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Increase in Streptococcus pneumoniae serotype 3 associated parapneumonic pleural effusion/empyema after the
D Goettler1, A Streng1, D Kemmling1
1Department of Pediatrics, University Hospital of Würzburg, Würzburg, Germany.
Insights
Pediatric pneumococcal pneumonia complicated by parapneumonic effusion/empyema (PPE/PE) is a concern. Serotype 3 emerged as a dominant cause after PCV13 introduction, highlighting the need for improved vaccines.
Area of Science:
- Pediatric infectious diseases
- Vaccinology
- Microbiology
Background:
- Pediatric pneumococcal pneumonia complicated by parapneumonic pleural effusion/empyema (PPE/PE) remains a significant health issue.
- Pneumococcal conjugate vaccines (PCVs) have reduced disease burden but do not offer complete protection.
Purpose of the Study:
- To investigate the serotype distribution and clinical characteristics of pediatric PPE/PE in Germany.
- To assess the impact of PCV13 introduction on serotype prevalence and vaccine effectiveness.
Main Methods:
- A nationwide surveillance study in German pediatric hospitals from October 2010 to June 2018.
- Identification and serotyping of Streptococcus pneumoniae in children with confirmed PPE/PE using culture and PCR.
- Analysis of vaccination status and vaccine effectiveness, including breakthrough cases.
Main Results:
- Streptococcus pneumoniae was identified in 43.8% of 584 children with PPE/PE.
- Serotype 3 became dominant after PCV13 introduction, particularly in younger children and those requiring intensive care.
- Vaccine failures were observed, with 30 breakthrough cases, 26 of which were serotype 3.
Conclusions:
- The introduction of PCV13 in Germany has been associated with a shift in pneumococcal serotype distribution, with a notable increase in serotype 3.
- Current PCVs may not be sufficiently effective against emerging serotypes like 3, necessitating the development of vaccines with broader or enhanced coverage.
Introduction:
Pediatric pneumococcal pneumonia complicated by parapneumonic pleural effusion/empyema (PPE/PE) remains a major concern despite general immunization with pneumococcal conjugate vaccines (PCVs).
Methods:
In a nationwide pediatric hospital surveillance study in Germany we identified 584 children <18 years of age with bacteriologically confirmed PPE/PE from October 2010 to June 2018. Streptococcus pneumoniae was identified by culture and/or PCR of blood samples and/or pleural fluid and serotyped.
Results:
S. pneumoniae was identified in 256 of 584 (43.8%) children by culture (n = 122) and/or PCR (n = 207). The following pneumococcal serotypes were detected in 114 children: serotype 3 (42.1%), 1 (25.4%), 7F (12.3%), 19A (7.9%), other PCV13 serotypes (4.4%) and non-PCV13 serotypes (7.9%). Between October 2010 and June 2014 serotype 1 (38.1%) and serotype 3 (25.4%) were most prevalent, whereas between July 2014 and June 2018 serotype 3 (62.7%) and non-PCV13 serotypes (15.7%) were dominant. Compared to children with other pneumococcal serotypes, children with serotype 3 associated PPE/PE were younger (median 3.2 years [IQR 2.1-4.3 years] vs. median 5.6 years [IQR 3.8-8.2 years]; p < 0.001) and more frequently admitted to intensive care (43 [89.6%] vs. 48 [73.8%]; p = 0.04). Seventy-six of 114 (66.7%) children with pneumococcal PPE/PE had been vaccinated with pneumococcal vaccines. Thirty-nine of 76 (51.3%) had received a vaccine covering the serotype detected. Thirty of these 39 breakthrough cases were age-appropriately vaccinated with PCV13 and considered vaccine failures, including 26 children with serotype 3, three children with serotype 19A and one child with serotype 1.
Conclusion:
Following the introduction of PCV13 in general childhood vaccination we observed a strong emergence of serotype 3 associated PPE/PE in the German pediatric population, including a considerable number of younger children with serotype 3 vaccine breakthrough cases and failures. Future PCVs should not only cover newly emerging serotypes, but also include a more effective component against serotype 3.
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