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Five-fold increase in pediatric parapneumonic empyema since introduction of pneumococcal conjugate vaccine

Debra J Hendrickson1, Dean A Blumberg, Jesse P Joad

  • 1Department of Pediatrics, UC Davis Medical Center, Sacramento, CA, USA. debrasrb@aol.com

The Pediatric Infectious Disease Journal
|October 11, 2008
PubMed

Insights

Parapneumonic empyema (PPE) cases in children increased fivefold after the heptavalent pneumococcal conjugate vaccine (PCV7) introduction. This rise was mainly due to culture-negative empyema and non-PCV7 serotypes.

Area of Science:

  • Pediatric infectious diseases
  • Vaccinology
  • Pulmonary medicine

Background:

  • Parapneumonic empyema (PPE) is a significant pediatric respiratory infection.
  • The introduction of the heptavalent pneumococcal conjugate vaccine (PCV7) aimed to reduce pneumococcal disease burden.

Purpose of the Study:

  • To evaluate the incidence of pediatric parapneumonic empyema (PPE) before and after the PCV7 vaccine introduction.
  • To identify changes in causative pathogens and empyema types post-PCV7.

Main Methods:

  • Retrospective review of medical records for pediatric PPE patients (1996-2006).
  • Comparison of PPE incidence in pre-PCV7 (1996-2000) and post-PCV7 (2001-2005) periods.
  • Analysis of microbial cultures and serotype prevalence.

Main Results:

  • A fivefold increase in pediatric PPE incidence was observed post-PCV7 (13 to 65 cases).
  • Culture-negative empyema constituted 61% of post-2000 cases.
  • Culture-positive pneumococcal empyema accounted for 19% of cases, with a shift towards non-PCV7 serotypes.

Conclusions:

  • The PCV7 vaccine was associated with a significant increase in pediatric PPE.
  • Non-PCV7 serotypes and culture-negative empyema appear to be driving this trend.
  • Further research is needed to understand the evolving epidemiology of pediatric empyema.

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