Trends in Pediatric Complicated Pneumonia in an Ontario Local Health Integration Network

Abstract

Following the introduction of 7-valent pneumococcal vaccine (PCV7), while overall rates of invasive pneumococcal disease and pneumococcal pneumonia in children declined, rates of empyema increased. We examined changes in the incidence of hospitalization for pediatric complicated pneumonia (PCOMP) in Eastern Ontario, Canada, particularly since the introduction of the 13-valent vaccine (PCV13). A retrospective chart review was carried out evaluating previously healthy children admitted with PCOMP, which included empyema, parapneumonic effusion, necrotizing pneumonia, and lung abscess between 2002 and 2015. Three-hundred seventy-one children were included. Subjects had a median age of four years, and 188/370 (50.8%) required a chest tube. Admission rates changed markedly during this time period. The number of admissions per year rose most sharply between 2009 and 2012, corresponding to the period following introduction of PCV7 and then the occurrence of pandemic influenza A (H1N1). In children who likely received PCV13, the incidence of PCOMP returned to approximately pre-PCV7 levels. In contrast, rates of PCOMP in older children (who would not have received PCV13) remained elevated during the post-PCV13 time period. While rates of PCOMP, particularly in older children, remain elevated following the introduction of PCV13, this might be expected to resolve with more widespread vaccine coverage with PCV13 and herd immunity.

Changes in the incidence and bacterial aetiology of paediatric parapneumonic pleural effusions/empyema in Germany, 2010–2017: a nationwide surveillance study

“…Initially, there was a pronounced decrease from about 16e18 (2010/11e2012/13) to 14 PPE/ PE per million children (2013/14 and 2014/15), which was followed by a re-increase to 17 and 15 cases per million in 2015/16 and 2016/ 17. Besides the use of pneumococcal vaccine, changes in PPE/PE incidence in populations with widespread pneumococcal vaccination may be associated with the use of more sensitive diagnostic methods, serotype replacement due to non-PCV serotypes, an increase in other PPE/PE-associated bacterial species, or the activity of the influenza season [7,17,20,30]. However, one of the lowest incidences of PPE/PE hospitalizations in our study was observed in the period 2014/15, which was an exceptionally strong influenza season in Germany [31].…”

Necrotizing pneumonia among Italian children in the pneumococcal conjugate vaccine era

“…Another retrospective study in Eastern Ontario showed an increase of complicated pneumonia in post‐PCV13 period (2012–2015) in older children who were unlikely to receive PCV13 vaccination. However, when considering single complications, a rise in the incidence of NP was not found 31 . Only one study focused exclusively on the epidemiology of NP in childhood over the years.…”

Visuomenėje įgytos vaikų pneumonijos komplikacijų diagnostika ir gydymas

“…Streptococcus pneumonia yra dažniausias bakterinės pneumonijos sukėlėjas, todėl natūralu, kad daugelyje šalių įvestas visuotinis vaikų skiepijimas nuo pneumokokinės infekcijos reikšmingai sumažino sergamumą ir mirštamumą nuo šios ligos, ypač tarp vaikų iki penkerių metų. Nepaisant to, VĮVP ir jos sukeliamos komplikacijos tebėra aktuali problema visame pasaulyje [4,5]. Įvairių šaltinių duomenimis, komplikuotų pneumonijų dažnis mažai kinta, stinga jautrių ir specifiškų žymenų numatyti ligos eigai ir prognozei, etiologija nustatoma mažiau nei pusei susirgusiųjų VĮVP, o didėjantis mikrobų atsparumas vaistams lemia vis sudėtingesnį racionalaus ir savalaikio gydymo pasirinkimą [3].…”