Pediatrics |

Outbreak of Pediatric Complicated Pneumococcal Pneumonia in the Era of Pneumococcal Conjugated Vaccine (PCV)-7 in Childhood FREE TO VIEW

Gary Wong, MD; Ting Leung, MD; Chante Ng, MBChB
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Paediatrics, Chinese University of Hong Kong, Shatin, Hong Kong

Chest. 2014;145(3_MeetingAbstracts):454B. doi:10.1378/chest.1914375
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SESSION TITLE: Late Breaking Abstracts

SESSION TYPE: Slide Presentation

PRESENTED ON: Saturday, March 22, 2014 at 09:00 AM - 10:00 AM

PURPOSE: Within 2 weeks in Nov 2013, there were 8 pediatric cases of complicated pneumonia admitted to 6 pediatric ICU in Hong Kong, resulting in 2 deaths associated with hemolytic uremic syndrome. This outbreak led to this description study of the changing epidemiology of complicated pneumonia and associated hemolytic uremic syndrome in children.

METHODS: A retrospective review of the computerized hospital record of a tertiary university hospital was conducted. This hospital has a catchment population of 1.3 million with 91,000 children under 10 years of age. PCV7 was included in the public immunization schedule with a total of 4 injections per child starting in Oct 2009. The study period was from Jan 2007 to Nov 2013. All case records of children older than one month of age with a discharge diagnosis of parapneumonic effusion, pulmonary effusion or empyema, complicated pneumonia, hemolytic uremic syndrome, acute renal failure were retrieved. The clinical presentation, microbiological results, treatment, outcomes were analysed. . Age-adjusted incidence was calculated for the pre-PCV period (2007-2009) and compared with the post PCV era (2010-2013).

RESULTS: 41 cases of complicated pneumonia were identified. Among them, there were 4 cases of pneumococcal pneumonia with hemolytic uremic syndrome. 21 (51%) had a microbiological diagnosis and 18 (86%) of them were due to strept pneumonia. The annual incidence of complicated pneumonia has increased from 3.9 in the prePCV period to 8.2 in the post PCV period per 100,000 children per year for children under 10 years of age (P < 0.001). All 5 deaths occurred in the post PCV7 period and 4 were related to pneumococcal pneumonia with hemolytic uremic syndrome. Two were due to serotype 3 and two were serotype 19A. These two serotypes are not covered by PCV7 or 10

CONCLUSIONS: In line with reports in the US and Canada, we have documented a significant increase of complicated pneumonia and related HUS shortly after PCV7 vaccination. Serotype replacement may be a significant contributor to the increase.The severe and death cases are due to serotypes not covered by PCV7 or 10.

CLINICAL IMPLICATIONS: Careful monitoring of invasive pneumococcal diseases and complicated pneumonia are needed for proper evaluation of efficacy of pneumococcal vaccination in countries planning to institute PCV vaccination. PCV-13 may be the better alternative as it covers those strains that are now known to be associated with severe pneumococcal diseases in childhood.

DISCLOSURE: The following authors have nothing to disclose: Gary Wong, Ting Leung, Chante Ng

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