Streptococcus pneumoniae: Perspectives of Clinicians and Microbiologists on the Underrecognized Threat of Pneumococcal Disease in India

Background: Invasive pneumococcal disease (IPD) is predominantly caused by Streptococcus pneumoniae and is associated with high mortality. This vaccine-preventable disease has been a significant public health concern, particularly among children < 5 years and adults > 50 years in India. Pneumococcal vaccines help prevent pneumococcal infections caused by certain strains of S. pneumoniae, but diagnostic challenges in India hinder disease management. Methods: The objective of this expert panel discussion is to deliberate upon the pathogenesis and epidemiology of S. pneumoniae in India, techniques for overcoming the diagnostic challenges in the isolation and detection of S. pneumoniae, and to explore opportunities for partnerships between clinicians and microbiologists to bridge gaps. A non-systematic, targeted literature search was conducted to identify studies supporting key themes of expert panel discussion. Eight microbiologists, one infectious disease, one pediatrics and neonatology, and one respiratory medicine specialist from different parts of India participated in the discussion. Results: The panelists reiterated that while culture is the gold standard, multiplex real-time polymerase chain reaction and BioFire® FilmArray® technology have been the most common diagnostic methods for the detection of S. pneumoniae in India, especially in tier 1 cities. Conclusions: This article elucidates the challenges faced by microbiologists and clinicians in isolating and detecting the pathogen, and proposes solutions to determine the true burden of pneumococcal disease in India. This information could further inform public health policy and vaccination strategies.