Editorial Commentary:Replacement Pneumococcal Disease in Perspective

Abstract

Bender et al. [1] describe 33 patients with pneumococcal necrotizing pneumonia who were admitted to Primary Children's Medical Center (Salt Lake City, Utah) from January 2001 through March 2006. One-third of all hospitalized cases of pneumococcal pneumonia in the period after the introduction of 7-valent pneumococcal conjugate vaccine (PCV-7) were complicated by radiographic evidence of necrosis (evidence of necrotic lung, lung abscess, or pneumatocele), compared with 13% of cases before 2001. This group has also reported an increase in pediatric parapneumonic empyema beginning the same year [2]. The number of cases of parapneumonic empyema among children also increased in Spain and France during the period following the introduction of PCV-7. At Primary Children's Medical Center, 88% of cases of necrotizing pneumonia and 86% of cases of parapneumonic empyema identified from January 2001 through March 2006 were due to nonvaccine serotypes. These reports represent the latest part of the changing ecology of pneumococcal disease in association with the universal vaccination of infants with PCV-7. PCV-7 was introduced in 2000 for universal vaccination of infants 85% of cases of invasive pneumococcal disease (IPD) in children in North America. Following the introduction of PCV-7, a rapid decrease in the incidence of IPD occurred as a result of the direct effect of vaccination. A decrease in the incidence of IPD in children <5