Bacteremic Pneumonia before and after Withdrawal of 13-Valent Pneumococcal Conjugate Vaccine from a Public Vaccination Program in Spain: A Case-Control Study - 24/03/16

Doi : 10.1016/j.jpeds.2015.12.031

Alfredo Tagarro, PhD, MD ^1,^2,^⁎ , Andrea Benito, MD ³, Aida Sánchez, MD ⁴, Esteban Aznar, PhD, MD ⁴, Enrique Otheo, MD ⁵, David Sanz-Rosa, PhD ²
on behalf of the
Bacteremia in Children Observation Program (BACO) Group^{^∗}
List of additional members of the Bacteremia in Children Observation Program Group is available at www.jpeds.com (Appendix).
María Luisa Herreros, MD, Patricia Bote, MD, Carmen Vázquez, MD, Elena Loza, MD, Francisco José Sanz de Santaeufemia, Mercedes Alonso, MD, PhD, Susana Jiménez, MD, PhD, Juan Carlos Sanz, MD, PhD, Belén Ramos, MD, PhD, Marta Llorente, MD, Cristina Calvo, MD, PhD, Isabel Wilhemi, MD, Pilar Galán, MD, Jerónimo Jaqueti, MD, Rosa Funes, MD, PhD, Peña Gómez, MD, María Elena Alonso, MD, Isabel Barranco, MD, Ainhoa Martín, MD, Miguel Angel Roa, MD, José Luis Gómez, MD, Ana Belén Jiménez, MD, Natalia Cerdeira, MD, Graciela Rodríguez, MD, Sara Guillén, MD, Luis Prieto, MD, Juana Cacho, MD, PhD, Beatriz Soto, MD, Esther Aleo, MD, PhD, Ana Arribi, MD, Laura Francisco, MD, Elisa Fernández-Cooke, MD, María Mateo, MD, Alfonso Cañete, MD, PhD, Marta Goyanes, Diego Martínez de Carneros, Amaia Armenteros, Guillermo Visedo, Santiago Fernández Blas, Israel Thuissard

¹ Pediatrics Department, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
² Clinical Department, School of Biomedicine, Universidad Europea, Madrid, Spain
³ Pediatrics, Tropical and Infectious Diseases Department, Hospital Universitario La Paz, Madrid, Spain
⁴ Microbiology Department, Laboratory BR, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
⁵ Pediatrics Department, Hospital Universitario Ramón y Cajal, Madrid, Spain

^∗Reprint requests: Alfredo Tagarro, PhD, MD, Pediatrics Department, Hospital Universitario Infanta Sofía, Paseo de Europa 37, San Sebastian de los Reyes 28007, Madrid, Spain.Pediatrics DepartmentHospital Universitario Infanta SofíaPaseo de Europa 37San Sebastian de los ReyesMadrid28007Spain

Abstract

Objective

To compare the incidence and epidemiology of bacteremic community-acquired pneumonia (CAP) in the setting of changes in 13-valent pneumococcal conjugate vaccine (PCV13) coverage.

Study design

In the region of Madrid, universal immunization with the PCV13 started in May 2010. In July 2012, public funding ceased. Vaccination coverage decreased from >95% to 82% in 2013 and to 67% in 2014. We performed a multicenter surveillance and case-control study from 2009-2014. Cases were hospitalized children with bacteremic CAP. Controls were children selected 1:1 from next-admitted with negative blood cultures and typical, presumed bacterial CAP.

Results

Annual incidence of bacteremic CAP declined from 7.9/100 000 children (95% CI 5.1-11.1) in 2009 to 2.1/100 000 children (95% CI 1.1-4.1) in 2012. In 2014, 2 years after PCV13 was withdrawn from the universal vaccination program, the incidence of bacteremic CAP increased to 5.4/100 000 children (95% CI 3.5-8.4). We enrolled 113 cases and 113 controls. Streptococcus pneumoniae caused most of bloodstream infections (78%). Empyema was associated with bacteremia (P = .003, OR 3.6; 95% CI 1.4-8.9). Simple parapneumonic effusion was not associated with bacteremia. Incomplete PCV immunization was not a risk factor for bacteremic pneumonia.

Conclusions

High rate of PCV13 immunization was associated with decreased incidence of bacteremic CAP; this incidence increased when rate of immunization fell. Empyema (but not parapneumonic pleural effusion) was associated with bacteremia.

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Keyword : CAP, IPD, PCV13, PCV7, WBC

Plan

Methods

Selection of Control Subjects

Multivariate Conditional Logistic Regression Analysis

Discussion

A.T., A.S., E.O. have participated previously in research activities financed by Pfizer and are employees of the Regional Health Department of Madrid. A.B. and E.A. are employees of the Regional Health Department of Madrid Region. The remaining author declares no conflicts of interest.

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Bacteremic Pneumonia before and after Withdrawal of 13-Valent Pneumococcal Conjugate Vaccine from a Public Vaccination Program in Spain: A Case-Control Study - 24/03/16

Abstract

Objective

Study design

Results

Conclusions

Plan

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