Risk factor profiles and clinical outcomes for children and adults with pneumococcal infections in Singapore: A need to expand vaccination policy?

English version

Autoři: Rosario Martinez-Vega ^aff001; Elita Jauneikaite ^aff002; Koh Cheng Thoon ^aff004; Hui Ying Chua ^aff001; Amanda Huishi Chua ^aff001; Wei Xin Khong ^aff001; Ban Hock Tan ^aff006; Jenny Low Guek Hong ^aff006; Indumathi Venkatachalam ^aff006; Paul Anantharajah Tambyah ^aff007; Martin L. Hibberd ^aff002; Stuart C. Clarke ^aff003; Oon Tek Ng ^aff001
Působiště autorů: Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore ^aff001; Infectious Diseases, Genome Institute of Singapore, Singapore, Singapore ^aff002; Faculty of Medicine and Institute of Life Sciences, University of Southampton, Southampton, United Kingdom ^aff003; Infectious Disease Service, Department of Paediatrics, KK Women’s and Children’s Hospital, Singapore, Singapore ^aff004; Duke-NUS Graduate Medical School, Singapore, Singapore ^aff005; Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore ^aff006; Division of Infectious Diseases, National University of Singapore, Singapore, Singapore ^aff007; National Centre for Infectious Diseases (NCID), Singapore, Singapore ^aff008; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore ^aff009
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0220951

Souhrn

Invasive pneumococcal infection is a major cause of morbidity and mortality worldwide despite the availability of pneumococcal vaccines. The aim of this study was to re-evaluate the clinical syndromes, prognostic factors and outcomes for pneumococcal disease in adults and children in Singapore during the period before and after the introduction of the pneumococcal vaccine. We retrospectively analyzed a large cohort of patients admitted to the four main public hospitals in Singapore with S. pneumoniae infection between 1997 and 2013. A total of 889 (64% of all isolates identified in the clinical laboratories) cases were included in the analysis; 561 (63.1%) were adult (≥16 years) cases with a median age of 62 years and 328 (36.9%) were paediatric cases with a median age of 3 years. Bacteraemic pneumonia was the most common syndrome in both groups (69.3% vs. 44.2%), followed by primary bacteraemia without pneumonia (14.3% vs. 13.4%), meningitis (6.4% vs. 7.6%) and non-bacteraemic pneumonia (5.2% vs. 21%). The major serotypes in adults were 3, 4, 6B, 14, 19F and 23F whereas in children they were 14, 6B and 19F, accounting both for nearly half of pneumococcal disease cases. No particular serotype was associated with mortality or severity of the pneumococcal disease. Overall mortality rate was 18.5% in adults and 3% in children. Risk factors for mortality included acute cardiac events in adults, meningitis in children and critical illness and bilateral pulmonary infiltrates in both adults and children. Penicillin resistance was not associated with increased mortality. Our results agree with global reports that the course of pneumococcal disease and its clinical outcome were more severe in adults than in children. The main serotypes causing invasive disease were mostly covered by the vaccines in use. The high mortality rates reflect an urgent need to increase vaccination coverage in both adults and children to tackle this vaccine-preventable infection.

Klíčová slova:

Death rates – Vaccination and immunization – Antibiotics – Vaccines – Pneumonia – Singapore – Pneumococcus – Meningitis

Zdroje

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Risk factor profiles and clinical outcomes for children and adults with pneumococcal infections in Singapore: A need to expand vaccination policy?

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