Anand Manoharan1, Vikas Manchanda2, Sundaram Balasubramanian3, Sanjay Lalwani4, Meera Modak5, Sushama Bai6, Ajith Vijayan7, Anita Shet8, Savitha Nagaraj9, Sunil Karande10, Gita Nataraj11, Vijay N Yewale12, Shrikrishna A Joshi13, Ranganathan N Iyer14, Mathuram Santosham15, Geoffrey D Kahn15, Maria Deloria Knoll15. 1. Pushpagiri Research Centre, Pushpagiri Institute of Medical Science and Research Centre, Tiruvalla, Kerala, India. Electronic address: anandmanoharan@pushpagiri.in. 2. Department of Microbiology, Chacha Nehru Bal Chikitsalya, Maulana Azad Medical College, New Delhi, India. 3. Department of Pediatrics, Kanchi Kamakoti CHILDS Trust Hospital, and CHILDS Trust Research Foundation, Chennai, Tamil Nadu, India. 4. Department of Pediatrics, Bharati Vidyapeeth Deemed University Medical College, Pune, Maharashtra, India. 5. Department of Microbiology, Bharati Vidyapeeth Deemed University Medical College, Pune, Maharashtra, India. 6. Department of Pediatrics, Pushpagiri Institute of Medical Science and Research Centre, Tiruvalla, Kerala, India. 7. Department of Microbiology, Pushpagiri Institute of Medical Science and Research Centre, Tiruvalla, Kerala, India. 8. Department of Pediatrics, St John's Medical College, Bengaluru, Karnataka, India. 9. Department of Microbiology, St John's Medical College, Bengaluru, Karnataka, India. 10. Department of Pediatrics, King Edward Memorial Hospital, Mumbai, Maharashtra, India. 11. Department of Microbiology, King Edward Memorial Hospital, Mumbai, Maharashtra, India. 12. Dr Yewale Multispecialty Hospital for Children, Vashi, Navi Mumbai, Maharashtra, India. 13. Dr Joshi's Central Clinical Microbiology Laboratory, Vashi, Navi Mumbai, Maharashtra, India. 14. Department of Microbiology and Infectious Diseases, Global Hospitals, Lakdi-Ka Pul, Hyderabad, Telangana, India. 15. Department of International Health and International Vaccine Access Center, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
Abstract
BACKGROUND: Invasive pneumococcal disease continues to be a major cause of morbidity and mortality among children younger than 5 years of age in India. We aimed to provide nationally representative data for the pattern of disease due to Streptococcus pneumoniae, trends in the serotype of invasive pneumococci, and invasive pneumococci antimicrobial resistance patterns, in India. METHODS: In this prospective hospital-based and retrospective laboratory-based surveillance study, we prospectively enrolled children aged younger than 5 years with suspected or proven invasive pneumococcal disease from 18 hospitals or institutional centres and retrospectively included laboratory-confirmed pneumococcal isolates from ten sentinel laboratories, together representing 11 states in India. Eligibility criteria were fever higher than 38°C without localising symptoms, clinical presentation of suspected meningitis or pneumonia, and evidence of radiographic pneumonia. We cultured blood and other normally sterile body fluids, reconfirmed and serotyped pneumococcal isolates, and established antimicrobial susceptibility using standard study protocols. FINDINGS: Between Jan 1, 2011, and June 30, 2015, we enrolled 4377 patients. Among 361 (8%) patients with culture-proven pneumococcal disease, all clinical data were known for 226 (63%); among these patients, 132 (58%) presented with pneumonia, 78 (35%) presented with meningitis, and 16 (7%) had other clinical conditions. 131 (3%) died overall and 29 (8%) patients with invasive pneumococcal disease died. Serotypes 14 (52 [14%] of 361), 1 (49 [14%]), 5 (37 [10%]), and 19F (33 [9%]) were the most common. Penicillin non-susceptibility occurred in isolates from 29 (8%) patients, co-trimoxazole resistance occurred in 239 (66%), erythromycin resistance occurred in 132 (37%), and chloramphenicol resistance occurred in 33 (9%). We found multidrug resistance in 33 (9%) of 361 patients. INTERPRETATION: The proportion of positive blood cultures, number of isolates, geographical representation, and data generated over the 4·5 years of the study are representative of data for most of India. Continued surveillance is warranted as the decision to introduce protein conjugated vaccine in India is made. FUNDING: GlaxoSmithKline India.
BACKGROUND:Invasive pneumococcal disease continues to be a major cause of morbidity and mortality among children younger than 5 years of age in India. We aimed to provide nationally representative data for the pattern of disease due to Streptococcus pneumoniae, trends in the serotype of invasive pneumococci, and invasive pneumococci antimicrobial resistance patterns, in India. METHODS: In this prospective hospital-based and retrospective laboratory-based surveillance study, we prospectively enrolled children aged younger than 5 years with suspected or proven invasive pneumococcal disease from 18 hospitals or institutional centres and retrospectively included laboratory-confirmed pneumococcal isolates from ten sentinel laboratories, together representing 11 states in India. Eligibility criteria were fever higher than 38°C without localising symptoms, clinical presentation of suspected meningitis or pneumonia, and evidence of radiographic pneumonia. We cultured blood and other normally sterile body fluids, reconfirmed and serotyped pneumococcal isolates, and established antimicrobial susceptibility using standard study protocols. FINDINGS: Between Jan 1, 2011, and June 30, 2015, we enrolled 4377 patients. Among 361 (8%) patients with culture-proven pneumococcal disease, all clinical data were known for 226 (63%); among these patients, 132 (58%) presented with pneumonia, 78 (35%) presented with meningitis, and 16 (7%) had other clinical conditions. 131 (3%) died overall and 29 (8%) patients with invasive pneumococcal disease died. Serotypes 14 (52 [14%] of 361), 1 (49 [14%]), 5 (37 [10%]), and 19F (33 [9%]) were the most common. Penicillin non-susceptibility occurred in isolates from 29 (8%) patients, co-trimoxazole resistance occurred in 239 (66%), erythromycin resistance occurred in 132 (37%), and chloramphenicol resistance occurred in 33 (9%). We found multidrug resistance in 33 (9%) of 361 patients. INTERPRETATION: The proportion of positive blood cultures, number of isolates, geographical representation, and data generated over the 4·5 years of the study are representative of data for most of India. Continued surveillance is warranted as the decision to introduce protein conjugated vaccine in India is made. FUNDING: GlaxoSmithKline India.
Authors: Brian Wahl; Apoorva Sharan; Maria Deloria Knoll; Rajesh Kumar; Li Liu; Yue Chu; David A McAllister; Harish Nair; Harry Campbell; Igor Rudan; Usha Ram; Molly Sauer; Anita Shet; Robert Black; Mathuram Santosham; Katherine L O'Brien; Narendra K Arora Journal: Lancet Glob Health Date: 2019-06 Impact factor: 26.763
Authors: Michael J Carter; Pallavi Gurung; Claire Jones; Shristy Rajkarnikar; Rama Kandasamy; Meeru Gurung; Stephen Thorson; Madhav C Gautam; Krishna G Prajapati; Bibek Khadka; Anju Maharjan; Julian C Knight; David R Murdoch; Thomas C Darton; Merryn Voysey; Brian Wahl; Katherine L O'Brien; Sarah Kelly; Imran Ansari; Ganesh Shah; Nina Ekström; Merit Melin; Andrew J Pollard; Dominic F Kelly; Shrijana Shrestha Journal: Front Cell Infect Microbiol Date: 2020-01-17 Impact factor: 5.293