Changes in invasive pneumococcal disease among children after the introduction of the heptavalent pneumococcal conjugate vaccine
Abstract number: P1321
Gimenez M., Eril M., Molinos S., Azuara M., Rodrigo C., Ausina V.
Objectives: Pneumococcal conjugate vaccine (PVC-7) has been reported to prevent invasive disease (IPD) by covering the most prevalent serotypes isolated from blood or CSF. Implementation of PCV-7 could have changed epidemiology, clinical and analytical features of IPD. We analysed the impact of PCV-7 in our community, focusing on emergence of nonvaccine serogrups, clinical diagnosis, incidence of empyema and inflammatory response (C-reactive protein [CRP], procalcitonin [PCT]).
Methods: we analysed 75 episodes of bacteraemia within two periods, from 1995 to 2001 (prelicensure period) and from 2002 to September 2007 (postlicensure) in children below 18 years old admitted in the Department of Paediatrics of a tertiary-care Hospital of Barcelona.
Results: A total of 76 children with pneumococcal bacteraemia were identified, with 28 episodes occurring in the prelicensure period and 48 in the postlicensure period. Forty-two (42.1%) were <2 years old, 39.5% were between 2 and 5 years old and 18.4% were >5 years old. Respiratory (60.5%), occult bacteraemia (15.8%), sepsis without focus (11.8%) and meningitis (7.9%) were the most frequent clinical manifestations, without statistical differences between the two periods. There was a trend towards increasing frequency of respiratory focus during the second period but changes in incidence of non-vaccine serotypes were not statistically significant. Serotypes 1 and 14 accounted for 44% of all isolates vs 29% in the pre-licensure period. Serotype 1 was significantly associated with empyema, increased CRP and PCT values, and length of hospitalisation (14±4 days). Serotypes 1 (4 cases), 15B, 19A and 24 caused IPD in 7 vaccinated children. High resistant penicillin strains showed an increase from 17.9% to 25% and eritromycin from 21.4% to 31.3%, between the pre and postlicensure period.
Conclusions: We found an increased number of empyema cases caused by serotype 1, with high CRP and PCT during the postlicensure period. Changes towards the emergence of non-vaccine serotypes causing IPD are not significant in our area. We didn't find vaccinated children with IPD caused by serotypes included in PCV-7.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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