Fleur Lorton1,2,3, Martin Chalumeau2,4,5, Rémy Assathiany6,7, Alain Martinot8, Marie Bucchia3, Jean-Michel Roué9, Pierre Bourgoin10, Julie Chantreuil11, Gérald Boussicault12, Théophile Gaillot13, Jean-Pascal Saulnier14, Jocelyne Caillon15, Corinne Levy16, Robert Cohen16,17, Christèle Gras-Le Guen1,2,3, Elise Launay2,3. 1. Centre d'investigation clinique INSERM 1413, Femme Enfant Adolescent CHU de Nantes, Nantes, France. 2. Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris Descartes University, Paris, France. 3. Services d'urgences pédiatriques et de pédiatrie générale, Hôpital Femme Enfant Adolescent, Nantes, France. 4. Department of General Pediatrics and Pediatric Infectious Diseases, Necker hospital for Sick Children, Paris, France. 5. Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris, France. 6. Association pour le Recherche et l'Enseignement en Pédiatrie Générale (AREPEGE), Versailles, France. 7. Cabinet de Pédiatrie, Association Française de Pédiatrie Ambulatoire (AFPA), Issy-les-Moulineaux, France. 8. EA2694, Univ. Lille, CHU Lille, Lille, France. 9. Service de réanimation pédiatrique et néonatale, Hôpital Morvan, CHU de Brest, Brest, France. 10. Service de réanimation pédiatrique et néonatale, Hôpital Femme Enfant Adolescent, CHU de Nantes, Nantes, France. 11. Service de réanimation pédiatrique et néonatale, Hôpital Clocheville, CHU de Tours, Tours, France. 12. Service de réanimation pédiatrique, CHU d'Angers, Angers, France. 13. Service de réanimation pédiatrique, Hôpital Sud, CHU de Rennes, Rennes, France. 14. Service de réanimation pédiatrique et néonatale, Tour Jean Bernard, CHU de Poitiers, Poitiers, France. 15. Laboratoire de microbiologie, Hôtel Dieu, CHU de Nantes, Nantes, France. 16. ACTIV, Association Clinique et Thérapeutique Infantile du Val de Marne, Saint-Maur des Fossés, France. 17. Centre Hospitalier Intercommunal de Créteil, Centre de Recherche Clinique, Créteil, France.
Abstract
BACKGROUND: In a context of suboptimal vaccination coverage and increasing vaccine hesitancy, we aimed to study morbidity and mortality in children related to missing or incomplete meningococcal C and pneumococcal conjugate vaccines. METHODS: We conducted a prospective, observational, population-based study from 2009 to 2014 in a French administrative area that included all children from age 1 month to 16 years who died before admission or were admitted to an intensive care unit for a community-onset bacterial infection. Vaccine-preventable infection was defined as an infection with an identified serotype included in the national vaccine schedule at the time of infection and occurring in a non- or incompletely vaccinated child. Death and severe sequelae were studied at hospital discharge. Frequencies of vaccine-preventable morbidity and mortality caused by meningococcus and pneumococcus were calculated. RESULTS: Among the 124 children with serotyped meningococcal (n = 75) or pneumococcal (n = 49) severe infections included (median age 26 months), 20 (16%) died and 12 (10%) had severe sequelae. Vaccine-preventable infections accounted for 18/124 infections (15%, 95% CI 9, 22), 5/20 deaths (25%, 95% CI 9, 49), and 3/12 severe sequelae cases (25%, 95% CI 0, 54). The vaccine schedule for meningococcal C and pneumococcal conjugate vaccinations was incomplete for 71/116 (61%) children targeted by at least one of these two vaccination programs. CONCLUSIONS: Mortality and morbidity rates related to vaccine-preventable meningococcal or pneumococcal infection could be reduced by one quarter with better implementation of immunisation programs. Such information could help enhance the perception of vaccine benefits and fight vaccine hesitancy.
BACKGROUND: In a context of suboptimal vaccination coverage and increasing vaccine hesitancy, we aimed to study morbidity and mortality in children related to missing or incomplete meningococcal C and pneumococcal conjugate vaccines. METHODS: We conducted a prospective, observational, population-based study from 2009 to 2014 in a French administrative area that included all children from age 1 month to 16 years who died before admission or were admitted to an intensive care unit for a community-onset bacterial infection. Vaccine-preventable infection was defined as an infection with an identified serotype included in the national vaccine schedule at the time of infection and occurring in a non- or incompletely vaccinated child. Death and severe sequelae were studied at hospital discharge. Frequencies of vaccine-preventable morbidity and mortality caused by meningococcus and pneumococcus were calculated. RESULTS: Among the 124 children with serotyped meningococcal (n = 75) or pneumococcal (n = 49) severe infections included (median age 26 months), 20 (16%) died and 12 (10%) had severe sequelae. Vaccine-preventable infections accounted for 18/124 infections (15%, 95% CI 9, 22), 5/20 deaths (25%, 95% CI 9, 49), and 3/12 severe sequelae cases (25%, 95% CI 0, 54). The vaccine schedule for meningococcal C and pneumococcal conjugate vaccinations was incomplete for 71/116 (61%) children targeted by at least one of these two vaccination programs. CONCLUSIONS: Mortality and morbidity rates related to vaccine-preventable meningococcal or pneumococcal infection could be reduced by one quarter with better implementation of immunisation programs. Such information could help enhance the perception of vaccine benefits and fight vaccine hesitancy.