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Following in Real Time the Impact of Pneumococcal Virulence Factors in an Acute Mouse Pneumonia Model Using Bioluminescent Bacteria
Published on: February 23, 2014
[Pneumococcal pneumonia highly probable in immunized children cared for in-group settings]
D Gendrel1, C Vallet, C Gelmetti
1Service de pédiatrie, université Paris 5, hôpital Saint-Vincent-de-Paul, 82, avenue Denfert-Rochereau, 75014 Paris, France. dominique.gendrel@svp.ap-hop-paris.fr
Insights
Pneumococcal conjugate vaccine reduced invasive pneumococcal disease, but pneumonia in vaccinated children persists, especially in group settings. High procalcitonin and C-reactive protein levels predict pneumococcal pneumonia in young children.
Area of Science:
- Pediatrics
- Infectious Diseases
- Vaccinology
Background:
- Invasive pneumococcal diseases (IPD) decreased post-pneumococcal conjugate vaccine (PCV) introduction.
- Non-vaccine serotype infections and community-acquired pneumonia (CAP) remain concerns.
- Predicting pneumococcal CAP requires specific clinical and laboratory markers.
Purpose of the Study:
- To evaluate the occurrence of pneumococcal pneumonia in young children after PCV widespread use.
- To identify risk factors for pneumococcal pneumonia in vaccinated children.
Main Methods:
- Retrospective analysis of 259 children under 7 hospitalized for CAP (2003-2008).
- Inclusion criteria: high procalcitonin and C-reactive protein, fever ≤48h post-antibiotics.
- Comparison of PCV-vaccinated vs. unvaccinated children, focusing on 2006-2008 cohort.
Main Results:
- 47 children met criteria for pneumococcal CAP.
- 27 cases occurred between 2006-2008 (post-PCV generalization).
- 21 of these 27 were PCV-vaccinated, with 19 attending group care settings.
Conclusions:
- Pneumococcal pneumonia can occur in PCV-immunized children.
- Group-care attendance is a significant risk factor for pneumococcal pneumonia in vaccinated children.
- Continued surveillance and potential vaccine updates are warranted.
Abstract:
Invasive pneumococcal diseases were reduced after introduction of pneumococcal conjugate vaccine, but infections due to non-vaccine serotypes persisted. The pneumococcal origin of community-acquired pneumonia remains difficult to affirm, but high procalcitonin and C-reactive protein blood levels and duration of fever 48 h or less after initial antibiotic treatment are excellent predictors of pneumococci. Among 259 patients under 7 years of age hospitalized from 2003 to 2008 for community-acquired pneumonia, 47 met these criteria, including 27 of 141 hospitalized between 2006 (date of vaccine generalization) and 2008. Of these 27, 21 had previously received pneumococcal conjugate vaccine and 19 of 21 were attendees of nursery school or day care centers versus only 2 in 2003-2006. These data show that pneumococcal pneumonias are possible in immunized children cared for in-group settings.
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