Pediatric Invasive Pneumococcal Disease Spectrum Before Third-Generation Pneumococcal Conjugate Vaccine Implementation
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Published on: February 23, 2014
Corinne Levy1,2,3,4,5, Aude Estivaux3,4,6, Emmanuelle Varon1,3,4,7
1ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, 94000 Créteil, France.
Insights
Invasive pneumococcal disease (IPD) cases shifted after PCV13, with serotype 24F now most common. Newer vaccines like PCV20 cover more serotypes, including those linked to fatal IPD cases.
Area of Science:
- Pediatrics
- Infectious Diseases
- Vaccinology
Background:
- Pneumococcal conjugate vaccines (PCVs) have altered the landscape of invasive pneumococcal disease (IPD).
- Changes in serotype distribution and clinical presentation of IPD have been observed post-PCV implementation.
- This study examines IPD 15 years after PCV13 introduction, before next-generation PCVs.
Purpose of the Study:
- To describe the clinical profile of invasive pneumococcal disease (IPD) in children.
- To determine the serotype distribution of IPD cases.
- To evaluate the impact of PCV13 and the potential coverage of newer vaccines (PCV15, PCV20).
Main Methods:
- Prospective surveillance of IPD cases in 128 French pediatric wards (2017-2022).
- Data collection included demographics, clinical data, risk factors, and outcomes.
- IPD cases were categorized into meningitis, bacteremia without source, bacteremic pneumonia, and other IPD.
Main Results:
- Meningitis was the most frequent clinical entity (36.4%), followed by bacteremia without source (31.6%).
- Serotype 24F was the most prevalent overall (16.4%), and PCV20 non-PCV13 serotypes were associated with a significant proportion of deaths (33.3%).
- PCV13 serotypes (3, 19A, 19F) still accounted for 15.0% of cases, and PCV20 offers broader coverage than PCV13 and PCV15.
Conclusions:
- Serotype 24F, the leading cause of IPD in this study, is not covered by current third-generation PCVs.
- PCV20 demonstrates increased serotype coverage compared to PCV13 and PCV15, potentially impacting mortality.
- Understanding evolving serotype distribution is crucial for optimizing pneumococcal vaccination strategies.
Background:
After the implementation of pneumococcal conjugate vaccines (PCVs), besides the decrease of invasive pneumococcal disease (IPD), the clinical spectrum of the remaining cases changed, with many differences among serotypes. This study aimed to describe the clinical profile of IPD and the serotype distribution 15 years after PCV13 implementation and before the implementation of third-generation PCVs.
Methods:
From 2017 to 2022, 128 French pediatric wards prospectively reported IPDs in children. Data were collected on demographics and clinical data, underlying conditions increasing the risk of IPD and outcome. Four clinical entities were considered: meningitis, bacteremia without source, bacteremic pneumonia, and other IPD.
Results:
Among 931 IPD cases (median age of children: 19.2 months, Interquartile range (IQR): 7.7-52.5), meningitis accounted for 36.4%, followed by bacteremia without source (31.6%), bacteremic pneumonia (20.5%), and other IPDs (11.5%). Underlying conditions were reported in 21.5% of children. Death was reported in 4.8% of IPD cases and meningitis represented 51.1% of fatal cases. PCV13 serotypes, mainly 3, 19A, and 19F, still accounted for 15.0% of cases. PCV15 covered 6.2% more serotypes than did PCV13, whereas PCV20 covered 29.1% more serotypes than did PCV15. PCV20 non-PCV13 and PCV13 serotypes accounted for 33.3% and 11.1% of deaths, respectively. Serotype 24F ranked first and accounted for 16.4% of overall IPD cases.
Conclusions:
From 2017 to 2022, among 931 IPD cases, PCV20 non-PCV13 serotypes (35.0% of cases) were implicated in 33.3% of deaths. Serotype 24F ranked first in overall IPD cases but is not included in third-generation PCVs.
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