63. Invasive Pneumococcal Infections in Children Following Transplantation in the Pneumococcal Conjugate Vaccine (PCV) Era
Session: Oral Abstract Session: Bacterial Diseases
Thursday, October 8, 2015: 8:45 AM
Room: 25--ABC

Background: Pediatric recipients of stem cell (SCT) and solid-organ transplants are at high risk of invasive pneumococcal diseases (IPD) and data on IPD in this population is lacking in the post PCV era. We describe the current epidemiology of IPD among pediatric transplant recipients.

Methods: We identified transplant recipients with IPD at 8 children's hospitals in the US from our surveillance database (2000 -2014). Pneumococcal isolates were collected prospectively. Serotyping and antibiotic susceptibility were performed in a central laboratory. Patients were divided into: Pre-PCV13 era (Feb 2000- Feb 2010), and Post-PCV13 era (Mar 2010-Dec 2014). Dichotomous variables were analyzed by Χtest and continuous variables with nonparametric tests.

Results: We identified 65 episodes of IPD in transplant recipients from 2000 to 2014. Three transplant recipients had 2 IPD episodes each. One isolate was non-viable. Proportion of IPD cases per transplanted organ was similar in both vaccine periods (p>0.05 for all). Serotype 19A was the most common serotype (n=11), followed by 6C (n=6), 19F and 23B (n=4 each).  Eleven out of 41 episodes (27%) in the pre-PCV13 era and 10 out of 23 (44%) in the post-PCV13 era were secondary to PCV serotypes. Only 31% (13/42) and 26% (6/23) of patients received at least one dose of the recommended PCV in the pre- and post-PCV13 eras, respectively. Three cases of vaccine breakthrough and one of vaccine failure were identified. Six percent (4/64) of isolates had a penicillin minimum inhibitory concentration (MIC) ≥ 2 mg/L and a ceftriaxone MIC ≥ 1 mg/L, respectively. No case fatalities occurred from 2007-2014.

Total

n=65

SCT

n=23

Heart

n=15

Liver

n=11

Kidney

n=6

Lung

n=5

Intestine

n=5

Vaccine Period

 

 

Pre-PCV13

42

15

9

7

5

3

3

Post-PCV13

23

8

6

4

1

2

2

Median age, mo (IQR)

80.4

(42.0-136.3)

98.1

(49.1-196.2)

73.4

(43.8-95.1)

53.8

(25.6-56.1)

74.5

(63.3-107.5)

199.0

(62.9-207.4)

119.4

(41.8-179.1)

Gender

 

Male

35

12

7

4

5

4

3

Female

30

11

8

7

1

1

2

Diagnosis

 

Bacteremia

44

18

9

7

5

5

Pneumonia

18

4

5

3

1

5

Meningitis

1

1

 

 

 

 

Peritonitis

1

 

 

1

 

 

 

Mastoiditis

1

1

 

 

 

 

 

Serotype

 

PCV13 serotype

29

9

6

6

4

2

2

Non-PCV13 serotype

35

14

9

5

2

3

2

 

Conclusion:  Pediatric transplant recipients remain at risk of IPD in the PCV13 era, partially due to the low pneumococcal immunization rate among these patients.

Liset Olarte, MD1, Philana Ling Lin, MD2, William J. Barson, MD, FPIDS3, Jose R. Romero, MD4, Jill Hoffman, MD5, Laurence B. Givner, MD6, John S. Bradley, MD, FPIDS7, Tina Tan, MD, FIDSA8, Kristina G. Hulten, PhD1, Edward O. Mason Jr., PhD, FIDSA1 and Sheldon L. Kaplan, MD, FIDSA1, (1)Baylor College of Medicine and Texas Children's Hospital, Houston, TX, (2)Children's Hospital of Pittsburgh, Pittsburgh, PA, (3)Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH, (4)University of Arkansas for Medical Sciences, Little Rock, AR, (5)Children's Hospital, Los Angeles, Los Angeles, CA, (6)Wake Forest University School of Medicine, Winston-Salem, NC, (7)Rady Children's Hospital - San Diego, San Diego, CA, (8)Northwestern University Feinberg School of Medicine, Chicago, IL

Disclosures:

L. Olarte, None

P. L. Lin, None

W. J. Barson, None

J. R. Romero, None

J. Hoffman, None

L. B. Givner, None

J. S. Bradley, None

T. Tan, None

K. G. Hulten, None

E. O. Mason Jr., None

S. L. Kaplan, Forest Labs: Grant Investigator , Grant recipient
Pfizer: Grant Investigator , Grant recipient

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