Invasive pneumococcal disease among children in a health district of Barcelona: early impact of pneumococcal conjugate vaccine.
This study evaluated the impact of heptavalent pneumococcal conjugate vaccine (HPCV) on invasive pneumococcal disease (IPD) in children aged < or = 5 years in Barcelona, Spain. The incidence of IPD, vaccine uptake and prevalence of nasopharyngeal colonisation were analysed in two different periods: 1999-2001 (pre-licence period), and 2002-2004 (post-licence period). In total, 121 cases of IPD were identified. The overall incidence of IPD decreased from 96.9 cases/100,000 to 90.6 cases/100,000 (OR 0.93, 95% CI 0.69-1.26, p 0.71) between the two periods. The proportion of cases caused by non-vaccine-related serotypes (NVS) increased from 21% to 43.7% (OR 2.9, 95% CI 1.2-7, p 0.01). IPD was diagnosed in seven vaccinated children, six of whom were infected by NVS. There was a trend of diminishing prevalence of resistance to penicillin and macrolides in 2002-2004. The incidence of empyema increased from 1.7 to 8.5/100,000 (OR 4.5, 95% CI 0.91-18, p 0.06). The rate of vaccination ranged from 4.8% to 34%. It was concluded that the rates of IPD in this area did not decrease following the introduction of HPCV. The low uptake of vaccine and the greater proportion of colonisation/infection by NVS probably explain these findings. A trend of increasing empyema was also apparent. A decrease in the prevalence of penicillin and macrolide resistance paralleled the progressive uptake of vaccine.
Calbo
E
E
Service of Internal Medicine, Hospital Mútua de Terrassa, University of Barcelona, Barcelona, Spain. estercalbo@hotmail.com
Díaz
A
A
Cañadell
E
E
Fábrega
J
J
Uriz
S
S
Xercavins
M
M
Morera
M A
MA
Cuchi
E
E
Rodríguez-Carballeira
M
M
Garau
J
J
D000900:Anti-Bacterial Agents / Q000494:pharmacology; D002353:Carrier State / Q000453:epidemiology / Q000382:microbiology; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D006801:Humans; D015994:Incidence; D022401:Meningococcal Vaccines / Q000008:administration & dosage*; D008826:Microbial Sensitivity Tests; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*; D015995:Prevalence; D012703:Serotyping; D013030:Spain / Q000453:epidemiology; D013296:Streptococcus pneumoniae / Q000145:classification / Q000187:drug effects / Q000276:immunology*; D014611:Vaccination
D000900:Anti-Bacterial Agents; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D022401:Meningococcal Vaccines; D022242:Pneumococcal Vaccines