774. Trends in Pediatric Pneumococcal Pleural Empyema following Pneumococcal Conjugate 13-Valent Vaccination: 10 Years of Active Surveillance in a Mexican Hospital
Session: Poster Abstract Session: Vaccines: Pneumococcal
Thursday, October 27, 2016
Room: Poster Hall
  • eposterchaconetal.pdf (481.0 kB)
  • Background: We have previously published the first Mexican study showing a decrease in pneumococcal invasive disease following implementation of the 13-valent pneumococcal conjugate vaccine (PCV13), however, the impact of this vaccine on Pneumococcal Pleural Empyema (PPE), serotypes distribution, and appearance by other non-pneumococcal bacteriae has not been yet published. The Tijuana, Mexico and San Diego, California border is considered the most transited border in the world.

    Methods: Since October-2005 until September-2015, active surveillance for pleural empyema (PE) in children < 16 years old was performed in the Tijuana, Mexico, General Hospital (TGH). Diagnosis of PE was established by Lyell criteria of a pleural effusion with a community acquired pneumonia +- bacterial isolation. For Streptococcus pneumoniae isolates serotype identification was performed using the Quellung reaction (Statens Serum Institute®, Copenhagen, Denmark). A descriptive analysis for all PPE was performed.

    Results: A total of 48 PE were diagnosed. Bacterial identification was possible in 35 (73%) cases. Among these, 26 (74.28%) were caused by S. pneumoniae. Median age for PPE was of 3.91 years (4 months -15 years), pleural decortication was performed in 10 patients (38.5%), and one patient died. Before PCV13 implementation (a period of 77 months), the total number of PPE were of 21 (3.27 cases per year), with serotypes 3, 19A and 6A/C accounting for 64.3% of cases since PCV13 introduction. Following PCV13 implementation (43 months period), PPE dropped to 5 cases (1.4 cases per year), with isolation of serotypes 6A/C, 7B,15, 3 and 24F (one each). Appearance of non-PPE started to appear since 2010 with two cases, but have increased since implementation of PCV13 (seven cases). Non-pneumococcal isolates have been Staphylococcus aureus (3), Streptococcus pyogenes (2), and Streptococcus salivarus, Group Milleri Streptococcus, Klebsiella oxytoca and Pseudomonas aeruginosa(one each).

    Conclusion: 1. Following PCV13 universal vaccination, all PPE cases have decreased, with a trend on decrease on serotypes 6A/C, 3 and 19A. 2. This study shows an impact of PCV13 on PPE, however, early appearance of non-pneumococcal bacteriae causing PE is present. 3. Continuous active surveillance for PE is mandatory.

    Enrique Chacon-Cruz, MD1, Erika Zoe Lopatynsky-Reyes, MD1, Rosa Maria Rivas-Landeros, PhD2, Maria Luisa Volker-Soberanes, PhD2 and Jorge Arturo Alvelais-Palacios, MD, PhD3, (1)Pediatrics, Hospital General de Tijuana, Tijuana, Baja-California, Mexico, (2)Microbiology, Hospital General de Tijuana, Tijuana, Baja-California, Mexico, (3)School of Medicine, Universidad Autonoma de Baja California, CISALUD, Tecate, Baja-California, Mexico


    E. Chacon-Cruz, None

    E. Z. Lopatynsky-Reyes, None

    R. M. Rivas-Landeros, None

    M. L. Volker-Soberanes, None

    J. A. Alvelais-Palacios, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.