Streptococcus pneumoniae Serotypes and Mortality in Adults and Adolescents in South Africa: Analysis of National Surveillance Data, 2003 - 2008

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dc.contributor.authorCohen, Cherylen_ZA
dc.contributor.authorNaidoo, Nireshnien_ZA
dc.contributor.authorMeiring, Susanen_ZA
dc.contributor.authorde Gouveia, Lindaen_ZA
dc.contributor.authorvan Mollendorf, Claireen_ZA
dc.contributor.authorWalaza, Sibongileen_ZA
dc.contributor.authorNaicker, Preneshnien_ZA
dc.contributor.authorMadhi, Shabir Aen_ZA
dc.contributor.authorFeldman, Charlesen_ZA
dc.contributor.authorKlugman, Keith Pen_ZA
dc.contributor.authorDawood, Halimaen_ZA
dc.contributor.authorvon Gottberg, Anneen_ZA
dc.contributor.authorGERMS-SAen_ZA
dc.date.accessioned2016-01-11T06:55:15Z
dc.date.available2016-01-11T06:55:15Z
dc.date.issued2015en_ZA
dc.description.abstractBACKGROUND: An association between pneumococcal serotypes and mortality has been suggested. We aimed to investigate this among individuals aged ≥15 years with invasive pneumococcal disease (IPD) in South Africa. METHODS: IPD cases were identified through national laboratory-based surveillance at 25 sites, pre-pneumococcal conjugate vaccine (PCV) introduction, from 2003-2008. We assessed the association between the 20 commonest serotypes and in-hospital mortality using logistic regression with serotype 4 (the third commonest serotype with intermediate case-fatality ratio (CFR)) as referent. RESULTS: Among 3953 IPD cases, CFR was 55% (641/1166) for meningitis and 23% (576/2484) for bacteremia (p<0.001). Serotype 19F had the highest CFR (48%, 100/207), followed by serotype 23F (39%, 99/252) and serotype 1 (38%, 246/651). On multivariable analysis, factors independently associated with mortality included serotype 1 (OR 1.9, 95%CI 1.1-3.5) and 19F (OR 2.9, 95%CI 1.4-6.1) vs. serotype 4; increasing age (25-44 years, OR 1.8, 95%CI 1.0-3.0; 45-64 years, OR 3.6, 95%CI 2.0-6.4; ≥65 years, OR 5.2, 95%CI 1.9-14.1; vs. 15-24 years); meningitis (OR 4.1, 95%CI 3.0-5.6) vs. bacteremic pneumonia; and HIV infection (OR1.7, 95%CI 1.0-2.8). On stratified multivariate analysis, serotype 19F was associated with increased mortality amongst bacteremic pneumococcal pneumonia cases, while no serotype was associated with increased mortality in meningitis cases. CONCLUSION: Mortality was increased in HIV-infected individuals, which may be reduced by increased antiretroviral therapy availability. Serotypes associated with increased mortality are included in the 10-and-13-valent PCV and may become less common in adults due to indirect effects following routine infant immunization.en_ZA
dc.identifier.apacitationCohen, C., Naidoo, N., Meiring, S., de Gouveia, L., van Mollendorf, C., Walaza, S., ... (2015). Streptococcus pneumoniae Serotypes and Mortality in Adults and Adolescents in South Africa: Analysis of National Surveillance Data, 2003 - 2008. <i>PLoS One</i>, http://hdl.handle.net/11427/16297en_ZA
dc.identifier.chicagocitationCohen, Cheryl, Nireshni Naidoo, Susan Meiring, Linda de Gouveia, Claire van Mollendorf, Sibongile Walaza, Preneshni Naicker, et al "Streptococcus pneumoniae Serotypes and Mortality in Adults and Adolescents in South Africa: Analysis of National Surveillance Data, 2003 - 2008." <i>PLoS One</i> (2015) http://hdl.handle.net/11427/16297en_ZA
dc.identifier.citationCohen, C., Naidoo, N., Meiring, S., de Gouveia, L., von Mollendorf, C., Walaza, S., ... & Dawood, H. (2015). Streptococcus pneumoniae Serotypes and Mortality in Adults and Adolescents in South Africa: Analysis of National Surveillance Data, 2003-2008. PloS one, 10(10), e0140185. doi:10.1371/journal.pone.0140185en_ZA
