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Clin Infect Dis. 2015 Sep 1;61(5):767-75. doi: 10.1093/cid/civ368. Epub 2015 May 13.

Impact of the 13-Valent Pneumococcal Conjugate Vaccine on Pneumococcal Meningitis in US Children.

Author information

1
Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
2
Department of Pediatrics, Ohio State University College of Medicine, Columbus.
3
Department of Pediatrics, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pennsylvania.
4
Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock.
5
Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
6
Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina.
7
Department of Pediatrics, Rady Children's Hospital-San Diego, California.
8
Department of Pediatrics, University of Southern California School of Medicine, Los Angeles.

Abstract

BACKGROUND:

The impact of 13-valent pneumococcal conjugate vaccine (PCV13) on pneumococcal meningitis (PM) in US children is unknown. We compared the serotype distribution, antibiotic susceptibility, hospital course, and outcomes of children with PM 3 years before and 3 years after the introduction of PCV13.

METHODS:

We identified patients ≤ 18 years of age with PM at 8 children's hospitals in the United States. Pneumococcal isolates were collected prospectively. Serotyping and antibiotic susceptibility were performed in a central laboratory. Clinical data were abstracted from medical records. Patients were divided into 3 subgroups: pre-PCV13 (2007-2009), transitional year (2010), and post-PCV13 (2011-2013). Categorical variables were analyzed by the χ(2) test and continuous variables by the Mann--Whitney U test.

RESULTS:

During the study period, 173 of 1207 episodes (14%) of invasive pneumococcal disease were identified as PM; 76 of 645 (12%) were during 2007-2009 and 69 of 394 (18%) during 2011-2013 (50% increase; P = .03). The proportion of PCV13 serotype cases decreased from 54% in 2007-2009 to 27% in 2011-2013 (P = .001). Non-PCV13 serotype cases represented 73% of the isolates in 2011-2013. Isolates with ceftriaxone minimum inhibitory concentration ≥ 1 µg/mL decreased (13% to 3%) from 2007-2009 to 2011-2013 (P = .03). No significant differences were identified for hospital course or outcome, with the exception that a greater proportion of patients had subdural empyema and hemiparesis in 2011-2013.

CONCLUSIONS:

After the introduction of PCV13, the number of cases of PM in children remained unchanged compared with 2007-2009, although the proportion of PCV13 serotypes decreased significantly. Serotype 19A continued to be the most common serotype in 2011-2013. Antibiotic resistance decreased significantly. Morbidity and case-fatality rate due to PM remain substantial.

KEYWORDS:

Streptococcus pneumoniae; conjugate vaccine; meningitis; pneumococcal disease

PMID:
25972022
DOI:
10.1093/cid/civ368
[Indexed for MEDLINE]

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