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Published on: April 28, 2014
Epidemiology of childhood invasive pneumococcal disease in Australia: a prospective cohort study
Linny Kimly Phuong1,2, Abigail Cheung3, Tiarni Templeton4
1Antimicrobials Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia linny.phuong@mcri.edu.au.
Insights
Pneumococcal conjugate vaccines (PCV) have altered invasive pneumococcal disease (IPD) in children. Complicated pneumonia remains common, while non-vaccine serotypes (NVTs) dominate serious IPD cases, necessitating treatment guideline updates.
Area of Science:
- Pediatric Infectious Diseases
- Vaccinology
- Epidemiology
Background:
- Widespread use of pneumococcal conjugate vaccines (PCV) has significantly impacted the epidemiology of invasive pneumococcal disease (IPD) in children globally.
- Despite vaccination, IPD remains a concern in pediatric populations.
Purpose of the Study:
- To analyze current trends in IPD presentations, serotypes, and antimicrobial resistance in Australian children.
- To inform clinical management and public health strategies for IPD.
Main Methods:
- A multicentre prospective audit of IPD episodes in children (<18 years) across five Australian pediatric hospitals.
- Data collected over 5.5 years (2016-2021) for children with *Streptococcus pneumoniae* isolated from sterile sites.
Main Results:
- 377 IPD episodes occurred in 375 children; 90% had received ≥3 PCV doses.
- Complicated pneumonia was the most frequent presentation (67%), followed by bacteraemia (17%) and meningitis (8%).
- Non-vaccine serotypes (NVTs) predominated in bacteraemia and meningitis, and high ceftriaxone resistance (17%) was observed in NVT 23B isolates, particularly in meningitis cases (22%).
Conclusions:
- Complicated pneumonia is the leading IPD manifestation in vaccinated children.
- NVTs are increasingly responsible for severe IPD, including meningitis and bacteraemia.
- High ceftriaxone resistance in NVT 23B suggests vancomycin should be considered for empiric meningitis treatment.
Background:
The widespread use of pneumococcal conjugate vaccines (PCV) has changed the epidemiology of invasive pneumococcal disease (IPD) in children globally.
Methods:
Multicentre prospective audit of IPD episodes from five paediatric hospitals in Australia over 5.5 years between 2016 and June 2021. Children (<18 years) with Streptococcus pneumoniae isolated from a sterile site were included.
Results:
There were 377 IPD episodes in 375 children: 338 (90%) had received ≥3 PCV doses; 42 (11%) had IPD risk factors. The most common presentations were complicated pneumonia (254, 67%), bacteraemia (65, 17%) and meningitis (29, 8%). Five (1%) children died.Serotype information was available for 230 (61%) episodes; 140 (61%) were 13vPCV vaccine serotypes (VTs). The majority (85%) of episodes of complicated pneumonia were due to a VT; predominantly 3, 19A, 19F. Children with risk factors were more likely to present with bacteraemia ± sepsis (42% vs 12%) and to have a non-vaccine serotype (NVT) (74% vs 32%). Resistance to ceftriaxone (meningitis cut-off) occurred in 17% of 23B isolates (n=12) and accounted for 22% (5/23) of meningitis cases.
Conclusions:
Complicated pneumonia is the most common IPD presentation. NVTs account for the majority of bacteraemia and meningitis episodes. High rates of ceftriaxone resistance for NVT 23B support the addition of vancomycin for empiric treatment of suspected meningitis.
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