Children who survived pneumococcal meningitis had lower full-scale intelligence quotients (IQFS) than matched controls, according to a study by El Bashir and colleagues (see poster EPI-25). Survivors of pneumococcal meningitis often suffer long-term disabilities including neuropsychological and educational sequelae. The study, conducted in the UK, included 114 survivors of pneumococcal meningitis and 104 matched controls. The study found that greater reductions in IQFS were associated with younger age at diagnosis and longer time since illness.

According to the study’s senior author, Dr. Robert Booy of the University of London, “The results of this study allow us to quantify the educational impairment of children who survive pneumococcal meningitis. This finding is important because it underlines the importance of providing long-term support for survivors of meningitis. The effect on IQ is partly mediated by deafness but is also a result of more widespread cerebral insult.”

Although adults and children in most developing countries get pneumonia the aetiology of that episode is rarely known. As a result, there is little data to determine what interventions would be most effective for pneumonia prevention and control. Now it seems that a combination of three uncomplicated techniques could be used to estimate the aetiology of hospitalized pneumonia in developing countries, according to a study from Dr. Anthony Scott of the Wellcome Trust/Kenya Medical Research Institute in Kilifi, Kenya (see poster DGN-23). In this study of 281 Kenyan adults hospitalized with pneumonia and 301 adults without pneumonia, the combination of blood culture, capsular antigen detection in urine, and an enzyme immunoassay for pneumococcal surface adhesin A (psaA) defined 62% of pneumonia episodes as pneumococcal with a combined specificity >95%.

“The three techniques used are relatively simple,” says Dr. Scott, “and they could be used in other countries in the developing world to build up a picture of the burden of pneumococcal disease in adults.”

Alaska Natives have 2-3 fold higher risk of pneumococcal invasive disease than non-Natives. To reduce their risk, CDC recommends Alaska Native adults with underlying illnesses and/or aged =55 years receive the 23-valent pneumococcal polysaccharide vaccine. A study by Dr. Jay Butler and colleagues at the CDC’s Arctic Investigations Program shows that the currently recommended 23-valent pneumococcal polysaccharide vaccine provides significant protection for certain underlying conditions but not for Alaska Natives =55 years old (see poster EPI-17). The study included 394 cases of culture-confirmed pneumococcal invasive disease with known serotypes and estimated vaccine effectiveness (VE) using the indirect cohort method. Significant protection was observed among Alaska Native adults who used ethanol heavily (VE=86%) and those who smoked (VE=86%). However, among those aged =55 years of age no significant protection was observed.

“The study shows the benefits of the current polysaccharide vaccine but highlights the need for a more effective vaccine in the elderly,” according to lead investigator, Dr. Jay Butler.

If the number of presentations and posters on the first day of ISPPD is any indication, African pneumococcal research is alive and well. Every oral session of the Scientific Programme today includes at least one presentation from Africa. In the Epidemiology poster section of ISPPD, 11 (14%) of 81 poster presentations are from Africa. These presentations include data from established names in pneumococcal research like the Gambia and South Africa but also research from Kenya, Mozambique, Tanzania, and Uganda. These presentations and posters cover a range of issues including improved diagnosis of infections, issues in surveillance, assessments of clinical severity and outcomes of pneumococcal disease in all age groups, and the prevalence of different serotypes and their antibiotic susceptibilities.

“It’s really a pleasure to see so much pneumococcal research represented at this conference”, says this year’s keynote speaker Professor Brian Greenwood of the London School of Hygiene and Tropical Medicine. Prof. Greenwood spent more than 30 years in Africa, first in Nigeria and then as Director of the MRC Laboratories in the Gambia. According to Dr. Kim Mulholland, Director of the Centre for International Child Health at Royal Children’s Hospital in Melbourne, Australia, “the contribution of Africa to medical research of global significance is underappreciated. It is not a coincidence that in the field of pneumococcal disease, like the meningococcal field, African research has frequently led the way. Few realize that the first pneumococcal vaccine studies were conducted in Africa.”

Below is a list of the poster presentations from Epidemiology, Diagnostics and Colonization that represent data from Africa, by country of origin.

Gambia: EPI-13, EPI-26, DGN-12
Kenya: EPI-51, DGN-23
Mozambique: EPI-74, EPI-76, EPI-83
South Africa: EPI-20, EPI-31, EPI-32, EPI-75, COL-30
Tanzania: EPI-15