Increasing Incidence of Empyema Complicating Childhood Community‐Acquired Pneumonia in the United States

Grijalva, Carlos G.; Nuorti, J. Pekka; Zhu, Yuwei; Griffin, Marie R.

doi:10.1086/650573

Cited by 201 publications

(192 citation statements)

References 35 publications

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“…36 An increase in staphylococcal empyema or empyema of unknown etiology has been described, as well as an increase in pneumonia complicated by empyema, from 3.7 cases per 100 000 children to 10.3 after vaccine introduction in the United States. [35][36][37] As was found in earlier studies, we found a nearly twofold increase in hospitalizations for empyema in children aged ,2 years; this was nonsignificant, probably because of low numbers. The highest incidence of empyema was observed in 2007 to 2009, immediately after introduction of PCV7, indicating that factors other than the vaccine may have contributed.…”

Section: Discussionsupporting

confidence: 76%

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Sinusitis and Pneumonia Hospitalization After Introduction of Pneumococcal Conjugate Vaccine

Lindstrand

Bennet²,

Galanis

et al. 2014

Pediatrics

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BACKGROUND AND OBJECTIVE: Streptococcus pneumoniae is a major cause of pneumonia and sinusitis. Pneumonia kills >1 million children annually, and sinusitis is a potentially serious pediatric disease that increases the risk of orbital and intracranial complications. Although pneumococcal conjugate vaccine (PCV) is effective against invasive pneumococcal disease, its effectiveness against pneumonia is less consistent, and its effect on sinusitis is not known. We compared hospitalization rates due to sinusitis, pneumonia, and empyema before and after sequential introduction of PCV7 and PCV13. METHOD: All children 0 to <18 years old hospitalized for sinusitis, pneumonia, or empyema in Stockholm County, Sweden, from 2003 to 2012 were included in a population-based study of hospital registry data on hospitalizations due to sinusitis, pneumonia, or empyema. Trend analysis, incidence rates, and rate ratios (RRs) were calculated comparing July 2003 to June 2007 with July 2008 to June 2012, excluding the year of PCV7 introduction. RESULTS: Hospitalizations for sinusitis decreased significantly in children aged 0 to <2 years, from 70 to 24 cases per 100 000 population (RR = 0.34, P < .001). Hospitalizations for pneumonia decreased significantly in children aged 0 to <2 years, from 450 to 366 per 100 000 population (RR = 0.81, P < .001) and in those aged 2 to <5 years from 250 to 212 per 100 000 population (RR = 0.85, P = .002). Hospitalization for empyema increased nonsignificantly. Trend analyses showed increasing hospitalization for pneumonia in children 0 to <2 years before intervention and confirmed a decrease in hospitalizations for sinusitis and pneumonia in children aged 0 to <5 years after intervention. CONCLUSIONS: PCV7 and PCV13 vaccination led to a 66% lower risk of hospitalization for sinusitis and 19% lower risk of hospitalization for pneumonia in children aged 0 to <2 years, in a comparison of 4 years before and 4 years after vaccine introduction.

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Section: Discussionsupporting

confidence: 76%

“…Grijalva et al 34,35 showed a twofold increase in hospitalizations for parapneumonic empyema after vaccine introduction in children in the United States. Serotypes 1 and 3 have been associated with empyema, and because they are not included in PCV7, serotype replacement may cause increased rates of empyema after vaccine introduction.…”

Section: Discussionmentioning

confidence: 99%

Sinusitis and Pneumonia Hospitalization After Introduction of Pneumococcal Conjugate Vaccine

Lindstrand

Bennet²,

Galanis

et al. 2014

Pediatrics

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“…Herd effects may also have contributed to the reported unexpectedly high reductions of otitis media (by 43%) (21) and all-cause pneumonia (by 33%) (22) in young children in the United States since PCV7 introduction. These reductions exceed overall vaccine effi cacy found in randomized controlled trials: 6%-9% reduction of otitis media (9,23), and 4% reduction of all-cause pneumonia (24).…”

Section: Discussionmentioning

confidence: 99%

Carriage ofStreptococcus pneumoniae3 Years after Start of Vaccination Program, the Netherlands

Spijkerman¹,

Gils²,

Veenhoven³

et al. 2011

Emerg. Infect. Dis.

