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Etiology of Pneumonia in a Pediatric Population with High Pneumococcal Vaccine Coverage: A Prospective Study
Are Stuwitz Berg1, Christopher Stephen Inchley, Audun Aase
1From the *Department of Pediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway; †Department of Bacteriology and Immunology, Norwegian Institute of Public Health, Oslo, Norway; ‡Department of Radiology and §Department of Microbiology and Infection Control, Akershus University Hospital, Lørenskog, Norway; and ¶Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Insights
In children with high pneumococcal vaccination rates, viral infections like respiratory syncytial virus are the main cause of pneumonia. Bacterial causes, including pneumococcus, were less common, suggesting a need to reduce antibiotic overuse.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Public Health
Background:
- Childhood immunization programs, particularly pneumococcal vaccination, have advanced.
- Better diagnostics and reduced antibiotic misuse necessitate updated knowledge on pediatric pneumonia etiology.
- High pneumococcal conjugate vaccine coverage in a population requires reassessment of pneumonia causes.
Purpose of the Study:
- To determine the contribution of various microbiological species to pediatric pneumonia.
- To investigate pneumonia etiology in previously healthy children and adolescents.
- To assess pathogens in a population with high pneumococcal conjugate vaccine coverage.
Main Methods:
- Prospective, observational study over 2 years.
- Inclusion of both inpatient and outpatient cases with clinical and radiological pneumonia signs.
- Analysis of paired sera, nasopharyngeal PCR, and bacterial cultures for pathogen detection.
Main Results:
- 265 cases of verified pneumonia identified with 85% pneumococcal vaccine coverage.
- Causative pathogens identified in 84.2% of cases.
- Single viral etiology in 63.4%, pneumococcus in 11.3%, and Mycoplasma in 7.5%.
Conclusions:
- The majority of pediatric pneumonia cases were single viral infections, predominantly respiratory syncytial virus.
- Bacterial causes, including Streptococcus pneumoniae, were less frequent.
- Findings may inform pneumonia management guidelines and reduce antibiotic overuse in vaccinated populations.
Background:
Improved Childhood Immunizations Programs, especially the introduction of pneumococcal vaccination, better diagnostic methods and the importance of reduced antibiotic misuse, make this a critical time to increase knowledge on the etiology of pediatric pneumonia. Our main objective was to identify the contribution of various microbiological species that causes pneumonia in previously healthy children and adolescents in a population with high pneumococcal conjugate vaccine coverage.
Methods:
This prospective, observational study enrolled patients with clinical and radiological signs of pneumonia over a 2-year period. Both inpatients and outpatients were included. Paired sera, nasopharyngeal polymerase chain reaction and bacterial cultures from blood and pleura were analyzed to detect potential viral and bacterial causative pathogens.
Results:
TWO HUNDRED AND SIXTY-FIVE: cases of clinical and radiological verified pneumonia were identified. The pneumococcal vaccine coverage was 85%. We identified a causative pathogen in 84.2% of all cases; 63.4% with single viral etiology, 11.3% with pneumococcus and 7.5% with mycoplasma infection. Respiratory syncytial virus was the most common pathogen in children younger than 5 years, whereas mycoplasma was the most common in older children.
Conclusions:
We identified the majority of 265 cases with radiology proven pneumonia as single viral infections, predominantly respiratory syncytial virus and a much lower proportion of bacterial causes. These findings may impact pneumonia management guidelines in areas where widespread pneumococcal vaccination is provided and contribute to reduced antibiotic overuse in pediatric pneumonia.
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