title: Aetiology of paediatric pneumonia after the introduction of pneumococcal conjugate vaccine.
abstract: We describe the aetiology of community-acquired pneumonia in children before and after the introduction of the pneumococcal conjugate vaccination (PCV) programme in 2006. Prospective studies were conducted in 2001-2002 (pre-vaccine) and 2009-2011 (post-vaccine) of children aged 0-16 years with radiologically confirmed pneumonia seen in hospital. Investigations included culture, serology, immunofluorescence antibody and urine antigen testing, with an increased use of PCR assays and expanded panels of pathogens in the post-vaccine study. 241 and 160 children were enrolled in the pre- and post-vaccine studies, respectively (73% aged <5 years). Identification of a causative pathogen was higher post-vaccination (61%) than pre-vaccination (48.5%) (p=0.019). Rates of bacterial infections were not different between post- and pre-vaccine studies (17.5% versus 24%, p=0.258). Viral (31%) and mixed (12.5%) infections were found more often post-vaccination (19.5%, p=0.021) than pre-vaccination (5%, p=0.015). Rates of identified pneumococcal infections were comparable between pre- and post-vaccine studies (14.7% versus 17.4%, p=0.557). Diagnosis of pneumococcal infection post-vaccination improved when PCR was used compared to culture (21.6% versus 6%, p=0.0004). Serotypes included in PCV13 but not PCV7 were identified in 75% (18 out of 24) post-vaccination. Infection with nonvaccine pneumococcal serotypes continues to be a significant cause of pneumonia in children in the UK.
authors.affiliation: Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Elemraid
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Sails
authors.forename: Gary J A
authors.initials: GJ
authors.lastname: Eltringham
authors.forename: John D
authors.initials: JD
authors.lastname: Perry
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Rushton
authors.forename: David A
authors.initials: DA
authors.lastname: Spencer
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Thomas
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Eastham
authors.forename: Fiona
authors.initials: F
authors.lastname: Hampton
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Gennery
authors.forename: Julia E
authors.initials: JE
authors.lastname: Clark
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D022242:Pneumococcal Vaccines / Q000627:therapeutic use*; D011014:Pneumonia / Q000150:complications* / Q000453:epidemiology / Q000517:prevention & control; D011018:Pneumonia, Pneumococcal / Q000453:epidemiology / Q000517:prevention & control; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D012698:Serologic Tests; D013290:Streptococcal Infections / Q000453:epidemiology / Q000517:prevention & control; D006113:United Kingdom / Q000453:epidemiology; D018074:Vaccines, Conjugate / Q000627:therapeutic use; D014777:Virus Diseases / Q000453:epidemiology / Q000517:prevention & control
chemical_list: D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate