Serotype distribution and antimicrobial susceptibility pattern in children≤5years with invasive pneumococcal disease in India - A systematic review

Vaccine. 2017 Aug 16;35(35 Pt B):4501-4509. doi: 10.1016/j.vaccine.2017.06.079. Epub 2017 Jul 12.


Background: Streptococcus pneumoniae is a leading cause of childhood diseases that result in significant morbidity and mortality in India. Commercially licensed and available pneumococcal conjugate vaccines (PCVs) include ten (PCV-10) and 13 (PCV-13) pneumococcal serotypes. Vaccines with other serotype combinations are under development. Reviewing and reporting trends and distribution of pneumococcal serotypes causing invasive pneumococcal disease in India will be useful for policy making as PCV is being introduced into India's universal immunization program.

Methods: We conducted a systematic literature review of hospital based observational studies (both peer reviewed and gray literature published in English) from India available from January 1990 to December 2016. Studies that documented data on the prevalence of serotype distribution and the antimicrobial resistance pattern of S. pneumoniae in children≤5years of age were included.

Result: We screened a total number of 116 studies, of which 109 studies were excluded. Final analysis included seven studies. The most frequent pneumococcal serotypes causing invasive disease among children≤5years were 14, 1, 19F, 6B, 5, 6A, 9V and 23F. Serotype 14 and 19A were represented in most of the geographical regions studied in the reviewed articles. Currently available PCV formulations included 67.3-78.4% of all serotypes contributing to IPD among Indian children≤5years. Pneumococcal resistance to trimethoprim/sulfamethoxazole, erythromycin, penicillin, chloramphenicol, levofloxacin and cefotaxime was seen in 81%, 37%, 10%, 8%, 6% and 4% of all pneumococcal isolates respectively, while vancomycin resistance was not reported.

Conclusion: The present review demonstrates that up to 78.4% of reported invasive pneumococcal disease in children≤5years in India are currently caused by serotypes that are included in the available licensed PCVs. However, sentinel surveillance must be continued in representative parts of the country to assess the changing trends in distribution of pneumococcal serotypes and their implication for vaccine selection and rollout in India.

Keywords: Antibiotic resistance; India; Pneumococcal vaccine; Serotypes.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Anti-Bacterial Agents / pharmacology*
  • Anti-Bacterial Agents / therapeutic use
  • Bacteremia / epidemiology
  • Bacteremia / microbiology*
  • Child, Preschool
  • Drug Resistance, Multiple, Bacterial
  • Female
  • Humans
  • India / epidemiology
  • Infant
  • Infant, Newborn
  • Male
  • Microbial Sensitivity Tests
  • Penicillins / pharmacology
  • Pneumococcal Infections / drug therapy
  • Pneumococcal Infections / epidemiology
  • Pneumococcal Infections / microbiology*
  • Pneumococcal Infections / prevention & control
  • Pneumococcal Vaccines / administration & dosage
  • Pneumococcal Vaccines / immunology*
  • Prevalence
  • Serogroup
  • Serotyping
  • Streptococcus pneumoniae / drug effects*
  • Streptococcus pneumoniae / immunology*
  • Vaccines, Conjugate / administration & dosage
  • Vaccines, Conjugate / immunology


  • Anti-Bacterial Agents
  • Penicillins
  • Pneumococcal Vaccines
  • Vaccines, Conjugate