Age‐ and Serotype‐Specific Pediatric Invasive Pneumococcal Disease: Insights from Systematic Surveillance in Santiago, Chile, 1994–2007

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Abstract
Background. We monitored pediatric invasive pneumococcal disease (IPD) in Santiago, Chile, from 1994 to 2007. Methods. Three related data sets were generated: (1) IPD cases requiring hospitalization, 1994–2007; (2) cases of bacteremia detected among febrile patients aged 0–35 months seen in emergency departments, 2000–2007; and (3) nasopharyngeal carriage of pneumococcal serotypes, determined from repetitive culturing, among 524 newborns followed up through age 23 months. Results. Of 2369 IPD cases requiring hospitalization, 1878 (79.3%) occurred in those aged 0–59 months, and 1200 (50.7%) occurred in those aged 6–35 months. Among infants aged 0–5 months, meningitis and sepsis comprised 48.4% of all IPD cases (serotype 5 predominated); among those 6–35 months old, 522 (43.5%) of 1200 cases were bacteremic pneumonia (serotype 14 predominated). Serotype 1 peritonitis was common among 5–14-year-old girls. Meningitis and sepsis exhibited high case fatality rates (14%–29%) among all ages. Remarkably, 34 (28.8%) of 118 children with sepsis died, versus 1 fatality (0.4%) among 276 children hospitalized with bacteremia without a focus (P<.001, Fisher's exact test). Serotype 5 was significantly more common among hospitalized patients Conclusions. Clinical syndromes of IPD and predominant serotypes vary with age.