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S. pneumoniae remains significant cause of chronic sinusitis
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Despite effectiveness of pneumococcal conjugate vaccines, Streptococcus pneumoniae is still an important pathogen in chronic sinusitis among children younger than 5 years, according to recent study findings published in The Pediatric Infectious Disease Journal.
Sheldon L. Kaplan, MD, an Infectious Diseases in Children Editorial Board member, and colleagues from Texas Children’s Hospital evaluated 652 children (median age, 24 months) with chronic sinusitis. A positive sinus culture for S. pneumoniae was obtained during endoscopic sinus surgery from August 2008 to December 2013 to determine epidemiological changes of S. pneumoniae chronic sinusitis after introduction of the 13-valent pneumococcal conjugate vaccine (Prevnar13, Pfizer). Of the patients, 245 were evaluated during the pre-PCV13 period and 407 were in the post-PCV13 period. The 7-valent pneumococcal conjugate vaccine (Prevnar, Pfizer) was licensed in 2000 and PCV13 was licensed in 2010.
Sheldon L. Kaplan
Overall, 14% of participants had a positive sinus culture for S. pneumoniae; 22% were in the pre-vaccine period and 9% were in the post-vaccine period (P<.0001). There were 19 cases in 2009; 26 in 2010; 11 in 2011; 20 in 2012; and five in 2013. Chronic nasal congestion/drainage and chronic cough were present in all patients. Before surgery, information on antibiotic therapy was available in 43 patients and 40 had received an antibiotic within 4 weeks before surgery. Chronic otitis media (67%) was the most common comorbid condition, followed by allergic rhinitis (37%), reactive airway disease/asthma (30%) and gastroesophageal reflux (15%).
At least one dose of pneumococcal vaccine was received by 88% of patients, 30 of whom received PCV13. Three or more doses of pneumococcal vaccine were received by 79% of patients, 14 of whom received three or more doses of PCV13.
Overall, 19 different serotypes were identified; 33% were PCV13 serotypes and 67% were non-PCV13 serotypes. There was a 31% decrease in isolates containing PCV13 serotypes during the post-PCV13 era compared with the pre-PCV13 era (P=.003). According to researchers, the decrease is due to a 27% decrease of serotype 19A cases during the post-PCV13 period (P=.007). Thirty-eight percent of serotypes were serotype 19A during the post-PCV13 period and 17% were serotype 15C during the post-PCV13 period.
PCV13 serotypes caused sinusitis in five patients despite full immunization against S. pneumoniae, including at least one PCV13 dose.
Eighteen percent of cases were positive for S. pneumoniae only, whereas 82% were polymicrobial infections. No particular pneumococcal serotype was associated with S. pneumoniae-only infections. Nontypeable Haemophilus influenzae was the most common co-isolated organism, followed by Moraxella catarrhalis (36%) and Staphylococcus aureus (11%). Among patients with pneumococcal isolates, there was an increase in the isolation of Prevotella species during the post-PCV13 period.
“In conclusion, our study provides evidence of important epidemiological changes of pneumococcal chronic sinusitis among children after the introduction of PCV13,” the researchers wrote. “We reported a significant decline of S. pneumoniae isolation rate in children with chronic sinusitis at [Texas Children’s Hospital]. This decrease of a pneumococcal chronic sinusitis cases was driven by a substantial reduction of PCV13 serotypes, predominantly serotype 19A. S. pneumoniae continues to represent an important pathogen in chronic sinusitis, especially in children younger than 5 years of age; however, additional studies are needed to fully understand the microbiology of chronic sinusitis in children, particularly in the PCV13 era.”
Disclosure: The study was funded in part by Pfizer. The researchers report no relevant financial disclosures.
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