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

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• 作者：Alfredo Tagarro ; PhD ; MD¹ ; ² ; ^{alfredo.tagarro@salud.madrid.org" class="auth_mail" title="E-mail the corresponding author} ; Andrea Benito ; MD³ ; Aida Sá ; nchez ; MD⁴ ; Esteban Aznar ; PhD ; MD⁴ ; Enrique Otheo ; MD⁵ ; David Sanz-Rosa ; PhD² ; on behalf of the Bacteremia in Children Observation Program (BACO) Group^&lowast ; ; Marí ; a Luisa Herreros ; MD ; Patricia Bote ; MD ; Carmen Vá ; zquez ; MD ; Elena Loza ; MD ; Francisco José ; Sanz de Santaeufemia ; Mercedes Alonso ; MD ; PhD ; Susana Jimé ; nez ; MD ; PhD ; Juan Carlos Sanz ; MD ; PhD ; Belé ; n Ramos ; MD ; PhD ; Marta Llorente ; MD ; Cristina Calvo ; MD ; PhD ; Isabel Wilhemi ; MD ; Pilar Galá ; n ; MD ; Jeró ; nimo Jaqueti ; MD ; Rosa Funes ; MD ; PhD ; Peñ ; a Gó ; mez ; MD ; Marí ; a Elena Alonso ; MD ; Isabel Barranco ; MD ; Ainhoa Martí ; n ; MD ; Miguel Angel Roa ; MD ; José ; Luis Gó ; mez ; MD ; Ana Belé ; n Jimé ; nez ; MD ; Natalia Cerdeira ; MD ; Graciela Rodrí ; guez ; MD ; Sara Guillé ; n ; MD ; Luis Prieto ; MD ; Juana Cacho ; MD ; PhD ; Beatriz Soto ; MD ; Esther Aleo ; MD ; PhD ; Ana Arribi ; MD ; Laura Francisco ; MD ; Elisa Ferná ; ndez-Cooke ; MD ; Marí ; a Mateo ; MD ; Alfonso Cañ ; ete ; MD ; PhD ; Marta Goyanes ; Diego Martí ; nez de Carneros ; Amaia Armenteros ; Guillermo Visedo ; Santiago Ferná ; ndez Blas ; Israel Thuissard
• 关键词：CAP ; Community-acquired pneumonia ; IPD ; Invasive pneumococcal disease ; PCV13 ; 13-valent pneumococcal conjugate vaccine ; PCV7 ; 7-valent pneumococcal conjugate vaccine ; WBC ; White blood cell
• 刊名：The Journal of Pediatrics
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：171
• 期：Complete
• 页码：111-115.e3
• 全文大小：318 K

文摘

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.