Pneumococcal haemolytic uraemic syndrome in the postvaccine era. Issue 10 (19th April 2018)

• Record Type: Journal Article
• Authors: Lawrence, Jolie; Gwee, Amanda; Quinlan, Catherine
• Is Part Of: Archives of disease in childhood. Volume 103:Issue 10(2018)
• Page Start: 957
• Page End: 961
• Publication Date: 2018-04-19
• Subjects: general paediatrics -- infectious diseases -- nephrology -- immunisation -- intensive care; Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2017-313923
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Objective: Pneumococcal infection is a leading cause of haemolytic uraemic syndrome (HUS) and is potentially vaccine preventable. Published data suggest high mortality and poor renal outcomes. The introduction of the 7-valent pneumococcal conjugate vaccine (PCV) has seen the emergence of disease caused by non-vaccine strains, particularly 19A. We sought to describe serotype prevalence and outcomes, particularly after the introduction of the 13-valent PCV. Design and setting: We performed a retrospective chart review, using hospital medical records to identify cases of HUS in a tertiary paediatric hospital in Australia over a 20-year period (January 1997–December 2016). Associated pneumococcal infection was identified, and serotype data were categorised according to vaccine era: prevaccine (January 1997–December 2004), PCV7 (January 2005–June 2011) and PCV13 (July 2011–December 2016). Results: We identified 66 cases of HUS. Pneumococcal infection was proven in 11 cases, representing 4% (1/26) of cases prior to the introduction of PCV7, 20% (3/15) in the PCV7 era and 28% (7/25) in the PCV13 era. Subtype 19A was the most prevalent pneumococcal serotype (6/11). All four patients who received PCV7 were infected with a non-vaccine serotype. Four of the five patients who received PCV13 were classed as vaccine failures. Median follow-up was 14 (range 1–108) months. Chronic kidney disease was the most common complication (4/7). We observed no mortality, neurological sequelae or progression to end-stage kidney disease. Conclusions: Serotype 19A is most commonly associated with pneumococcal HUS, despite the introduction of the 13-valent vaccine. Chronic kidney disease is a significant complication of pneumococcal HUS.