Complications of Pneumococcal Bacteremia After Thirteen-valent Conjugate Vaccine Withdrawal. Issue 12 (December 2016)

• Record Type: Journal Article
• Authors: Tagarro, Alfredo; Bote, Patricia; Sánchez, Aida; Otheo, Enrique; Sanz, Juan-Carlos; Sanz-Rosa, David
• Is Part Of: Pediatric infectious disease journal. Volume 35:Issue 12(2016)
• Publication Date: 2016-12
• Subjects: Streptococcus pneumoniae -- bacteremia -- bloodstream infection -- complications; Communicable diseases in children -- Periodicals; Infection in children -- Periodicals; 618.929
• DOI: 10.1097/INF.0000000000001302
• Languages: English
• ISSNs: 0891-3668

Abstract

Abstract : Background: In the Region of Madrid, universal immunization with the 13-serotypes pneumococcal conjugate vaccine (PCV13) started in May 2010. In July 2012, public funding ceased. Vaccination coverage decreased from >95% to 82% in 2013 and to 67% in 2014. Our aim was to investigate the impact of PCV13 withdrawal from Madrid Region universal immunization program on the incidence of complicated pneumococcal bacteremia. Methods: We performed a multicenter retrospective cohort study, from 2009 to 2014. Participants were children aged <14 years with Streptococcus pneumoniae bacteremia. Complications were defined as any condition requiring intensive care or surgery. Sequelae were conditions lasting ≥90 days. Results: A total of 168 patients were recruited. One-fourth of both immunized and nonimmunized patients had complications. Global complications increased after PCV13 withdrawal. About 28% of PCV13 serotypes presented complications. Complications caused by PCV13 serotypes did not increase after July 2012. Non-PCV13 serotypes increased progressively from 2009 on, and 23% presented complications. A significant risk of complications was found for patients with meningitis, empyema, C-reactive protein >100 mg/L and serotype 1. A multivariate analysis indicated that complications were associated with meningitis and hospital admission after July 2012. Sequelae were significantly associated with children <2 years of age, meningitis and non-PCV13 serotypes. Conclusions: The incidence of complications caused by PCV13 serotypes did not increase 2 years after PCV13 withdrawal. Nevertheless, all-serotypes complications increased. The likely cause was that non-PCV13 serotypes (associated with meningitis) are on the rise. Abstract : Supplemental Digital Content is available in the text.