S Hultman Dennison1, L Schollin Ask2, M Eriksson3, A Granath4, O Hertting3, R Bennet3, A Lindstrand5, P Masaba6, P Dimitriou6, P Stjärne4. 1. Department of Otorhinolaryngology, Karolinska University Hospital, Karolinska vägen, 171 76, Solna, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Ear, Nose- and Throat Diseases, Karolinska Institutet, 171 77, Stockholm, Sweden. Electronic address: Sofia.hultman-dennison@sll.se. 2. South General Hospital, Sachs' Children and Youth Hospital, Sjukhusbacken 10, 118 83, Stockholm, Sweden; Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, 171 77, Stockholm, Sweden. 3. Astrid Lindgren Children´s Hospital, Karolinska University Hospital, Department of Pediatric Infectious Diseases, Eugeniavägen 23, 171 64, Solna, Stockholm, Sweden. 4. Department of Otorhinolaryngology, Karolinska University Hospital, Karolinska vägen, 171 76, Solna, Stockholm, Sweden; Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Ear, Nose- and Throat Diseases, Karolinska Institutet, 171 77, Stockholm, Sweden. 5. Department of Public Health Sciences, Division of Global Health, Karolinska Institutet, 171 77, Stockholm, Sweden; Public Health Agency of Sweden, Nobels väg 18, 171 65, Solna, Sweden. 6. Department of Radiology, Karolinska University Hospital, Karolinska Vägen, 171 76, Solna, Stockholm, Sweden.
Abstract
OBJECTIVES: The aim of this study was to analyze the rate of admissions, the rate of serious complications (postseptal orbital complications and surgery) and the bacterial etiology of acute rhinosinusitis in hospitalized children under five years old in Stockholm County, eight years after the introduction of the pneumococcal conjugate vaccine (PCV). The secondary aim was to compare this period with the period four years prior to the vaccine's introduction. METHODS: This was a population-based, descriptive observational study with retrospectively collected data from 1 July 2008 to 30 June 2016 in Stockholm County. Hospital admissions of children with a discharge diagnosis of rhinosinusitis and related complications were reviewed and compared to the pre-PCV period of 2003-2007. RESULTS: A total of 215 children were admitted, for a yearly incidence of 18.8 per 100 000 children (22.8 for boys, 14.6 for girls). Computer tomography-verified postseptal orbital complications occurred in 29 cases (13.5%) and surgery was necessary in nine (4.2%). Pathogens other than Streptococcus pneumoniae were found in the cases with postseptal complication or surgery (Streptococcus pyogenes in four, Haemophilus influenzae in three and Staphylococcus aureus in one case). In comparison to the four years pre-PCV, the incidence of admission decreased from 43.81 to 20.31 and 17.45 per 100 000/year for the two four-year periods after vaccine introduction. The incidence of CT-verified postseptal complication increased slightly from 1.51 to 2.34 and 2.74 per 100 000/year. The incidence of surgeries increased marginally but continued to be very low, from 0.22 to 0.54 and 1.03 per 100 000/year. CONCLUSIONS: Complications due to acute rhinosinusitis in children living in Stockholm County continues to be very rare after the introduction of pneumococcal vaccine. Hospitalization has decreased for children under five years old after PCV introduction, but the incidence or postseptal complications and surgery in the same population increased slightly. Predominantly bacteria other than Streptococcus pneumoniae was found. There is a need of larger studies to determine trends, and a need of prospective studies to elucidate the bacterial etiology, of serious complications due to acute rhinosinusitis in children.
OBJECTIVES: The aim of this study was to analyze the rate of admissions, the rate of serious complications (postseptal orbital complications and surgery) and the bacterial etiology of acute rhinosinusitis in hospitalized children under five years old in Stockholm County, eight years after the introduction of the pneumococcal conjugate vaccine (PCV). The secondary aim was to compare this period with the period four years prior to the vaccine's introduction. METHODS: This was a population-based, descriptive observational study with retrospectively collected data from 1 July 2008 to 30 June 2016 in Stockholm County. Hospital admissions of children with a discharge diagnosis of rhinosinusitis and related complications were reviewed and compared to the pre-PCV period of 2003-2007. RESULTS: A total of 215 children were admitted, for a yearly incidence of 18.8 per 100 000 children (22.8 for boys, 14.6 for girls). Computer tomography-verified postseptal orbital complications occurred in 29 cases (13.5%) and surgery was necessary in nine (4.2%). Pathogens other than Streptococcus pneumoniae were found in the cases with postseptal complication or surgery (Streptococcus pyogenes in four, Haemophilus influenzae in three and Staphylococcus aureus in one case). In comparison to the four years pre-PCV, the incidence of admission decreased from 43.81 to 20.31 and 17.45 per 100 000/year for the two four-year periods after vaccine introduction. The incidence of CT-verified postseptal complication increased slightly from 1.51 to 2.34 and 2.74 per 100 000/year. The incidence of surgeries increased marginally but continued to be very low, from 0.22 to 0.54 and 1.03 per 100 000/year. CONCLUSIONS: Complications due to acute rhinosinusitis in children living in Stockholm County continues to be very rare after the introduction of pneumococcal vaccine. Hospitalization has decreased for children under five years old after PCV introduction, but the incidence or postseptal complications and surgery in the same population increased slightly. Predominantly bacteria other than Streptococcus pneumoniae was found. There is a need of larger studies to determine trends, and a need of prospective studies to elucidate the bacterial etiology, of serious complications due to acute rhinosinusitis in children.
Authors: Hans J Welkoborsky; Susanne Pitz; Sylvia Grass; Boris Breuer; Anja Pähler Vor der Holte; Oliver Bertram; Burkhard Wiechens Journal: Dtsch Arztebl Int Date: 2022-01-21 Impact factor: 8.251