Vigilancia de las neumococcias del niño hospitalizado: Su prevención específica (1994-2000)

María Hortal; Teresa Camou; Rosario Palacio; Gabriel Pérez-Giffoni; José Luis Di Fabio; Grupo OPS/SIREVA- Uruguay

Authors

María Hortal Universidad de la República, Programa de Desarrollo de las Ciencias Básicas (PEDECIBA), Prof. (de primer nivel). Facultad de Medicina, Departamento de Bacteriología y Virología, Ex Prof. Agregado. Programa OPS/SIREVA, Coordinador Nacional. Proyecto sobre Carga de Enfermedad de las Neumonías y Meningitis del Niño, Investigador principal
Teresa Camou Uruguay. Ministerio de Salud Pública, Departamento de Laboratorios, Bacteriólogo. Programa OPS/SIREVA, Investigador asociado
Rosario Palacio Uruguay. Ministerio de Salud Pública, Departamento de Laboratorios, Médico Infectólogo. Programa OPS/SIREVA, Investigador asociado
Gabriel Pérez-Giffoni Uruguay. Ministerio de Salud Pública, Departamento de Laboratorios, Médico Infectólogo. Universidad de la República, Facultad de Ciencias, Laboratorio de Microbiología, Docente titular grado 2
José Luis Di Fabio OPS, Washington, DC, EEUU, Programa especial de vacunas e inmunizaciones, Asesor en investigación, producción y control de calidad de vacunas
Grupo OPS/SIREVA- Uruguay OPS/SIREVA: Oficina Panamericana de la Salud/Sistema Regional de Vacunas

Keywords:

VACCINES, PNEUMOCOCCAL INFECTIONS, STREPTOCOCCUS PNEUMONIAE, EPIDEMIOLOGICAL SURVEILLANCE, CHILD, ADOLESCENCE

Abstract

The aim of this paper are to promote available national information and to analyze the effects of the recently released vaccinations such as serum streptococcus pneumo-niae capsules in infants up to 14 years old.
During seven years (1994-2000) 520 isolate invaders were collected in patients with pneumonia (67%), meningitis (21%), bacteremia/sepsis (8%), and other processes (4%) such as peritonitis, osteomyelitis, cellulite, and abscess. Serotype distribution showed a global potentially coverage of 44% with heptavalent vaccine (serotypes 4, 6B, 9V, 14, 18C, 19F and 23F), 77% with nonavalent vaccine (plus serotypes 1 and 5), and 86,9% with 11-valent vaccine (plus serotypes 3 and 7F). Antigenic combination with other serotypes not included in vaccines allows to estimate rate increase up to 53.2%, 86.5% and 95,7% respectively. In patients from 4 months to 5 years old, primary beneficiaries of recent vaccines, coverage rates ranged from 40% (2-5 years) to 67% (4-11 months), whereas nonavalent vaccine showed a better coverage, 78% to 86%. Coverage reached in patients with meningitis was lower compared to patients with pneumonia since serotype dispersion was higher.
Forty-three fatal cases (meningitis, 30 and pneumonia, 13) could have potentially been prevented in 67-70%, 73-78% and 93-100% with these new vaccines.
Strains with diminished susceptibility to penicillin, countrywide found, were more frequently isolated in cases of pneumonia (39%) than in cases of meningitis (12%). Overall coverage of any of these vaccines was 92% for intermediate resistant strains and 100% for high resistant strains.
In summary, considering cost effectiveness, nonava-lent vaccine appears to be as the best choice to prevent invasive pneumococcia, particularly in Uruguayan infants since it includes three of the most frequent serotypes found in this population at risk. Obviously, 11-valent vaccine may widen coverage in case costs were lower.

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