van Warmerdam Jacqui, Campigotto Aaron, Bitnun Ari, MacDougall Georgina, Kirby-Allen Melanie, Papsin Blake, McGeer Allison, Allen Upton, Morris Shaun K
From the Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Pediatr Infect Dis J. 2023 Jan 1;42(1):74-81. doi: 10.1097/INF.0000000000003748. Epub 2022 Nov 18.
Despite the availability of conjugate pneumococcal vaccines, children with high-risk conditions remain vulnerable to invasive pneumococcal disease (IPD). This study sought to describe IPD prevalence, vaccination and outcomes among high-risk children.
We used International Classification of Disease10 discharge and microbiology codes to identify patients hospitalized for IPD at a large pediatric hospital from January 1, 2009, to December 31, 2018. Patients were considered high-risk if they had: primary immunodeficiency, asplenia, transplant, active malignancy, sickle cell disease, cochlear implant, nephrotic syndrome, chronic lung disease, cerebrospinal fluid leak, HIV or used immunosuppressive therapy.
In total 94 high-risk patients were hospitalized for IPD. The most common high-risk conditions included malignancy (n = 33, 35%), solid-organ or bone marrow transplant (n = 17, 18%) and sickle cell disease (n = 14, 15%). Bacteremia was the most common presentation (n = 81, 86%) followed by pneumonia (n = 23, 25%) and meningitis (n = 9, 10%). No deaths occurred. Of 66 patients with known pneumococcal vaccination status, 15 (23%) were unvaccinated, and 51 (77%) received at least one dose of a pneumococcal vaccine; 20 received all four recommended pneumococcal conjugate vaccine (PCV) doses. Only three children received PPSV23. Of 20 children with no or partial (<3 doses) immunization, 70% (14) of IPD episodes were due to vaccine-preventable serotypes. Of 66 known IPD serotypes, 17% (n = 11) were covered by PCV13, 39% (n = 26) were covered by PPSV23 and 39% (n = 26) were nonvaccine serotype.
Despite the availability of effective pneumococcal vaccines, IPD persists among children with high-risk conditions. Improving PCV13 and PPSV23 vaccination could significantly reduce IPD; most episodes were due to vaccine-preventable serotypes in incompletely immunized patients.
尽管有结合型肺炎球菌疫苗，但高危儿童仍易患侵袭性肺炎球菌疾病（IPD）。本研究旨在描述高危儿童中IPD的患病率、疫苗接种情况及转归。
我们使用国际疾病分类第10版的出院和微生物学编码，来识别2009年1月1日至2018年12月31日期间在一家大型儿科医院因IPD住院的患者。如果患者有以下情况，则被视为高危：原发性免疫缺陷、无脾、移植、活动性恶性肿瘤、镰状细胞病、人工耳蜗植入、肾病综合征、慢性肺病、脑脊液漏、HIV感染或使用免疫抑制治疗。
共有94名高危患者因IPD住院。最常见的高危情况包括恶性肿瘤（n = 33，35%）、实体器官或骨髓移植（n = 17，18%）和镰状细胞病（n = 14，15%）。菌血症是最常见的表现（n = 81，86%），其次是肺炎（n = 23，25%）和脑膜炎（n = 9，10%）。无死亡病例。在66名已知肺炎球菌疫苗接种情况的患者中，15名（23%）未接种疫苗，51名（77%）至少接种了一剂肺炎球菌疫苗；20名接种了所有四剂推荐的肺炎球菌结合疫苗（PCV）。只有三名儿童接种了23价肺炎球菌多糖疫苗（PPSV23）。在20名未接种或部分接种（<3剂）疫苗的儿童中，70%（14例）的IPD发作是由疫苗可预防血清型引起的。在66种已知的IPD血清型中，17%（n = 11）被PCV13覆盖，39%（n = 26）被PPSV23覆盖，39%（n = 26）为非疫苗血清型。
尽管有有效的肺炎球菌疫苗，但IPD在高危儿童中仍然存在。改进PCV13和PPSV23疫苗接种可显著降低IPD；大多数发作是由未完全免疫患者中疫苗可预防血清型引起的。
