Impact of Conjugated Pneumococcal Vaccines on Bacteremic Pneumococcal Pneumonia among Children in Massachusetts, 2002-2017 Open Access

Abstract

Introduction: Streptococcus pneumoniae is a major cause of community-acquired pneumonia at all ages. Invasive pneumococcal disease (IPD) more frequently affects those in extreme age group and those with comorbidities.Pneumococcal pneumonia is a leading cause of morbidity and mortality with an estimated 826,000 annual deaths globally in children under five years of age.In 2010, a second-generation 13-valent pneumococcal conjugate vaccine (PCV13) replaced the 7-valent vaccine (PCV7) in the routine infant immunization program in the USA. The main aim of this study was to analyze the effect of the PCV13 on bacteremic pneumococcal pneumonia among children in Massachusetts during 2010-2017. 

Methods: A population-based enhanced passive surveillance for IPD in children in the entire state of Massachusetts was initiated in October 2001. All clinical microbiology laboratories in Massachusetts submit isolates of S pneumoniae from blood, cerebrospinal fluid, or other normally sterile body sites collected from Massachusetts residents < 18 years of age to the Massachusetts Department of Public Health (MDPH). Epidemiologists at the MDPH subsequently interview parents/guardians and/or primary care providers to obtain demographic and clinical information, including underlying comorbidities, about each case by using a standardized case report form. 

Results: One-thousand-one-hundred-sixty-six cases of IPD were identified among children younger than 18 years of age between October 2001 and December 2017.  Most of the cases (521, 44.6%) were under 2 years of age, 320 (27.4%) cases had at least one underlying clinical condition and 310 (29.2%) were nonvaccinated.The most common clinical presentation was bacteremia (581, 49.8%) followed by bacteremic pneumonia (392, 33.6%). Prevalence of bacteremic pneumococcal pneumonia among IPD cases declined to 30.6% (106/346 children) in postPCV13 period from 34.9% (286/820 children) which represents a 4.3% reduction (p< 0.05). Serotypes 19A, 7F, 3, 6A, 22F, 4, and 33F were the most frequent serotypes in the prePCV13 era (37.8%, 21.5%, 6.0%, 4.6%, 3.7%, 3.2%, and 2.8%, respectively) whereas in the postPCV13 era serotypes 19A, 22F, 7F, 3, 33F, 7C, 15A, and 15BC were the most frequent serotypes (16.3%, 11.9%, 7.6%, 5.4%, 4.3%, 4.3%, 4.3%, and 3.2% respectively). Penicillin non-susceptibility was found in 102 (47.1%) and 31 (23.2%) of isolates in pre and postPCV13 era respectively (p <0.005). 

Conclusion: Sustained high vaccine coverage with PCV13 is expected to further reduce the number of bacteremic pneumococcal pneumonia cases. Continued surveillance is critical to monitor trends of nonvaccine serotypes that might emerge to be highly associated with antibiotic resistance strains and the potential impact of new PCVs. In addition, appropriate antibiotic use remains essential to reducing rates of this problem.

Table of Contents

Background...............................................................1

Methods....................................................................3

Results......................................................................5

Discussion.................................................................7

Conclusions...............................................................10

References................................................................11

Tables and Figures......................................................13

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology
Keyword	pneumonia PCV13 Streptococcus pneumoniae antimicrobial resistance children PCV7 invasive pneumococcal disease
Committee Chair / Thesis Advisor	Inci Yildirim, Emory University

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