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To evaluate the effectiveness of the 7-valent pneumococcal conjugate vaccine (PCV7) program, we conducted a cross-sectional observational study on nasopharyngeal carriage of Streptococcus pneumoniae 3 years after implementation of the program in the Netherlands. We compared pneumococcal serotypes in 329 prebooster 11-month-old children, 330 fully vaccinated 24-month-old children, and 324 parents with age-matched pre-PCV7 (unvaccinated) controls (ages 12 and 24 months, n = 319 and n = 321, respectively) and 296 of their parents. PCV7 serotype prevalences before and after PCV7 implementation, respectively, were 38% and 8% among 11-month-old children, 36% and 4% among 24-monthold children, and 8% and 1% among parents. Non-PCV7 serotype prevalences were 29% and 39% among 11-monthold children, 30% and 45% among 24-month-old children, and 8% and 15% among parents, respectively; serotypes 11A and 19A were most frequently isolated. PCV7 serotypes were largely replaced by non-PCV7 serotypes. Disappearance of PCV7 serotypes in parents suggests strong transmission reduction through vaccination.

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“…It has been observed that the increase in invasive disease owing to pneumococcal serotypes not included in PCV7 has been temporally associated with an increase in culture-negative empyema [19]. Where there has been extensive use of the polymerase chain reaction to detect pneumococcal DNA in empyema specimens, the role of these non-vaccine types as the leading cause of culture-negative empyema has been clearly established [20,21].…”

Section: The Clinical Spectrum and Burden Of Pneumococcal Diseasementioning

confidence: 99%

Contribution of vaccines to our understanding of pneumococcal disease

Klugman

2011

Phil. Trans. R. Soc. B

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Pneumonia is the leading cause of mortality in children in developing countries and is also the leading infectious cause of death in adults. The most important cause of pneumonia is the Gram-positive bacterial pathogen, Streptococcus pneumoniae, also known as the pneumococcus. It has thus become the leading vaccine-preventable cause of death and is a successful and diverse human pathogen. The development of conjugate pneumococcal vaccines has made possible the prevention of pneumococcal disease in infants, but has also elucidated aspects of pneumococcal biology in a number of ways. Use of the vaccine as a probe has increased our understanding of the burden of pneumococcal disease in children globally. Vaccination has also elucidated the clinical spectrum of vaccine-preventable pneumococcal infections; the identification of a biological niche for multiple pneumococcal serotypes in carriage and the differential invasiveness of pneumococcal serotypes; the impact of pneumococcal transmission among children on disease burden in adults; the role of carriage as a precursor to pneumonia; the plasticity of a naturally transformable pathogen to respond to selective pressure through capsular switching and the accumulation of antibioticresistance determinants; and the role of pneumococcal infections in hospitalization and mortality associated with respiratory viral infections, including both seasonal and pandemic influenza. Finally, there has been a recent demonstration that pneumococcal pneumonia in children may be an important cause of hospitalization for those with underlying tuberculosis.

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Increasing Incidence of Empyema Complicating Childhood Community‐Acquired Pneumonia in the United States

Cited by 201 publications

References 35 publications

Sinusitis and Pneumonia Hospitalization After Introduction of Pneumococcal Conjugate Vaccine

Sinusitis and Pneumonia Hospitalization After Introduction of Pneumococcal Conjugate Vaccine

Carriage ofStreptococcus pneumoniae3 Years after Start of Vaccination Program, the Netherlands

Contribution of vaccines to our understanding of pneumococcal disease

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