EPIDEMIOLOGY OF INVASIVE CHILDHOOD PNEUMOCOCCAL INFECTIONS IN ISRAEL

Objective.-To study the epidemiology of childhood pneumococcal invasive infections in Israel as a background for immunization programs. Design.-A 2-year (October 1988 through September 1990) prospective, nationwide surveillance of all invasive pediatric pneumococcal infections. Setting.-All 25 medical centers hospitalizing children in Israel, including all laboratories performing blood cultures from pediatric patients. Patients.-Infants and children aged 0 to 12 years visiting the pediatric emergency department or hospitalized in pediatric departments were included if Streptococcus pneumoniae was isolated from blood or cerebrospinal fluid. Results.-Four hundred sixty-nine invasive infections were diagnosed. Pneumonia, bacteremia without apparent focus, meningitis, and cellulitis were found in 39%, 37%, 17%, and 3%, respectively. The annual incidence was 42 per 100 000 for children younger than 5 years of age (104 per 100 000 for those <12 months old). The two most common serotypes were 1 and 5, which are rare in Western 'Europe and North America. Eight groups comprised 82% of all invasive infections. Extrapolated to a population in which 100 000 live births occur yearly, the total annual hospitalizations for pneumococci infections was calculated to be 1928 days. The overall case-fatality rate was 2.2%, but it was 30% during the first month of life. Conclusions.-Pneumococcal invasive infections are common in children in Israel and carry considerable morbidity.