dc.identifier.ris TY - Journal Article AU - Cohen, Cheryl AU - Naidoo, Nireshni AU - Meiring, Susan AU - de Gouveia, Linda AU - van Mollendorf, Claire AU - Walaza, Sibongile AU - Naicker, Preneshni AU - Madhi, Shabir A AU - Feldman, Charles AU - Klugman, Keith P AU - Dawood, Halima AU - von Gottberg, Anne AU - GERMS-SA AB - BACKGROUND: An association between pneumococcal serotypes and mortality has been suggested. We aimed to investigate this among individuals aged ≥15 years with invasive pneumococcal disease (IPD) in South Africa. METHODS: IPD cases were identified through national laboratory-based surveillance at 25 sites, pre-pneumococcal conjugate vaccine (PCV) introduction, from 2003-2008. We assessed the association between the 20 commonest serotypes and in-hospital mortality using logistic regression with serotype 4 (the third commonest serotype with intermediate case-fatality ratio (CFR)) as referent. RESULTS: Among 3953 IPD cases, CFR was 55% (641/1166) for meningitis and 23% (576/2484) for bacteremia (p<0.001). Serotype 19F had the highest CFR (48%, 100/207), followed by serotype 23F (39%, 99/252) and serotype 1 (38%, 246/651). On multivariable analysis, factors independently associated with mortality included serotype 1 (OR 1.9, 95%CI 1.1-3.5) and 19F (OR 2.9, 95%CI 1.4-6.1) vs. serotype 4; increasing age (25-44 years, OR 1.8, 95%CI 1.0-3.0; 45-64 years, OR 3.6, 95%CI 2.0-6.4; ≥65 years, OR 5.2, 95%CI 1.9-14.1; vs. 15-24 years); meningitis (OR 4.1, 95%CI 3.0-5.6) vs. bacteremic pneumonia; and HIV infection (OR1.7, 95%CI 1.0-2.8). On stratified multivariate analysis, serotype 19F was associated with increased mortality amongst bacteremic pneumococcal pneumonia cases, while no serotype was associated with increased mortality in meningitis cases. CONCLUSION: Mortality was increased in HIV-infected individuals, which may be reduced by increased antiretroviral therapy availability. Serotypes associated with increased mortality are included in the 10-and-13-valent PCV and may become less common in adults due to indirect effects following routine infant immunization. DA - 2015 DB - OpenUCT DO - 10.1371/journal.pone.0140185 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2015 T1 - Streptococcus pneumoniae Serotypes and Mortality in Adults and Adolescents in South Africa: Analysis of National Surveillance Data, 2003 - 2008 TI - Streptococcus pneumoniae Serotypes and Mortality in Adults and Adolescents in South Africa: Analysis of National Surveillance Data, 2003 - 2008 UR - http://hdl.handle.net/11427/16297 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/16297
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0140185
dc.identifier.vancouvercitationCohen C, Naidoo N, Meiring S, de Gouveia L, van Mollendorf C, Walaza S, et al. Streptococcus pneumoniae Serotypes and Mortality in Adults and Adolescents in South Africa: Analysis of National Surveillance Data, 2003 - 2008. PLoS One. 2015; http://hdl.handle.net/11427/16297.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentDivision of Medical Biochemistryen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis 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 credited.en_ZA
dc.rights.holder© 2015 Cohen et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherMeningitisen_ZA
dc.subject.otherAntibioticsen_ZA
dc.subject.otherDeath ratesen_ZA
dc.subject.otherPneumoniaen_ZA
dc.subject.otherAge groupsen_ZA
dc.subject.otherHIV infectionsen_ZA
dc.subject.otherBacteremiaen_ZA
dc.subject.otherHIVen_ZA
dc.titleStreptococcus pneumoniae Serotypes and Mortality in Adults and Adolescents in South Africa: Analysis of National Surveillance Data, 2003 - 2008en_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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