Pediatrics
August 2014, VOLUME 134 / ISSUE 2
http://pediatrics.aappublications.org/current.shtml

Article
Invasive Pneumococcal Disease After Implementation of 13-Valent Conjugate Vaccine
Pui-Ying Iroh Tam, MDa, Lawrence C. Madoff, MDb,c, Brandon Coombes, BSd, and Stephen I. Pelton, MDe
Author Affiliations
aUniversity of Minnesota Children’s Hospital, Minneapolis, Minnesota;
bMassachusetts Department of Public Health, Boston, Massachusetts;
cUniversity of Massachusetts Medical School, Worcester, Massachusetts;
dClinical and Translational Science Institute, University of Minnesota, Minneapolis, Minnesota; and
eBoston University Medical Center, Boston, Massachusetts
Abstract
OBJECTIVE: To examine whether there is a different clinical profile and severity of invasive pneumococcal disease (IPD) in children caused by nonvaccine types in the era of 13-valent pneumococcal conjugate vaccine (PCV13).
METHODS: Observational study of childhood IPD in Massachusetts based on state public health surveillance data comparing pre-PCV13 (2007–2009) and post-PCV13 (2010–2012) eras.
RESULTS: There were 168 pre-PCV13 cases of IPD and 85 post-PCV13 cases of IPD in Massachusetts children ≤5 years of age. PCV13 serotypes declined by 18% in the first 2 years after PCV13 use (P = .011). In the post-PCV13 phase, a higher proportion of children were hospitalized (57.6% vs 50.6%), and a higher proportion of children had comorbidity (23.5% vs 19.6%). Neither difference was statistically significant, nor were comparisons of IPD caused by vaccine and nonvaccine types. Children with comorbidities had higher rates of IPD caused by a nonvaccine type (27.6% vs 17.2%; P = .085), were more likely to be hospitalized (80.4% vs 50%; P < .0001), and were more likely to have a longer hospital stay (median of 3 days vs 0.5 days; P = .0001).
CONCLUSIONS: Initial data suggest that nonvaccine serotypes are more common in children with underlying conditions, who have greater morbidity from disease. In the post-PCV13 era, a larger proportion of patients are hospitalized, but mortality rates are unchanged. Routine vaccination with PCV13 may not be enough to reduce the risk in patients with comorbidity.