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Open Access Highly Accessed Research article

Streptococcus pneumoniae serotype 19A in Latin America and the Caribbean: a systematic review and meta-analysis, 1990–2010

Elizabeth Castañeda1*, Clara Inés Agudelo1, Rodrigo De Antonio2, Diego Rosselli3, Claudia Calderón4, Eduardo Ortega-Barria5 and Rómulo E Colindres6

Author Affiliations

1 Instituto Nacional de Salud Bogotá, Bogotá, Colombia

2 GlaxoSmithKline Biologicals, Panama City, Panama

3 Department of Clinical Epidemiology and Biostatistics, Universidad Javeriana Medical School, Bogotá, Colombia

4 Independent investigator, Bogotá, Colombia

5 GlaxoSmithKline Biologicals, Rio de Janeiro, Brazil

6 GlaxoSmithKline Biologicals, Wavre, Belgium

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BMC Infectious Diseases 2012, 12:124  doi:10.1186/1471-2334-12-124

Published: 28 May 2012

Abstract

Background

Pneumococcal conjugate vaccines (PCVs) are in the process of implementation in Latin America. Experience in developed countries has shown that they reduce the incidence of invasive and non-invasive disease. However, there is evidence that the introduction of PCVs in universal mass vaccination programs, combined with inappropriate and extensive use of antibiotics, could be associated to changes in non-PCV serotypes, including serotype 19A. We conducted a systematic review to determine the distribution of serotype 19A, burden of pneumococcal disease and antibiotic resistance in the region.

Methods

We performed a systematic review of serotype 19A data from observational and randomized clinical studies in the region, conducted between 1990 and 2010, for children under 6 years. Pooled prevalence estimates from surveillance activities with confidence intervals were calculated.

Results

We included 100 studies in 22 countries and extracted data from 63. These data reported 19733 serotyped invasive pneumococcal isolates, 3.8% of which were serotype 19A. Serotype 19A isolates were responsible for 2.4% acute otitis media episodes, and accounted for 4.1% and 4.4% of 4,380 nasopharyngeal isolates from healthy children and in hospital-based/sick children, respectively. This serotype was stable over the twenty years of surveillance in the region. A total of 53.7% Spn19A isolates from meningitis cases and only 14% from non meningitis were resistant to penicillin.

Conclusions

Before widespread PCV implementation in this region, serotype 19A was responsible for a relatively small number of pneumococcal disease cases. With increased use of PCVs and a greater number of serotypes included, monitoring S. pneumoniae serotype distribution will be essential for understanding the epidemiology of pneumococcal disease.

Keywords:
Streptococcus pneumoniae serotype 19A; Latin American and the Caribbean; Resistance to penicillin; Conjugate vaccines; Serotype replacement