INVASIVE PNEUMOCOCCAL DISEASE IN A PEDIATRIC POPULATION, AUCKLAND, NEW-ZEALAND

Streptococcus pneumoniae is one of the major invasive pathogens in chi ldhood. The increasing worldwide prevalence of penicillin-resistant st rains makes management of invasive infections difficult and underscore s the need for effective vaccines. Currently available vaccines are of limited value in the pediatric age group. Trials are taking place to evaluate conjugated pneumococcal vaccines and in view of this it is im portant to establish local epidemiology of pneumococcal disease. The a ims of this population-based study were to review all of the cases of invasive pneumococcal disease occurring during a 9-year period (1984 t o 1992) in Auckland, New Zealand. Through the use of laboratory record s and hospital discharge codes, 413 isolates from 407 patients were fo und. Age specific incidence for all invasive disease was 22.0/100 000 for children less than 15 years old but 56.0/100 000 for children less than 5 years old (chi(2) Yates corrected 18.20; P = 0.001). Two-third s were less than 2 years old. The rates were higher in Maori and Pacif ic Island children than in Caucasian children. A total of 70 isolates from 68 patients with meningitis occurred. The majority were less than 5 years old (incidence of meningitis was 10.0/ 100 000) and 84% were less than 2 years old. The overall mortality from meningitis was 4.3%. Of the 129 isolates serogrouped or serotyped, 14, 6 and 19 accounted for 23%, 16% and 16%, respectively, of cases. Although 98% of serotype s identified would be covered by the currently available 23-valent vac cine, two-thirds of the children affected by these isolates would be u nprotected because of poor immunogenicity of polysaccharide vaccines i n children less than 2 years old.