Complicated pneumococcal pneumonia with pleural effusion or empyema in the 13‐valent pneumococcal conjugate vaccine era

Abstract

Aim: The aim was to analyze the epidemiological, microbiological and clinical characteristics of patients with complicated pneumococcal pneumonia with pleural effusion (PE) or empyema. Method: Prospective study in three Catalan hospitals in persons aged <18 years diagnosed with complicated pneumonia with PE or empyema with isolation of Streptococcus pneumoniae in blood or pleural fluid by culture or real-time PCR between January 2012 and June 2016. Patients were divided into <2 years and 2-17 years age groups. Epidemiological, microbiological, and clinical data of patients were compared annually in both groups. PCV13 vaccination coverage increased from 48.2% in 2012 to 74.5% in 2015. Results:We included 143 patients. The incidence of pneumococcal pneumonia was 6.83 cases × 10 −5 persons/year in cases with PE or empyema and 2.09 cases × 10 −5 person-years in cases without (rate ratio [RR]: 3.27; 2.25-4.86; P < 0.001). Empyema was more frequent than PE (79.7% vs 20.3%, P < 0.005). Of 143 cases studied, 93 (65.0%, P < 0.001) were diagnosed by real-time-PCR, 43 (30.1%) by culture and RT-PCR and 7 (4.9%) by culture only. PCV13 serotypes were more frequent in complicated than in uncomplicated pneumonia (116/142, 81.7% vs 27/45, 60.0%; P = 0.003), especially serotype 1 (41/142, 28.9% vs 6/45, 13.3%, P : 0.036). From 2012 to 2015 there was a significant reduction in serotype 1 (16/43, 37.2% vs 3/27, 11.1%, P = 0.026), and a trend to an increase in non-PCV13 serotypes (6/43, 14% vs 9/27, 33.3%, P = 0.054). Conclusions:A directly proportional relationship was observed between the reduction in pneumonia complicated with PE or empyema and a significant

Necrotizing pneumonia among Italian children in the pneumococcal conjugate vaccine era

“…Albeit a reduced incidence of complicated pneumonia in childhood has been observed in many studies following replacement of PCV7 with PCV13, 16–24 this finding has not been universal. Recent studies reported increasing cases of complicated pneumonia over the last few years.…”

“…The introduction of the 7‐valent pneumococcal conjugate vaccine (PCV7, containing Serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F) into immunization programs initially led to a declining incidence of pneumonia in childhood, 10,11 but was associated with an increased incidence of empyema, 12–14 primarily due to nonvaccine serotypes 15 . Following global replacement of PCV7 with 13‐valent PCV (PCV13, containing additional Serotypes 1, 3, 5, 6A, 7F, and 19A), incidence and hospitalization rates for empyema reduced substantially 16–20 without serotype shift 21–24 …”

Continued Vaccine Breakthrough Cases of Serotype 3 Complicated Pneumonia in Vaccinated Children, Portugal (2016–2019)

“…Similarly, in Australia, although there was a decrease in all-cause hospitalizations for bacterial pneumonia following PCV13 introduction, empyema hospitalizations increased ( 1 ). Cultures of pleural fluid or blood from PCPP case patients are frequently negative, so serologic or nucleic acid diagnostic methods are essential for identifying PCPP cases and the serotypes involved ( 1 , 4 , 6 , 9 ). In countries where serotype information is available, most PCPP cases following PCV13 use were due to serotype 3, even among vaccinated children ( 1 , 4 , 6 , 9 ).…”

Management of necrotizing pneumonia in children: Time for a patient‐oriented approach

“…7 After the introduction of 13-valent pneumococcal conjugate vaccine (PCV13), rates of complicated pneumonia including empyema fell consistently. [19][20][21][22] To our knowledge, there is no data on the epidemiology of NP in this period. A recent Italian study evaluated 502 children with complicated pneumonia over a 12-year period.…”

“…After the introduction of 13‐valent pneumococcal conjugate vaccine (PCV13), rates of complicated pneumonia including empyema fell consistently . To our knowledge, there is no data on the epidemiology of NP in this period.…”