Program Schedule

78
Pneumococcal Meningitis among 8 Children’s Hospitals in the United States in the 13-valent Pneumococcal Conjugate Vaccine Era

Session: Oral Abstract Session: Defining and Reducing the Impact of Pediatric Infections
Thursday, October 9, 2014: 8:45 AM
Room: The Pennsylvania Convention Center: 111-AB

Background: After the introduction of PCV7 the incidence of pediatric pneumococcal meningitis (PM) decreased significantly. The impact of PCV13 on PM in children is unknown. We compared the serotype (ST) distribution, antibiotic susceptibility and outcomes of children with PM 3 yrs before and 3 yrs after the introduction of PCV13.

Methods: We identified patients ≤18 years with PM at 8 children's hospitals in the US (1/1/2007 - 12/31/2013). Pneumococcal isolates were collected prospectively. Serotyping and antibiotic susceptibility were performed in a central laboratory. Clinical and laboratory data were collected retrospectively. Patients were divided into 3 subgroups: pre-PCV13 (2007-2009), transitional year (2010) and post-PCV13 (2011-2013). Dichotomous variables were analyzed by Χtest and continuous variables with parametric/non-parametric tests.

Results: During the study period, 173 of 1158 (15%) children with invasive pneumococcal disease (IPD) had PM; 76 of 644 (12%) during 2007-2009 and 69 of 344 (20%) during 2011-2013 (+8%, p<0.001) (Figure). We obtained clinical data from 125 patients (72%), of those 7 pneumococcal isolates were not viable for serotyping. In 2010, 22 cases were identified.

2007-2009

2011-2013

p

N=103

56

47

Age, mo median (IQR)

16.8 (5-81)

16.3 (6-84)

0.9

Underlying condition (%)

16(29)

17(36)

0.4

CSF WBC (x103/mm3), median (IQR)

1.1 (0.1-2.9)

0.9 (0.1-2.8)

0.9

PCV13 ST

26/54 (48)

12/45 (27)

0.03

ST 19A

10/54 (19)

10/45 (22)

0.7

Penicillin MIC ≥0.12g/ml

13/54 (24)

14/45 (31)

0.4

Ceftriaxone MIC ≥0.5g/ml*

9/54 (17)

9/45 (20)

0.7

Death

1 (1.8)

5 (10.6)

0.08

Intensive care

33 (59)

38(81)

0.02

Fever after admission, days

3.22.4

4.73.7

0.02

*All ST 19A and 35B

ST 7F decreased by 13% (p=0.02). The most common non-PCV13 STs during 2011-2013 were 33F (n=5; increased by 11%, p=0.02), 22F and 35B (n=4 each). Other measures of severity were similar during 2007-2009 and 2011-2013. Of all survivors, 46% had neurologic sequelae and 24% had sensorineural hearing loss. Rates of sequelae were similar among PCV13 and non-PCV13 ST cases; and during 2007-2009 and 2011-2013.

Conclusion: After the introduction of PCV13, the number of cases of PM per year in children has remained unchanged, but with an increasing proportion of PM among children with IPD. ST 19A continues to be the most common ST in 2011-2013. Rates of morbidity and mortality remain substantial.

Text Box:
Liset Olarte, MD1, William J. Barson, MD2, Philana Ling Lin, MD3, Jose Romero, MD4, Tina Tan, MD, FIDSA5, Laurence B. Givner, MD6, John S. Bradley, MD, FIDSA7, Jill Hoffman, MD8, Kristina G. Hulten, PhD9, Edward Mason, PhD1 and Sheldon L. Kaplan, MD, FIDSA9, (1)Baylor College of Medicine and Texas Children's Hospital, Houston, TX, (2)Nationwide Children's Hospital 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)Northwestern University Feinberg School of Medicine, Chicago, IL, (6)Wake Forest University School of Medicine, Winston-Salem, NC, (7)Rady Children's Hospital - San Diego, San Diego, CA, (8)Children's Hospital, Los Angeles, Los Angeles, CA, (9)Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX

Disclosures:

L. Olarte, None

W. J. Barson, UpToDate: Author, Royalty
Pfizer: Investigator, Research support
Wyeth: Investigator, Research support

P. L. Lin, None

J. Romero, None

T. Tan, Pfizer/Wyeth: Scientific Advisor, Nothing to date

L. B. Givner, Pfizer: Investigator, Research support

J. S. Bradley, None

J. Hoffman, None

K. G. Hulten, None

E. Mason, None

S. L. Kaplan, Pfizer: Grant Investigator and Scientific Advisor, Consulting fee and Grant recipient

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