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Epidemiology of Community-Onset Severe Bacterial Infections in Children and Its Evolution: A Population-Based Study
Fleur Lorton1,2, Martin Chalumeau2,3, Alain Martinot4
1Centre of Clinical Research CIC Femme Enfant Adolescent Inserm 1413, CHU de Nantes, Nantes, France.
Insights
Severe bacterial infections in children have decreased in incidence and mortality, except for Staphylococcus aureus. Continued vigilance and improved vaccination strategies are essential for Neisseria meningitidis and Streptococcus pneumoniae.
Area of Science:
- Pediatric infectious diseases
- Epidemiology
- Public health
Background:
- Community-onset severe bacterial infections (CSBI) pose a significant threat to child health.
- Understanding the evolving epidemiology of CSBI is crucial for effective public health interventions.
- Vaccination strategies have evolved, potentially impacting CSBI rates.
Purpose of the Study:
- To describe the epidemiology of CSBI in children.
- To analyze recent trends and evolution in CSBI incidence and mortality.
- To assess the impact of vaccination on CSBI patterns.
Main Methods:
- Prospective, observational, population-based study conducted in a French administrative area.
- Inclusion of children aged 1 month to 16 years admitted to PICU or deceased due to CSBI.
- Comparison of data with a reference period (2000-2006) before widespread vaccination recommendations.
Main Results:
- Overall CSBI incidence decreased by 53% and mortality by 73% compared to the reference period.
- Neisseria meningitidis and Streptococcus pneumoniae infections significantly decreased, aligning with vaccination impacts.
- Staphylococcus aureus infections showed a concerning 220% increase in incidence.
Conclusions:
- Incidence and mortality of CSBI, excluding S. aureus, have declined in French children.
- N. meningitidis and S. pneumoniae remain significant pathogens, highlighting the need for enhanced vaccination coverage and broader-spectrum vaccines.
- The rise in S. aureus CSBI warrants further investigation and targeted prevention strategies.
Objectives:
To describe the epidemiology of community-onset severe bacterial infections in children and its recent evolution.
Design:
Prospective, observational, population-based study from 2009 to 2014.
Setting:
An administrative area accounting for 13% of the French pediatric population.
Patients:
All children 1 month to 16 years old who died before admission or were admitted to a PICU for a community-onset severe bacterial infection.
Interventions:
None.
Measurements And Main Results:
The incidence and mortality rate of community-onset severe bacterial infections were compared with data from a reference population-based study conducted between 2000 and 2006, that is, before national recommendations for antimeningococcal C and antipneumococcal generalized vaccinations. Among the 261 children included (median age 25 mo), 28 (10.7%) died. The main diagnoses were meningitis (n = 85; 32%) and purpura fulminans (n = 59; 22%). The most common isolated bacteria were Neisseria meningitidis (n = 75; 29%), including 47 (63%) cases of serogroup B and 15 (20%) serogroup C, Streptococcus pneumoniae (n = 49, 19%), and Staphylococcus aureus (n = 15; 6%). The incidence of community-onset severe bacterial infections was three per 100,000 person-years (95% CI, 2.6-3.3) and had decreased by 53% from the reference period. Mortality rate was 0.3 per 100,000 person-years (95% CI, 0.2-0.4) and had decreased by 73% from the reference period. The incidence of community-onset severe bacterial infections caused by N. meningitidis and S. pneumoniae was 0.8 and 0.5 per 100,000 person-years and had decreased by 70% and 67% from the reference period. The incidence of community-onset severe bacterial infections-related to Staphylococcus aureus was 0.16 per 100,000 person-years and had increased by 220% from the reference period.
Conclusions:
The incidence and mortality rate of community-onset severe bacterial infections, except for S. aureus infection, have decreased in France. N. meningitidis and S. pneumoniae continue to account for many infections, which indicates the need for better vaccination coverage and spectrum.
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