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Invasive Pneumococcal Disease in High-risk Children: A 10-Year Retrospective Study
Jacqui van Warmerdam1, Aaron Campigotto2,3, Ari Bitnun2,4
1From the Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Insights
Invasive pneumococcal disease (IPD) remains a threat to high-risk children despite available vaccines. Improving vaccination rates with pneumococcal conjugate vaccine (PCV) and PPSV23 is crucial to prevent IPD caused by vaccine-preventable serotypes.
Area of Science:
- Pediatric Infectious Diseases
- Vaccinology
- Epidemiology
Background:
- High-risk children remain susceptible to invasive pneumococcal disease (IPD) despite existing conjugate pneumococcal vaccines.
- This study addresses the ongoing challenge of IPD in pediatric populations with underlying health conditions.
Purpose of the Study:
- To determine the prevalence of IPD among high-risk children.
- To analyze vaccination status and outcomes in this vulnerable group.
Main Methods:
- Retrospective cohort study of IPD hospitalizations from 2009-2018 at a major pediatric hospital.
- Utilized ICD-10 and microbiology codes to identify cases and define high-risk conditions (e.g., malignancy, transplant, immunodeficiency).
Main Results:
- 94 high-risk children were hospitalized for IPD, with malignancy, transplant, and sickle cell disease being most common.
- No deaths occurred; however, 23% of patients were unvaccinated, and many IPD cases involved vaccine-preventable serotypes in incompletely immunized children.
- Serotype analysis showed significant coverage gaps for current vaccines like PCV13 and PPSV23.
Conclusions:
- IPD continues to affect high-risk children, underscoring the need for enhanced vaccination strategies.
- Increased uptake of pneumococcal conjugate vaccine (PCV) and PPSV23 could substantially decrease IPD incidence in this population.
- Targeted immunization efforts are vital, especially for vaccine-preventable serotypes prevalent in incompletely vaccinated high-risk children.
Background:
Despite the availability of conjugate pneumococcal vaccines, children with high-risk conditions remain vulnerable to invasive pneumococcal disease (IPD). This study sought to describe IPD prevalence, vaccination and outcomes among high-risk children.
Methods:
We used International Classification of Disease10 discharge and microbiology codes to identify patients hospitalized for IPD at a large pediatric hospital from January 1, 2009, to December 31, 2018. Patients were considered high-risk if they had: primary immunodeficiency, asplenia, transplant, active malignancy, sickle cell disease, cochlear implant, nephrotic syndrome, chronic lung disease, cerebrospinal fluid leak, HIV or used immunosuppressive therapy.
Results:
In total 94 high-risk patients were hospitalized for IPD. The most common high-risk conditions included malignancy (n = 33, 35%), solid-organ or bone marrow transplant (n = 17, 18%) and sickle cell disease (n = 14, 15%). Bacteremia was the most common presentation (n = 81, 86%) followed by pneumonia (n = 23, 25%) and meningitis (n = 9, 10%). No deaths occurred. Of 66 patients with known pneumococcal vaccination status, 15 (23%) were unvaccinated, and 51 (77%) received at least one dose of a pneumococcal vaccine; 20 received all four recommended pneumococcal conjugate vaccine (PCV) doses. Only three children received PPSV23. Of 20 children with no or partial (<3 doses) immunization, 70% (14) of IPD episodes were due to vaccine-preventable serotypes. Of 66 known IPD serotypes, 17% (n = 11) were covered by PCV13, 39% (n = 26) were covered by PPSV23 and 39% (n = 26) were nonvaccine serotype.
Conclusions:
Despite the availability of effective pneumococcal vaccines, IPD persists among children with high-risk conditions. Improving PCV13 and PPSV23 vaccination could significantly reduce IPD; most episodes were due to vaccine-preventable serotypes in incompletely immunized patients.
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