LB-1. Early Trends for Invasive Pneumococcal Infections in Children Following the Introduction of the 13-Valent Pneumococcal Conjugate Vaccine
Session: Poster Abstract Session: Late Breaker Posters
Saturday, October 22, 2011
Room: Poster Hall B1
  • IDSA 2011 Early Trends Kaplan_Final.pdf (383.3 kB)
  • Background:  Invasive pneumococcal infections (IPI) in children were reduced about 75% following the introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) in 2000. Since 2005 IPI in children has increased due to non-PCV7 serotypes, especially 19A.  In February 2010, PCV13 (PCV7 + serotypes 1, 3, 5, 6A, 7F, and 19A) was approved and we report the early experience with IPI in children since then.

    Methods:  Children with IPI have been prospectively identified by investigators from 8 children's hospitals in the United States since 1993.  Demographic and clinical data are collected on case report forms and isolates are sent to a central laboratory where serotype and antibiotic susceptibilities are performed. The % of isolates with penicillin MICs > 2 µg/mL is reported. Data were analyzed for 12 mo periods starting 7/1/2007 through 6/30/2011. Dichotomous variables were analyzed by Chi-square.

    Results: The total number of IPI cases, number of serotype 19A, 7F, 3, 6C and 33F isolates, the % of children < 60 mo and the % of isolates with penicillin MIC > 2µg/mL for each of the study years are shown in the table.   In 2010-11 serogroup 15 (n=9; 15A-2, 15B-3, 15C-4) was also common.  Isolates with penicillin MIC > 2µg/mL decreased significantly over the study years. (p=0.003)
    Isolates 2007-8 2008-9 2009-10 2010-11
    Total 211 209 210 133
    19A 85 72 75 43
    7F 24 25 33 14
    3 14 16 12 8
    6C 7 6 10 4
    33F 0 0 4 10
    %< 60 mo old 72 68 75 61
    % MIC > 2µg/mL 8 6 1 0

    In 2010-11, 43% of children had underlying conditions.   In 2010-11, 42 children had received one (n= 27) or more doses (2 doses-9, 3 doses-6) of PCV13; 16 of their isolates were PCV13 serotypes (12 were 19A).  Six of the 16 with PCV13 isolates had underlying conditions. Serotype 33F was found in 3/6 who had received 3 PCV13 doses.   

    Conclusions: Early trends indicate a 36% reduction in IPI cases among 8 children's hospitals for the 12 month period starting 4 months after the introduction of PCV13.  Penicillin resistance also decreased.  19A cases decreased by 45%. Some cross-protection for 6C is likely.   Serotype 33F and serogroup 15 were the most common non-PCV13 serotypes encountered. Continued surveillance is necessary to further document the impact of PCV13 on IPI in children.

    Subject Category: P. Pediatric and perinatal infections

    Sheldon L. Kaplan, MD, FIDSA1, William Barson, MD2, Philana Lin, MD, MSc3, Jose Romero, MD4, John Bradley, MD, FIDSA5, Tina Tan, MD6, Jill Hoffman, MD7, Laurence Givner, MD8, Kristina Hulten, PhD1 and Edward Mason, PhD1, (1)Baylor College of Medicine and Texas Children's Hospital, Houston, TX, (2)Department of Pediatrics, Section of Infectious Diseases, Nationwide Children's Hospital (NCH) and The Ohio State University College of Medicine, Columbus, OH, (3)Children's Hospital of Pittsburgh, Pittsburgh, PA, (4)University of Arkansas for Medical Sciences, Little Rock, AR, (5)Rady Children's Hospital - San Diego, San Diego, CA, (6)Northwestern University Feinberg School of Medicine, Chicago, IL, (7)Children's Hospital, Los Angeles, Los Angeles, CA, (8)Wake Forest University School of Medicine, Winston-Salem, NC


    S. L. Kaplan, Pfizer: Investigator, Research support

    W. Barson, None

    P. Lin, None

    J. Romero, None

    J. Bradley, None

    T. Tan, None

    J. Hoffman, None

    L. Givner, None

    K. Hulten, None

    E. Mason, None

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