Pneumonia with empyema among children in the first five years of high coverage with 13-valent pneumococcal conjugate vaccine

Abstract

Background: Parapneumonic effusions in children are usually associated with pneumococcal infections. In Greece, the 7-valent pneumococcal conjugate vaccine was replaced by higher-valent pneumococcal conjugate vaccines (PCVs); 10-valent was introduced in May 2009 and 13-valent (PCV13) in June 2010. Since July 2010, PCV13 has been the most commonly used PCV. In a study conducted at the University General Hospital of Larissa, Central Greece, from January 2012 to January 2016, 85.7% of children born after the implementation of PCV13 and aged 24–59 months had received the complete series (3 + 1 immunization schedule) of PCV13.

Methods: We studied all paediatric community-acquired pneumonia cases with empyema hospitalized at the University General Hospital of Larissa from January 2008 to January 2016.

Results: There were 30 cases of parapneumonic empyema. Among 27 empyema cases of known aetiology, 19 (70.4%) were due to Streptococcus pneumoniae (identifiable serotypes 3, 19A, 7F, and 9N/L). After September 2011, no more cases caused by serotypes 7F and 19A were observed, whereas serotype 3 emerged as the predominant pathogen of pneumococcal empyema (9 of 11 cases). Serotype 3 continued to cause empyema despite vaccination with PCV13 either fully with a 3 + 1 schedule (n = 3) or with one booster dose at the age of 21 months (n = 1).

Conclusion: In Central Greece during the first five years of high coverage with PCV13, serotype 3 was the only PCV13 serotype that clearly persisted in children with empyema.

Keywords:

• 10-valent pneumococcal conjugate vaccine
• 13-valent pneumococcal conjugate vaccine
• parapneumonic effusion
• pneumococcal conjugate vaccine
• pneumococcal parapneumonic empyema

Acknowledgements

We thank Drs. Chiara Azzari and Francesco Nieddu of the Immunology Laboratory, Anna Meyer Children’s Hospital, Florence, Italy and Georgina Tzanakaki of the National Meningitis Reference Laboratory, National School of Public Health, Athens, Greece for performing the molecular studies of the pleural fluid specimens.

Disclosure statement

The authors declare that they have not any commercial relationship or potential conflict of interest related to the submission. No funding was received for the study.