title: Invasive pneumococcal disease after routine pneumococcal conjugate vaccination in children, England and Wales.
abstract: We assessed known risk factors, clinical presentation, and outcome of invasive pneumococcal disease (IPD) in children 3-59 months of age after introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) in England and Wales. During September 2006-March 2010, a total of 1,342 IPD episodes occurred in 1,332 children; 14.9% (198/1,332) had comorbidities. Compared with IPD caused by PCV7 serotypes (44/248; 17.7%), comorbidities were less common for the extra 3 serotypes in the 10-valent vaccine (15/299; 5.0%) but similar to the 3 additional PCV13 serotypes (45/336; 13.4%) and increased for the 11 extra serotypes in 23-valent polysaccharide vaccine (PPV23) (39/186; 21.0%) and non-PPV23 serotypes (38/138; 27.5%). Fifty-two (3.9%) cases resulted from PCV7 failure; 9 (0.7%) case-patients had recurrent IPD. Case-fatality rate was 4.4% (58/1,332) but higher for meningitis (11.0%) and children with comorbidities (9.1%). Thus, comorbidities were more prevalent in children with IPD caused by non-PCV13 serotypes and were associated with increased case fatality.
authors.affiliation: Immunisation Department, Health Protection Agency Colindale, London, UK. shamez.ladhani@hpa.org.uk
authors.forename: Shamez N
authors.initials: SN
authors.lastname: Ladhani
authors.forename: Mary P E
authors.initials: MP
authors.lastname: Slack
authors.forename: Nick J
authors.initials: NJ
authors.lastname: Andrews
authors.forename: Pauline A
authors.initials: PA
authors.lastname: Waight
authors.forename: Ray
authors.initials: R
authors.lastname: Borrow
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Miller
mesh_terms: D000208:Acute Disease; D002675:Child, Preschool; D015897:Comorbidity; D004739:England / Q000453:epidemiology; D005260:Female; D006330:Heart Defects, Congenital / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008586:Meningitis, Pneumococcal / Q000453:epidemiology* / Q000276:immunology / Q000401:mortality / Q000517:prevention & control*; D009369:Neoplasms / Q000453:epidemiology* / Q000401:mortality; D022242:Pneumococcal Vaccines / Q000276:immunology*; D011018:Pneumonia, Pneumococcal / Q000453:epidemiology* / Q000276:immunology / Q000401:mortality / Q000517:prevention & control*; D012307:Risk Factors; D016036:Seroepidemiologic Studies; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000276:immunology* / Q000472:pathogenicity; D016019:Survival Analysis; D014611:Vaccination; D018074:Vaccines, Conjugate; D014852:Wales / Q000453:epidemiology
chemical_list: D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate