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Has the incidence of empyema in Scottish children continued to increase beyond 2005?
Stuart Nath1, Matt Thomas2, David Spencer3
1Department of Child Health, University of Aberdeen, Aberdeen, UK.
Insights
Childhood empyema incidence rose after pneumococcal vaccination (PCV-7) but fell after the 13-valent vaccine (PCV-13) introduction. This study tracked empyema trends in Scotland to understand vaccine impacts.
Area of Science:
- Pediatric infectious diseases
- Vaccinology
- Epidemiology
Background:
- Childhood empyema incidence surged in the late 20th and early 21st centuries.
- The study examines empyema trends in Scotland following the introduction of pneumococcal conjugate vaccines (PCV-7 in 2006 and PCV-13 in 2010).
Purpose of the Study:
- To investigate the impact of PCV-7 and PCV-13 introduction on childhood empyema incidence in Scotland.
- To analyze secular trends in pediatric empyema admissions in relation to vaccination programs.
Main Methods:
- A comprehensive population-based study of Scottish hospital admissions from 1981 to 2013.
- Utilized International Classification of Diseases (ICD-9 and ICD-10) codes to identify empyema cases.
- Collected data on pneumonia and croup admissions to contextualize respiratory illness trends.
Main Results:
- Empyema admissions significantly increased from 9 cases/million/year (1981-2005) to 47 cases/million/year (2006-2013).
- The introduction of PCV-7 in 2006 correlated with a 2.0 per 100,000 children increase in empyema admissions.
- A decrease in the empyema admission rate ratio was observed between 2010-2013 compared to 2006-2009, coinciding with PCV-13 introduction.
Conclusions:
- Childhood empyema incidence initially increased in 1-9 year olds after PCV-7 introduction.
- Empyema incidence has subsequently declined following the introduction of the PCV-13 vaccine in 2010.
Background:
The incidence of empyema increased dramatically in children during the 1990s and early 2000s. We investigated the relationship between changes in the incidence of childhood empyema in Scotland following the 2006 introduction of routine heptavalent conjugate pneumococcal vaccination (PCv-7) and the 2010 introduction of the 13-valent (PCV-13) vaccine.
Methods:
This was a whole-population study of Scottish hospital admissions between 1981 and 2013 using ICD (International Classification of Diseases)-9 and ICD-10 diagnostic codes for empyema. The number of admissions for pneumonia and croup was also captured to give insight into secular trends in admissions with other related and unrelated respiratory presentations.
Results:
There were 217 admissions with empyema between 1981 and 2005 (mean incidence 9 cases/million/year) and 323 between 2006 and 2013 (mean incidence 47 cases/million/year), p<0.001. The introduction of conjugate vaccines in 2006 was associated with an overall increase in admissions for empyema of 2.0 (95% CI 1.4 to 2.8) per 100 000 children, however, the incidence rate ratio for empyema admission between 2010 and 2013 was lower relative to 2006-2009 (0.78 (95% CI 0.63 to 0.98)). Secular changes in pneumonia, but not croup, were comparable with those for empyema.
Conclusions:
The incidence of empyema in Scottish children initially rose in children aged 1 to 9 years after the introduction of routine conjugate pneumococcal vaccination, however, empyema incidence has fallen since 2010 when the PCV-13 was introduced.
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