Anne von Gottberg.

In 2012, the populace of South Africa was around 52 million; 4 percent were younger than 2 years old, and 31 percent were 25 to 44 years.20 HIV prevalence among pregnant women was stable, at 30 percent, from 2004 through 2012.21,22 HIV infection rates among infants younger than 2 months of age who were born to HIV-infected ladies declined from 9.6 percent in 2008 to 2.8 percent in 2011, as a complete consequence of improved prevention of mother-to-child transmission.23 Estimates of the %age of infants who received the 3rd dosage of PCV before these were 12 months old are 10 percent for 2009, 64 percent for 2010 2010, 72 percent for 2011, and 81 percent for 2012.24 Surveillance for Invasive Pneumococcal Disease Laboratory-structured surveillance for invasive pneumococcal disease in Southern Africa began in 1999.25 Since 2003, improved surveillance at 24 sentinel hospitals located in all nine provinces has included the collection of more information, including admission day, HIV serologic status, discharge diagnosis, and outcome .Status regarding individual immunodeficiency virus contamination was determined by using two rapid assessments: Uni-Gold Recombigen HIV-1/2 and Determine HIV-1/2 . A lumbar puncture was performed unless, in the judgment of the admitting clinician, it was contraindicated. The opening pressure was measured with the use of a flexible manometer,25 and the cerebrospinal fluid was analyzed with the use of standard methods.26 Further details of the study are given in the protocol , available with the entire text of the article at NEJM.org.