title: Early impact of 13-valent pneumococcal conjugate vaccine on community-acquired pneumonia in children.
abstract: BACKGROUND
  Pneumococcal serotypes 1, 3, 5, 7F, and 19A were the most implicated in community-acquired pneumonia (CAP) after implementation of 7-valent pneumococcal conjugate vaccine (PCV7). In France, the switch from PCV7 to 13-valent pneumococcal conjugate vaccine (PCV13) occurred in June 2010. An active surveillance network was set up to analyze the impact of PCV13 on CAP.
  
  
  METHODS
  An observational prospective study performed in 8 pediatric emergency departments from June 2009 to May 2012 included all children between 1 month and 15 years of age with chest radiography-confirmed pneumonia. Three 1-year periods were defined: pre-PCV13, transitional, and post-PCV13.
  
  
  RESULTS
  During the 3-year study period, among the 953 274 pediatric emergency visits, 5645 children with CAP were included. CAP with pleural effusion and documented pneumococcal CAP were diagnosed in 365 and 136 patients, respectively. Despite an increase (4.5%) in number of pediatric emergency visits, cases of CAP decreased by 16% (2060 to 1725) between pre- and post-PCV13 periods. The decrease reached 32% in infants in the same periods (757 to 516; P < .001). Between pre- and post-PCV13 periods, the proportion of CAP patients with a C-reactive protein level >120 mg/dL decreased from 41.3% to 29.7% (P < .001), the number of pleural effusion cases decreased by 53% (167 to 79; P < .001) and the number of pneumococcal CAP cases decreased by 63% (64 to 24; P = .002). The number of additional PCV13 serotypes identified decreased by 74% (27 to 7).
  
  
  CONCLUSIONS
  Our data suggest a strong impact of PCV13 on CAP, pleural effusion, and documented pneumococcal pneumonia, particularly cases due to PCV13 serotypes.
authors.affiliation: Groupe de Pathologie Infectieuse Pédiatrique, Société Francaise de Pédiatrie.
authors.forename: F
authors.initials: F
authors.lastname: Angoulvant
authors.forename: C
authors.initials: C
authors.lastname: Levy
authors.forename: E
authors.initials: E
authors.lastname: Grimprel
authors.forename: E
authors.initials: E
authors.lastname: Varon
authors.forename: M
authors.initials: M
authors.lastname: Lorrot
authors.forename: S
authors.initials: S
authors.lastname: Biscardi
authors.forename: P
authors.initials: P
authors.lastname: Minodier
authors.forename: M A
authors.initials: MA
authors.lastname: Dommergues
authors.forename: L
authors.initials: L
authors.lastname: Hees
authors.forename: Y
authors.initials: Y
authors.lastname: Gillet
authors.forename: I
authors.initials: I
authors.lastname: Craiu
authors.forename: F
authors.initials: F
authors.lastname: Zenkhri
authors.forename: F
authors.initials: F
authors.lastname: Dubos
authors.forename: C Gras-Le
authors.initials: CG
authors.lastname: Guen
authors.forename: E
authors.initials: E
authors.lastname: Launay
authors.forename: A
authors.initials: A
authors.lastname: Martinot
authors.forename: R
authors.initials: R
authors.lastname: Cohen
mesh_terms: D002097:C-Reactive Protein; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000517:prevention & control*; D005602:France / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008297:Male; D022242:Pneumococcal Vaccines / Q000627:therapeutic use*; D011018:Pneumonia, Pneumococcal / Q000453:epidemiology / Q000517:prevention & control*; D011446:Prospective Studies; D018074:Vaccines, Conjugate / Q000627:therapeutic use
chemical_list: C538862:13-valent pneumococcal vaccine; D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate; D002097:C-Reactive Protein
keywords: PCV13; community-acquired pneumonia; pediatric; pneumococcal infections; vaccination