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HK J Paediatr (New Series)
Vol 6. No. 2, 2001
HK J Paediatr (New Series) 2001;6:129

Proceedings of The First Current Topic in Infectious Diseases

Burden of Pneumococcal Disease in Hong Kong

CB Chow

HK J Paediatr (new series) 2001;6:127-132

Proceedings of The First Current Topic in Infectious Diseases: Consensus Meeting on Conjugate Vaccines of the Center of Infection
Faculty of Medicine, The University of Hong Kong (Selected Abstracts)

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.

Method and Process of Consensus Building

The consensus meeting on Consensus meeting on conjugate vaccines was held on February 17, 2001, as the first current topic in infectious diseases that was organized by the Centre of Infection, the University of Hong Kong. A panel of experts from the fields of Internal Medicine, Clinical Microbiology, Internal Medicine, Paediatrics and Public Health were provided with the latest scientific papers1-8 and were invited to speak and discuss on various aspects concerning the topic.

After the formal presentation, panel discussion was held. All speakers, invited discussants from various aspects of the medical fields and audiences actively participated in the discussion with further elaboration on issues around S. pneumoniae and H. influenzae disease burden, antimicrobial resistance and conjugate vaccine.

Finally, conclusions were drawn on the basis of the current scientific information and views expressed by the panel and other participants. Drafts in progress and final copies of the manuscript were distributed to panel for comments before submission for publication.

Consensus Panel Members

Daniel CS Chiu, Pediatrician in private practice
Susan SS Chiu, Assistant Professor, Department of Paediatrics, The University of Hong Kong
CB Chow, Consultant, Department of Paediatrics, Princess Margaret Hospital
PL Ho, Associate Professor, Department of Microbiology, The University of Hong Kong
YL Lau, Chair Professor in Paediatrics, Department of Paediatrics, The University of Hong Kong
CW Leung, Consultant, Department of Paediatrics, Princess Margaret Hospital
Dominic NC Tsang, Consultant, Department of Clinical Pathology, Queen Elizabeth Hospital
Kenneth WT Tsang, Associate Professor, Department of Medicine, University of Hong Kong.
Thomas HF Tsang, Community Physician, Department of Health
Samson SY Wong, Assistant Professor, Department of Microbiology, University of Hong Kong.
YH Yang, Professor, Beijing Children's Hospital, Beijing
KY Yuen, Chair Professor in Infectious Diseases, Department of Microbiology, The University of Hong Kong

Consensus Statements

Disease burden of paediatric Haemophilus influenzae type b infections in Hong Kong

1. The incidence of Haemophilus influenzae type b (Hib) diseases in Hong Kong appears to be low. Multiple confounding factors, such as prior antibiotic usage, might be the causes for the apparent low recorded prevalence.

2. Further study to collect epidemiological data in Hong Kong would be difficult due to the following factors:

a) Some children might have been given Hib vaccination on an individual basis.

b) There are quite a number of patients taking antibiotics prior to collection of specimens for cultures and the recovery rate of any microorganisms in these situations is relatively low.

3. Gaps in existing data should be addressed in future studies using new research methodology, such as the WHO rapid assessment tool.

Use of conjugate Haemophilus influenzae type b vaccine

1. Conjugate Hib vaccine has proven safety and efficacy in prevention of invasive Hib disease.

2. Thorough cost-effective/benefit/utility analysis and comparison of existing program would be very helpful in supporting recommendation for universal vaccination in this locality. Broader discussion/consultation on what constitute the "acceptable" cost is required.

Disease burden of pneumococcal infections in Hong Kong

1. Disease burden of pneumococcal disease is still unclear and further study would be needed for different at-risk groups.

2. Penicillin-resistant and multiple antibiotic-resistant pneumococci are a major problem in Hong Kong.

Use of conjugate pneumococcal vaccine

1. The heptavalent conjugate vaccine provides good coverage of the serotypes causing invasive pneumococcal disease in Hong Kong at present.

2. Conjugate pneumococcal vaccine is effective in decreasing vaccine strain carriage, and preventing invasive pneumococcal disease in young children from published experience.

Acknowledgement

The meeting was sponsored by the Hong Kong Paediatric Foundation.

References

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.

 
 

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