5,249 Mean±SD age, months 19.8±13.9 Age group, n (%) 28 days to <6 months 806 (15.4) 6 months to <12 months 1,132 (21.6) 12 months to <24 months 1,551 (29.5) 24 months to <36 months 1,082 (20.6) 36 months to <60 months 678 (12.9) Gender, n (%) Male 2,901 (55.3) Female 2,348 (44.7) SD = standard deviation. Table 2. Incidence Rates of IPD by Age Group Age group Number of cases No. in at-risk population Incidence rate per 100,000 children* (95% CI) 28 days to <6 months 3 8,186 36.65 (7.56–107.10) 6 months to <12 months 6 13,040 46.01 (16.89–100.15) 12 months to <24 months 3 22,777 13.17 (2.72–38.49) 24 months to <36 months 4 22,470 17.80 (4.85–45.58) 36 months to <60 months 1 46,010 2.17 (0.06–12.11) Overall 17 112,483 15.11 (8.80–24.20) *Calculated using number of cases divided by number in at-risk population. Table 3. Serotype Distribution and Antibiotic Resistance of IPD Isolates From Children Aged 28 Days to <60 Months (18 Isolatesa ) Serotype n Antibiotic resistanceb 6A 5 Erythromycin (2 isolates) Ceftriaxone (1 isolate) 5 3 1 2 Trimethoprim/sulfamethoxazole (1 isolate) 3 2 Trimethoprim/sulfamethoxazole (1 isolate) 14 2 Erythromycin (1 isolate) Trimethoprim/sulfamethoxazole (1 isolate) 9V 1 19F 1 18C 1 19A 1 Trimethoprim/sulfamethoxazole (1 isolate) a 1 subject 2 different serotypes were obtained from blood/CSF (6A in CSF and 3 in blood). *denominator based on non missing values b Antibiotic susceptibility was determined for 17 isolates only.

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