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Streptococcus pneumoniae isolated from patients with invasive pneumococcal disease has been subjected to laboratory-based surveillance in Latin American and Caribbean countries since 1993. Invasive pneumococcal diseases remain a major cause of death and disability worldwide, particularly in children. We therefore aimed to assess the direct effect of pneumococcal conjugate vaccines (PCVs) on the distribution of pneumococcal serotypes causing invasive pneumococcal disease in children younger than 5 years before and after PCV introduction.We did a multicentre, retrospective observational study in eight countries that had introduced PCV (ie, PCV countries) in the Latin American and Caribbean region: Argentina, Brazil, Chile, Colombia, Dominican Republic, Mexico, Paraguay, and Uruguay. Cuba and Venezuela were also included as non-PCV countries. Isolate data for Streptococcus pneumoniae were obtained between 2006 and 2017 from children younger than 5 years with an invasive pneumococcal disease from local laboratories or hospitals. Species' confirmation and capsular serotyping were done by the respective national reference laboratories. Databases from the Sistema Regional de Vacunas (SIREVA) participating countries were managed and cleaned in a unified database using Microsoft Excel 2016 and the program R (version 3.6.1). Analysis involved percentage change in vaccine serotypes between pre-PCV and post-PCV periods and the annual reporting rate of invasive pneumococcal diseases per 100 000 children younger than 5 years, which was used as a population reference to calculate percentage vaccine type reduction.Between 2006 and 2017, 12 269 isolates of invasive pneumococcal disease were collected from children younger than 5 years in the ten Latin American and Caribbean countries. The ten serotypes included in ten-valent pneumococcal conjugate vaccine (PCV10) decreased significantly (p0·0001) after any PCV introduction, except for the Dominican Republic. The percentage change for the ten vaccine serotypes in PCV10 countries was -91·6% in Brazil (530 [72·9%] of 727 before, 27 [6·1%] of 441 after); -85·0% in Chile (613 [72·6%] of 844 before, 44 [10·9%] of 404] after); -84·7% in Colombia (231 [63·1%] of 366 before, 34 [9·7%] of 352 after); and -73·8% in Paraguay (127 [77·0%] of 165 before, 22 [20·2%] of 109 after). In the 13-valent pneumococcal conjugate vaccine (PCV13) countries, the percentage change for the 13 vaccine serotypes was -59·6% in Argentina (853 [85·0%] of 1003 before, 149 [34·3%] of 434 after); -16·5% in the Dominican Republic (95 [80·5%] of 118 before, 39 [67·2%] of 58 after); -43·7% in Mexico (202 [73·2%] of 276 before, 63 [41·2%] of 153 after); and -45·9% in Uruguay (138 [80·7%] of 171 before, 38 [43·7%] of 87 after). Annual reporting rates showed a reduction from -82·5% (6·21 before vs 1·09 after per 100 000, 95% CI -61·6 to -92·0) to -94·7% (1·15 vs 0·06 per 100 000, -89·7 to -97·3) for PCV10 countries, and -58·8% (2·98 vs 1·23 per 100 000, -21·4 to -78·4) to -82·9% (7·80 vs 1·33 per 100 000, -76·9 to -87·4) for PCV13 countries. An increase in the amount of non-vaccine types was observed in the eight countries after PCV introduction together with an increase in their percentage in relation to total invasive strains in the post-PCV period.SIREVA laboratory surveillance was able to confirm the effect of PCV vaccine on serotypes causing invasive pneumococcal disease in the eight PCV countries. Improved monitoring of the effect and trends in vaccine type as well as in non-vaccine type isolates is needed, as this information will be relevant for future decisions associated with new PCVs.None.For the Portuguese and Spanish translations of the abstract see Supplementary Materials section.

Streptococcus pneumoniae is a major cause of severe invasive disease associated with high mortality and morbidity worldwide. To identify the serotypes most commonly associated with infection in adults in Argentina, 791 pneumococcal isolates from 56 hospitals belonging to 16 provinces and Buenos Aires city were serotyped. The isolates were submitted as part of a National Surveillance Program for invasive pneumococcal disease in adults, which started in 2013. Serotypes 3, 8, 12F, 7F and 1 were the most prevalent among adult patients. During the study period there was no significant difference in serotype distribution between the age groups studied (18-64 and ≥65 years old), except for serotype 1, 3 and 23A. Most prevalent serotypes in pneumonia were serotype 7F, 1, 12F, 8, and 3. When the clinical diagnosis was meningitis, serotype 3 and 12F were the most prevalent, whereas when the diagnosis was sepsis/bacteremia the most prevalent was serotype 8. In this work, for the 18-64-year-old group, PPSV23 and PCV13 serotypes accounted for 74.56% and 44.54% respectively of the cases in the studied period. On the other hand, for the ≥65-year-old group, these serotypes represented 72.30% and 41.42% respectively. The aim of this work was to establish the knowledge bases of the serotypes that cause invasive pneumococcal diseases in the adult population in Argentina and to be able to detect changes in their distribution over time in order to explore the potential serotype coverage of the vaccines in current use.

The incorporation of Haemophilus influenzae type b (Hib) vaccine into the Argentine National Immunization Program in 1998 resulted in a dramatic decrease in the incidence of invasive disease due to this serotype. We assessed 1405 H. influenzae (Hi) isolates causing invasive infections referred to the National Reference Laboratory between 2011 and 2019. Non-encapsulated Hi were the most common strains (44.5%), followed by types b (41.1%) and a (10.0%). Significant increase in the proportion of type b was observed, from 31.2% in 2011, to 50% in 2015, correlating with the peak incidence rate, later decreasing to 33.6% by 2019. We compared the genetic relationship between clones circulating during the period of increased Hib incidence (2011-2015) and those of the prevaccination-transition period (1997-1998). Four pulsotypes predominated in both periods, G, M, P and K, G being the most common. Multi-locus sequence typing revealed that the 4 pulsotypes belonged to ST6, or one of its simple or double locus variants. Isolates from fully vaccinated individuals did not differ from those of the rest of the population studied. After ruling out aspects associated with emergence of specific clones, we concluded that factors such as low booster coverage rates, delayed vaccination schedules and use of different vaccines may have contributed to the reemergence of Hib infections.

Invasive disease caused by Streptococcus pneumoniae (IPD) is one of the leading causes of morbidity and mortality in young children worldwide. In Argentina, PCV13 was introduced into the childhood immunization programme nationwide in 2012 and PCV7 was available from 2000, but only in the private market. Since 1993 the National IPD Surveillance Programme, consisting of 150 hospitals, has conducted nationwide pneumococcal surveillance in Argentina in children under 6 years of age, as part of the SIREVA II-OPS network. A total of 1713 pneumococcal isolates characterized by serotype (Quellung) and antimicrobial resistance (agar dilution) to ten antibiotics, belonging to three study periods: pre-PCV7 era 1998–1999 (pre-PCV), before the introduction of PCV13 2010–2011 (PCV7) and after the introduction of PCV13 2012–2013 (PCV13), were available for inclusion. Fifty-four serotypes were identified in the entire collection and serotypes 14, 5 and 1 represented 50 % of the isolates. Resistance to penicillin was 34.9 %, cefotaxime 10.6 %, meropenem 4.9 %, cotrimoxazole 45 %, erythromycin 21.5 %, tetracycline 15.4 % and chloramphenicol 0.4 %. All the isolates were susceptible to levofloxacin, rifampin and vancomycin. Of 1713 isolates, 1061 (61.9 %) were non-susceptible to at least one antibiotic and 235(13.7 %) were multidrug resistant. A subset of 413 isolates was randomly selected and whole-genome sequenced as part of Global Pneumococcal Sequencing Project (GPS). The genome data was used to investigate the population structure of S. pneumoniae defining pneumococcal lineages using Global Pneumococcal Sequence Clusters (GPSCs), sequence types (STs) and clonal complexes (CCs), prevalent serotypes and their associated pneumococcal lineages and genomic inference of antimicrobial resistance. The collection showed a great diversity of strains. Among the 413 isolates, 73 known and 36 new STs were identified belonging to 38 CCs and 25 singletons, grouped into 52 GPSCs. Important changes were observed among vaccine types when pre-PCV and PCV13 periods were compared; a significant decrease in serotypes 14, 6B and 19F and a significant increase in 7F and 3. Among non-PCV13 types, serogroup 24 increased from 0 % in pre-PCV to 3.2 % in the PCV13 period. Our analysis showed that 66.1 % (273/413) of the isolates were predicted to be non-susceptible to at least one antibiotic and 11.9 % (49/413) were multidrug resistant. We found an agreement of 100 % when comparing the serotype determined by Quellung and WGS-based serotyping and 98.4 % of agreement in antimicrobial resistance. Continued surveillance of the pneumococcal population is needed to reveal the dynamics of pneumococcal isolates in Argentina in post-PCV13. This article contains data hosted by Microreact.

Streptococcus pneumoniae is a major cause of severe invasive disease associated with high mortality and morbidity worldwide. A total of 2908 pneumococcal isolates were analyzed between 2006 and 2019. Gold standard pneumococcal serotyping (the Neufeld-Quellung reaction) was performed to identify the serotypes associated with infection in children 5 years in Argentina and agar dilution method was carried out to determine their profiles to 14 antimicrobial agents. In 2012, the 13-valent pneumococcal conjugate vaccine (PCV13) was included in the National Immunization Program. In this work we have analyzed the local epidemiology of invasive pneumococcal diseases before and after the introduction of this vaccine in order to understand the epidemiological relevance and impact of PCV13. During the periods compared in the present study there was a significant increase in the proportion of non-PCV13 serotypes, serogroup 24 (246.7%) and 12F (85.7%), and a significant decrease in PCV13 serotypes, including serotypes 14 (91.2%), 5 (95.6%) and 1 (84.6%) among others. Another observation was that serotypes 3 (7.4%) and 19A (4.9%) still remain among the most frequent serotypes despite being part of the PCV13 formulation. Regarding antimicrobial resistance, in the present study we observed an increase in erythromycin resistance during the period of study mainly associated to serotype 14 in the pre-PCV13 period and to serogroup 24 in the post-PCV13 period, which also was the major NVT serotype associated with antimicrobial resistance and MDR. Serotypes 14, 24A/B/F and 19A were in the first three places among isolates resistant to all the antibiotics tested. Our data highlight the importance of continuous surveillance to assess the impact of pneumococcal vaccines and the use of antibiotics in the dynamic of pneumococcal serotypes.

