Increase in Streptococcus pneumoniae serotype 3 associated parapneumonic pleural effusion/empyema after the introduction of PCV13 in Germany

Goettler, David; Streng, Andrea; Kemmling, Daniel; Schoen, Christoph; Kries, Rüdiger von; Rose, Markus A.; Linden, Mark van der; Liese, Johannes G.

doi:10.1016/j.vaccine.2019.10.056

Cited by 45 publications

(35 citation statements)

References 57 publications

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“…Furthermore, Serotype 3 was the most frequent in both pre‐ and post‐PCV13 periods, and all cases of PCV13 vaccine failure except one were due to such serotype. This finding confirms that the efficacy of PCV13 against Serotype 3 in invasive pneumococcal disease, especially complicated pneumonia, 42,43 is modest 44 . Serotype 3 has been reported to be associated with severe lung complications, such as pulmonary necrosis 45 and bronchopleural fistula 46 .…”

Section: Discussionsupporting

confidence: 77%

Necrotizing pneumonia among Italian children in the pneumococcal conjugate vaccine era

Carloni¹,

Ricci

Rubino

et al. 2021

Pediatric Pulmonology

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Background Necrotizing pneumonia (NP) is a severe complication of community‐acquired pneumonia. The impact of 13‐valent pneumococcal conjugate vaccine (PCV13) on the epidemiology of NP in children has not been assessed. Patients and methods Medical records of children less than 18 years admitted with NP to two pediatric hospitals in Italy between 2005 and 2019 were reviewed. The following four periods were defined: 2005–2010 (pre‐PCV13), 2011–2013 (early post‐PCV13), 2014–2016 (intermediate post‐PCV13), and 2017–2019 (late post‐PCV13). Results Forty‐three children (median age, 44 months) were included. Most of them (93%) were previously healthy. No differences in age, sex, season of admission, comorbidity, clinical presentation, or hospital course were identified between pre‐PCV13 and post‐PCV13 periods. A significant decrease in the rate of NP‐associated hospitalizations was found between the early (1.5/1000 admissions/year) and the intermediate (0.35/1000 admissions/year) post‐PCV13 period (p = .001). An increased trend in admissions was found thereafter. Streptococcus pneumoniae was the most common agent detected in both periods (pre‐PCV13: 11/18, 61%; post‐PCV13: 13/25, 52%). Serotype 3 was the most common strain in both periods (pre‐PCV13: 3/11, 27%; post‐PCV13; 4/13, 31%). There were no changes in the etiology over time, but most patients with Streptococcus pyogenes or Staphylococcus aureus infection were admitted during the post‐PCV13 period. Conclusions The hospitalization rate for NP in children decreased a few years after the implementation of PCV13 immunization in Italy. However, an increased trend in admissions was found thereafter. S. pneumoniae was the most frequent causal agent in both pre‐ and post‐PCV13 periods. Pneumococcal serotypes were mainly represented by Strain 3.

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Section: Discussionsupporting

confidence: 77%

Necrotizing pneumonia among Italian children in the pneumococcal conjugate vaccine era

Carloni¹,

Ricci

Rubino

et al. 2021

Pediatric Pulmonology

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“…In England and Wales serotype 3 IPD incidence fluctuated over a period of 17 years, with an increase in incidence seen three years following the introduction of PCV13 [17]. In Spain, there were no significant changes in incidence of serotype 3 IPD following the vaccine [18], in Germany and Hong Kong an increase in serotype 3 empyema and IPD, respectively, was reported [19,20].…”

