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Hospital admissions in children due to pneumococcal pneumonia in England
T Djuretic1, M J Ryan, E Miller
1Immunisation Division, PHLS Communicable Disease Surveillance Centre, London, UK.
Insights
Streptococcus pneumoniae likely causes most childhood lobar pneumonia in England, despite low blood isolation rates. Improved diagnostics are crucial with new conjugate pneumococcal vaccines.
Area of Science:
- Pediatric infectious diseases
- Respiratory medicine
- Microbiology
Background:
- Community-acquired pneumonia (CAP) is a leading cause of mortality in children under five.
- Streptococcus pneumoniae is a primary bacterial pathogen responsible for CAP.
- The introduction of conjugate pneumococcal vaccines necessitates accurate etiological diagnosis.
Purpose of the Study:
- To estimate the proportion of lobar pneumonia in young children attributable to Streptococcus pneumoniae.
- To assess the utility of clinical and laboratory markers in diagnosing pneumococcal pneumonia.
- To highlight the need for improved diagnostic methods for pediatric pneumonia.
Main Methods:
- Retrospective review of hospital records for 116 children under five with lobar pneumonia.
- Analysis of chest X-ray findings, white cell count, C-reactive protein levels, and pathogen isolation (blood, sputum, nasopharyngeal aspirate).
- Evaluation of 135 additional cases diagnosed with bronchopneumonia or unspecified pneumonia.
Main Results:
- 86% of lobar pneumonia cases showed X-ray findings consistent with pneumococcal infection.
- Only 1% had S. pneumoniae isolated from blood, but 89% were likely or possibly pneumococcal based on combined criteria.
- For unspecified pneumonia, 70% showed features suggestive of pneumococcal infection.
Conclusions:
- Streptococcus pneumoniae is likely an under-recognized cause of pediatric lobar pneumonia.
- Current diagnostic methods, particularly blood cultures, underestimate the burden of pneumococcal pneumonia.
- Enhanced diagnostic strategies are essential for effective management and surveillance of pneumococcal disease in children, especially with vaccine availability.
Abstract:
Hospital records of 116 children under 5 years of age discharged from 11 hospitals in three regions in England with a diagnosis of lobar (pneumococcal) pneumonia were reviewed to estimate the proportion likely to be attributable to infection with Streptococcus pneumoniae. Of these, 100 (86%) had lobar/focal changes on chest X-ray consistent with pneumococcal infection, although only one (1%) had pneumococcus isolated from blood. However, a further 89 (89%) with a lobar/focal picture were considered to be likely or possibly due to pneumococcal infection on the basis of the white cell count, level of C-reactive protein, isolation of the S. pneumoniae from either sputum or nasopharingeal aspirate and failure to identify another responsible pathogen. Of 135 cases with a discharge diagnosis of bronchopneumonia or pneumonia (organism unspecified), two (1%) had S. pneumoniae isolated from blood and a further 95 (70%) had clinical or laboratory features consistent with pneumococcal infection or S. pneumoniae isolated from either sputum or nasopharyngeal aspirate. With the imminent availability of conjugate pneumococcal vaccines, there is a need for improved diagnostic methods for identifying the pathogens responsible for community-acquired pneumonia in young children.