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Children with comorbidities more likely to have non-vaccine serotype IPD
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Non-vaccine serotypes of invasive pneumococcal disease are more common among children with underlying conditions, according to study findings in Pediatrics.
Pui-Ying Iroh Tam, MD, of the University of Minnesota Children’s Hospital in Minneapolis, and colleagues compared Massachusetts public health surveillance data from before the introduction of PCV13 (Prevnar13, Pfizer), defined as September 2007 to August 2009, and after the introduction of PCV13, defined as September 2010 to August 2012, for children aged younger than 5 years who had invasive pneumococcal disease (IPD).
Pui-Ying Iroh Tam
There were 168 cases of IPD during the pre-PCV13 phase and 85 cases of IPD during the post-PCV13 phase. The incidence rates were 46 per 100,000 in the pre-PCV13 phase and 23 per 100,000 in the post-PCV13 phase. Children aged 2 to 23 months accounted for 53% of patients in the pre-PCV13 phase and 56.5% of patients in the post-PCV13 phase. During the pre-PCV13 phase, 59.5% of the study cohort were up to date with their PCV immunizations, compared with 58.8% in the post-PCV13 phase.
Fever was the most common symptom: 29.2% of children had fever during the pre-PCV13 phase and 40% had fever during the post-PCV13 phase.
The most common serotype during the pre-PCV13 phase was serotype 19A, which accounted for 39.9% of the cases. PCV13 serotypes made up 51% of cases in the pre-PCV13 phase, and decreased to 33% in the first two years after the introduction of PCV13. Serotype 19A remained the most common serotype during the post-PCV13 phase, although it decreased significantly to 20%.
Chronic lung disease, malignancy or immunosuppressive therapy, asthma, and sickle cell disease or asplenia were the most common comorbidities. An estimated 20% of children had comorbidity during the pre-PCV13 phase, compared with 23.5% in the post-PCV13 phase. Of children with a vaccine serotype, 17.2% had a comorbidity, whereas 27.6% of children with a non-vaccine serotype had a comorbidity.
In the pre-PCV13 phase, 50.6% of children were hospitalized, compared with 57.6% in the post-PCV13 phase. Of those with vaccine serotype IPD, 56.9% of patients were hospitalized, compared with 54% of those with non-vaccine serotype IPD.
Children with comorbidities were hospitalized for a median of 3 days, whereas those without comorbidities were hospitalized for a median of 0.5 days. An estimated 5% of children with vaccine serotype IPD were readmitted to the hospital, whereas 1.1% of those with non-vaccine serotype IPD were readmitted. Vaccine serotype was not associated with readmission, hospitalization or mortality rates.
“The data support a reduction in overall morbidity for invasive pneumococcal disease, with a trend toward children with underlying illness, and show that those with comorbid conditions have greater morbidity… Routine vaccination with PCV13 may not be sufficient to reduce risk of invasive disease in patients with comorbidity, and administering 23-valent pneumococcal polysaccharide vaccine to all children with comorbidity at the earliest acceptable age should be considered,” the researchers concluded.
Disclosure: Two researchers have financial ties with Pfizer, GlaxoSmithKline, and Merck.
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Iroh Tam P-Y. Pediatrics. 2014; doi:10.1542/peds.2014-0473.
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