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Pneumococcal Pneumonia Requiring Hospitalization in US Children in the 13-Valent Pneumococcal Conjugate Vaccine Era
Liset Olarte1, William J Barson2, Ryan M Barson2
1Departments of Pediatrics of Baylor College of Medicine, Houston, Texas.
Insights
The introduction of pneumococcal conjugate vaccine 13 (PCV13) significantly reduced pneumococcal pneumonia hospitalizations in children. However, PCV13 serotypes 19A and 3 remained common causes of remaining cases.
Area of Science:
- Pediatrics
- Infectious Diseases
- Vaccinology
Background:
- Pneumococcal pneumonia (PP) remains a significant pediatric health concern.
- The impact of the 13-valent pneumococcal conjugate vaccine (PCV13) on clinical outcomes of pediatric PP is not well-documented.
- Understanding serotype distribution and antibiotic susceptibility pre- and post-PCV13 is crucial for public health strategies.
Purpose of the Study:
- To evaluate the impact of PCV13 introduction on the epidemiology and clinical aspects of pneumococcal pneumonia in children.
- To compare serotype distribution, antibiotic susceptibility, and patient outcomes before and after PCV13 implementation.
- To assess changes in hospitalization rates and disease severity associated with pediatric PP.
Main Methods:
- Retrospective analysis of 377 pediatric patients hospitalized with PP across 8 US children's hospitals from 2006-2014.
- Prospective collection and central laboratory analysis of pneumococcal isolates for serotyping and antibiotic susceptibility testing.
- Calculation of annual PP hospitalization rates and statistical comparison of clinical outcomes pre- and post-PCV13 introduction.
Main Results:
- Pediatric PP hospitalization rates significantly decreased post-PCV13 introduction (53.6 to 23.3 per 100,000 admissions).
- Rates of complicated PP also showed a significant decline, although intensive care, mechanical ventilation, and invasive procedures remained unchanged.
- PCV13 serotypes 19A, 3, 7F, and 1 were predominant, causing 80% of PP cases; hospitalization rates for these serotypes also decreased substantially post-PCV13.
Conclusions:
- PCV13 introduction led to a significant reduction in pediatric pneumococcal pneumonia hospitalizations and complicated cases.
- Despite the overall decrease, specific PCV13 serotypes, notably 19A and 3, continued to be major contributors to PP in the post-vaccine era.
- Ongoing surveillance of serotype distribution and antibiotic resistance remains essential for optimizing pediatric pneumococcal disease prevention strategies.
Background.:
The impact of PCV13 on a number of clinical aspects of pneumococcal pneumonia (PP) in children has not been reported. We compared the serotype distribution, antibiotic susceptibility, and outcomes of children with PP 4 years before and 4 years after the introduction of PCV13.
Methods.:
We identified patients ≤18 years with PP at 8 children's hospitals in the United States (2006-2014). Pneumococcal isolates were collected prospectively. Serotyping and antibiotic susceptibility were performed in a central laboratory. Clinical and laboratory data were collected retrospectively. Annual pneumococcal pneumonia hospitalization rates per 100 000 admissions with 95% confidence intervals were calculated. Dichotomous variables were analyzed by χ2 test and continuous variables with Mann-Whitney U test.
Results.:
A total of 377 patients with PP requiring hospitalization were identified. Hospitalization rates of PP decreased from 53.6 to 23.3 per 100000 admissions post PCV13 (P < .0001). Complicated PP rates also decreased (P < .0001). Need for intensive care, mechanical ventilation, and invasive procedure remained unchanged after the introduction of PCV13. Comorbidities were more common among children with uncomplicated than complicated pneumonia (52.2% vs. 22.5%, P < .001). Overall, PCV13 serotypes 19A, 3, 7F, and 1 caused 80% of PP. Hospitalization rates of PCV13 serotype pneumonia decreased from 47.2 to 15.7 per 100000 admissions post PCV13. In 2014, the most common serotypes were 3, 19A and 35B.
Conclusions.:
PP requiring hospitalization significantly decreased in children after PCV13 introduction. Complicated PP rates decreased steadily in 2011-2014. PCV13 serotypes 19A and 3 were still responsible for half of the cases of PP in 2011-2014.
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