Epidemiology of Serotype 1 Invasive Pneumococcal Disease, South Africa, 2003–2013
EID FEB 2016 V.22 N.2
Claire von Mollendorf, Cheryl Cohen, Stefano Tempia, Susan Meiring, Linda de Gouveia, Vanessa Quan, Sarona Lengana, Alan Karstaedt, Halima Dawood, Sharona Seetharam, Ruth Lekalakala, Shabir A. Madhi, Keith P. Klugman, Anne von Gottberg, and for the Group for Enteric, Respiratory, and Meningeal Disease Surveillance in South Africa (GERMS-SA)
National Institute for Communicable Diseases, Johannesburg, South Africa (C. von Mollendorf, C. Cohen, S. Tempia, S. Meiring, L. de Gouveia, V. Quan, S. Lengana, S.A. Madhi, K.P. Klugman, A. von Gottberg); University of the Witwatersrand, Johannesburg (C. von Mollendorf, C. Cohen, A. Karstaedt, S. Seetharam, S.A. Madhi, A. von Gottberg); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S. Tempia), and Pretoria, South Africa (S. Tempia); Chris Hani Baragwanath Academic Hospital, Johannesburg (A. Karstaedt, S. Seetharam); Pietermaritzburg Metropolitan Hospital, Pietermaritzburg, South Africa (H. Dawood); University of KwaZulu-Natal, Pietermaritzburg (H. Dawood); National Health Laboratory Service, Johannesburg (S. Seetharam); National Health Laboratory Service, Polokwane, South Africa (R. Lekalakala); University of Limpopo, Polokwane (R. Lekalakala); Emory University, Atlanta, Georgia, USA (K.P. Klugman)
In South Africa, 7-valent pneumococcal conjugate vaccine (PCV) was introduced in April 2009 and replaced with 13-valent PCV in April 2011. We describe the epidemiology of serotype 1 Streptococcus pneumoniae disease during the pre- and post-PCV eras (2003–2013). Using laboratory-based invasive pneumococcal disease (IPD) surveillance, we calculated annual incidences, identified IPD clusters, and determined serotype 1–associated factors. Of 46,483 IPD cases, 4,544 (10%) were caused by serotype 1. Two clusters of serotype 1 infection were detected during 2003–2004 and 2008–2012, but incidence decreased after 2011. Among children <5 years of age, those who had non–serotype 1 IPD had shorter hospital stays, fewer cases of penicillin-nonsusceptible disease, and lower HIV prevalence and in-hospital death rates than did those with serotype 1 IPD; similar factors were noted for older patients. Serotype 1 IPD had distinctive clinical features in South Africa, and annual incidences fluctuated, with decreases noted after the introduction of PCV13.