1432. County-Wide Pediatric IPD Experience Following Prevnar 13 Implementation

Abstract

BackgroundAlthough invasive pneumococcal disease (IPD) has declined following pneumococcal conjugate vaccines, both respiratory (R-IPD; e.g., pneumonias +/− empyema) and nonrespiratory IPD (NR-IPD) remain concerning. We evaluate 13-valent pneumococcal conjugate vaccine (PCV13) impact on county-wide IPD, serotypes involved and patients affected since its 2010 introduction.MethodsProspective analysis of culture confirmed pediatric IPD was conducted in Orange County, CA following PCV13 vaccine implementation comparing 2010–2013 (transition; Era 1) to 2014–2017 (full implementation; Era 2). We reviewed age, ethnicity, health status, immunizations, immune work up, site of infection, and serotype distribution.ResultsThere were 135 IPD cases (78[58%] male; 63[47%] Hispanic, 38[28%] White, 14[10%] Asian, 9[7%] other and 11[8%] unknown). IPD decreased by 37.3% (Era 1 = 83 cases vs. Era 2 = 52). R-IPD (41.5%) and NR-IPD (58.5%) exhibited a similar decrease. Serotype was known for 116 (86%) cases. Overall PCV13 serotype incidence rate (IR) per 100,000 population decreased by 44.7%; of note non-PCV13 decreased by 14.8%. The largest change was seen in PCV13 serotype NR-IPD (−60%) (Figure 1). As a percentage of PCV13 serotypes, 19A and 3 increased from 32 and 21% to 46% (+44%) and 27% (+29%), respectively. Meanwhile, 7F decreased from 36 to 7% (−81%). R-IPD due to PCV13 serotype in children <5 years old did not decrease during the study (Figure 2). By Era 2 PCV13 immunization was broadly implemented (Figure 3). Despite being fully immunized, 12 patients (5[42%] male; 7[58%] White, 4[33%] Asian, 1[8%] other) developed PCV13 serotype IPD. The majority (10/12) were previously healthy, with R-IPD (83%) and affected by serotypes 19A (58%) or 3 (25%). No immune deficiency was identified among these subjects.ConclusionPediatric IPD continues to decrease post PCV13 implementation, most notably due to a decrease in PCV13 serotype NR-IPD and disappearance of 7F. We did not see an increase in non-PCV13 IPD. Serotypes 19A and 3 remain a significant proportion of a lower number of cases. Children <5 remain at highest risk for IPD, particularly R-IPD. A notable proportion of PCV13 serotype R-IPD occurred in fully immunized and previously healthy children. Disclosures A. Arrieta, Melinta Therapeutics: Investigator, Research support.