Background Neisseria meningitidis (Nm) pharyngeal carriage is a necessary condition for invasive disease. We present the first carriage study in children in Buenos Aires, Argentina, considering 2017 as a transition year. Aims: to assess the rate of Nm carriage, to determine genogroup, clonal complex and outer membrane protein distribution, to determine carriage risk factors by age. Methods Cross-sectional study including children 1–17 yrs, at Ricardo Gutiérrez Children’s Hospital in Buenos Aires 2017. Oro-pharyngeal swabs were taken and cultured within a short time after collection. Genogroup was determined by PCR and clonal complex by MLST. Categorical variables were analyzed. Results A total of 1,751 children were included. Group 1: 943 children 1–9 yrs, 38 Nm were isolated; overall carriage 4.0%. Genogroup distribution: B 26.3%, W 5.3%, Y 2.6%, Z 5.3%, other groups 7.9% and capsule null (cnl) 52.6%. Participating in extracurricular activities was the only independent predictor of Nm carriage. Group 2: 808 children 10–17 yrs, 76 Nm were isolated; overall carriage 9.4%. Genogroup distribution: B 19.7%, C 5.3%, W 7.9%, Y 9.2%, Z 5.3%, other groups 7.9% and cnl 44.7%. Independent predictors of carriage: attending pubs/night clubs and passive smoking (adjusted OR: 0.55, 95%CI = 0.32–0.93; p = 0.025). Conclusions Overall carriage was higher in 10–17 yrs. The isolates presenting the cnl locus were prevalent in both age groups and genogroup B was the second most frequent.

To measure the effectiveness of pneumococcal conjugated vaccine (PCV13) against Community Acquired Pneumonia (CAP) and invasive pneumococcal disease, 2 years after the vaccine (2+1) was included into the National Immunization Program of Argentina, and to describe variables associated with bacterial pneumonia and hospitalization.This was a prospective, population-based surveillance study of CAP incidence (ambulatory and hospitalized) among children less than 5 years of age in the Department of Concordia (Entre Rios, Argentina) from April 2014 - March 2016. The diagnosis of probable bacterial pneumonia (PBP) was determined following the standardized WHO protocol. Incidence during the post-vaccine introduction period was compared with the results from a previous study that used similar methodology for the pre-PCV13 introduction period from 2002 - 2005.During the study period, 330 patients had a clinical diagnosis of CAP, of which 92 were PBP (6 with pleural effusion). S. pneumoniae was not isolated from any sample. No factors associated with PBP were found in multivariable analysis. The decrease in PBP and pleural effusion was significant in relation to the previous study: 63% (P0.0001) and 80.9% (P0.003), respectively. PCV13 uptake was 97.3% for the 1st dose and 84.8% for the booster dose.PCV13 was effective to reduce incidence of consolidated pneumonia and pleural effusion, among children less than 5 years of age in Concordia, Argentina. Vaccination is a very effective public health strategy for reducing vaccine preventable diseases, with impact on burden of disease and hospitalization.Medir la efectividad de la vacuna antineumocócica conjugada (VNC13)contra la neumonía extrahospitalaria y las enfermedades neumocócicas invasoras, dos años después de que se incorporara la vacuna (2+1) en el Programa Nacional de Vacunación de Argentina, y describir las variables asociadas con la neumonía bacteriana y la hospitalización.Se llevó a cabo un estudio prospectivo de vigilancia poblacional de la incidencia de la neumonía extrahospitalaria (pacientes ambulatorios y hospitalizados) en menores de 5 años en el departamento Concordia (Entre Ríos, Argentina) desde abril del 2014 hasta marzo del 2016. Se determinó el diagnóstico de probable neumonía bacteriana según el protocolo estandarizado de la OMS. Se comparó la incidencia durante el período posterior a la incorporación de la vacuna con los resultados de un estudio anterior en el que se usó una metodología similar para el período previo a la incorporación de la VNC13 entre el 2002 y el 2005.Durante el estudio, 330 pacientes presentaron un diagnóstico clínico de neumonía extrahospitalaria, de los cuales 92 presentaron probable neumonía bacteriana (6 con derrame pleural). No se aisló ninguna muestra delLa VNC13 fue efectiva para reducir la incidencia consolidada de derrame pleural y neumonía en menores de 5 años en Concordia (Argentina). La vacunación es una estrategia de salud pública muy efectiva para reducir las enfermedades prevenibles por vacunación, con repercusión en la carga de enfermedad y la hospitalización.Avaliar a efetividade da vacina pneumocócica conjugada (PCV13) em prevenir pneumonia adquirida na comunidade (PAC) e doença pneumocócica invasiva (DPI) após 2 anos da incorporação da vacina (2 + 1) ao Programa Nacional de Vacinação da Argentina e descrever as variáveis associadas à ocorrência de pneumonia bacteriana e internação hospitalar.Estudo prospectivo de base populacional de vigilância da incidência de PAC (atendimento ambulatorial e em internação hospitalar) em crianças menores de 5 anos de idade realizado no Departamento de Concordia, Entre Rios, na Argentina, de abril de 2014 a março de 2016. O diagnóstico de provável pneumonia bacteriana foi determinado segundo o protocolo padronizado da OMS. A incidência no período pós-introdução da vacina foi comparada aos resultados de um estudo anterior realizado com metodologia semelhante no período pré-introdução da PCV13 de 2002 a 2005.No período de estudo, foi feito o diagnóstico clínico de PAC em 330 pacientes, dos quais 92 foram casos de provável pneumonia bacteriana (6 com derrame pleural). A bactériaA PCV13 foi efetiva em reduzir a incidência de pneumonia com consolidação e derrame pleural em crianças menores de 5 anos em Concordia, na Argentina. A vacinação é uma estratégia de saúde pública muito efetiva para reduzir doenças que podem ser evitadas com vacina, com impacto na morbidade e nas internações hospitalares.

Streptococcus pneumoniaeis a prevalent cause of invasive diseases in children, justifying continuous surveillance programs such as by the SIREVA group (Pan American Health Organization). The aim of this study was to determine the serotype distribution of S. pneumoniae causing invasive disease in children < 6 years old, the serotype coverage of the pneumococcal conjugate vaccine 7-valent (PCV7), 10-valent (PCV10) and 13-valent (PCV13), and antibiotic resistance, from 1994 to 2007. During this period, 2205 invasive S. pneumoniaewere included in the study. Although 49 different capsular types were identified, 12 serotypes accounted for 86% of all isolates. These were prevalent throughout the study period with serotype 14 predominating. Penicillin non-susceptible S. pneumoniaewas detected in 33.2% of all isolates. The coverage of PCV7, PCV10 and PCV13 from 2004 to 2007 for children < 2 years old was 51.7%, 72.4% and 84.5%, respectively. The data demonstrates a decline in serotype 14, and an increase in serotypes 1 and 19A in the study period. Resistance to penicillin and trimethoprim-sulfamethoxazole decreased, while resistance to erythromycin increased. These results demonstrate the need for the introduction of a conjugate pneumococcal vaccine and continuing surveillance to monitor changes in serotypes distribution and antimicrobial resistance.

Objetivos. Caracterizar la población en estudio en el marco del Sistema Nacional de Vigilancia de Salud de la Argentina,determinar la proporción de infección por Bordetella pertussis y Bordetella parapertussis e identificar factores asociados de los casos con sospecha de coqueluche atendidos en la ciudad de Mar del Plata y alrededores durante el período 2011-2015. Materiales y Métodos. Se realizó un estudio observacional y descriptivo. Se diagnosticaron por laboratorio casos clínicos con sospecha de coqueluche. Los estudios de laboratorio consistieron en cultivo, PCR y serología por técnica de ELISA. Resultados. Se evaluaron 572 casos. El sexo femenino fue el más frecuente con 51,9% (296/570), el rango etario más frecuente fue de 2 a 17 meses con 51,1% (290/568) que fue además el grupo con más casos confirmados. Solo el 47,8% (155/324) de la población estudiada tenía vacunación completa para su edad. Se confirmó coqueluche por Bordetella pertussis en el 15,5 % y un solo caso con Bordetella parapertussis. Hubo asociación entre tener un contacto familiar tosedor por más de dos semanas con la confirmación de Bordetella spp. (odds ratio [OR]: 3,3; [intervalo de confianza al 95%] IC 95%: 1,9 - 5,4). Conclusiones. Existe la necesidad de realizar una evaluación oportuna de los casos sospechosos de coqueluche tanto en niños como en adolescentes y adultos para lograr un mejor control de la enfermedad. Asimismo, continuar con las medidas de prevención y de contención resulta fundamental para disminuir la circulación del agente causal. Objectives. To classify the study population in the Argentinian National Health Surveillance System framework, determine the proportion of infection by Bordetella pertussis and Bordetella parapertussis, and identify factors associated with the cases of suspected whooping cough attended to in the city of Mar del Plata and its outskirts during the period 2011-2015. Materials and Methods. An observational and descriptive study was carried out. Clinical cases with suspicion of whooping cough were diagnosed by laboratory. The laboratory studies consisted of culture, PCR, and serology using the ELISA technique. Results. A total of 572 cases were evaluated. The female sex was the most frequent (51.9%). The most frequent age range was 2 to 17 moths (51.1%; 290/568), which was also the group with the most confirmed cases. Only 47.8% (155/324) of the population studied had complete vaccination for their age. Whooping cough due to B. pertussis was confirmed in 15.5% (89/572) of cases and one case with B. parapertussis. Those cases that had contact with a coughing relative were significantly associated with the confirmation of Bordetella spp. by the laboratory (odds ratio: 3.3; 95% confidence interval: 1.9-5.4). Conclusions. The results show the need to suspect whooping cough and diagnose it early in children, adolescents, and adults in order to better control the disease. Likewise, continuing prevention and containment measures are fundamental in decreasing the circulation of the causal agent.

