Sandra A Asner1,2, Philipp K A Agyeman3, Eugénie Gradoux1, Klara M Posfay-Barbe4, Ulrich Heininger5, Eric Giannoni2,6, Pierre A Crisinel1, Martin Stocker7, Sara Bernhard-Stirnemann8, Anita Niederer-Loher9, Christian R Kahlert9, Paul Hasters10, Christa Relly11, Walter Baer12, Christoph Aebi3, Luregn J Schlapbach3,13,14,15, Christoph Berger11. 1. Pediatric Infectious Diseases and Vaccinology Unit, Department Mother-Woman-Child, Switzerland. 2. Infectious Diseases Service, Department of Internal Medicine, Lausanne University Hospital, Switzerland. 3. Department of Pediatrics, Inselspital, Bern University Hospital, Switzerland. 4. Pediatric Infectious Diseases Unit, Children's Hospital of Geneva, University Hospitals of Geneva, Switzerland. 5. Infectious Diseases and Vaccinology, University Children's Hospital Basel, Switzerland. 6. Clinic of Neonatology, Department Mother-Woman-Child, Lausanne University Hospital, Switzerland. 7. Department of Pediatrics, Children's Hospital Lucerne, Switzerland. 8. Children's Hospital Aarau, Switzerland. 9. Children's Hospital of Eastern Switzerland St. Gallen, Switzerland. 10. Department of Neonatology, University Hospital Zurich, Switzerland. 11. Division of Infectious Diseases and Children's Research Center, University Children's Hospital Zurich, Switzerland. 12. Children's Hospital Chur, Switzerland. 13. Faculty of Medicine, Child Health Research Centre, The University of Queensland, Brisbane, Australia. 14. Paediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Brisbane, Australia. 15. Intensive Care Unit, Queensland Children's Hospital, Children's Health Queensland, Brisbane, Australia.
Abstract
BACKGROUND: Population-based studies assessing the impact of pneumococcal conjugate vaccines (PCV) on burden of pneumococcal sepsis in children are lacking. We aimed to assess this burden following introduction of PCV-13 in a nationwide cohort study. METHODS: The Swiss Pediatric Sepsis Study (September 2011 to December 2015) prospectively recruited children <17 years of age with blood culture-proven sepsis due to Streptococcus pneumoniae, meeting criteria for systemic inflammatory response syndrome. Infection with vaccine serotype in children up to date with PCV immunization was defined as vaccine failure. Main outcomes were admission to pediatric intensive care unit (PICU) and length of hospital stay (LOS). RESULTS: Children with pneumococcal sepsis (n = 117) accounted for a crude incidence of 2.0 per 100 000 children (95% confidence interval [CI] 1.7-2.4) and 25% of community-acquired sepsis episodes. Case fatality rate was 8%. Forty-two (36%) patients required PICU admission. Children with meningitis (29; 25%) were more often infected by serotypes not included in PCV (69% vs 31%; P < .001). Sixteen (26%) of 62 children up to date with PCV immunization presented with vaccine failure, including 11 infected with serotype 3. In multivariable analyses, children with meningitis (odds ratio [OR] 6.8; 95% CI 2.4-19.3; P < .001) or infected with serotype 3 (OR 2.8; 95% CI 1.1-7.3; P = .04) were more often admitted to PICU. Children infected with serotype 3 had longer LOS (β coefficient 0.2, 95% CI .1-1.1; P = .01). CONCLUSIONS: The incidence of pneumococcal sepsis in children shortly after introduction of PCV-13 remained substantial. Meningitis mostly due to non-vaccine serotypes and disease caused by serotype 3 represented significant predictors of severity.
BACKGROUND: Population-based studies assessing the impact of pneumococcal conjugate vaccines (PCV) on burden of pneumococcal sepsis in children are lacking. We aimed to assess this burden following introduction of PCV-13 in a nationwide cohort study. METHODS: The Swiss Pediatric Sepsis Study (September 2011 to December 2015) prospectively recruited children <17 years of age with blood culture-proven sepsis due to Streptococcus pneumoniae, meeting criteria for systemic inflammatory response syndrome. Infection with vaccine serotype in children up to date with PCV immunization was defined as vaccine failure. Main outcomes were admission to pediatric intensive care unit (PICU) and length of hospital stay (LOS). RESULTS:Children with pneumococcal sepsis (n = 117) accounted for a crude incidence of 2.0 per 100 000 children (95% confidence interval [CI] 1.7-2.4) and 25% of community-acquired sepsis episodes. Case fatality rate was 8%. Forty-two (36%) patients required PICU admission. Children with meningitis (29; 25%) were more often infected by serotypes not included in PCV (69% vs 31%; P < .001). Sixteen (26%) of 62 children up to date with PCV immunization presented with vaccine failure, including 11 infected with serotype 3. In multivariable analyses, children with meningitis (odds ratio [OR] 6.8; 95% CI 2.4-19.3; P < .001) or infected with serotype 3 (OR 2.8; 95% CI 1.1-7.3; P = .04) were more often admitted to PICU. Childreninfected with serotype 3 had longer LOS (β coefficient 0.2, 95% CI .1-1.1; P = .01). CONCLUSIONS: The incidence of pneumococcal sepsis in children shortly after introduction of PCV-13 remained substantial. Meningitis mostly due to non-vaccine serotypes and disease caused by serotype 3 represented significant predictors of severity.
Authors: Ekaterina A Kurbatova; Nelli K Akhmatova; Anton E Zaytsev; Elina A Akhmatova; Nadezhda B Egorova; Natalya E Yastrebova; Elena V Sukhova; Dmitriy V Yashunsky; Yury E Tsvetkov; Nikolay E Nifantiev Journal: Front Immunol Date: 2020-12-04 Impact factor: 7.561
Authors: Oluwaseun Rume-Abiola Oyewole; Phung Lang; Werner C Albrich; Kerstin Wissel; Stephen L Leib; Carlo Casanova; Markus Hilty Journal: Microorganisms Date: 2021-05-18