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Impact of the 13-valent Pneumococcal Conjugate Vaccine on Chronic Sinusitis Associated With Streptococcus pneumoniae in Children

Olarte, Liset MD*†; Hulten, Kristina G. PhD*†; Lamberth, Linda BS*†; Mason, Edward O. Jr. PhD*†; Kaplan, Sheldon L. MD*†

The Pediatric Infectious Disease Journal: October 2014 - Volume 33 - Issue 10 - p 1033–1036
doi: 10.1097/INF.0000000000000387
Original Studies
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Background: The widespread use of the 7-valent pneumococcal conjugate vaccine has been associated with epidemiologic changes of mucosal and invasive pneumococcal disease. No study describes the impact of 13-valent pneumococcal conjugate vaccine (PCV13) on chronic sinusitis in children. We describe changes in epidemiology of Streptococcus pneumoniae chronic sinusitis after the introduction of PCV13 at Texas Children’s Hospital.

Methods: We identified patients <18 years with positive sinus culture for S. pneumoniae who underwent endoscopic sinus surgery because of chronic sinusitis from August 2008 to December 2013 at Texas Children’s Hospital. Isolates were serotyped by the capsular swelling method. Demographic and clinical information was collected retrospectively. The χ2 test and Fisher’s exact test were used to analyze dichotomous variables.

Results: We identified 91 cases of chronic sinusitis with positive sinus culture for S. pneumoniae. Sixty-one (67%) isolates were non-PCV13 serotypes. PCV13 cases decreased 31% in the post-PCV13 period (P = 0.003). Serotype 19A decreased 27% in the post-PCV13 period (P = 0.007), but accounted for all the isolates with penicillin minimal inhibitory concentration ≥ 4 μg/mL and ceftriaxone minimal inhibitory concentration ≥ 2 μg/mL. Serotypes 19A (38%) and 15C (17%) were the most common in the pre- and post-PCV13 periods, respectively. The most common organism co-isolated was Haemophilus influenzae (52%). Isolation of Prevotella spp. increased in the post-PCV13 period (P = 0.02).

Conclusions: S. pneumoniae continues to represent an important pathogen in chronic sinusitis in children <5 years of age. After the introduction of PCV13, S. pneumoniae isolation declined in children with chronic sinusitis at Texas Children’s Hospital. We also observed a substantial reduction of PCV13 serotypes, predominantly serotype 19A.

From the *Department of Pediatrics, Section of Pediatric Infectious Diseases, Baylor College of Medicine; and Texas Children’s Hospital, Houston, TX.

Accepted for publication April 16, 2014.

This study supported in part by grant from Pfizer for Streptococcus pneumoniae surveillance study. The authors have no other funding or conflicts of interest to disclose.

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

© 2014 by Lippincott Williams & Wilkins, Inc.