espanolCoqueluche, pertussis o tos convulsa es una enfermedad aguda de las vias respiratorias altamente contagiosa producida principalmente por Bordetella pertussis. Es una de las causas principales de morbi-mortalidad en la ninez. Esta enfermedad no siempre es clinicamente evidenciable en los adultos. El objetivo del trabajo fue describir la ocurrencia de casos de coqueluche en un grupo familiar en la ciudad de Mar del Plata. Se realizo un estudio descriptivo retrospectivo de contactos intrafamiliares sintomaticos a partir de la deteccion de un caso confirmado de coqueluche en un lactante. A partir de la confirmacion del caso indice, se analizaron las caracteristicas clinico– epidemiologicas y los resultados de laboratorio de los contactos que fueron clasificados como casos confirmados por nexo epidemiologico. Los estudios de laboratorio consistieron en cultivo, PCR y serologia por tecnica de ELISA. Del estudio surgio que la fuente probable de contagio para el lactante formaba parte del nucleo familiar. De esta manera se resalta la importancia de sospechar y diagnosticar esta enfermedad en pacientes adolescentes y adultos. Se comprueba el rol del nucleo familiar en la transmision de la enfermedad, lo cual conduce a priorizar las estrategias de proteccion para los mas vulnerables a la enfermedad, como la vacunacion durante el embarazo, implementada en Argentina a partir del ano 2012. EnglishPertussis or whooping cough is a highly contagious acute disease of respiratory tract mainly produced by Bordetella pertussis. It is one of the leading causes of morbidity and mortality in childhood. This disease is not always clinically evident in adults. The aim of this study was to describe the occurrence of cases of pertussis in the city of Mar del Plata. It consisted in an epidemiological-retrospective study of household contact of an confirmed case of pertussis in an infant. It was analysed the clinical-epidemiological characteristics and laboratory findings of the household contacts that were classified as cases confirmed by epidemiological link. Laboratory studies were performed by culture and PCR in respiratory samples. For the household contacts, also it was used serology by ELISA technique for detection of total antibodies anti-Bordetella spp. Of the study it could be inferred that the likely source of infection to the infant was part of the family. In this way highlights the importance of suspect and diagnose this disease in adults and adolescent patients. The role of the family in the transmission of the disease, leads to prioritize protection strategies for the most vulnerable to the disease, such as vaccination during pregnancy, implemented in Argentina from the year 2012.

Background Neisseria meningitidis (Nm) pharyngeal carriage is a necessary condition for invasive meningococcal disease. In 2017, Argentina introduced a tetravalent meningococcal conjugated vaccine (MenACYW) to the National Immunization Program for children. We present the first carriage study in children in the prevaccine era. Aims: 1) to assess the rate of Nm carriage in healthy children and adolescents attending a public hospital in Buenos Aires city; 2) to determine serogroup and clonal complex distribution; 3)to determine carriage risk factors by age. Methods Cross-sectional study including children 1–17 years, stratified in two age groups (1–9 years and 10–17 years) assisted at Ricardo Gutiérrez Children Hospital between March-December 2017. Oro-pharyngeal swabs were plated and meningococci identified by conventional microbiology methods. Serogroup was determined by PCR. Clonal complex was determined by MLST. Results A total of 1751 children were included. Group aged 1–9 years: 38 Nm were isolated from 943 samples collected: overall carriage 4.0%. Serogroups distribution: B 26.3%, Y 2.6%, W 5.3%, Z 5.3%, non-groupable 7.9% and non-capsulated 52.6%. Clonal complex was determined for 25 isolates. Attendance at social venues was the only independent predictor of Nm carriage (adjusted OR: 2.02, CI 95% = 1.01–4.03; P = 0.04). Group aged 10–17 years: 76 Nm were isolated from 808 samples: overall carriage 9.4%. Serogroups distribution: B 19.7%, C 5.3%, W 7.9%, Y 9.2%, Z 5.3%, non-groupable 7.9% and non-capsulated 44.7%. Clonal complex was determined for 58 isolates. Independent predictor of Nm carriage: attendance at night clubs (adjusted OR: 3.38, CI95% = 1.28–8.93; P = 0.013); passive smoking at home (adjusted OR: 0.55, CI 95% = 0.32–0.93; P = 0.025). Preliminary data show a total of 10 different clonal complexes present among all serogroups in the 1–9 years group aged and 13 in 10–17 years. Conclusion Overall carriage was higher in the 10–17 years population. The non-encapsulated Nm was prevalent in both groups and serogroup B was the most frequent among the encapsulated. The results demonstrated a high diversity of N. meningitis in pharyngeal carriage. Disclosures All authors: No reported disclosures.

Background Neisseria meningitides (Nm) cause different types of invasive infections.Nm pharyngeal carriage is a necessary condition for invasive meningococcal disease. In 2017 Argentina introduced a tetravalent meningococcal conjugated vaccine (MenACYW) to the National Immunization Program.Aims To assess the rate of Nm carriage in healthy children and adolescents attending a public hospital in Buenos Aires city, to determine genogroup and clonal complex distribution,to describe genogroup distribution of Nm isolated from ID in Argentina, during the same period. Methods Between March and December 2017, a single-center, cross-sectional study was performed among 1,751 children 1–17 years old attending Ricardo Gutiérrez Children Hospital in Buenos Aires, Argentina. From oro-pharyngeal swabs, genogroup and clonal complex (CC) were identified. We analyzed Nm ID genogroups data reported to the Regional Surveillance Program (SIREVA II) in the same year. at the same period were relevated. Results 114Nm were isolated from the carriage study, with an overall carriage of 6.5%.Genogroups distribution: B 25(21.9%), W 9(7.8%), Y 7(6.1%), Z 6(5.2%), C 4(3.5%), non-groupable 9(7.8%) and non-capsulated (NC)54 (47.3%). 105 Clonal complex (CC) were determined: Genogroup B isolates belonged to ST-41/44, ST-35, ST-32 and ST-865. Genogroup W was associated to ST-11 and ST-35. SIREVA reported 76 strains of Nminvasive infections in 2017, 53.9% meningitis, 11.8% meningitis and sepsis, 22.4% sepsis, and 11.8% others. Genogroupsdistribution: B59.2% (45), W 23.6% (18), C 10.5% (8), Y 6.5% (5). Conclusion Genogroup B is the most frequent cause of ID followed by W in our country. In the pharyngeal carriage study we found that NmNC was prevalent and genogroup B was the most frequent among the encapsulated.Genogroup B CCs detected in our carriage study coincided with those found previously in ID in Argentina. Genogroup W carriage was low and hypervirulent CC ST-11 was detected. Although genogroup Z does not cause ID in our country it was found in carriage. Disclosures All authors: No reported disclosures.

ResumenLa introducción de la vacuna contra Haemophilus influenzae tipo b en los programas de inmunización de muchos países produjo una reducción marcada en la incidencia de en-fermedad invasiva causada por este serotipo y en su portación y un incremento de otros tipos capsulares y de aislamientos no capsulados. Se estudiaron 313 aislamientos de H. influenzae recuperados de sitio estéril, provenientes de pacientes pediátricos y adul-tos con enfermedad invasiva atendidos en 90 hospitales de la Red Nacional de Laborato-rios para Meningitis e Infecciones Respiratorias Agudas Bacterianas durante el período 2005–2010. Las patologías más frecuentes fueron neumonía, 40,3 % (n=126), meningitis, 30,0 % (n=94) y bacteriemia, 26,5 % (n=83). En los pacientes pediátricos (n=279), la mayor frecuencia de aislamientos correspondió a menores de 2 años, 74,5 % (n=208). Con respecto a la distribución de tipos, el 61,3 %, correspondió a H. influenzae no capsu-lados (n=192); el 20,1 % al b (n=63); 11,2 % al a (n=35); 4,8 % al f y 2,6 % a otros. En meningitis predominaron H. influenzae capsulados mientras que en neumonía y bacterie-mia resultaron dominantes los tipos no capsulados. Se determinó el biotipo en 306 aislamientos. Todos los aislamientos de tipo a correspondieron al biotipo II; el 66,7 % de los tipo b pertenecieron al biotipo I. Mediante las técnicas de aglutinación en lámina y PCR se estudiaron 220 aislamientos; la concordancia entre ambas fue de 0,982 (IC: 0,92–1,00). En el último año se encontró un aumento significativo del tipo b, lo cual indi-ca la importancia de mantener la vigilancia clínica y laboratorial de la enfermedad inva-siva por H. influenzae.AbstractThe introduction of the Haemophilus influenzae type b vaccine in the immunization programs of many countries has greatly reduced this invasive disease and the carriage caused by this serotype, also increasing other capsular types and non-capsular isolations. There were 313 isolations of H. influenzae under study, which were recovered from a sterile site coming from pediatric and adult patients carrying the invasive disease. Patients were treated at 90 different hospitals belonging to the Red Nacional de Laboratorios para Meningitis e Infecciones Respiratorias Agudas Bacterianas (National Lab Network for Meningitis and Acute Bacterial Respiratory Infections) from 2005 to 2010 for the following disorders: pneumonia, 40.3% (n=126), meningitis, 30.0% (n=94) and bacteremia, 26.5% (n=83). In pediatric patients (n=279), the highest frequency of isolations corresponded to children under the age of 2 years, 74.5% (n=208). Regarding type distribution, 61.3% corresponded to non-capsular H. influenzae (n=192), 20.1% to type b (n=63), 11.2% to type a (n=35), 4.8% to type f, and 2.6% to other types. Capsular H. influenzae was predominant in meningitis whereas non-capsular H. influenzae in pneumonia and bacteremia. The biotype was determined in 306 isolations. The totality (100%) of type a (n=35) was biotype II whereas 66.7% of type b (n=63) was biotype I. Slide agglutination and PCR tests were used in 220 isolations. There was a match of 0.982 (IC: 0.92-1.00) between them. During the last year, there was a great increase in type b, showing the importance of clinical and laboratory-based surveillance of the invasive disease caused by H. influenzae.

