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Published on: February 23, 2014
Invasive pneumococcal disease after implementation of 13-valent conjugate vaccine
Pui-Ying Iroh Tam1, Lawrence C Madoff2, Brandon Coombes3
1University of Minnesota Children's Hospital, Minneapolis, Minnesota; irohtam@umn.edu.
Insights
Invasive pneumococcal disease (IPD) in children caused by nonvaccine types is more common in those with underlying conditions. The 13-valent pneumococcal conjugate vaccine (PCV13) may not fully protect children with comorbidities.
Area of Science:
- Pediatric infectious diseases
- Vaccinology
- Public health surveillance
Background:
- The 13-valent pneumococcal conjugate vaccine (PCV13) has reduced invasive pneumococcal disease (IPD) incidence.
- However, shifts in causative serotypes and disease profiles warrant ongoing investigation.
Purpose of the Study:
- To assess the clinical profile and severity of IPD in children caused by nonvaccine pneumococcal serotypes after PCV13 introduction.
- To compare IPD characteristics between pre-PCV13 and post-PCV13 eras in children.
Main Methods:
- Observational study utilizing Massachusetts public health surveillance data.
- Comparison of childhood IPD cases from 2007-2009 (pre-PCV13) and 2010-2012 (post-PCV13).
Main Results:
- A 18% decline in PCV13 serotypes was observed post-vaccine introduction.
- Children with comorbidities had higher rates of nonvaccine IPD, increased hospitalization, and longer hospital stays.
- While hospitalization rates increased post-PCV13, mortality rates remained unchanged.
Conclusions:
- Nonvaccine pneumococcal serotypes are disproportionately represented in children with comorbidities.
- PCV13 vaccination alone may be insufficient to mitigate IPD risk in immunocompromised children.
- Further strategies may be needed to protect vulnerable pediatric populations from IPD.
Objective:
To examine whether there is a different clinical profile and severity of invasive pneumococcal disease (IPD) in children caused by nonvaccine types in the era of 13-valent pneumococcal conjugate vaccine (PCV13).
Methods:
Observational study of childhood IPD in Massachusetts based on state public health surveillance data comparing pre-PCV13 (2007-2009) and post-PCV13 (2010-2012) eras.
Results:
There were 168 pre-PCV13 cases of IPD and 85 post-PCV13 cases of IPD in Massachusetts children ≤5 years of age. PCV13 serotypes declined by 18% in the first 2 years after PCV13 use (P = .011). In the post-PCV13 phase, a higher proportion of children were hospitalized (57.6% vs. 50.6%), and a higher proportion of children had comorbidity (23.5% vs. 19.6%). Neither difference was statistically significant, nor were comparisons of IPD caused by vaccine and nonvaccine types. Children with comorbidities had higher rates of IPD caused by a nonvaccine type (27.6% vs. 17.2%; P = .085), were more likely to be hospitalized (80.4% vs. 50%; P < .0001), and were more likely to have a longer hospital stay (median of 3 days vs. 0.5 days; P = .0001).
Conclusions:
Initial data suggest that nonvaccine serotypes are more common in children with underlying conditions, who have greater morbidity from disease. In the post-PCV13 era, a larger proportion of patients are hospitalized, but mortality rates are unchanged. Routine vaccination with PCV13 may not be enough to reduce the risk in patients with comorbidity.
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