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Early Trends for Invasive Pneumococcal Infections in Children After the Introduction of the 13-valent Pneumococcal Conjugate Vaccine

Kaplan, Sheldon L. MD*; Barson, William J. MD; Lin, Philana Ling MD; Romero, José R. MD§; Bradley, John S. MD; Tan, Tina Q. MD; Hoffman, Jill A. MD**; Givner, Laurence B. MD††; Mason, Edward O. Jr. PhD*

The Pediatric Infectious Disease Journal: March 2013 - Volume 32 - Issue 3 - p 203–207
doi: 10.1097/INF.0b013e318275614b
Original Studies

Background: The 13-valent pneumococcal conjugate vaccine (PCV13) was introduced for routine administration to infants and children in 2010 in the United States. We have monitored clinical and microbiologic features of invasive pneumococcal infections among children before and after PCV13 use.

Methods: Infants and children cared for at 8 children hospitals in the United States with culture-proven invasive infections caused by S. pneumoniae were identified in an ongoing prospective surveillance study. Demographic and clinical data were recorded on a standard case report form. Serotype and antimicrobial susceptibilities of isolates were determined.

Results: Since routine PCV13 immunization in 2010, invasive pneumococcal infections decreased 42% overall and 53% for children <24 months of age in 2011 compared with the average number of cases for 2007 to 2009. PCV13 serotype isolates decreased 57% during these same time periods; 19A, 7F and 3 decreased by 58%, 54% and 68%, respectively. The number of infections caused by serotypes 1 and 6C also decreased in 2011. The most common non-PCV13 serotypes encountered in 2010 and 2011 combined were 33F, 22F, 12, 15B, 15C, 23A and 11. Bacteremia, pneumonia and mastoiditis cases decreased more than meningitis cases.

Conclusions: After the introduction of PCV13, invasive pneumococcal infections decreased among 8 children hospitals compared with the 3 years before PCV13 use. Slight increases in some non-PCV13 serotype isolates were noted in 2011. Continued surveillance is necessary to determine the effectiveness of PCV13 including herd protection as well as any emerging invasive serotypes.

From the *Pediatric Infectious Diseases Sections of the Baylor College of Medicine, Houston, TX; Ohio State University College of Medicine and Public Health, Columbus, OH; Children’s Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA; §University of Arkansas for Medical Sciences, Little Rock, AR; Rady Children’s Hospital San Diego, San Diego, CA; Feinberg School of Medicine, Northwestern University, Chicago, IL; **University of Southern California School of Medicine, LA; and ††Wake Forest School of Medicine, Winston-Salem, NC.

Accepted for publication September 07, 2012.

This study was funded, in part, by a grant from Pfizer to S.L.K. The authors have no other funding or conflicts of interest to disclose.

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Address for correspondence: Sheldon L. Kaplan, MD, Texas Children’s Hospital, Feigin Center, Suite 1150, 1102 Bates Ave., Houston, TX 77030. E-mail:

© 2013 Lippincott Williams & Wilkins, Inc.