Meningococcal disease (MD) is a medical emergency and a serious public health problem. As new meningococcal vaccines become available, MD surveillance is crucial to provide baseline epidemiologic data before implementing preventive measures. We estimated MD incidence and epidemiology in Argentina using hospital-based surveillance.Three-year prospective active surveillance in patients ≤15 years of age was conducted at 6 pediatric hospital sentinel units (March 2012 to February 2015).Of 184,360 hospitalized patients, 1444 (0.78%) had suspected meningitis or MD. Of these, 268 (19%) presented probable acute bacterial meningitis or MD, 168 (63%) were culture positive and 51 (30%) tested positive for Neisseria meningitidis. Of 100 culture-negative cases, 30 had positive meningococcal polymerase chain reaction. Thirteen patients presented other uncommon MD manifestations, resulting in a total of 94 MD cases and an annual incidence of 5.1/10 hospitalized patients [95% confidence interval (CI): 4-6]. Fifty-four (57%) patients were males, 48% were1 year of age and the median age was 12.5 months (1 month to 15 years). Clinical presentations were the following: meningococcemia and meningitis (37%), meningitis (30%), meningococcemia (16%), arthritis (10%), bacteremia (5%) and pneumonia (2%). Twenty-eight percent had complications. Nine children died (case fatality rate: 10%), and 8 had sequelae. Serogroups were identified for 84 isolates. Serogroup W was associated with age1 year (odds ratio: 3.18; 95% CI: 1.14-8.99); meningococcemia was associated with mortality (P = 0.0038).Highest rates of MD were observed among young infants. This study provides baseline data to estimate the impact of introducing meningococcal vaccines in Argentina.

To inform World Health Organization recommendations regarding use of Haemophilus influenzae type b (Hib) vaccines in national immunization programs, a multi-country evaluation of trends in Hib meningitis incidence and prevalence of nasopharyngeal Hib carriage was conducted in four South American countries using either a primary, three-dose immunization schedule without a booster dose or with a booster dose in the second year of life. Surveillance data suggest that high coverage of Hib conjugate vaccine sustained low incidence of Hib meningitis and low prevalence of Hib carriage whether or not a booster dose was used.

Background In January 2012, Argentine introduced PCV-13 to the National Immunization Program. We performed an epidemiological study in order to describe consolidated pneumonia and pneumococcal disease incidence following PCV-13 routine vaccination. Methods Between April2014-March2016, a population-based surveillance study was carried out in Concordia. Clinical data, vaccination status and digital chest X-rays were recorded from children < 5 years old with pneumonia and pleural effusion. A pediatrician and a radiologist interpreted the images independently. A second reference radiologist arbitrated when discordances occurred. Bacterial etiology was investigated in blood and/or in pleural fluid. Probably bacterial pneumonia (PBP) was determined following WHO protocol. Results were compared with previous data (2002–2005) from the pre-PCV-13 vaccination era. Variables associated to consolidated pneumonia were evaluated by multivariate analysis using logistic regression Results 330 patients under 5 years old with pneumonia were assisted during the study period. Of these, 92 (27.9%-IC95% 23.2–33.1) were classified as PBP. Annual incidence rate, in pre and post vaccination period and impact of vaccination are described in table 1. Incidence of pneumococcal disease could not be estimated as pneumococcal isolation was negative in all cases. Multivariate analysis of post-PCV-13 vaccination era showed that incidence of consolidated pneumonia was significantly higher in hospitalized toddlers than outpatients OR: 2,97 (1,65–5,38). Table 1: PBP incidence (*100.000) by study period. Vaccination impact Final Classification Pre-vacccination period Post vaccination period Impact of vaccination N Population Incidence n Population Incidence Incidence Rate ratio (IC95%) Decrease P value Consolidated pneumonia 387 18.053 714,6 86 15.493 283.9 2.5 (1.8–3.6) 60.2%

Background In Argentina PCV13 was included in the National Vaccination Program in January 2012 for children

PspA, proteína de superficie de Streptococcus pneumoniae es un factor de virulencia, fuertemente inmunogénica y común a todos los serotipos. Aunque el gen que codifica para esta proteína presenta una marcada heterogeneidad en la región correspondiente al N-terminal, la PspA contiene epitopes conservados de manera tal que la inmunización genera protección contra neumococos pertenecientes a diversos tipos capsulares y con distintas PspA. A pesar del marcado polimorfismo del gen pspA es posible agrupar las distintas variantes en 3 familias mayoritarias. Estas propiedades las convierten en candidatas ideales para elaborar vacunas. Debido a que la mayoría de los trabajos sobre identificación de familias fueron realizados sobre serotipos frecuentes en otros países, el objetivo fue identificar las familias de PspA de aislamientos de pacientes de nuestra región y relacionarlas con los serotipos prevalentes y patologías. Se estudiaron 70 aislamientos, provenientes de niños con infecciones invasoras. Se aplicó una PCR utilizando cebadores específicos de cada familia. El 60% fueron familia 1 y 34% familia 2. En un 6% no se identificó ninguna de las familias de PspA. Los serotipos 1 y 5 presentaron familia 1 únicamente; los serotipos 14, 6B, 19F y 18C mostraron genes de ambas familias. La familia 1 se observó en 60% de las neumonías y 50% de las meningitis. La familia 2 en 33% de neumonías y 50% de meningitis. Esta información podría ser un valioso aporte para la formulación de una vacuna regional efectiva utilizando PspA recombinante como inmunógeno.

Summary Objectives Pertussis continues causing significant morbidity and mortality worldwide. Although its epidemiology has been studied in many developed countries, the current pertussis situation in South America is scarcely known. This review summarizes the most important recent data concerning pertussis in a country of South America, Argentina. Methods CDC criteria were used for pertussis diagnosis. Proportion of pertussis cases by age, immunization status, and immunization coverage rate evaluated at the Argentinean National Pertussis Reference Centers was reported. Bordetella pertussis isolates were characterized and compared with vaccine strains. Results From 2002 to nowadays, a steady increase of pertussis cases was observed. Most of these cases correspond to patients younger than six months old that received less than three doses of vaccine. However, cases in adolescent and adults have also been detected. For this situation, which is not peculiar to Argentina, several explanations have been proposed. Among them, the inability of current vaccines to induce long-lasting immunity is the most widely accepted as a cause of pertussis resurgence. Furthermore, antigenic divergence between local clinical isolates and vaccine strains may have aggravated the effect of waning immunity. Conclusions Pertussis is an important problem for public health in Argentina. Divergence between vaccine strains and local isolates could contribute to the described pertussis epidemiology.

Durante los últimos 14 años la Organización Panamericana de la Salud ha estado promoviendo la vigilancia de la enfermedad neumocócica invasiva en niños latinoamericanos para comprender mejor las tendencias de la enfermedad en cuanto a la circulación de tipos capsulares en cada país y la susceptibilidad a los antimicrobianos. Métodos: Se analizaron los datos de vigilancia de laboratorio de 10 países latinoamericanos recopilados entre 2000 y 2005, incluida la distribución de serotipos y la susceptibilidad a los antibióticos betalactámicos. Resultados: Aunque se identificaron 61 tipos capsulares diferentes durante la vigilancia de 6 años, 13 serotipos representaron el 86% de todos los aislamientos. Estos fueron consistentemente los más prevalentes durante todo el período de estudio con predominio del serotipo 14. Se detectó una disminución de la susceptibilidad a la penicilina en el 38% de todos los aislados de Streptococcus pneumoniae, con mayor prevalencia en República Dominicana y México. La menor susceptibilidad a la penicilina aumentó en Brasil y Colombia, mientras que en Chile se registró una disminución de las tasas de alta resistencia. Conclusiones: Estos datos indican que 10 países de la Región continúan teniendo vigilancia de laboratorio de alta calidad para la enfermedad neumocócica generando información valiosa para que los tomadores de decisiones en salud puedan priorizar las intervenciones. La vacuna heptavalente cubrirá potencialmente del 52,4% al 76,5% de las cepas que causan la enfermedad neumocócica invasiva y la 13 valente del 76,7% al 88,3%. Copyright © 2009 de Lippincott Williams y Wilkins. Estos datos indican que 10 países de la Región continúan teniendo vigilancia de laboratorio de alta calidad para la enfermedad neumocócica generando así información valiosa para que los tomadores de decisiones en salud puedan priorizar las intervenciones. La vacuna heptavalente cubrirá potencialmente del 52,4% al 76,5% de las cepas que causan la enfermedad neumocócica invasiva y la 13 valente del 76,7% al 88,3%. Copyright © 2009 de Lippincott Williams y Wilkins. Estos datos indican que 10 países de la Región continúan teniendo vigilancia de laboratorio de alta calidad para la enfermedad neumocócica generando así información valiosa para que los tomadores de decisiones en salud puedan priorizar las intervenciones. La vacuna heptavalente cubrirá potencialmente del 52,4% al 76,5% de las cepas que causan la enfermedad neumocócica invasiva y la 13 valente del 76,7% al 88,3%. For the last 14 years the Pan American Health Organization has been promoting surveillance of invasive pneumococcal disease in Latin American children for better understanding of the disease tendencies regarding capsular types circulation in each country and susceptibility to antimicrobials. Methods: Laboratory-based surveillance data from 10 Latin American countries collected from 2000 to 2005 were analyzed, including serotype distribution and susceptibility to beta-lactam antibiotics. Results: Although 61 different capsular types were identified during the 6-year surveillance, 13 serotypes accounted for 86% of all isolates. These were consistently the most prevalent throughout the study period with serotype 14 predominating. Diminished susceptibility to penicillin was detected in 38% of all Streptococcus pneumoniae isolates, with the highest prevalence in Dominican Republic and Mexico. Decreased susceptibility to penicillin increased in Brazil and Colombia whereas decreased high resistance rates was recorded in Chile. Conclusions: These data indicate that 10 countries of the Region continue to have high quality laboratory-based surveillance for pneumococcal disease thus generating valuable information so that healthcare decision makers may prioritize interventions. The heptavalent vaccine will potentially cover from 52.4% to 76.5% of strains causing invasive pneumococcal disease and the 13 valent from 76.7% to 88.3%.

