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

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.

• Authors: Liset Olarte, William J Barson, Ryan M Barson, Philana Ling Lin, José R Romero, Tina Q Tan, Laurence B Givner, John S Bradley, Jill A Hoffman, Kristina G Hultén, Edward O Mason, Sheldon L Kaplan
• Journal: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 61 Issue 5 Pg. 767-75 (Sep 01 2015) ISSN: 1537-6591 [Electronic] United States
• PMID: 25972022 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: [email protected].

Chemical References

• 13-valent pneumococcal vaccine
• Anti-Bacterial Agents
• Pneumococcal Vaccines

Topics

• Adolescent
• Adult
• Aged
• Anti-Bacterial Agents (pharmacology)
• Child
• Child, Preschool
• Female
• Humans
• Male
• Meningitis, Pneumococcal (epidemiology, microbiology, prevention & control)
• Middle Aged
• Pneumococcal Vaccines (administration & dosage, immunology)
• Prospective Studies
• Streptococcus pneumoniae (classification, drug effects, immunology)
• United States (epidemiology)
• Young Adult