Neonatal invasive pneumococcal disease (IPD) in developing countries is poorly described. We provide a baseline description of neonatal IPD in South Africa, before implementation of the 7-valent pneumococcal conjugate vaccine (PCV7) in 2009.
Data from children (age ≤ 2 years) with IPD (pneumococcus identified from a normally sterile specimen) from January 2003 to December 2008 were extracted from a national laboratory-based surveillance database. Clinical and laboratory characteristics of IPD among neonates (0–27 days old) was compared with IPD among young children (≥ 28 days ≤ 2 years). Early-onset IPD (0–6 days old) was compared with late-onset IPD (≥ 7–27 days old). Isolates were serotyped using the Quellung reaction.
Overall 27,630 IPD cases were reported. Of the 26,277 (95%) with known ages, 6583 (25%) were ≤ 2 years of age, of which 4.5% (294/6583) were neonates. The estimated annual incidence of neonatal IPD in 2008 was 5 per 100,000 live births. Fifty-one percent of neonates with IPD presented with early-onset IPD. Case fatality ratios (CFRs) were high in both groups, 31% (28/89) in neonatal IPD versus 26% (614/2383) in non-neonatal IPD (P = 0.18). Among neonates, the meningitis cases (15/37, 41%) were associated with the highest CFR. The 13-valent pneumococcal conjugate vaccine (PCV13) serotypes accounted for 69% (134/194) of neonatal IPD isolates.
Pneumococcal neonatal disease in South Africa was not uncommon before PCV introduction and is associated with a high CFR. The indirect effect on neonatal IPD of PCV rollout requires further evaluation.
From the *Microbiology, Lancet Laboratories, Kwa-Zulu Natal
†Antimicrobial Research Unit, College of Health Sciences, University of Kwa-Zulu-Natal, Durban
‡Department of Medical Microbiology, Nelson R Mandela School of Medicine, University of Kwa-Zulu Natal, Durban
§School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
¶Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg
‖Division of Public Health Surveillance and Response, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg
**Pediatric Infectious Diseases Unit, Red Cross War Memorial Children’s Hospital, Department of Pediatrics and Child Health, University of Cape Town, Cape Town
††Rahima Moosa Mother and Child Hospital, Department of Pediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng
‡‡Department of Microbiology, Charlotte Maxeke Johannesburg Academic Hospital, National Health Laboratory Services, Johannesburg
§§School of Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
Accepted for publication April 15, 2018.
Dr. Cohen was supported by the National Institute for Communicable Diseases of the National Health Laboratory Service and the US Centers for Disease Control and Prevention (co-operative agreement number: 5U51IP000155). In addition, Dr. Cohen has received grants from Sanofi and Parexel, unrelated to the current article. Dr. Mollendorf has received speaker funding from Pfizer in the last 3 years, unrelated to the current article. Dr. Anne von Gottberg received grant funds to institution from Pfizer and Sanofi, and travel expenses reimbursed from Pfizer, Sanofi, and Novartis.
This study received funding from the NICD/NHLS and was supported in part by funds from the United States Agency for International Development’s Antimicrobial Resistance Initiative, transferred via a cooperative agreement (number U60/CCU022088) from the Centers for Disease Control and Prevention (CDC), Atlanta, Georgia; and cooperative agreement U62/CCU022901 from the CDC. (The contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC.)
The rest of the authors have no conflicts of interest to disclose.
Address for correspondence: Krishnee Moodley, MBChB, FCPath, MMed, 74 Ismail C Meer Street, Durban, South Africa, 4000. E-mail: firstname.lastname@example.org; email@example.com.