Surveillance of pediatric parapneumonic effusion/empyema in New Zealand
Katherine Rix-Trott1,2, Catherine A Byrnes1,3, Catherine A Gilchrist3
1Starship Children's Health, Auckland District Health Board, Auckland, New Zealand.
Insights
Childhood empyema is increasing in New Zealand, with Staphylococcus aureus causing severe illness, especially in Māori and Pasifika children. Improved vaccination and S. aureus strategies are crucial.
Area of Science:
- Pediatric Infectious Diseases
- Respiratory Medicine
- Public Health Epidemiology
Background:
- Childhood empyema incidence is rising globally, even with pneumococcal vaccination.
- Understanding local epidemiology is vital for targeted interventions.
Purpose of the Study:
- To determine the incidence, causative pathogens, and outcomes of pediatric parapneumonic effusion/empyema in New Zealand.
- To identify risk factors and demographic disparities in affected children.
Main Methods:
- Prospective surveillance of 102 children under 15 with parapneumonic effusion/empyema from 2014-2016.
- Data collected via standardized questionnaires from notifying pediatricians.
Main Results:
- Annual incidence of pediatric empyema was 5.6/100,000.
- Staphylococcus aureus and Streptococcus pneumoniae were equally common pathogens (25%), but S. aureus led to more severe outcomes.
- Māori and Pasifika children were disproportionately affected, and vaccination rates were suboptimal.
Conclusions:
- New Zealand experiences high rates of pediatric complicated empyema with substantial morbidity.
- S. aureus is a key pathogen, particularly impacting Māori and Pasifika children.
- Enhanced vaccine coverage and S. aureus management strategies are urgently needed.
Aim:
The incidence of childhood empyema has been increasing in some developed countries despite the introduction of pneumococcal vaccination. This study aimed to document the incidence, bacterial pathogens, and morbidity/mortality of parapneumonic effusion/empyema in New Zealand.
Methods:
A prospective study of 102 children <15 years of age requiring hospitalization with parapneumonic effusion/empyema between May 1, 2014 and May 31, 2016 notified via the New Zealand Paediatric Surveillance Unit. Parapneumonic effusion/empyema was defined as pneumonia and pleural effusion persisting ≥7 days, and/or any pneumonia, and pleural effusion necessitating drainage. Notifying pediatricians completed standardized questionnaires.
Results:
Annual pediatric parapneumonic effusion/empyema incidence was 5.6/100,000 (95% confidence interval [CI]: 4.7-6.9). Most children (80%) required surgical intervention and 31% required intensive care. A causative organism was identified in 71/102 (70%) cases. Although Staphylococcus aureus (25%) and Streptococcus pneumoniae (25%) infection rates were equal, prolonged hospitalization and intensive care admission were more common in children with S. aureus PPE/E. Māori and Pasifika children were over-represented at 2.2 and 3.5 times, their representation in the New Zealand pediatric population. Pneumococcal vaccination was incomplete, with only 61% fully immunized and 30% unimmunized. Haemophilus influenzae type b vaccine uptake was near complete at 89/94 (95%), with influenza immunization only 3/78 (4%).
Conclusions:
New Zealand has a high incidence of pediatric complicated parapneumonic effusion/empyema with significant morbidity. S. aureus was a significant cause of severe empyema in New Zealand, particularly for Māori and Pasifika children. Improvements in vaccine coverage are needed along with strategies to reduce S. aureus disease morbidity.
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