OBJETIVO:Determinar la evolución de la resistencia a la eritromicina, el cloranfenicol, el trimetoprim-sulfametozaxol (SXT) y la vancomicina de aislamientos invasores de Streptococcus pneumoniae obtenidos de niños de 10 países de América Latina y del Caribe en seis años de vigilancia. MÉTODOS: Se analizaron 8 993 aislamientos de S. pneumoniae recuperados entre 2000 y 2005 de niños menores de 6 años con infecciones invasoras, procedentes de Argentina, Brasil, Chile, Colombia, Cuba, México, Paraguay, República Dominicana, Uruguay y Venezuela. La sensibilidad a los antibióticos se determinó mediante los métodos establecidos y estandarizados en el proyecto SIREVA. La resistencia a múltiples antibióticos se definió como la resistencia a tres o más familias de antibióticos, de los no betalactámicos analizados en este estudio o de los betalactámicos evaluados en un estudio previo en el que 37,8% de estos aislamientos presentaron sensibilidad disminuida a la penicilina. RESULTADOS: Se encontró algún grado de resistencia al SXT y la eritromicina (56,4% y 15,4% de los aislamientos estudiados, respectivamente) y 4,6% presentó alta resistencia al cloranfenicol. Todos los aislamientos fueron sensibles a la vancomicina. Se observó la mayor frecuencia de resistencia al SXT en los aislamientos de neumonía y a la eritromicina en los casos de sepsis (61,6% y 25,5%, respectivamente; P < 0,01). La mayor frecuencia de resistencia al SXT se observó en Brasil (71,9%) y a la eritromicina en México (38,2%) y Venezuela (32,9%). Los serotipos 14, 6B, 19F y 23F fueron los que más frecuentemente se asociaron con la resistencia a los antibióticos estudiados. CONCLUSIONES: Se observó una elevada y creciente frecuencia de aislamientos resistentes al SXT y la eritromicina, y una disminución en la proporción de aislamientos resistentes al cloranfenicol. Estas tendencias mostraron diferencias entre los países estudiados.OBJECTIVE: To examine the development of resistance to erythromycin, chloramphenicol, trimethoprim-sulfamethoxazole (TMP-SMZ), and vancomycin of the invasive isolates of Streptococcus pneumoniae obtained from children in 10 Latin American/Caribbean countries during six years of surveillance. METHODS: Analysis of 8 993 isolates of S. pneumoniae recovered in 2000-2005 from children with invasive infections, who were less than 6 years of age, and from Argentina, Brazil, Chile, Colombia, Cuba, Dominican Republic, Mexico, Paraguay, Uruguay, or Venezuela. Antibiotic susceptibility was determined through the methods established and standardized by the SIREVA project. Multidrug resistance was defined as: resistance to three or more antibiotics of the same class; to the non-beta-lactams analyzed by this study; or, to the beta-lactams evaluated by a previous study, in which 37.8% of these isolates showed decreased susceptibility to penicillin. RESULTS:Some degree of resistance was found to TMP-SMZ and erythromycin (56.4% and 15.4% of the isolates studied, respectively), with 4.6% highly resistant to chloramphenicol. All isolates were susceptible to vancomycin. The highest prevalence of TMP-SMZ resistance was observed in the pneumonia isolates; and that of erythromycin, in cases of sepsis (61.6% and 25.5%, respectively; P < 0.01). The high-est prevalence of TMP-SMZ resistance was found in Brazil (71.9%), and that of erythromycin, in Mexico (38.2%) and Venezuela (32.9%). The 14, 6B, 19F, and 23F serotypes were most often associated with resistance to the antibiotics in the study. CONCLUSIONS: High and increasing rates of isolates resistant to TMP-SMZ and erythromycin were observed, as well as a decreasing percentage of isolates resistant to chloramphenicol. These trends highlight differences among the countries studied.

Antecedentes. El objetivo de este trabajo fue evaluar los patrones de resistencia antibiotica local y los serotipos de Streptococcus pneumoniae implicados en enfermedades invasivas en pacientes pediatricos del Hospital Provincial de Pediatria de Misiones, Argentina. Metodos. Se estudiaron 101 cepas aisladas de ninos a partir de muestras esteriles, entre junio de 1998 y junio de 2001. Las muestras se procesaron por el metodo habitual, y los patrones de resistencia antibiotica se determinaron segun pautas del National Committee for Clinical Laboratory Standards (NCCLS), por tecnicas de difusion y dilucion. La serotipificacion se efectuo mediante la reaccion de Quellung. Resultados. El 62% de las neumonias, el 70% de las neumonias con derrame y de las meningitis y 78% de las sepsis correspondieron a ninos menores de 2 anos de edad (74% del total de pacientes). Se identificaron 12 serotipos entre 71 cepas analizadas. Los tipos 14 (37,1%), 5 (21,4%), 1 (10%), 6A/6B (7,1%), 9N y 19A (5,7%) y 9V (4,3%) fueron los mas frecuentes. Se observo sensibilidad disminuida a penicilina en el 39% de los aislamientos, el 17,5% de los cuales presento resistencia intermedia y el 21,5% alto nivel de resistencia. Para ningun aislamiento la concentracion inhibitoria minima (CIM) fue superior a 4 µg/ml. La resistencia a penicilina quedo circunscrita a cinco serotipos, correspondiendo en el 84% de los casos al 14. Entre 71 aislamientos en que se efectuo la CIM a cefotaxima, 50 presentaron un valor menor o igual a 0,5 µg/ml; 18 una CIM de 1 µg/ml y tres de 2 µg/ml. No se detectaron cepas cuya CIM fuera superior a 2 µg/ml. El 22% de los aislamientos fue resistente a tetraciclina, el 48% a trimetoprima-sulfametoxazol, el 11% a cloranfenicol y el 6,8% a eritromicina. Ningun aislamiento fue resistente a vancomicina, ofloxacino ni rifampicina. Los patrones de resistencia combinada mas comunes, entre las cepas no sensibles a penicilina, fueron: penicilina-trimetoprima-sulfametoxazol (20%) seguido de penicilina-cefotaxima-trimetoprima-sulfametoxazol (7%; 3 aislamientos con CIM a cefotaxima = 2 µg/ml) y penicilina-trimetoprima-sulfametoxazol-cloranfenicol (5%). Conclusiones. Los patrones de resistencia y los tipos capsulares circulantes locales observados en este trabajo permiten adecuar esquemas terapeuticos a nuestra realidad y brindan informacion al equipo medico para evaluar el uso de vacunas como herramienta de prevencion y control de las infecciones invasivas por S. pneumoniae.

PspA is an antigenically variable virulence factor of Streptococcus pneumoniae that inhibits complement deposition and is a potential candidate for human vaccines. Of 64 published strains 96% are in PspA families 1 and 2; optimal protection is family-specific. Effective development of a PspA-containing vaccine requires more information about the PspA family of strains in parts of the world where the vaccine is most needed. In these studies we observed that of 149 isolates (of 19 capsular types) from Argentina, 54·4% were family 1, 41·6% were family 2 and 4·0% expressed both family 1 and family 2 PspAs. Box typing revealed the Argentinian strains to be from at least 10 clonally related groups.

Background. Since 1993 the Pan American Health Organization has coordinated a surveillance network with the National Reference Laboratories of Argentina, Brazil, Chile, Colombia, Mexico and Uruguay aimed at monitoring capsular types and antimicrobial susceptibility of Streptococcus pneumoniae causing invasive disease in children

Streptococcus pneumoniae (SPN) is the most common cause of invasive infections in children, with high levels of mortality in developing countries. An increase in frequency of penicillin-resistant strains is reported in most parts of the world. A study was undertaken in Argentina and 5 other countries of the region, to determine the type distribution and penicillin resistance rate of SPN isolated from invasive infections in children less than 5 years old. Between June 1994 and March 1996, a total of 505 SPN isolated from sterile sites were collected from 15 hospitals located in 9 cities of different geographic areas. Clinical and epidemiological data from 443 children were analyzed. Sixty five percent SPN were isolated from children less than 2 years old. Pneumonia was the clinical diagnosis in 58% of the cases, meningitis in 22%, and sepsis in 10.6%. Isolates were recovered from blood (51.2%), pleural fluid (22.7%), CSF (20.7%), and other sterile sites (5.4%). Thirty different pneumococcal capsul...

