title: Incidence of invasive pneumococcal disease in 5-15 year old children with and without comorbidities in Germany after the introduction of PCV13: Implications for vaccinating children with comorbidities.
abstract: OBJECTIVE
  To describe the burden of suffering from IPD in children aged 5-15 years with and without comorbidities up to 5 years after the introduction of PCV13 in Germany and to identify the potential benefit for PCV13 and PPV23 vaccination.
  
  
  METHODS
  The surveillance of IPD for children <16 years was based on two independently reporting sources: active surveillance in pediatric hospitals and a laboratory-based sentinel surveillance system.
  
  
  METHODS
  IPD with cultural detection of pneumococci at a physiologically sterile site in children from 2010 to 2014 in Germany. Incidence was estimated by capture-recapture analysis with stratification by absence/presence of comorbidities. Coverage of the observed serotypes by different vaccines was assessed.
  
  
  RESULTS
  142 (Capture recapture-corrected: 437) cases were reported: 72.5% were healthy children and 27.5% had a comorbidity. The incidence of IPD related to children with comorbidities was 0.2 per 100,000. One third of these cases had serotypes not included in either vaccine. The remaining cases might benefit from pneumococcal vaccination but one third of all cases was not vaccinated. The additional potential benefit of PPV23 compared to PCV13 with respect to coverage was 10%.
  
  
  CONCLUSIONS
  The incidence of IPD in children with comorbidities in Germany is low. Pneumococcal vaccination uptake in children with comorbidities should be increased, although only about two-thirds of the cases might be preventable by presently available vaccines.
authors.affiliation: Division of Epidemiology, Institute of Social Pediatrics and Adolescent Medicine, Ludwig-Maximilians-University Munich, Munich, Germany. Electronic address: Raphael.Weinberger@med.uni-muenchen.de.
authors.forename: Raphael
authors.initials: R
authors.lastname: Weinberger
authors.affiliation: Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Falkenhorst
authors.affiliation: Mikrobiologisches Institut - Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Bogdan
authors.affiliation: National Reference Centre for Streptococci, Institute of Medical Microbiology, University Hospital RWTH, Aachen, Germany.
authors.forename: Mark
authors.initials: M
authors.lastname: van der Linden
authors.affiliation: National Reference Centre for Streptococci, Institute of Medical Microbiology, University Hospital RWTH, Aachen, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Imöhl
authors.affiliation: Division of Epidemiology, Institute of Social Pediatrics and Adolescent Medicine, Ludwig-Maximilians-University Munich, Munich, Germany.
authors.forename: Rüdiger
authors.initials: R
authors.lastname: von Kries
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D006776:Hospitals, Pediatric; D006801:Humans; D015994:Incidence; D008297:Male; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000276:immunology / Q000517:prevention & control; D022242:Pneumococcal Vaccines / Q000008:administration & dosage / Q000276:immunology; D018571:Sentinel Surveillance; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000276:immunology / Q000302:isolation & purification; D014611:Vaccination; D018074:Vaccines, Conjugate / Q000008:administration & dosage / Q000276:immunology
chemical_list: C538862:13-valent pneumococcal vaccine; D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate
keywords: Children with comorbidities; Germany; Invasive pneumococcal disease; Pneumococcal conjugate vaccination; School-aged children; Vaccination implication