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Vaccination, underlying comorbidities, and risk of invasive pneumococcal disease
Inci Yildirim1, Kimberly M Shea2, Brent A Little3
1Section of Pediatric Infectious Diseases, Boston University Medical Center, Boston, Massachusetts; and Department of Epidemiology, Boston University, School of Public Health, Boston, Massachusetts yildirim@bu.edu.
Insights
Children with underlying conditions face higher risks of invasive pneumococcal disease (IPD). A significant portion of IPD in these children is caused by vaccine-resistant serotypes, necessitating new prevention strategies.
Area of Science:
- Pediatric Infectious Diseases
- Epidemiology
- Vaccinology
Background:
- Children with underlying health conditions are at elevated risk for invasive pneumococcal diseases (IPD).
- Understanding the specific epidemiology and clinical outcomes of IPD in this vulnerable population is crucial for public health.
- Comorbidities in children can significantly alter the presentation and severity of IPD.
Purpose of the Study:
- To describe the epidemiology, serotype distribution, clinical presentations, and outcomes of IPD in children with and without comorbidities.
- To compare the characteristics and risk factors of IPD in children with and without underlying conditions.
- To identify serotypes responsible for IPD in children with comorbidities, particularly those not covered by current vaccines.
Main Methods:
- Enhanced surveillance was used to identify IPD cases in children under 18 in Massachusetts from 2002-2014.
- Demographic and clinical data were collected via parent and provider interviews.
- Underlying conditions were classified using established guidelines from the CDC and ACIP.
Main Results:
- 22.1% of 1052 IPD cases occurred in children with at least one comorbidity, most commonly immunocompromising or chronic respiratory conditions.
- Children with comorbidities were older at diagnosis and experienced higher hospitalization and case-fatality rates compared to those without comorbidities.
- During the study period, 50% of IPD cases in children with comorbidities were caused by serotypes not covered by the 13-valent pneumococcal conjugate vaccine (PCV13) or the 23-valent pneumococcal polysaccharide vaccine (PPSV23).
Conclusions:
- IPD in children with comorbidities leads to increased mortality.
- A substantial proportion of IPD in vulnerable children is caused by serotypes not included in current conjugate vaccines.
- Additional prevention strategies are needed to protect children with comorbidities from IPD.
Objectives:
Children with underlying conditions remain at increased risk for invasive pneumococcal diseases (IPD). This study describes the epidemiology, serotype distribution, clinical presentations, and outcomes of IPD in children with and without comorbidity.
Methods:
Cases of childhood IPD in Massachusetts were identified via enhanced surveillance from 2002 through 2014. Demographic and clinical data were collected via follow-up telephone interviews with parents and/or primary care providers. Underlying conditions were classified according to the 2012 Report of the Committee on Infectious Diseases and 2013 recommendations by the Advisory Committee on Immunization Practices.
Results:
Among 1052 IPD cases in Massachusetts children <18 years old, 22.1% had at least 1 comorbidity. Immunocompromising conditions (32.7%) and chronic respiratory diseases (22.4%) were most common. Children with comorbidities were older at the time of IPD diagnosis (median 54 vs 23 months, P < .001), had higher hospitalization (odds ratio 2.5; 95% confidence interval 1.7-3.6) and case-fatality rates (odds ratio 3.7; 95% confidence interval 1.5-8.9) compared with children without known underlying conditions after adjusting for age, gender, year of diagnosis, and pneumococcal vaccination status. During the last 2 years of the study, IPD among children with comorbidities was caused by non-pneumococcal conjugate vaccine 13 serotypes in 23-valent polysaccharide pneumococcal vaccine (6/12, 50%) or serotypes that are not included in any of the vaccines (6/12; 50%).
Conclusions:
In children with comorbidity, IPD results in higher mortality, and a large proportion of disease is due to serotypes not included in current conjugate vaccines. Further research is needed, specifically to develop and evaluate additional strategies for prevention of IPD in the most vulnerable children.
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