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Burden of Streptococcus pneumoniae sepsis in children after introduction of pneumococcal conjugate vaccines - a prospective population-based cohort study

Sandra A Asner, Philipp K A Agyeman, Eugénie Gradoux, Klara M Posfay-Barbe, Ulrich Heininger, Eric Giannoni, Pierre A Crisinel, Martin Stocker, Sara Bernhard-Stirnemann, Anita Niederer-Loher, Christian R. Kahlert, Paul Hasters, Christa Relly, Walter Baer, Christoph Aebi, Luregn J Schlapbach, Christoph Berger & Swiss Paediatric Sepsis Study Group

Kurzfassung

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 (09/2011-12/2015) 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% CI 1.7-2.4) and 25% of community-acquired sepsis episodes. Case fatality rate was 8%. 42 (36%) patients required PICU admission. Children with meningitis (29; 25%) were more often infected by serotypes not included in PCV (69% vs 31%; p<0.001). 16 (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 (OR 6.8; 95% C.I 2.4-19.3; p<0.001), or infected with serotype 3 (OR 2.8; 95% C.I 1.1- 7.3; p=0.04) were more often admitted to PICU. Children infected with serotype 3 had longer LOS ( coefficient 0.2, 95% CI 0.1-1.1; p=0.01).

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.
   
Zitation Asner S A, Agyeman P K A, Gradoux E, Posfay-Barbe K M, Heininger U, Giannoni E, Crisinel P A, Stocker M, Bernhard-Stirnemann S, Niederer-Loher A, Kahlert C R, Hasters P, Relly C, Baer W, Aebi C, Schlapbach L J, Berger C, Swiss Paediatric Sepsis Study group . Burden of Streptococcus pneumoniae sepsis in children after introduction of pneumococcal conjugate vaccines - a prospective population-based cohort study. Clin Infect Dis 2019;.
   
Typ Wissenschaftlicher Artikel/Review (Englisch)
Veröffentlichungsdatum 02-01-2019
Titel der Zeitschrift Clin Infect Dis
ISSN electronic 1537-6591
PubMed 30601988
DOI 10.1093/cid/ciy1139