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Refugee children in Germany at risk for invasive pneumococcal disease
Refugee children residing in Germany are significantly more likely to develop invasive pneumococcal disease than German-born children, according to research published in Emerging Infectious Diseases. According to the researchers, these children are less likely to be vaccinated and are nearly 24 times more likely to develop an infection resistant to multiple antibiotics.
“Invasive pneumococcal disease is a major cause of childhood death, especially in resource-poor environments,” Stephanie Perniciaro, MPH, CPH, a scientific employee and doctoral candidate at the University Hospital RWTH Aachen, Germany, and colleagues wrote. “Conflict settings are associated with outbreaks of vaccine-preventable diseases for reasons ranging from poor sanitation in refugee holding areas to the rapid movement of refugees, which, in turn, allows for a similarly rapid spread of disease and the interruption of immunization services because of the lack of personnel.”
Perniciaro and colleagues assessed 514 isolates collected from 514 children aged 16 years and younger who had invasive pneumococcal disease (IPD). The isolates collected from refugee children with IPD were compared with isolates collected from German-born children with IPD.
Between July 1, 2014, and June 30, 2017, 21 refugee children had isolates collected. The average age of these children was 3 years, and 44% had an unknown clinical diagnosis. Most of these isolates were taken from blood (n = 6). Two were tested through cerebrospinal fluid, and three were from other exudates.
When diagnoses were given, the most common causes were meningitis (19%), sepsis (14%) and pneumonia (14%).
The researchers wrote that 13 unvaccinated refugee children had contracted vaccine-type IPD (62% overall; 2014-2015, 67%; 2015-2016, 67%; 2016-2017, 50%) and that refugee children were nearly seven times more likely to develop a vaccine-type infection (OR = 6.60; 95% CI, 2.73-16.84).
Two children who were vaccinated with 13-valent pneumococcal conjugate vaccines both were infected with nonvaccine-type IPD. They each received one dose of the immunization after arriving in Germany.
Of the 405 isolates collected from German-born children (average age at infection, 2 years), an unknown diagnosis contributed to most cases (33%). Other reported diagnoses included meningitis (32%), sepsis (22%) and pneumonia (13%). Only 19% of these cases were identified as vaccine-type IPD (2014-2015, 26%; 2015-2016, 16%; 2016-2017, 16%).
Over one-third of isolates collected from refugee children (38% overall) were resistant to three or more classes of antimicrobial drugs (2014-2015, 33%; 2015-2016, 33%; 2016-2017, 50%), the researchers said. Only 2% of isolates collected from German-born children were multidrug resistant (2014-2015, 4%; 2015-2016, 1%; 2016-2017, 2%), making refugee children more than 23 times more likely to develop these infections (OR = 23.84; 95% CI, 7.98-72.73).
When Perniciaro and colleagues examined vaccine-type IPD, 38% were resistant to three or more antimicrobial drugs, and 7% of German-born children had vaccine-type IPD that was resistant to three or more drugs. According to the researchers, refugee children were nearly nine times more likely to have drug-resistant vaccine-type IPD compared with German-born children (OR = 8.82; 95% CI, 2.13-40.1).
“Vaccination in newly arrived refugees presents an opportunity to cost-effectively, safely and humanely protect a vulnerable population from negative health outcomes resulting from vaccine-preventable diseases,” Perniciaro and colleagues wrote. “Given that children in Germany with insecure residence status are twice as likely to be incompletely vaccinated, a pneumococcal conjugate vaccine program for refugee children in Germany might require additional follow-up measures to ensure consistency and provide sufficient protection, particularly because [vaccine] dosing in German-born children with IPD has been lax.”
Perniciaro and colleagues added that a pneumococcal vaccine program has the potential to reduce antimicrobial-resistant infections, the carriage of resistant strains and antimicrobial use. – by Katherine Bortz
Disclosures: Infectious Diseases in Children was unable to confirm relevant financial disclosures prior to publication.