Section: Discussionmentioning

confidence: 99%

Characteristics of Serotype 3 Invasive Pneumococcal Disease before and after Universal Childhood Immunization with PCV13 in Massachusetts

et al. 2020

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Background: Although a substantial decline in vaccine-serotype invasive pneumococcal disease (IPD) incidence was observed following the introduction of pneumococcal conjugate vaccines (PCV), the estimated range of thirteen-valent conjugate vaccine (PCV13) effectiveness for serotype 3 disease is wide and includes zero. We assessed the impact of PCV13 on serotype 3 IPD incidence and disease characteristics in Massachusetts’ children. Methods: Serotype 3 IPD cases in children <18 years old were identified via enhanced passive surveillance system in Massachusetts. We compared incidence rates and characteristics of IPD cases before and after PCV13. Results: A total of 47 serotype 3 IPD cases were identified from 2002 to 2017; incidence of serotype 3 IPD in the years following PCV13 was 0.19 per 100,000 children compared to 0.21 before PCV 13, incidence rate ratio (IRR) = 0.86 (95% CI 0.47–1.57). The majority (78%) of post-PCV13 serotype 3 IPD cases occurred among fully vaccinated children. Age distribution, clinical syndrome and presence of comorbidities among serotype 3 IPD cases were similar before and after PCV13 introduction. There was no association between the date of the last PCV13 dose and time to IPD to suggest waning of immunity. Conclusions: seven years following PCV 13 we found no significant changes in serotype 3 IPD incidence or disease characteristics in children in Massachusetts.

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“…In addition, the distribution of costs associated with IPD produced by the serotypes added to the PCV13 was very uneven. While the proportion of costs associated with serotype 1 decreased, the proportion associated with serotype 3, which is associated with complicated pneumonia [ 41 ], rose from 25.1% of the total costs of additional serotypes to 37.5%, and those of serotype 19A remained stable. This may be explained by the ineffectiveness of the vaccine against serotype 3 [ 42 ] and the number of vaccine failures recorded for serotypes 3 and 19A [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of the 13-Valent Conjugated Pneumococcal Vaccine on the Direct Costs of Invasive Pneumococcal Disease Requiring Hospital Admission in Children Aged < 5 Years: A Prospective Study

et al. 2020

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The lack of invasive pneumococcal disease (IPD) cost studies may underestimate the effect of pneumococcal polysaccharide conjugated vaccines (PCV). The objective of this study was to estimate the direct costs of hospitalized IPD cases. A prospective study was made in children aged <5 years diagnosed with IPD in two high-tech hospitals in Catalonia (Spain) between 2007–2009 (PCV7 period) and 2012–2015 (PCV13 period). Costs were calculated according to 2014 Catalan Health Service rates using diagnostic-related groups. In total, 319 and 154 cases were collected, respectively. Pneumonia had the highest cost (65.7% and 62.0%, respectively), followed by meningitis (25.8% and 26.1%, respectively). During 2007–2015, the costs associated with PCV7 serotypes (Pearson coefficient (Pc) = −0.79; p = 0.036) and additional PCV13 serotypes (Pc = −0.75; p = 0.05) decreased, but those of other serotypes did not (Pc = 0.23 p = 0.62). The total mean cost of IPD increased in the PCV13 period by 31.4% (€3016.1 vs. €3963.9), mainly due to ICU stay (77.4%; €1051.4 vs. €1865.6). During the PCV13 period, direct IPD costs decreased due to a reduction in the number of cases, but cases were more severe and had a higher mean cost. During 2015, IPD costs increased due to an increase in the costs associated with non-PCV13 serotypes and serotype 3 and this requires further investigation.

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Increase in Streptococcus pneumoniae serotype 3 associated parapneumonic pleural effusion/empyema after the introduction of PCV13 in Germany

Cited by 45 publications

References 57 publications

Necrotizing pneumonia among Italian children in the pneumococcal conjugate vaccine era

Necrotizing pneumonia among Italian children in the pneumococcal conjugate vaccine era

Characteristics of Serotype 3 Invasive Pneumococcal Disease before and after Universal Childhood Immunization with PCV13 in Massachusetts

Impact of the 13-Valent Conjugated Pneumococcal Vaccine on the Direct Costs of Invasive Pneumococcal Disease Requiring Hospital Admission in Children Aged < 5 Years: A Prospective Study

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