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Epidemiology of Pediatric Pneumococcal Meningitis and Bacteremia in Latin America and the Caribbean: A Systematic Review and Meta-analysis

Ciapponi, Agustín MD, MSc*; Elorriaga, Natalia Nut*; Rojas, Juan Ignacio MD*; Romano, Marina MD*; Martí, Sebastián García MD, MSc*; Bardach, Ariel MD, MSc, PhD*; Ruvinsky, Silvina MD, MSc

The Pediatric Infectious Disease Journal: September 2014 - Volume 33 - Issue 9 - p 971–978
doi: 10.1097/INF.0000000000000363
Review Articles

Background: Pneumococcal meningitis and bacteremia pose a significant disease burden in Latin America and the Caribbean (LAC).

Methods: To perform a systematic review of studies of pediatric pneumococcal meningitis and non-pneumonia, non-meningitis pneumococcal bacteremia in LAC, we conducted an exhaustive search from 2000 to 2010 in electronic databases and grey literature. Pairs of independently selected reviewers assessed the quality and extracted the studies’ data. A STROBE-based checklist was used to assess the risk of bias in observational studies. Meta-analyses were performed.

Results: Of 1218 retrieved studies, 39 were included. In children <5 years, the pooled 95% confidence interval (CI) percentage of pneumococcal etiology out of cases studied with cerebrospinal fluid/blood cultures was 6.0% (95% CI: 3.3–9.5) for meningitis and 8.0% (95% CI: 5.3–12.4) for bacteremia. The incidences per 100,000 children were 4.7 (95% CI: 3.2–6.1) and 3.9 (95% CI: 2.0–5.9) for pneumococcal meningitis and non-pneumonia, non-meningitis bacteremia, respectively. The mortality was 8.3 (95% CI: 0.0–21.0) and 0.5 (95% CI: 0.3.0-0.6)/100,000 for meningitis and sepsis, respectively. The case fatality ratio was 33.2% (95% CI: 21.3–46.2) for meningitis and 29.0% (95% CI: 21.9–36.8) for sepsis. The pooled serotype distribution from SIREVA surveillance data showed that 14, 5, 6B (for meningitis) and 14, 6B, 19F (for bacteremia) were the most frequent serotypes, all included in licensed vaccines.

Conclusion: Pneumococcal meningitis and bacteremia are important causes of morbidity and mortality in LAC children <5 years of age. This systematic review provided evidence about the burden of pneumococcal disease and the serotype distribution to assess the impact the pneumococcal vaccines and to assist decision makers in the region.

Supplemental Digital Content is available in the text.

From the *Institute for Clinical Effectiveness and Health Policy; and Pediatric Infectious Disease Unit, Hospital Nacional de Pediatría J.P. Garrahan, Buenos Aires, Argentina.

Accepted for publication April 9, 2014.

The authors have no other funding or conflicts of interest to disclose.

This work was funded by the Pan American Health Organization (PAHO) through its ProVac Initiative and by the Institute for Clinical Effectiveness and Health Policy.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (

Address for correspondence: Dr Agustín Ciapponi, MD, MSc, Address: Dr Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina. E-mail:

© 2014 by Lippincott Williams & Wilkins, Inc.