title: Invasive pneumococcal disease, comorbidities, and polysaccharide vaccine use in children aged 5-15 years in England and Wales.
abstract: BACKGROUND
  In the United Kingdom, the 23-valent pneumococcal polysaccharide vaccine (PPV23) is recommended in addition to routine pneumococcal conjugate vaccination for at-risk children aged ≥2 years. This study describes the epidemiology, serotype distribution, clinical characteristics, vaccination status, and reasons for nonvaccination in children aged 5-15 years with invasive pneumococcal disease (IPD).
  
  
  METHODS
  Public Health England conducts enhanced national surveillance of IPD in England and Wales. In 2012, general practitioners (GPs) were contacted to complete a questionnaire for children aged 5-15 years with laboratory-confirmed IPD diagnosed during 2 epidemiological years, July 2009-June 2011.
  
  
  RESULTS
  During 2009-2011, 447 IPD episodes occurred in 439 children (incidence, 2.2/100 000), and GPs of 423 of the 439 (96.4%) children completed the questionnaire. Comorbidity was reported in 124 (29.3%); a third each were immunocompromised or had chronic respiratory disease or other comorbidities. Pneumonia was the most common presentation (332/439 [75.6%]), and IPD-related case fatality was 1.8% (8/439). Only 26.6% (33/124) of children with comorbidities had received PPV23, and development of PPV23-type IPD was not associated with prior PPV23 vaccination (adjusted odds ratio [AOR], 1.09; 95% confidence interval [CI], .36-3.32; P = .88), even when analysis was restricted to the extra 11 PPV23 serotypes not contained in the 13-valent pneumococcal conjugate vaccine (AOR, 1.70; 95% CI, .30-9.76; P = .55). GPs of eligible but unvaccinated cases with comorbidities were mostly unaware that the child required PPV23 and/or expected pediatricians to inform them to administer the vaccine.
  
  
  CONCLUSIONS
  Only a quarter of children with comorbidities who developed IPD had received PPV23 prior to infection. Among PPV23-vaccinated children with comorbidities, however, there was no evidence of protection against PPV23 serotypes.
authors.affiliation: Immunisation, Hepatitis and Blood Safety Department, Public Health England, London.
authors.forename: Shamez N
authors.initials: SN
authors.lastname: Ladhani
authors.forename: Nick J
authors.initials: NJ
authors.lastname: Andrews
authors.forename: Pauline
authors.initials: P
authors.lastname: Waight
authors.forename: Ray
authors.initials: R
authors.lastname: Borrow
authors.forename: Mary P E
authors.initials: MP
authors.lastname: Slack
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Miller
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D004739:England / Q000453:epidemiology; D062665:Epidemiological Monitoring; D005260:Female; D006801:Humans; D008297:Male; D011008:Pneumococcal Infections / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage / Q000009:adverse effects* / Q000276:immunology; D011795:Surveys and Questionnaires; D014611:Vaccination; D014852:Wales / Q000453:epidemiology
chemical_list: C414006:23-valent pneumococcal capsular polysaccharide vaccine; D022242:Pneumococcal Vaccines
keywords: comorbidity; pneumonia; serotype distribution; vaccine effectiveness; vaccine impact