title: Seasonal invasive pneumococcal disease in children: role of preceding respiratory viral infection.
abstract: OBJECTIVE
  Our objective was to demonstrate correlations between invasive pneumococcal disease in children and circulating respiratory viruses.
  
  
  METHODS
  This retrospective study included 6 winter respiratory viral seasons (2001-2007) in Intermountain Healthcare, an integrated health system in the Intermountain West, including Primary Children's Medical Center in Salt Lake City, Utah. Children <18 years of age who were hospitalized with either invasive pneumococcal disease in any Intermountain Healthcare facility or culture-confirmed invasive pneumococcal disease at Primary Children's Medical Center were included. We analyzed the correlation between invasive pneumococcal disease and circulating respiratory viruses.
  
  
  RESULTS
  A total of 435 children with invasive pneumococcal disease and 203 with culture-confirmed invasive pneumococcal disease were hospitalized in an Intermountain Healthcare facility or Primary Children's Medical Center during the study period. During the same period, 6963 children with respiratory syncytial virus, 1860 with influenza virus, 1459 with parainfluenza virus, and 818 with adenoviruses were evaluated at Primary Children's Medical Center. A total of 253 children with human metapneumovirus were identified during the last 5 months of the study. There were correlations between invasive pneumococcal disease and seasonal respiratory syncytial virus, influenza virus, and human metapneumovirus activity. The correlation with invasive pneumococcal disease was strong up to 4 weeks after respiratory syncytial virus activity. For influenza virus and human metapneumovirus, the correlations were strong at 2 weeks after activity of these viruses. Pneumonia was the most common clinical disease associated with culture-confirmed invasive pneumococcal disease, mostly attributable to serotypes 1, 19A, 3, and 7F.
  
  
  CONCLUSIONS
  In the post-pneumococcal conjugate vaccine era, seasonal increases in respiratory syncytial virus, influenza virus, and human metapneumovirus infections in children were associated with increased pediatric admissions with invasive pneumococcal disease, especially pneumonia caused by nonvaccine serotypes.
authors.affiliation: Division of Pediatric Infectious Disease, Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City, Utah 84132, USA. krow.ampofo@hsc.utah.edu
authors.forename: Krow
authors.initials: K
authors.lastname: Ampofo
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Bender
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Sheng
authors.forename: Kent
authors.initials: K
authors.lastname: Korgenski
authors.forename: Judy
authors.initials: J
authors.lastname: Daly
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Pavia
authors.forename: Carrie L
authors.initials: CL
authors.lastname: Byington
mesh_terms: D017677:Age Distribution; D016470:Bacteremia / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D015999:Multivariate Analysis; D009975:Orthomyxoviridae / Q000302:isolation & purification*; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D022242:Pneumococcal Vaccines / Q000008:administration & dosage; D011322:Primary Prevention / Q000379:methods; D011336:Probability; D012136:Respiratory Syncytial Viruses / Q000302:isolation & purification*; D012141:Respiratory Tract Infections / Q000150:complications / Q000628:therapy / Q000821:virology*; D012189:Retrospective Studies; D012621:Seasons; D017678:Sex Distribution; D014589:Utah / Q000453:epidemiology
chemical_list: D022242:Pneumococcal Vaccines