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Invasive Pneumococcal Infections Among Hospitalized Children in Bamako, Mali

Campbell, James D. MD*; Kotloff, Karen L. MD*; Sow, Samba O. MD, MS; Tapia, Milagritos MD*; Keita, Mamadou Marouf MD; Keita, Tatiana MD; Diallo, Souleymane PharmD§; Hormazabal, Juan Carlos MD; Murray, Patrick PhD; Levine, Myron M. MD, DTPH*

The Pediatric Infectious Disease Journal: July 2004 - Volume 23 - Issue 7 - p 642-649
doi: 10.1097/01.inf.0000130951.85974.79
Original Studies

Background: Prevention of invasive pneumococcal disease (IPD) in children is a global public health priority, and determination of the most common serotypes is crucial for vaccine development and implementation.

Methods: We performed prospective surveillance for IPD in hospitalized children in Bamako, Mali. All febrile children and others suspected to have invasive bacterial disease had an admission blood culture and cultures of additional anatomic sites when indicated. Standard microbiologic methods were used to identify, serotype and determine antibiograms for pneumococcal isolates.

Results: Of 2049 children enrolled, 106 (5%) had an IPD, including 47 cases of meningitis and 44 bacteremic pneumonias. The incidence was highest in infants (84/100,000/year). The overall IPD case fatality rate was 24%. Only 2 of 96 isolates were nonsusceptible to penicillin. The serotypes isolated were 5 (54%), 2 (14%), 7F (10%), 19F (8%), 6A/B (3%), 9V (3%), 1 (2%) and 14 (1%).

Conclusions: IPD is common and frequently fatal among hospitalized children in Mali, but surprisingly little resistance has occurred. Notably, 91% of the serotypes causing IPD in Bamako children are found in the 11-valent pneumococcal conjugate vaccine.

From the *University of Maryland School of Medicine, Center for Vaccine Development, Baltimore, MD; the †Centre pour les Vaccins en Développement, Mali (CVD-Mali), Centre National d'Appui à la lutte contre la Maladie (CNAM), Ministiére de la Santé, L'Hôpital Gabriel Touré, and the Departments of ‡Pediatrics and §Laboratory Medicine, Bamako, Mali; the ¶Bacteriology Section, Instituto de Salud Publica, Santiago, Chile; and the ‖National Institutes of Health, Clinical Microbiology Laboratory, Bethesda, MD

Accepted for publication March 9, 2004.

Supported in part by grants from The Bill and Melinda Gates Foundation and the Rockefeller Foundation.

Address for reprints: James D. Campbell, MD, University of Maryland, Baltimore, Center for Vaccine Development-HSF 480, 685 West Baltimore Street, Baltimore, MD 21201. Fax 410-706-6205; E-mail

© 2004 Lippincott Williams & Wilkins, Inc.