Invasive Pneumococcal Disease in High-risk Children: A 10-Year Retrospective Study

Abstract

Background: Despite the availability of conjugate pneumococcal vaccines, children with high-risk conditions remain vulnerable to invasive pneumococcal disease (IPD). This study sought to describe IPD prevalence, vaccination and outcomes among high-risk children. Methods: We used International Classification of Disease10 discharge and microbiology codes to identify patients hospitalized for IPD at a large pediatric hospital from January 1, 2009, to December 31, 2018. Patients were considered high-risk if they had: primary immunodeficiency, asplenia, transplant, active malignancy, sickle cell disease, cochlear implant, nephrotic syndrome, chronic lung disease, cerebrospinal fluid leak, HIV or used immunosuppressive therapy. Results: In total 94 high-risk patients were hospitalized for IPD. The most common high-risk conditions included malignancy (n = 33, 35%), solid-organ or bone marrow transplant (n = 17, 18%) and sickle cell disease (n = 14, 15%). Bacteremia was the most common presentation (n = 81, 86%) followed by pneumonia (n = 23, 25%) and meningitis (n = 9, 10%). No deaths occurred. Of 66 patients with known pneumococcal vaccination status, 15 (23%) were unvaccinated, and 51 (77%) received at least one dose of a pneumococcal vaccine; 20 received all four recommended pneumococcal conjugate vaccine (PCV) doses. Only three children received PPSV23. Of 20 children with no or partial (<3 doses) immunization, 70% (14) of IPD episodes were due to vaccine-preventable serotypes. Of 66 known IPD serotypes, 17% (n = 11) were covered by PCV13, 39% (n = 26) were covered by PPSV23 and 39% (n = 26) were nonvaccine serotype. Conclusions: Despite the availability of effective pneumococcal vaccines, IPD persists among children with high-risk conditions. Improving PCV13 and PPSV23 vaccination could significantly reduce IPD; most episodes were due to vaccine-preventable serotypes in incompletely immunized patients.

Pneumococcal carriage and serotype distribution in children with nephrotic syndrome

“…In Canada, despite recommendations to vaccinate high-risk children older than 2 years with PPSV23, only three patients had received PPSV23 among 66 patients with known pneumococcal vaccination status. These data suggest that most children with NS at high risk of IPD are incompletely vaccinated according to standard recommendations [9]. We have detected non-PCV13 serotypes in at least 25% of children with NS.…”

“…Each year, around 1-2% of patients with NS suffer from invasive bacterial infections, specifically pneumococcal infections including peritonitis, bacteremia, and pneumonia and sepsis continues to be a leading cause of death in children with NS [5][6][7][8]. Despite the availability of PCVs, children with high-risk conditions remain vulnerable to IPD [9]. Van Warmerdam et al [9] retrospectively evaluated IPD in high-risk children between 2000 and 2018 in Canada.…”

“…Despite the availability of PCVs, children with high-risk conditions remain vulnerable to IPD [9]. Van Warmerdam et al [9] retrospectively evaluated IPD in high-risk children between 2000 and 2018 in Canada. Among the 94 hospitalized high-risk patients with IPD, 9% of children had NS and all had bacteremia.…”

Decreased risk of underdosing with continuous infusion versus intermittent administration of cefotaxime in patients with sickle cell disease and acute chest syndrome

“…All but two patients in the CI group had a cefotaxime trough level concentration ≥2 mg/L, while it was undetectable (<2 mg/L) in all but five patients of the IA group. Our findings have major clinical implications, given the burden of severe infections and difficult to treat infections in patients with SCD[ 22 , 23 ]. Our results are in accordance with those of Maksoud et al who found very low attainment of target cefotaxime serum concentrations in pediatric SCD patients (only 5.6% of patients achieved 90% of time above the MIC of 2mg/L) [ 24 ].…”

Parents’ Uptake and Willingness towards Recommended Vaccinations for Their Children with Underlying Chronic Medical Conditions in Italy

“…Over the past decades, the prevalence of children with chronic medical conditions has progressively increased with the risk of experiencing complications including more severe and long-term illness, hospitalization, and even death [ 1 , 2 , 3 ]. Moreover, it is well known that the introduction of vaccines, coupled with the implementation of programs aimed at universal infant immunization, have reduced the incidence of several vaccine-preventable diseases and their related complications [ 4 ].…”