D Goettler1, A Streng2, D Kemmling3, C Schoen4, R von Kries5, M A Rose6, M van der Linden7, J G Liese8. 1. Department of Pediatrics, University Hospital of Würzburg, Würzburg, Germany. Electronic address: davidgoettler@posteo.de. 2. Department of Pediatrics, University Hospital of Würzburg, Würzburg, Germany. Electronic address: Streng_A@ukw.de. 3. Department of Pediatrics, University Hospital of Würzburg, Würzburg, Germany. Electronic address: Kemmling_D@ukw.de. 4. Institute of Hygiene and Microbiology, University of Würzburg, Würzburg, Germany. Electronic address: E_Schoen_C@ukw.de. 5. Division of Epidemiology, Institute of Social Pediatrics and Adolescent Medicine, Ludwig-Maximilians-University Munich, Munich, Germany. Electronic address: ruediger.kries@med.uni-muenchen.de. 6. Olgahospital Stuttgart and Goethe University Frankfurt, Pediatric Pulmonology, Allergy and CF, Germany. Electronic address: m.rose@klinikum-stuttgart.de. 7. Department of Medical Microbiology, National Reference Centre for Streptococci, University Hospital RWTH Aachen, Aachen, Germany. Electronic address: mlinden@ukaachen.de. 8. Department of Pediatrics, University Hospital of Würzburg, Würzburg, Germany. Electronic address: Liese_J@ukw.de.
Abstract
INTRODUCTION: Pediatric pneumococcal pneumonia complicated by parapneumonic pleural effusion/empyema (PPE/PE) remains a major concern despite general immunization with pneumococcal conjugate vaccines (PCVs). METHODS: In a nationwide pediatric hospital surveillance study in Germany we identified 584 children <18 years of age with bacteriologically confirmed PPE/PE from October 2010 to June 2018. Streptococcus pneumoniae was identified by culture and/or PCR of blood samples and/or pleural fluid and serotyped. RESULTS: S. pneumoniae was identified in 256 of 584 (43.8%) children by culture (n = 122) and/or PCR (n = 207). The following pneumococcal serotypes were detected in 114 children: serotype 3 (42.1%), 1 (25.4%), 7F (12.3%), 19A (7.9%), other PCV13 serotypes (4.4%) and non-PCV13 serotypes (7.9%). Between October 2010 and June 2014 serotype 1 (38.1%) and serotype 3 (25.4%) were most prevalent, whereas between July 2014 and June 2018 serotype 3 (62.7%) and non-PCV13 serotypes (15.7%) were dominant. Compared to children with other pneumococcal serotypes, children with serotype 3 associated PPE/PE were younger (median 3.2 years [IQR 2.1-4.3 years] vs. median 5.6 years [IQR 3.8-8.2 years]; p < 0.001) and more frequently admitted to intensive care (43 [89.6%] vs. 48 [73.8%]; p = 0.04). Seventy-six of 114 (66.7%) children with pneumococcal PPE/PE had been vaccinated with pneumococcal vaccines. Thirty-nine of 76 (51.3%) had received a vaccine covering the serotype detected. Thirty of these 39 breakthrough cases were age-appropriately vaccinated with PCV13 and considered vaccine failures, including 26 children with serotype 3, three children with serotype 19A and one child with serotype 1. CONCLUSION: Following the introduction of PCV13 in general childhood vaccination we observed a strong emergence of serotype 3 associated PPE/PE in the German pediatric population, including a considerable number of younger children with serotype 3 vaccine breakthrough cases and failures. Future PCVs should not only cover newly emerging serotypes, but also include a more effective component against serotype 3.
INTRODUCTION:Pediatric pneumococcal pneumonia complicated by parapneumonic pleural effusion/empyema (PPE/PE) remains a major concern despite general immunization with pneumococcal conjugate vaccines (PCVs). METHODS: In a nationwide pediatric hospital surveillance study in Germany we identified 584 children <18 years of age with bacteriologically confirmed PPE/PE from October 2010 to June 2018. Streptococcus pneumoniae was identified by culture and/or PCR of blood samples and/or pleural fluid and serotyped. RESULTS:S. pneumoniae was identified in 256 of 584 (43.8%) children by culture (n = 122) and/or PCR (n = 207). The following pneumococcal serotypes were detected in 114 children: serotype 3 (42.1%), 1 (25.4%), 7F (12.3%), 19A (7.9%), other PCV13 serotypes (4.4%) and non-PCV13 serotypes (7.9%). Between October 2010 and June 2014 serotype 1 (38.1%) and serotype 3 (25.4%) were most prevalent, whereas between July 2014 and June 2018 serotype 3 (62.7%) and non-PCV13 serotypes (15.7%) were dominant. Compared to children with other pneumococcal serotypes, children with serotype 3 associated PPE/PE were younger (median 3.2 years [IQR 2.1-4.3 years] vs. median 5.6 years [IQR 3.8-8.2 years]; p < 0.001) and more frequently admitted to intensive care (43 [89.6%] vs. 48 [73.8%]; p = 0.04). Seventy-six of 114 (66.7%) children with pneumococcal PPE/PE had been vaccinated with pneumococcal vaccines. Thirty-nine of 76 (51.3%) had received a vaccine covering the serotype detected. Thirty of these 39 breakthrough cases were age-appropriately vaccinated with PCV13 and considered vaccine failures, including 26 children with serotype 3, three children with serotype 19A and one child with serotype 1. CONCLUSION: Following the introduction of PCV13 in general childhood vaccination we observed a strong emergence of serotype 3 associated PPE/PE in the German pediatric population, including a considerable number of younger children with serotype 3 vaccine breakthrough cases and failures. Future PCVs should not only cover newly emerging serotypes, but also include a more effective component against serotype 3.
Authors: Rotem Lapidot; Kimberly M Shea; Inci Yildirim; Howard J Cabral; Stephen I Pelton; The Massachusetts Department Of Public Health Journal: Pathogens Date: 2020-05-21
Authors: A Redin; P Ciruela; M F de Sevilla; F Gomez-Bertomeu; S Gonzalez-Peris; M A Benitez; G Trujillo; A Diaz; E Jou; C Izquierdo; M O Perez-Moreno; F Moraga-Llop; M Olsina; B Vinado; E Sanfeliu; A Garcia; S Gonzalez-di Lauro; J J Garcia-Garcia; A Dominguez; R Sa-Leao; C Muñoz-Almagro Journal: Microbiol Spectr Date: 2021-12-08