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Ten Years of Surveillance for Invasive Streptococcus pneumoniae during the Era of Antiretroviral Scale-Up and Cotrimoxazole Prophylaxis in Malawi

OBJECTIVE: To document trends in invasive pneumococcal disease (IPD) in a central hospital in Malawi during the period of national scale-up of antiretroviral therapy (ART) and cotrimoxazole prophylaxis. METHODS: Between 1 January 2000 and 31 December 2009 almost 100,000 blood cultures and 40,000 cer...

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Autores principales: Everett, Dean B., Mukaka, Mavuto, Denis, Brigitte, Gordon, Stephen B., Carrol, Enitan D., van Oosterhout, Joep J., Molyneux, Elizabeth M., Molyneux, Malcolm, French, Neil, Heyderman, Robert S.
Formato: Texto
Lenguaje:English
Publicado: Public Library of Science 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3058053/
https://www.ncbi.nlm.nih.gov/pubmed/21423577
http://dx.doi.org/10.1371/journal.pone.0017765
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author Everett, Dean B.
Mukaka, Mavuto
Denis, Brigitte
Gordon, Stephen B.
Carrol, Enitan D.
van Oosterhout, Joep J.
Molyneux, Elizabeth M.
Molyneux, Malcolm
French, Neil
Heyderman, Robert S.
author_facet Everett, Dean B.
Mukaka, Mavuto
Denis, Brigitte
Gordon, Stephen B.
Carrol, Enitan D.
van Oosterhout, Joep J.
Molyneux, Elizabeth M.
Molyneux, Malcolm
French, Neil
Heyderman, Robert S.
author_sort Everett, Dean B.
collection PubMed
description OBJECTIVE: To document trends in invasive pneumococcal disease (IPD) in a central hospital in Malawi during the period of national scale-up of antiretroviral therapy (ART) and cotrimoxazole prophylaxis. METHODS: Between 1 January 2000 and 31 December 2009 almost 100,000 blood cultures and 40,000 cerebrospinal fluid (CSF) cultures were obtained from adults and children admitted to the Queen Elizabeth Central Hospital, Blantyre, Malawi with suspected severe bacterial infection. RESULTS: 4,445 pneumococcal isolates were obtained over the 10 year period. 1,837 were from children: 885 (19.9%) from blood and 952 (21.4%) from CSF. 2,608 were from adults: 1,813 (40.8%) from blood and 795 (17.9%) from CSF. At the start of the surveillance period cotrimoxazole resistance was 73.8% and at the end was 92.6%. Multidrug resistance (MDR) was present in almost one third of isolates and was constant over time. Free ART was introduced in Malawi in 2004. From 2005 onwards there was a decline in invasive pneumococcal infections with a negative correlation between ART scale-up and the decline in IPD (Pearson's correlation r = −0.91; p<0.001). CONCLUSION: During 2004–2009, national ART scale-up in Malawi was associated with a downward trend in IPD at QECH. The introduction of cotrimoxazole prophylaxis in HIV-infected groups has not coincided with a further increase in pneumococcal cotrimoxazole or multidrug resistance. These data highlight the importance of surveillance for high disease burden infections such as IPD in the region, which will be vital for monitoring pneumococcal conjugate vaccine introduction into national immunisation programmes.
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spelling pubmed-30580532011-03-21 Ten Years of Surveillance for Invasive Streptococcus pneumoniae during the Era of Antiretroviral Scale-Up and Cotrimoxazole Prophylaxis in Malawi Everett, Dean B. Mukaka, Mavuto Denis, Brigitte Gordon, Stephen B. Carrol, Enitan D. van Oosterhout, Joep J. Molyneux, Elizabeth M. Molyneux, Malcolm French, Neil Heyderman, Robert S. PLoS One Research Article OBJECTIVE: To document trends in invasive pneumococcal disease (IPD) in a central hospital in Malawi during the period of national scale-up of antiretroviral therapy (ART) and cotrimoxazole prophylaxis. METHODS: Between 1 January 2000 and 31 December 2009 almost 100,000 blood cultures and 40,000 cerebrospinal fluid (CSF) cultures were obtained from adults and children admitted to the Queen Elizabeth Central Hospital, Blantyre, Malawi with suspected severe bacterial infection. RESULTS: 4,445 pneumococcal isolates were obtained over the 10 year period. 1,837 were from children: 885 (19.9%) from blood and 952 (21.4%) from CSF. 2,608 were from adults: 1,813 (40.8%) from blood and 795 (17.9%) from CSF. At the start of the surveillance period cotrimoxazole resistance was 73.8% and at the end was 92.6%. Multidrug resistance (MDR) was present in almost one third of isolates and was constant over time. Free ART was introduced in Malawi in 2004. From 2005 onwards there was a decline in invasive pneumococcal infections with a negative correlation between ART scale-up and the decline in IPD (Pearson's correlation r = −0.91; p<0.001). CONCLUSION: During 2004–2009, national ART scale-up in Malawi was associated with a downward trend in IPD at QECH. The introduction of cotrimoxazole prophylaxis in HIV-infected groups has not coincided with a further increase in pneumococcal cotrimoxazole or multidrug resistance. These data highlight the importance of surveillance for high disease burden infections such as IPD in the region, which will be vital for monitoring pneumococcal conjugate vaccine introduction into national immunisation programmes. Public Library of Science 2011-03-15 /pmc/articles/PMC3058053/ /pubmed/21423577 http://dx.doi.org/10.1371/journal.pone.0017765 Text en Everett et al. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Everett, Dean B.
Mukaka, Mavuto
Denis, Brigitte
Gordon, Stephen B.
Carrol, Enitan D.
van Oosterhout, Joep J.
Molyneux, Elizabeth M.
Molyneux, Malcolm
French, Neil
Heyderman, Robert S.
Ten Years of Surveillance for Invasive Streptococcus pneumoniae during the Era of Antiretroviral Scale-Up and Cotrimoxazole Prophylaxis in Malawi
title Ten Years of Surveillance for Invasive Streptococcus pneumoniae during the Era of Antiretroviral Scale-Up and Cotrimoxazole Prophylaxis in Malawi
title_full Ten Years of Surveillance for Invasive Streptococcus pneumoniae during the Era of Antiretroviral Scale-Up and Cotrimoxazole Prophylaxis in Malawi
title_fullStr Ten Years of Surveillance for Invasive Streptococcus pneumoniae during the Era of Antiretroviral Scale-Up and Cotrimoxazole Prophylaxis in Malawi
title_full_unstemmed Ten Years of Surveillance for Invasive Streptococcus pneumoniae during the Era of Antiretroviral Scale-Up and Cotrimoxazole Prophylaxis in Malawi
title_short Ten Years of Surveillance for Invasive Streptococcus pneumoniae during the Era of Antiretroviral Scale-Up and Cotrimoxazole Prophylaxis in Malawi
title_sort ten years of surveillance for invasive streptococcus pneumoniae during the era of antiretroviral scale-up and cotrimoxazole prophylaxis in malawi
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3058053/
https://www.ncbi.nlm.nih.gov/pubmed/21423577
http://dx.doi.org/10.1371/journal.pone.0017765
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