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Updated: Jan 31, 2026
Capsular Serotyping of Streptococcus pneumoniae Using the Quellung Reaction
Published on: February 24, 2014
Burden of Streptococcus pneumoniae Sepsis in Children After Introduction of Pneumococcal Conjugate Vaccines: A
Sandra A Asner1,2, Philipp K A Agyeman3, Eugénie Gradoux1
1Pediatric Infectious Diseases and Vaccinology Unit, Department Mother-Woman-Child, Switzerland.
Insights
Pneumococcal sepsis remains a significant threat in children, with PCV-13 vaccination showing limited impact on overall incidence. Meningitis and serotype 3 infections are key predictors of severe pneumococcal sepsis outcomes.
Area of Science:
- Pediatric infectious diseases
- Vaccinology
- Epidemiology
Background:
- Population-based studies on pneumococcal conjugate vaccine (PCV) impact on childhood pneumococcal sepsis are scarce.
- This study assesses the burden of pneumococcal sepsis following the introduction of PCV-13 in a nationwide cohort.
Purpose of the Study:
- To evaluate the incidence and severity of pneumococcal sepsis in children after PCV-13 implementation.
- To identify risk factors for severe outcomes, including pediatric intensive care unit (PICU) admission and prolonged hospital stay.
Main Methods:
- Prospective nationwide cohort study (Swiss Pediatric Sepsis Study, 2011-2015).
- Inclusion of children (<17 years) with blood culture-proven Streptococcus pneumoniae sepsis and systemic inflammatory response syndrome.
- Definition of vaccine failure as infection with a vaccine serotype in PCV-immunized children.
Main Results:
- The crude incidence of pneumococcal sepsis was 2.0 per 100,000 children, accounting for 25% of community-acquired sepsis.
- Case fatality rate was 8%, with 36% requiring PICU admission.
- Meningitis (often non-PCV serotypes) and serotype 3 infections were associated with increased PICU admission and longer hospital stays, respectively.
Conclusions:
- The incidence of pneumococcal sepsis in children remains substantial despite PCV-13 introduction.
- Meningitis and serotype 3 infections are significant predictors of severe pneumococcal sepsis.
- Further strategies may be needed to address remaining vaccine-preventable serotypes and disease burdens.
Background:
Population-based studies assessing the impact of pneumococcal conjugate vaccines (PCV) on burden of pneumococcal sepsis in children are lacking. We aimed to assess this burden following introduction of PCV-13 in a nationwide cohort study.
Methods:
The Swiss Pediatric Sepsis Study (September 2011 to December 2015) prospectively recruited children <17 years of age with blood culture-proven sepsis due to Streptococcus pneumoniae, meeting criteria for systemic inflammatory response syndrome. Infection with vaccine serotype in children up to date with PCV immunization was defined as vaccine failure. Main outcomes were admission to pediatric intensive care unit (PICU) and length of hospital stay (LOS).
Results:
Children with pneumococcal sepsis (n = 117) accounted for a crude incidence of 2.0 per 100 000 children (95% confidence interval [CI] 1.7-2.4) and 25% of community-acquired sepsis episodes. Case fatality rate was 8%. Forty-two (36%) patients required PICU admission. Children with meningitis (29; 25%) were more often infected by serotypes not included in PCV (69% vs 31%; P < .001). Sixteen (26%) of 62 children up to date with PCV immunization presented with vaccine failure, including 11 infected with serotype 3. In multivariable analyses, children with meningitis (odds ratio [OR] 6.8; 95% CI 2.4-19.3; P < .001) or infected with serotype 3 (OR 2.8; 95% CI 1.1-7.3; P = .04) were more often admitted to PICU. Children infected with serotype 3 had longer LOS (β coefficient 0.2, 95% CI .1-1.1; P = .01).
Conclusions:
The incidence of pneumococcal sepsis in children shortly after introduction of PCV-13 remained substantial. Meningitis mostly due to non-vaccine serotypes and disease caused by serotype 3 represented significant predictors of severity.
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