Proceedings of The First Current Topic in Infectious Diseases
Burden of Pneumococcal Disease in Hong Kong
Streptococcus pneumoniae causes a spectrum of diseases. The general breakdown of diseases caused by pneumococcus is as follows: meningitis (4.1%), bacteremia without focus (38.7%), bacteremic pneumonia (53.4%). The incidence of invasive pneumococcal disease (IPD) is more well defined in the US, the UK and Australia. In general, the incidence is highest in children <=2 years of age, although the absolute incidence varies with countries and risk factors. The incidence in the US was 165.3/100,000 population <1 year of age, 203.3/100000 <2 years, and 37.1-48.1/100,000 and 96.4/100,000 population <1 year in the UK and Australia, respectively. Children with sickle cell disease and HIV infection also had extremely high incidence of IPD. Population-based data from Hong Kong are lacking. The incidence of pneumococcal septicemia appears low. One study reported that 22% of septicemia in infants and preschoolers were due to pneumococcus although the incidence is not known. In Hong Kong, one study reported an incidence of 5.2/100,000/year for bacterial meningitis in children <5 years.12 Data from Princess Margaret Hospital between 1976 and 1991 revealed that 76.9% of bacterial meningitis were culture negative and 5.9% grew S. pneumoniae. Another study documented 6.4 episodes of community-acquired pneumonia per 1000 children <5 years of age in Hong Kong, with pneumococcus accounting for 5%-17%.13 Putting available information together leads to a rough "guestimate" of the pneumococcal disease burden in Hong Kong for children <=5 years would be: 20/100,000 for bacteremia, ~1/100,000 for meningitis, 1/1000 for pneumonia. Better studies to ascertain the disease burden in Hong Kong is much needed.
1. Yang Y, Shen X, Jiang Z, et al. Study on Haemophilus influenzae type b diseases in China: the past, present and future. Pediatr Infect Dis J 1998;17:S159-S165.
2. Lau YL, Yung R, Low L, Sung R, Leung CW, Lee WH. Haemophilus influenzae type b infections in Hong Kong. Pediatr Infect Dis J 1998;17:S165-S169.
3. Lau YL. Haemophilus influenzae type b diseases in Asia. Bull.World Health Organ 1999;77:867-8.
4. Levine OS, Schwartz B, Pierce N, Kane M. Development, evaluation and implementation of Haemophilusinfluenzae type b vaccines for young children in developing countries: current status and priority actions. Pediatr Infect Dis J 1998;17:S95-S113.
5. Heath PT. Haemophilus influenzae type b conjugate vaccines: a review of efficacy data. Pediatr Infect Dis J 1998;17:S117-S122.
6. American Academy of Pediatrics. American Academy of Pediatrics. Committee on Infectious Diseases. Policy statement: recommendations for the prevention of pneumococcal infections, including the use of pneumococcal conjugate vaccine (Prevnar), pneumococcal polysaccharide vaccine, and antibiotic prophylaxis. Pediatrics 2000;106: 362-6.
7. Hausdorff WP, Bryant J, Kloek C, Paradiso PR, Siber GR. The contribution of specific pneumococcal serogroups to different disease manifestations: implications for conjugate vaccine formulation and use, part II. Clin Infect Dis 2000;30:122-40.
8. Hausdorff WP, Bryant J, Paradiso PR, Siber GR. Which pneumococcal serogroups cause the most invasive disease: implications for conjugate vaccine formulation and use, part I. Clin Infect Dis 2000;30:100-21.
9. Yang Y, Leng Z, Lu D. Pediatric Haemophilus influenzae type b meninngitis in Hefei city: an epidemiologic study. Chung Hua I. Hsueh Tsa Chih 1998;78:251-3.
10. Levine OS, Liu G, Garman RL, Dowell SF, Yu S, Yang YH. Haemophilus influenzae type b and Streptococcus pneumoniae as causes of pneumonia among children in Beijing, China Emerg Infect Dis 2000;6:165-70.
11. Yang Y, Shen X, Vuori-Holopainen E, et al. Sero-etiology of acute lower respiratory infections among hospitalized children in Beijing. Pediatr Infect Dis J 2001;20:52-8.
12. Lau YL, Low LC, Yung R, et al. Invasive Haemophilus influenzae type b infections in children hospitalized in Hong Kong, 1986-1990. Hong Kong Hib Study Group. Acta Paediatr 1995;84:173-6.
13. Sung RY, Cheng AF, Chan RC, Tam JS, Oppenheimer SJ. Epidemiology and etiology of pneumonia in children in Hong Kong. Clin Infect Dis 1993;17:894-6.
14. Ho PL, Que TL, Tsang DN, Ng TK, Chow KH, Seto WH. Emergence of fluoroquinolone resistance among multiply resistant strains of Streptococcus pneumoniae in Hong Kong. Antimicrob. Agents Chemother 1999;43:1310-3.
15. Ho PL, Yam WC, Cheung TKM, et al. Rapid rise of fluoroquinolone resistance among Streptococcus pneumoniae in Hong Kong linked to acquisition of fluoroquinolone resistance by the locally dominant Spanish 23F clone. Emerg Infect Dis 2001. In press.
16. Luey KY, Kam KM. Vaccine coverage of Streptococcus pneumoniae in Hong Kong with attention to the multiple-antibiotic-resistant strains. Vaccine 1996;14:1573-80.