Vaccination urged for daycare children to protect against drug-resistant S. pneumoniae

ATLANTA (Reuters Health) – Most parents of young children in daycare may be unaware of the availability of Prevnar vaccine to prevent multidrug-resistant Streptococcus pneumoniae infection, according to the US Centers for Disease Control and Prevention (CDC).

The pneumococcal conjugate vaccine (PCV7) Prevnar (Wyeth Lederle Vaccines and Pediatrics, Philadelphia) offers protection against the seven serotypes that most commonly cause invasive pneumococcal disease in children in the United States. The CDC currently recommends the vaccine for children under 2 years of age, and that healthcare providers consider Prevnar for children aged 24-59 months who attend group daycare centers.

On December 18, 2000, a case of refractory otitis media in an 11-month old child who attended a daycare center with approximately 54 other children in southwest Georgia was brought to the attention of the Georgia Division of Public Health (GDPH). Eight days before the child was hospitalized, a culture revealed the presence of S. pneumoniae resistant to penicillin, clindamycin, erythromycin, trimethoprim/sulfamethoxazole, and tetracycline.

The CDC and the GDPH then began an investigation to determine the rate of pneumococcal carriage among children attending the childcare center, and to evaluate parental knowledge and use of antibiotics and Prevnar.

Writing in the January 4th issue of the CDC's Morbidity and Mortality Weekly Report, CDC researchers report that S. pneumoniae was isolated from 90% of 21 nasopharyngeal swab cultures taken. About half of the swabs had susceptibility profiles that were identical to that the index patient.

Sixteen parents completed a questionnaire with one parent responding for each child, accounting for 20 (91%) of the children from whom swabs were obtained. Of the 16 parents, five (31%) were unaware of the health dangers of frequent antibiotic use, and 10 (63%) were unaware of the availability of Prevnar.

"Although the efficacy of PCV7 against all acute otitis media (AOM) episodes is 6%, efficacies against PCV7 serotype-related pneumococcal AOM and invasive pneumococcal disease are 57% and 94%, respectively," CDC researchers point out.

MMWR 2002;50:1156-1158.

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