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PLoS One. 2014 Feb 18;9(2):e89013. doi: 10.1371/journal.pone.0089013. eCollection 2014.

Pneumococcal aetiology and serotype distribution in paediatric community-acquired pneumonia.

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Department of Pediatric Pulmonology, Cystic Fibrosis Clinic and Pediatric Infectious Diseases, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.
Pediatric Infectious Disease Department, Infection Control and Hospital Epidemiology Unit, Université Libre de Bruxelles-Hôpital Universitaire des Enfants Reine Fabiola, Brussels, Belgium.
Department of Pediatrics, Université Catholique Louvain, University Hospital Mont-Godinne, Yvoir, Belgium.
Department of Pediatrics, Virga Jesse Hospital, Hasselt, Belgium.
Immunobiology Clinic, Hôpital Erasme, Brussels, Belgium ; Laboratory of Vaccinology and Mucosal Immunity, Université Libre de Bruxelles, Brussels, Belgium.
Bacterial Genetics and Physiology Laboratory, Université Libre de Bruxelles, Gosselies, Belgium ; Murdoch Childrens Research Institute, Melbourne, Australia.
Department of Laboratory Medicine-Microbiology, Pneumococcal Reference Laboratory, Universitair Ziekenhuis Katholieke Universiteit Leuven, Leuven, Belgium.
Pfizer Inc., Brussels, Belgium.


Community-acquired pneumonia (CAP) is a major cause of morbidity in children. This study estimated the proportion of children with pneumococcal CAP among children hospitalised with CAP in Belgium and describes the causative serotype distribution after implementation of the 7-valent pneumococcal conjugate vaccine. Children 0-14 years hospitalised with X-ray-confirmed CAP were prospectively enrolled in a multicentre observational study. Acute and convalescent blood samples were collected. Pneumococcal aetiology was assessed by conventional methods (blood or pleural fluid cultures with Quellung reaction capsular typing or polymerase chain reaction [PCR] in pleural fluid), and recently developed methods (real-time PCR in blood and World Health Organization-validated serotype-specific serology). A total of 561 children were enrolled. Pneumococcal aetiology was assessed by conventional methods in 539, serology in 171, and real-time PCR in blood in 154. Pneumococcal aetiology was identified in 12.2% (66/539) of the children by conventional methods alone but in 73.9% by the combination of conventional and recently developed methods. The pneumococcal detection rate adjusted for the whole study population was 61.7%. Serotypes 1 (42.3%), 5 (16.0%), and 7F(7A) (12.8%) were predominant. In conclusion, Streptococcus pneumoniae remains the predominant bacteria in children hospitalised for CAP in Belgium after implementation of 7-valent pneumococcal conjugate vaccine, with non-vaccine-serotypes accounting for the majority of cases. The use of recently developed methods improves diagnosis of pneumococcal aetiology.

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