Invasive pneumococcal disease in children <5 years of age in rural Mozambique

OBJECTIVES To estimate the incidence and epidemiological characteristics of invasive pneumococcal disease (IPD) in children < 5 years of age living in a rural area of southern Mozambique. METHODS As part of the clinical management of children admitted to Manhica District Hospital, prospective surveillance for invasive bacterial disease was conducted from June 2001 to May 2003. The level of antibiotic resistance of the isolates was also analysed. RESULTS Pneumococcus was the most commonly isolated bacterium, accounting for 212 episodes. The estimated crude incidence rate of IPD in the study area among children < 5 years of age was 416/100 000 per child-year at risk. The youngest age group (< 3 months) had the highest incidence (779/100 000). Cases were detected during both rainy and dry seasons. The most common clinical diagnosis was pneumonia, made in 146/212 (69%) of the episodes of IPD. The overall case fatality rate was 10%, being highest among children with pneumococcal meningitis (5/9 = 56%). Pneumococcal isolates were highly susceptible to penicillin (86% susceptible and 14% with intermediate resistance) and chloramphenicol (98% susceptible). In contrast, up to 37% of the isolates tested were non-susceptible to cotrimoxazole. CONCLUSIONS Incidence rates of IPD and associated mortality shown in this study highlight the need for pneumococcal vaccines in rural Africa, which must be effective in infants and young children.