The introduction of the Haemophilus influenzae type b vaccine in the immunization programs of many countries has greatly reduced this invasive disease and the carriage caused by this serotype, also increasing other capsular types and non-capsular isolations. There were 313 isolations of H. influenzae under study, which were recovered from a sterile site coming from pediatric and adult patients carrying the invasive disease. Patients were treated at 90 different hospitals belonging to the Red Nacional de Laboratorios para Meningitis e Infecciones Respiratorias Agudas Bacterianas (National Lab Network for Meningitis and Acute Bacterial Respiratory Infections) from 2005 to 2010 for the following disorders: pneumonia, 40.3% (n=126), meningitis, 30.0% (n=94) and bacteremia, 26.5% (n=83). In pediatric patients (n=279), the highest frequency of isolations corresponded to children under the age of 2 years, 74.5% (n=208). Regarding type distribution, 61.3% corresponded to non-capsular H. influenzae (n=192), 20.1% to type b (n=63), 11.2% to type a (n=35), 4.8% to type f, and 2.6% to other types. Capsular H. influenzae was predominant in meningitis whereas non-capsular H. influenzae in pneumonia and bacteremia. The biotype was determined in 306 isolations. The totality (100%) of type a (n=35) was biotype II whereas 66.7% of type b (n=63) was biotype I. Slide agglutination and PCR tests were used in 220 isolations. There was a match of 0.982 (IC: 0.92-1.00) between them. During the last year, there was a great increase in type b, showing the importance of clinical and laboratory-based surveillance of the invasive disease caused by H. influenzae.

PspA, a pneumococcal surface protein, is highly immunogenic and common to all serotypes. Although pspA gene shows a great heterogeneity at the N-terminal region, PspA protein has conserved epytopes which are able to elicit protective cross-reaction against various serotypes presenting different PspA. In spite of the high polimorfism of the PspA, three majority families can be identified. These properties convert PspA as ideal candidate for the formulation of a pneumococcal vaccine. Investigations of the PspA families were mostly carried out on prevalent serotypes in other countries. The aim of this study was to identify PspA families from Streptococcus pneumoniae isolates of our region as well as to associate them to prevalent serotypes or pathologies. We studied 70 isolates from pediatric patients with invasive infections. PCR was performed using specific primers for each family. In these studies we observed that 60% were PspA family 1, 34% were PspA family 2 and 6% remained unclassified. Serotypes 1 and 5 presented only family 1; serotypes 14, 6B, 19F y 18C showed genes from both families. Family 1 was observed respectively in 60 y 50% of pneumonias and meningitis. The family 2 was identified in 33 and 50% of pneumonias and meningitis. This information about the PspA family distribution could become a valuable contribution to develop an effective regional vaccine using recombinant PspA as immunogen.

OBJETIVO:Determinar la evolucion de la resistencia a la eritromicina, el cloranfenicol, el trimetoprim-sulfametozaxol (SXT) y la vancomicina de aislamientos invasores de Streptococcus pneumoniae obtenidos de ninos de 10 paises de America Latina y del Caribe en seis anos de vigilancia. METODOS: Se analizaron 8 993 aislamientos de S. pneumoniae recuperados entre 2000 y 2005 de ninos menores de 6 anos con infecciones invasoras, procedentes de Argentina, Brasil, Chile, Colombia, Cuba, Mexico, Paraguay, Republica Dominicana, Uruguay y Venezuela. La sensibilidad a los antibioticos se determino mediante los metodos establecidos y estandarizados en el proyecto SIREVA. La resistencia a multiples antibioticos se definio como la resistencia a tres o mas familias de antibioticos, de los no betalactamicos analizados en este estudio o de los betalactamicos evaluados en un estudio previo en el que 37,8% de estos aislamientos presentaron sensibilidad disminuida a la penicilina. RESULTADOS: Se encontro algun grado de resistencia al SXT y la eritromicina (56,4% y 15,4% de los aislamientos estudiados, respectivamente) y 4,6% presento alta resistencia al cloranfenicol. Todos los aislamientos fueron sensibles a la vancomicina. Se observo la mayor frecuencia de resistencia al SXT en los aislamientos de neumonia y a la eritromicina en los casos de sepsis (61,6% y 25,5%, respectivamente; P < 0,01). La mayor frecuencia de resistencia al SXT se observo en Brasil (71,9%) y a la eritromicina en Mexico (38,2%) y Venezuela (32,9%). Los serotipos 14, 6B, 19F y 23F fueron los que mas frecuentemente se asociaron con la resistencia a los antibioticos estudiados. CONCLUSIONES: Se observo una elevada y creciente frecuencia de aislamientos resistentes al SXT y la eritromicina, y una disminucion en la proporcion de aislamientos resistentes al cloranfenicol. Estas tendencias mostraron diferencias entre los paises estudiados.

Summary Objectives To improve the understanding of serogroup Y invasive meningococcal disease (IMD) in Latin America, particularly IMD molecular epidemiology; 166 Y serogroup isolates received at the National Reference Laboratories of Argentina, Brazil, Chile, Colombia, and Costa Rica during 2000–2006 were characterized by their molecular markers. Methods This analysis included serological assays to determine serogroup/serotype/serosubtype, DNA sequencing and genotyping of the porB and/or porA genes, multilocus sequence typing (MLST) and fetA allele determination. Results Sixteen different antigenic combinations were observed. Sixty-two (37.3%) isolates were NT:P1.5 and 36 (21.7%) isolates were 14:NST. Thirty-two different STs appeared, but 3 STs (ST-1624, ST-23, and ST-5770) accounted for 69.9% (116) of the strains. Most of the IMD isolates belonged to the ST-23, ST-167 clonal complexes or the group composed by ST-5770 and related STs. Conclusions Isolates obtained in Colombia and Costa Rica were similar to that of the United States, in that most sequence types belonged to the ST-23 clonal complex. IMD isolates found in Argentina appear to be the result of an independent event and did not spread from nearby countries, being the sequence type ST-1624 (ST-167 clonal complex) the most frequently found. We were unable to correlate an antigenic shift of outer membrane proteins with an increase of serogroup Y meningococcal cases in our collection of isolates.

Introducción. En el contexto del “Protocolo para una evaluación del Impacto de los Programas de Vacunación contra Haemophilus influenzae tipo b, en cuatro países latinoamericanos” auspiciado por la OPS, se efectuó un estudio en Argentina luego de 8 años de introducción de la vacuna anti-Hib. Objetivos. Estimar el impacto de la vacunación anti-Hib mediante la evaluación de la tasa de portación nasofaríngea. Identificar factores asociados a la portación de Haemophilus influenzae. Métodos. Estudio de corte transversal, junio 2005-abril 2006, en el Hospital de Niños “Dr. Ricardo Gutiérrez” y el Hospital de NIños “Dr. Pedro de Elizalde”. Las muestras de hisopado nasofarígeo se procesaron en el INEI-ANLIS “Dr. Carlos Malbrán”, se realizó cultivo en agar chocolate con bacitracina, se identificó H. influenzae mediante Gram, oxidasa, catalasa, requerimiento de factores y prueba de la porfirina. La serotipificación capsular se realizó por aglutinación en lámina con antisueros específicos y su confirmación por reacción en cadena de la polimerasa. Población.900 niños de 1 año y 700 de 5 años, con 3 y 4 dosis de vacuna, respectivamente. Resultados. Hi se detectó en el 40% (641/1.600) de las muestras; entre los Hi, 4,8% (31/641) fueron capsulados. Los Hi capsulados fueron: 3 serotipo a, 1b, 3c, 5d, 7e y 12f. Sólo un niño de 1 año fue portador de Hib (tasa= 0,06%). Los factores asociados a la portación de Hi fueron: la edad, convivir con algún hermano menor de 18 años y concurrir a jardín maternal. Conclusiones. Se halló una tasa de portación nasofaríngea de Hib muy baja, de 0,06%; por ello, no se pudieron analizar asociaciones. La edad, los contactos familiares y los extradomiciliarios se asociaron con la portación de Haemophilus influenzae. Fil: Chiavetta, Laura. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas; Argentina. Fil: Salvay, María C. Hospital de Niños “Dr. Ricardo Gutiérrez”; Argentina. Fil: Romanin, Viviana. Hospital de Niños “Dr. Ricardo Gutiérrez”; Argentina. Fil: Chiolo, María J. Hospital de Niños “Dr. Pedro de Elizalde”; Argentina. Fil: Regueira, Mabel. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas; Argentina. Fil: Barrios, Adriana. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas; Argentina. Fil: Califano, Gloria. Hospital de Niños “Dr. Pedro de Elizalde”; Argentina. Fil: García, Salvador. Organización Panamericana de la Salud (OPS); Argentina. Fil: Gentile, Angela. Hospital de Niños “Dr. Ricardo Gutiérrez”; Argentina. Introduction. As a part of the PAHO supported protocol “Evaluation of the impact of Haemophilus influenzae b vaccination programs in four Latinamerican countrys”, a study took place in Argentine 8 years after introduction of Hib vaccine. Objective. To evaluate the impact of Hib vaccination measuring Nasopharyngeal Colonization (NC) rate and to identify factors associated to Haemophilus influenzae (HI) carrier status. Methods. Cross-sectional study –from June 27th 2005 to April 12th 2006– in two pediatric hospitals, HNRG and PE. Nasopharyngeal swab specimens were processed in the INEI-ANLIS “Dr. C. Malbrán”; samples were cultured in chocolate agar medium containing bacitracin. Hi was identified with technics of Gram, oxidase, catalase, growth factors (V-X-XV) and test of porphyrin. Capsular serotypification was made by agglutination in lamina with specific antisera and the confirmation by polymerase chain reaction. Population. 900 children of 1 year of age, vaccinated with 3 doses and 700 children of 5 years, with 4 vaccine doses. Results. Hi was detected in 40% (641/1.600) of samples, among Hi, 4,8% (31/641) were encapsulated (3 serotypes a, 1 b, 3 c, 5 d, 7 e, and 12 f). Only one child of 1 year was NC carrier of Hi type b (0.06%). Conclusions. We found a very low NC Hib (0.06%) rate, for this reason associations could not be analyzed. The age, household and day care center contacts were associated with NC by Haemophilus influenzae.

