Epidemiology of Pediatric Pneumococcal Meningitis and bacteremia in Latin America and the Caribbean: a Systematic Review and Meta-Analysis

A. CIAPPONI; N. ELORRIAGA; N. ROJAS

PEDIATRIC INFECTIOUS DISEASE JOURNAL

LIPPINCOTT WILLIAMS & WILKINS

Lugar: Philadelphia; Año: 2014 p. 1 - 14

0891-3668

ACKGROUND: Pneumococcal meningitis and bacteremia pose a significant disease burden in Latin America and the Caribbean (LAC). METHODS: To perform a systematic review of studies of pediatric pneumococcal meningitis and non-pneumonia, non-meningitis (NPNM) pneumococcal bacteremia in LAC, we conducted an exhaustive search from 2000 to 2010 in electronic databases and grey literature. Pairs of independently selected reviewers assessed the quality and extracted the studies´ data. A STROBE-based checklist was used to assess the risk of bias in observational studies. Meta-analyses were performed. RESULTS: 39 out of 1218 retrieved studies were included. In children less than 5 years the pooled 95%CI percentage of pneumococcal etiology out of cases studied with cerebrospinal fluid/blood cultures was 6.0%(95%CI 3.3-9.5) for meningitis and 8.0%(95%CI 5.3-12.4) for bacteremia. The incidences per 100.000 children were 4.7(CI95%, 3.2-6.1) and 3.9(CI95% 2.0-5.9) for pneumococcal meningitis and NPNM bacteremia, respectively. The mortality was 8.3(95%CI 0.0-21.0) and 0.5(95%CI 0.3.0-0.6)/100,000 for meningitis and sepsis, respectively. The case fatality ratio was 33.2%(CI95% 21.3-46.2) for meningitis and 29.0%(CI95% 21.9-36.8) for sepsis. The pooled serotype distribution from SIREVA surveillance data showed that 14, 5, 6B (for meningitis) and 14, 6B, 19F (for bacteremia) were the most frequent serotypes, all included in licensed vaccines. CONCLUSION: Pneumococcal meningitis and bacteremia are important causes of morbidity and mortality in LAC children under 5 years old. This systematic review provided evidence about the burden of pneumococcal disease and the serotype distribution in order to assess the impact the pneumococcal vaccines and to assist decision-makers in the region.