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Pneumococcal Vaccination and Pneumonia Associated With Pleural Effusion in a Pediatric Population
Insights
The introduction of pneumococcal conjugate vaccine 7 (PCV7) increased pneumonia with parapneumonic pleural effusion (PPE) risk. Later PCV13 use returned PPE incidence to prevaccine levels, especially in vaccinated children.
Area of Science:
- Pediatric infectious diseases
- Vaccinology
- Epidemiology
Background:
- Pneumonia associated with parapneumonic pleural effusion (PPE) is a significant pediatric illness.
- The impact of pneumococcal conjugate vaccines (PCV) on PPE incidence requires ongoing evaluation.
Purpose of the Study:
- To evaluate the effect of nonsystematic pneumococcal conjugate vaccine (PCV) introduction on the incidence of pneumonia with parapneumonic pleural effusion (PPE) in children.
- To compare PPE risk across prevaccine, PCV7, and PCV13 vaccination periods.
Main Methods:
- Retrospective analysis of 321 pediatric PPE cases (1995-2014) in Navarra, Spain.
- Logistic regression models assessed vaccination status (PCV7, PCV13), age, and time periods.
- Vaccination status data were obtained from computerized medical records.
Main Results:
- The incidence of PPE increased significantly during the PCV7 period compared to the prevaccine era (aOR, 3.34).
- PCV7 vaccination was an independent risk factor for PPE (aOR, 1.44).
- During the PCV13 period, PPE incidence returned to prevaccine levels for PCV13-vaccinated children, but remained elevated for unvaccinated children and those vaccinated with PCV7.
Conclusions:
- Nonsystematic PCV7 introduction was linked to a rise in pediatric PPE incidence.
- Subsequent PCV13 introduction was associated with a decrease in PPE incidence, returning it to prevaccine levels, particularly in PCV13-vaccinated children.
Objective:
The aim was to assess the effect of the nonsystematic pneumococcal conjugate vaccine (PCV) on incidence of pneumonia associated with parapneumonic pleural effusion (PPE) in vaccinated and unvaccinated children.
Methods:
Cases were patients <15 years of age who had been diagnosed with pneumonia associated with PPE in a tertiary hospital in Navarra (Spain) between 1995 and 2014. The population <15 years of age and covered by the public health service was used as reference. The vaccination status of the cases and population was obtained from computerized medical records. Logistic regression analyses included vaccination status, age group and time periods: prevaccine (1995-2001) and vaccination with PCV7 (2002-2010) and PCV13 (2011-2014).
Results:
A total of 321 cases of PPE were included. The risk of PPE increased between the prevaccine and PCV7 period (adjusted odds ratio [OR], 3.34; 95% confidence interval [CI]: 2.37-4.71), while vaccination with PCV7 was found to be an independent risk factor (OR, 1.44; 95% CI: 1.09-1.89) in the same analysis. In the PCV13 period, the risk of PPE returned to the prevaccination incidence level among children vaccinated with PCV13 (OR, 1.07; 95% CI: 0.56-2.04), while unvaccinated children (OR, 1.69; 95% CI: 0.96-2.98) and overall those vaccinated with PCV7 (OR, 3.64; 95% CI: 2.15-6.17) maintained an increased risk of PPE.
Conclusion:
The nonsystematic introduction of PCV7 was followed by an increased incidence of PPE. The subsequent introduction of PCV13 was associated with a return to the incidence level in the prevaccine period, mainly in children vaccinated with PCV13.
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