Pertussis or whooping cough is a respiratory disease that has emerged in recent years in several countries including Argentina. The aim is to retrospectively describe clinical and epidemiological characteristics of 20 patients in the Pediatric Hospital of Misiones with confirmed diagnosis of whooping cough, according to criteria set by WHO and CDC, during the years 2005 and 2006. The median age was 4 months, 13 were male (65%). Fourteen patients (70%) were younger than 6 months and 9 (45%) younger than 3 months. All had cough (average duration of 7.6 days), 5 (25%) paroxysmal cough and 1 (5%) apnea and cyanosis. Two children died. Sixteen (80%) had not the three doses of vaccine quadruple, 7 children (35%) were younger than 3 months and had no dose. The disease remains a public health problem affecting not only children but also adults.

Optochin susceptibility is a key test used for pneumococcal diagnosis, but optochin-resistant (Opt r ) pneumococci have been reported in the last 2 decades. In this work, we characterized eight Opt r clinical strains which presented a new mutation, G47V, a predominant A49S mutation (recently reported in Brazil) and A49T. These mutations were found in the c subunit of the F 0 F 1 ATPase encoded by the atpC gene, and W206C was found in the a subunit encoded by the atpA gene. The Opt r clinical isolates were analyzed by BOX PCR, multilocus sequence typing, and serotype and antimicrobial resistance profiles, and they showed no epidemiological relationship. To characterize the Opt r mutations that could emerge among clinical strains, we studied a pool of spontaneous Opt r colonies obtained in vitro from the virulent D39 strain. We compared the atpAC mutations of these Opt r pneumococci (with or without passage through C57BL/6 mice) with those described in the clinical isolates. This analysis revealed three new mutations, G47V and L26M in the c subunit and L184S in the a subunit. Most of the mutations identified in the laboratory-generated Opt r strains were also found in clinical strains, with the exception of the L26M and L184S mutations, and we suppose that both mutations could emerge among invasive strains in the future. Considering that atpAC are essential genes, we propose that all spontaneous mutations that confer in vitro optochin resistance would not present severe physiological alterations in S. pneumoniae and may be carried by circulating pneumococcal strains.

Identification ofNeisseria meningitidisPorA types remains important, as the PorA protein is a major immunogenic component of several meningococcal vaccines under development. In this study, 191N. meningitidisserogroup B isolates collected in Argentina through active laboratory-based surveillance from 2001 to 2003 were serosubtyped. Nucleotide sequences of theporAvariable region 1 (VR1) and VR2 regions were determined in 52 non-serosubtypeable isolates. A substantial number of distinct VR types were identified, and a new VR2 variant from the P1.16 family was described. This is the first report describing PorA types inN. meningitidisserogroup B isolates in Argentina. Furthermore, the wide diversity of subtypes detected by serosubtyping and genosubtyping reveals the difficulty in designing a useful outer-membrane vaccine applicable in this country. A possible mechanism responsible for altered PorA expression was analysed in two PorA types.

In 1993 the Pan American Health Organization initiated a laboratory-based surveillance system, called the SIREVA project, to learn about Streptococcus pneumoniae invasive disease in Latin American children. In 1994, National Laboratories in six countries were trained to perform serotyping and antibiotic susceptibility testing using broth microdilution to determine the MIC for specified antibiotics. An international External Quality Assurance (EQA) program was developed to monitor and support ongoing laboratory performance. The EQA program was coordinated by the National Centre for Streptococcus (NCS), Edmonton, Canada, and included external proficiency testing (EPT) and a validation process requiring regular submission of a sample of isolates from each laboratory to the NCS for verification of the serotype and MIC. In 1999, the EQA program was decentralized to use three of the original laboratories as regional quality control centers to address operational concerns and to accommodate the growth of the laboratory network to more than 20 countries including the Caribbean region. The overall EPT serotyping accuracies for phase I (1993 to 1998) and phase II (1999 to 2005) were 88.0 and 93.8%, respectively; the MIC correlations within ±1 log 2 dilution of the expected result were 83.0 and 91.0% and the interpretive category agreements were 89.1 and 95.3%. Overall, the validation process serotyping accuracies for phases I and II were 81.9 and 88.1%, respectively, 80.4 and 90.5% for MIC agreement, and 85.8 and 94.3% for category agreement. These results indicate a high level of testing accuracy in participating National Laboratories and a sustained increase in EQA participation in Latin America and the Caribbean.

To add new insight to our previous work on the molecular epidemiology of Bordetella pertussis in Argentina, the prn and ptxS1 gene sequences and pulsed-field gel electrophoresis (PFGE) profiles of 57 clinical isolates obtained during two periods, 1969 to 1989 and 1997 to 2006, were analyzed. Non-vaccine-type ptxS1A was detected in isolates obtained since 1969. From 1989 on, a shift of predominance from the vaccine prn1 type to the nonvaccine prn2 type was observed. This was also reflected in a transition of PFGE group IV to group VI. These results show that nonvaccine B. pertussis strains are currently circulating. To analyze whether the observed genomic divergences between vaccine strains and clinical isolates have functional implications, protection assays using the intranasal mouse challenge model were performed. For such experiments, the clinical isolate B. pertussis 106 was selected as representative of circulating bacteria, since it came from the major group of the PFGE dendrogram (PFGE group VI). Groups of mice were immunized either with diphtheria-tetanus- whole-cell pertussis vaccine (ptxS1B prn1) or a vaccine prepared by us containing B. pertussis 106. Immunized mice were then challenged with a B. pertussis vaccine strain (Tohama, harboring ptxS1B and prn1) or the clinical isolate B. pertussis 106 (ptxS1A prn2). An adequate bacterial-elimination rate was observed only when mice were immunized and challenged with the same kind of strain. For further characterization, comparative proteomic profiling of enriched membrane proteins was done using three vaccine strains and the selected B. pertussis 106 clinical isolate. By matrix-assisted laser desorption ionization-time of flight mass spectrometry analysis, a total of 54 proteins were identified. This methodology allowed us to detect differing proteins among the four strains studied and, in particular, to distinguish the three vaccine strains from each other, as well as the vaccine strains from the clinical isolate. The differing proteins observed have cellular roles associated with amino acid and carbohydrate transport and metabolism. Some of them have been proposed as novel vaccine candidate proteins for other pathogens. Overall, the global strategy described here is presented as a good tool for the development of next-generation acellular vaccines., Instituto de Biotecnologia y Biologia Molecular

