Pneumonia with empyema among children in the first five years of high coverage with 13-valent pneumococcal conjugate vaccine.
BACKGROUND
Parapneumonic effusions in children are usually associated with pneumococcal infections. In Greece, the 7-valent pneumococcal conjugate vaccine was replaced by higher-valent pneumococcal conjugate vaccines (PCVs); 10-valent was introduced in May 2009 and 13-valent (PCV13) in June 2010. Since July 2010, PCV13 has been the most commonly used PCV. In a study conducted at the University General Hospital of Larissa, Central Greece, from January 2012 to January 2016, 85.7% of children born after the implementation of PCV13 and aged 24-59 months had received the complete series (3 + 1 immunization schedule) of PCV13.


METHODS
We studied all paediatric community-acquired pneumonia cases with empyema hospitalized at the University General Hospital of Larissa from January 2008 to January 2016.


RESULTS
There were 30 cases of parapneumonic empyema. Among 27 empyema cases of known aetiology, 19 (70.4%) were due to Streptococcus pneumoniae (identifiable serotypes 3, 19A, 7F, and 9N/L). After September 2011, no more cases caused by serotypes 7F and 19A were observed, whereas serotype 3 emerged as the predominant pathogen of pneumococcal empyema (9 of 11 cases). Serotype 3 continued to cause empyema despite vaccination with PCV13 either fully with a 3 + 1 schedule (n = 3) or with one booster dose at the age of 21 months (n = 1).


CONCLUSIONS
In Central Greece during the first five years of high coverage with PCV13, serotype 3 was the only PCV13 serotype that clearly persisted in children with empyema.
a Department of Paediatrics , University of Thessaly, School of Health Sciences, Faculty of Medicine , Larissa , Greece ;
George A
GA
Syrogiannopoulos
a Department of Paediatrics , University of Thessaly, School of Health Sciences, Faculty of Medicine , Larissa , Greece ;
Aspasia N
AN
Michoula
b Department of Radiology , University of Thessaly, School of Health Sciences, Faculty of Medicine , Larissa , Greece ;
Georgios
G
Tsimitselis
b Department of Radiology , University of Thessaly, School of Health Sciences, Faculty of Medicine , Larissa , Greece ;|c Department of Anatomy , University of Thessaly, School of Health Sciences, Faculty of Medicine , Larissa , Greece.
Katerina
K
Vassiou
a Department of Paediatrics , University of Thessaly, School of Health Sciences, Faculty of Medicine , Larissa , Greece ;
Denise C
DC
Chryssanthopoulou
a Department of Paediatrics , University of Thessaly, School of Health Sciences, Faculty of Medicine , Larissa , Greece ;
Ioanna N
IN
Grivea
D002648:Child; D002675:Child, Preschool; D004653:Empyema / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D005260:Female; D006115:Greece / Q000453:epidemiology; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*; D011018:Pneumonia, Pneumococcal / Q000150:complications* / Q000453:epidemiology*; D011446:Prospective Studies; D065288:Serogroup; D013296:Streptococcus pneumoniae / Q000145:classification* / Q000302:isolation & purification; D014611:Vaccination / Q000706:statistics & numerical data*
C538862:13-valent pneumococcal vaccine; D022242:Pneumococcal Vaccines
10-valent pneumococcal conjugate vaccine; 13-valent pneumococcal conjugate vaccine; parapneumonic effusion; pneumococcal conjugate vaccine; pneumococcal parapneumonic empyema