Abstract
BackgroundPneumococcal conjugate vaccine (PCV) reduces both invasive pneumococcal disease (IPD) and other pneumococcal infections worldwide. We investigated the impact of stepwise implementation of childhood PCV programs on the prevalence of pneumococcal pneumonia, severity of acute inflammation, and associations between breakthrough pneumonia and pneumococcal serotypes in Taiwan.MethodsIn total, 983 children diagnosed with community-acquired pneumococcal pneumonia were enrolled between January 2010 and December 2015.ResultsProportions of pneumococcal vaccinations increased each year in age-stratified groups with PCV7 (32.2%) as the majority, followed by PCV13 (12.2%). The proportion of pneumococcal pneumonia decreased each year in age-stratified groups, especially in 2–5 year group. Serotype 19A is the leading serotype either in vaccinated (6.4%) or unvaccinated patients (5.2%). In particular, vaccinated patients had significantly higher lowest WBC, lower neutrophils, lower lymphocytes and lower CRP values than non-vaccinated patients (p < 0.05). After stratifying patients by breakthrough infection, those with breakthrough pneumococcal infection with vaccine coverage serotypes had more severe pneumonia disease (p < 0.05).ConclusionSystematic childhood pneumococcal vaccination reduced the prevalence of community-acquired pneumococcal pneumonia, especially in 2–5 year group. Serotype 19A was the major serotype for all vaccine types in patients with pneumococcal pneumonia and severity of acute inflammatory response was reduced in vaccinated patients.
Highlights
Pneumococcal conjugate vaccine (PCV) reduces both invasive pneumococcal disease (IPD) and other pneumococcal infections worldwide
The overall purpose of the present study was to investigate the impact of stepwise implementation of pneumococcal conjugate vaccine (PCV) on epidemiological change in pneumococcal community-acquired pneumonia (CAP), including: 1) potential reduction in the prevalence of pneumococcal pneumonia, 2) whether or not childhood PCV vaccination affects the severity of acute inflammation in those who develop pneumococcal pneumonia, and 3) whether breakthrough pneumococcal pneumonia is associated with specific pneumococcal serotypes or not
The distribution of serotypes was similar between vaccinated patients and non-vaccinated patients with pneumococcal pneumonia (Table 3)
Summary
Pneumococcal conjugate vaccine (PCV) reduces both invasive pneumococcal disease (IPD) and other pneumococcal infections worldwide. We investigated the impact of stepwise implementation of childhood PCV programs on the prevalence of pneumococcal pneumonia, severity of acute inflammation, and associations between breakthrough pneumonia and pneumococcal serotypes in Taiwan. Pneumococcal disease is the primary cause of childhood morbidity and mortality worldwide, resulting in 0.7 to 1.0 million deaths each year in children younger than age 5 years [3]. Childhood community-acquired pneumonia is most often attributed to Streptococcus pneumoniae, and the greatest incidence of invasive pneumococcal infection (IPD) is observed in children younger than age 2 [4]. Universal vaccination with PCV7 resulted in a 77% reduction in pneumococcal disease in children aged 1–5 and a 39% reduction in hospitalization of children age under age 2 [3]. A recent review and meta-analysis reported that systematic childhood PCV immunization programs provided widespread protection against IPD and reduced cases by 90% within 10 years [9]
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