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

• DOI: 10.1016/j.jpeds.2015.12.031
• Publication Date: 2016-01-16T19:57:32Z
• Authors: Alfredo Tagarro; Andrea Benito; Aida Sánchez; Esteban Aznar; Enrique Otheo; David Sanz-Rosa; María Luisa Herreros; Patricia Bote; Carmen Vázquez; Elena Loza; Francisco José Sa...; Mercedes Alonso; Susana Jiménez; Juan Carlos Sanz; Belén Ramos; Marta Llorente; Cristina Calvo; Isabel Wilhemi; Pilar Galán; Jerónimo Jaqueti; Rosa Funes; Peña Gómez; María Elena Alonso; Isabel Barranco; Ainhoa Martín; Miguel Angel Roa; José Luis Gómez; Ana Belén Jiménez; Natalia Cerdeira; Graciela Rodríguez; Sara Guillén; Luis Prieto; Juana Cacho; Beatriz Soto; Esther Aleo; Ana Arribi; Laura Francisco; Elisa Fernández-C...; María Mateo; Alfonso Cañete; Marta Goyanes; Diego Martínez de...; Amaia Armenteros; Guillermo Visedo; Santiago Fernánde...; Israel Thuissard
• Keywords: Male; 613; IPD (Invasive pneumococcal disease); Pneumococcal Infections; 618; Pneumococcal Vaccines; 03 medical and health sciences; 0302 clinical medicine; Humans; CAP (Community-acquired pneumonia); Immunization Programs; Incidence; Pediatría; PCV7 (7-valent pneumococcal conjugate vaccine); Aparato respiratorio; PCV13 (13-valent pneumococcal conjugate vaccine); 3. Good health; Community-Acquired Infections; Hospitalization; Streptococcus pneumoniae; Spain; Case-Control Studies; Child, Preschool; Female; WBC (White blood cell); Pulmones - Enfermedades

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.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.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 In 2014, 2 years after PCV13 was withdrawn from the universal vaccination program, the incidence of bacteremic CAP increased to 5.4/100,000 children (95% CI 3.5-8.4).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.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.