Las infecciones invasivas por Streptococcus pneumoniae (Spn) producen mortalidad elevada en países en desarrollo, con tasas entre 4 y 100 veces mayores que las de Estados Unidos o Canadá. Es el primer agente causal de neumonía en la infancia y de meningitis fuera de los brotes epidémicos por Neisseria meningitidis. La OPS, a través del grupo SIREVA, dedicado al desarrollo de vacunas en Latinoamérica, organizó un programa de vigilancia de infecciones invasivas por Spn en seis países: Argentina, Brasil, Chile, Colombia, México y Uruguay, iniciado en 1993 y que continúa actualmente. En Argentina participan en la actualidad más de 20 centros hospitalarios distribuidos en todas las áreas geográficas del país, actuando como Centro Nacional de referencia para la serotipificación y determinación de la resistencia a los antibióticos el Instituto ANLIS "Dr. Carlos G. Malbrán". Objetivos: 1) Determinar los serotipos predominantes, su resistencia a los antibióticos y los cambios temporales en infecciones invasivas por Spn de niños menores de 5 años de edad; 2) Obtener información confiable para la formulación de una vacuna conjugada adecuada para la región. Metodología: Diseño prospectivo observacional. Se incluyeron todos los niños menores de 6 años de edad internados por infecciones invasivas (neumonía, meningitis, sepsis o bacteriemia), en los que se aisló Spn de un sitio previamente estéril. Se realizó control externo de confiabilidad de los resultados, inicialmente en el laboratorio de referencia de Canadá y actualmente en el Instituto Adolfo Lutz de San Pablo. El análisis estadístico se realizó con EPIINFO 6 y con el programa WHONET de OMS. Resultados: Se destacan los siguientes hallazgos: Se aisló Spn en 1 390 muestras clínicas. La edad media (N = 1 175) fue de 19,5 meses, con 74,4% - 2 años; fueron neumonías 60,5%; meningitis 26,6%, sepsis 8,2%. Se halló sensibilidad disminuida a penicilina en 32,1% (414/1 288), con resistencia alta 16,1% e intermedia 16%. La resistencia a los antibióticos betalactámicos se incrementó en el período 1993-8. Los serotipos prevalentes fueron: 14 (32,5%), 6A/6B, 9V, 23F, 19F, 18C, 4, 5, 1. Los serotipos 14 y 6AB prevalecieron en menores de 2 años mientras que el 5 y el 1 prevalecieron en mayores de 2 años (p < 0,001). El serotipo 14, la neumonía y la edad menor de 2 años fueron los factores de riesgo para resistencia a penicilina. La representatividad para las vacunas conjugadas 7-valente, 9-valente y 11-valente fue de 53,3%, 77,4% y 82,6% respectivamente, mayor para la 7-valente en los menores de 2 años (61,2%) y en los menores de 2 años con neumonía (71,2%). Más del 90% de los serotipos aislados con algún grado de resistencia estuvieron contenidos en las tres vacunas analizadas. Conclusiones: Un programa nacional de vigilancia de Spn invasivo fue desarrollado en Argentina y otros países latinoamericanos. Se identificaron por primera vez los serotipos predominantes en infecciones invasivas y se comprobó el incremento significativo de la resistencia a penicilina y otros antibióticos, similar a lo informado en casi todos los países del mundo. Se obtuvo información epidemiológica válida para evaluar estrategias de prevención con nuevas vacunas Since 1993, the PAHO, through the Regional Vaccine System (SIREVA Group) organized a surveillance protocol of invasive Streptococcus pneumoniae (Spn) infections in children less than 5 years old in six Latin-American countries: Argentina, Brazil, Chile, Colombia, Mexico and Uruguay. In Argentina more than 20 hospitals are now participating in this project. Objectives: 1) To determine the predominant serotypes, the antibiotic resistance and changes along the time. 2) To know the representativity of the serotypes isolated in the new conjugated vaccines. Methodology: Children less than 6 years old hospitalized by Spn invasive infections were included (pneumonia, meningitis, bacteremia o sepsis). The ANLISS "Dr. Carlos G. Malbrán" Institute was the reference center for Spn serotyping and antibiotic resistance determination. Results: Spn was isolated from 1 390 clinical samples. The average age was 19.5 months, 74.4% belonged to children equal or less than 2 years of age. The main clinical diagnosis were: pneumonia 60.5%, meningitits 26.6%, fever without foccus (bacteremia) or sepsis 8.2%. Decreased penicillin sensitivity (DPS) was found in 32.1% of the cases, with high resistance in 16.1% and intermediate resistance in 16%; the increase of DPS in the 1993-98 period was significant, like in other countries. The more frequent serotypes were: 14 (32.5%), 6A/6B, 9V, 23F, 19F, 18C, 4, 5, and 1. Serotypes 14 and 6AB were prevalent in children less than 2 years old and serotypes 5 and 1, in children than 2 years older (p < 0.001). Serotype 14, pneumonia and age less than 2 years were risk factors for penicillin resistance. Finally, the representativity of the serotypes in the new conjugated vaccines 7-valent, 9-valent and 11-valent was: 53.3%, 77.4% and 82.6% respectively. For the 7-valent vaccine, was higher in the less than 2 years old group (61.2%), and for this age group with pneumonia (71.2%). More than 90% of penicillin resistant serotypes were included in the three conjugated vaccines. Conclusions: A national surveillance program was developped in Argentina and other Latin-American countries. Prevalent invasive Spn serotypes were identified; a significative increase in penicillin and other antibiotic resistance was found, like in almost all countries. This epidemiologic information is of great importance for evaluating the new conjugated vaccines

In Argentina, the incidence rate of meningococcal disease is 0.6 cases per 105 inhabitants, representing around 250 cases declared every year. The number of meningococcal strains received annually at the Reference Laboratory for Meningococci of the National Institute for Infectious Diseases (INEI

Six Latin-American countries participated in an epidemiological surveillance study conducted by the Pan American Health Organization in order to determine the relative prevalence of capsular types and antimicrobial resistance patterns of Streptococcus pneumoniae (SPN) causing invasive infections in children

Neisseria meningitidis is a leading cause of adult meningitis worldwide. From 5 to 14 August 1996, 8 cases of meningococcal disease occurred in Corrientes city (population 306,000) in northeastern Argentina. Those infected ranged in age from 15 to 45 years (median, 18.5). To determine risk factors for infection, a case-control study was done. Infecting isolates were serogrouped and underwent phenotyping by multilocus enzyme electrophoresis (MLEE) and pulsed-field gel electrophoresis (PFGE). Those infected were significantly more likely than those not infected to have had exposure to passive or active cigarette smoke or to have attended a particular disco. Isolates available from 6 case-patients were all serogroup C; all had identical MLEE and PFGE patterns. These data suggest that dance clubs or discos may be a focus of transmission of N. meningitidis among young people.

dissolution and oral bioavailability of different formulations of two essential drugs marketed in Tanzania, the drug content and drug release from all the tested ciprofloxacin formulations were within USP-24 requirements and remained stable during storage at simulated tropical conditions. Oral bioavailability was also not influenced by tropical conditions. The stability of essential drugs (ampicillin, benzylpenicillin, phenoxymethylpenicillin and tetracycline) was not affected during shipment to the tropics after being exposed to much higher temperatures and humidity than recommended by the manufacturer, with temperatures recorded within packs ranging from 23.5 to 42.48C and humidity ranging from 20% to 88%. A controlled longitudinal study on the quality and stability of essential drugs in rural Zimbabwe showed that even under the most adverse tropical conditions, clinically relevant instability of these agents is rare. Evidence of potency is an important aspect to consider whilst procuring data about consumption of antimicrobials in developing countries. However, in order to achieve this, one would have to establish potency for each drug on the market, a difficult, unrealistic and expensive exercise, considering the limited funding for research in developing countries. Otherwise, assumptions would be based on random sampling of imported or locally manufactured drugs. Accurate information relating to national antibiotic consumption would be essential in order to extrapolate the impact of these storage issues.

ResumenSe presentan en este trabajo los resultados de 16 años de vigilancia epidemiológica de meningitis neumocócica llevada a cabo en el Hospital Provincial de Pediatría de Misiones (Argentina), antes de la introducción de la vacuna conjugada al calendario nacional.En el período que va de enero de 1994 a diciembre de 2009 se diagnosticaron 167 casos de meningitis por Streptococcus pneumoniae en niños (1 mes-15 años).La tasa de ataque cada 100 000 niños varió entre 19,2 (1997) y 4,3 (2009), con una media de 10,6 y una tendencia en disminución (y = −0,689x + 16,52). Esto fue a expensas del grupo de niños entre 1 y 11 meses (94/167, 56 %), en el que disminuyó de 146,6 a 34,8 casos cada 100 000 niñosEl 30,7 % de los aislamientos (46/150) fueron resistentes a penicilina y el 16,7 % (25/150) no sensibles a cefotaxima. La resistencia a β-lactámicos se incrementó a partir de 1997 y comenzó a disminuir en 2005.Se detectaron 19 serotipos, predominó el 14 (32 %; 40/125). El 84,8 % de los aislamientos quedaron circunscriptos a nueve serotipos: 14, 5, 1, 7F, 18C, 6B, 9N, 9V y 4.La cobertura teórica en los niños < 2 años y > 2 años fue de 84,1 % (74/88) y 83,8 % (31/37) con la vacuna 10-valente, y de 89,8 % (79/88) y 83,8 % (31/37) con la vacuna 13-valente, respectivamente. La resistencia a penicilina estuvo circunscripta a 8 serotipos (14, 6B, 6A, 9V, 4, 23B, 1 y 19A), y la no sensibilidad a cefotaxima a 3 serotipos (14, 9V y 1), el más importante fue en ambos casos el serotipo 14.Este estudio permitirá evaluar el impacto de la implementación de las vacunas conjugadas en nuestra zona.AbstractWe report the results of pneumococcal meningitis surveillance conducted at the Provincial Pediatric Hospital of Posadas, Misiones (Argentina), before the conjugate vaccine was introduced into the national vaccination schedule.Between January 1994 and December 2009, 167 cases of Streptococcus pneumoniae meningitis were diagnosed in children aged 1 month to 15 years.The attack rate/100,000 children ranged from 19.2 (1997) to 4.3 (2009), with a mean of 10.6 and a tendency to decrease (y=−0.689x+16.52). The number of cases per 100,000 children decreased from 146.6 to 34.8 and particularly involved the group of children aged 1 to 11 months (94/167, 56%).Thirty point seven percent (30.7%) (46/150) of the isolates were resistant to penicillin whereas 16.7% (25/150) were non-susceptible to cefotaxime. β-lactam resistance increased as from 1997 and began to decline in 2005.Nineteen serotypes were detected; type 14 was predominant and accounted for 32% (40/125). Eighty four point eight percent (84.8%) of the isolates were circumscribed to nine serotypes: 14, 5, 1, 7F, 18C, 6B, 9N, 9V and 4.Theoretical coverage for patients aged 2 years was 84.1% (74/88) and 83.8% (31/37) for the 10-valent vaccine and 89.8 % (79/88) and 83.8% (31/37) for the 13-valent vaccine respectively. Penicillin resistance was restricted to 8 serotypes (14, 6B, 6A, 9V, 4, 23B, 19A1) and nonsusceptibility to cefotaxime was circumscribed to 3 serotypes (14, 9V and 1).This study will allow to evaluate the impact of the implementation of conjugate vaccines on our area.

Streptococcus pneumoniae is a rarely recognized cause of neonatal sepsis. A case of early-onset neonatal sepsis due to penicillin susceptible pneumococci and maternal endometritis is herein described. A male infant was born at 33 weeks of gestation. The baby developed S. pneumoniae bacteraemia and recovered completely following treatment with antibiotics. Four days after partum, the mother was readmitted with fever. S. pneumoniae was recovered from an endometrial sample. Isolates from mother and child were both serogroup 1 and confirmed to be identical on the basis of BOX-polymerase chain reaction typing and pulse-field gel electrophoresis. Perinatal transmission of S. pneumoniae had probably occurred due to ascending infection from the maternal genital tract.