Risk factor profiles and clinical outcomes for children and adults with pneumococcal infections in Singapore: A need to expand vaccination policy?

Autoři: Rosario Martinez-Vega aff001;  Elita Jauneikaite aff002;  Koh Cheng Thoon aff004;  Hui Ying Chua aff001;  Amanda Huishi Chua aff001;  Wei Xin Khong aff001;  Ban Hock Tan aff006;  Jenny Low Guek Hong aff006;  Indumathi Venkatachalam aff006;  Paul Anantharajah Tambyah aff007;  Martin L. Hibberd aff002;  Stuart C. Clarke aff003;  Oon Tek Ng aff001
Působiště autorů: Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore aff001;  Infectious Diseases, Genome Institute of Singapore, Singapore, Singapore aff002;  Faculty of Medicine and Institute of Life Sciences, University of Southampton, Southampton, United Kingdom aff003;  Infectious Disease Service, Department of Paediatrics, KK Women’s and Children’s Hospital, Singapore, Singapore aff004;  Duke-NUS Graduate Medical School, Singapore, Singapore aff005;  Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore aff006;  Division of Infectious Diseases, National University of Singapore, Singapore, Singapore aff007;  National Centre for Infectious Diseases (NCID), Singapore, Singapore aff008;  Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore aff009
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0220951


Invasive pneumococcal infection is a major cause of morbidity and mortality worldwide despite the availability of pneumococcal vaccines. The aim of this study was to re-evaluate the clinical syndromes, prognostic factors and outcomes for pneumococcal disease in adults and children in Singapore during the period before and after the introduction of the pneumococcal vaccine. We retrospectively analyzed a large cohort of patients admitted to the four main public hospitals in Singapore with S. pneumoniae infection between 1997 and 2013. A total of 889 (64% of all isolates identified in the clinical laboratories) cases were included in the analysis; 561 (63.1%) were adult (≥16 years) cases with a median age of 62 years and 328 (36.9%) were paediatric cases with a median age of 3 years. Bacteraemic pneumonia was the most common syndrome in both groups (69.3% vs. 44.2%), followed by primary bacteraemia without pneumonia (14.3% vs. 13.4%), meningitis (6.4% vs. 7.6%) and non-bacteraemic pneumonia (5.2% vs. 21%). The major serotypes in adults were 3, 4, 6B, 14, 19F and 23F whereas in children they were 14, 6B and 19F, accounting both for nearly half of pneumococcal disease cases. No particular serotype was associated with mortality or severity of the pneumococcal disease. Overall mortality rate was 18.5% in adults and 3% in children. Risk factors for mortality included acute cardiac events in adults, meningitis in children and critical illness and bilateral pulmonary infiltrates in both adults and children. Penicillin resistance was not associated with increased mortality. Our results agree with global reports that the course of pneumococcal disease and its clinical outcome were more severe in adults than in children. The main serotypes causing invasive disease were mostly covered by the vaccines in use. The high mortality rates reflect an urgent need to increase vaccination coverage in both adults and children to tackle this vaccine-preventable infection.

Klíčová slova:

Antibiotics – Death rates – Pneumococcus – Pneumonia – Singapore – Vaccination and immunization – Vaccines – Meningitis


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2019 Číslo 10