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The Changing Epidemiology of Invasive Pneumococcal Disease at a Tertiary Children’s Hospital through the PCV7 Era
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Mar 2012
Source: Pediatr Infect Dis J. 31(3). -
Alternative Title:Pediatr Infect Dis J
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Description:Background
In 2000, a 7-valent pneumococcal conjugate vaccine (PCV7) was licensed for use among U.S. children. Many sites have since reported changes in invasive pneumococcal disease (IPD). We recognized an opportunity to describe the changes in epidemiology, clinical syndromes and serotype distribution over a 14 year period including 4 years before vaccine introduction and spanning the entire PCV7 era.
Methods
Cases were defined as children <18 years of age who were cared for at Primary Children’s Medical Center for culture-confirmed IPD. We defined the pre-vaccine period as the timeframe spanning 1997–2000 and the post-vaccine period from 2001–2010. Demographics, clinical data, and outcomes were collected through electronic query and chart review. S. pneumoniae serotyping was performed using the capsular swelling method.
Results
The median age of children with IPD increased from 19 months during the pre-vaccine period to 27 months during post-vaccine period (P = 0.02) with a larger proportion of IPD among children older than 5 years. The proportion of IPD associated with pneumonia increased substantially from 29% to 50% (P < 0.001). This increase was primarily attributable to an increase in complicated pneumonia (17% to 33%; P < 0.001). Non-vaccine serotypes 7F, 19A, 22F and 3 emerged as the dominant serotypes in the post-vaccine period. Of S. pneumoniae isolates collected from children <5 years of age, for which vaccine is recommended, 67% of IPD was due to serotypes in PCV13 during 2005–2010.
Conclusions
After PCV7 was introduced, significant changes in IPD were noted. One third of IPD occurred in children older than 5 years, who were outside the age group for which PCV is recommended. Continued surveillance is warranted to identify further evolution of the epidemiology, clinical syndromes, and serotype distribution of S. pneumoniae following PCV13 licensure.
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Pubmed ID:22330164
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Pubmed Central ID:PMC3299810
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