title: Complications of Pneumococcal Bacteremia After Thirteen-valent Conjugate Vaccine Withdrawal.
abstract: In the Region of Madrid, universal immunization with the 13-serotypes pneumococcal conjugate vaccine (PCV13) started in May 2010. In July 2012, public funding ceased. Vaccination coverage decreased from >95% to 82% in 2013 and to 67% in 2014. Our aim was to investigate the impact of PCV13 withdrawal from Madrid Region universal immunization program on the incidence of complicated pneumococcal bacteremia.
  
  
  
  We performed a multicenter retrospective cohort study, from 2009 to 2014. Participants were children aged <14 years with Streptococcus pneumoniae bacteremia. Complications were defined as any condition requiring intensive care or surgery. Sequelae were conditions lasting ≥90 days.
  
  
  
  A total of 168 patients were recruited. One-fourth of both immunized and nonimmunized patients had complications. Global complications increased after PCV13 withdrawal. About 28% of PCV13 serotypes presented complications. Complications caused by PCV13 serotypes did not increase after July 2012. Non-PCV13 serotypes increased progressively from 2009 on, and 23% presented complications. A significant risk of complications was found for patients with meningitis, empyema, C-reactive protein >100 mg/L and serotype 1. A multivariate analysis indicated that complications were associated with meningitis and hospital admission after July 2012. Sequelae were significantly associated with children <2 years of age, meningitis and non-PCV13 serotypes.
  
  
  
  The incidence of complications caused by PCV13 serotypes did not increase 2 years after PCV13 withdrawal. Nevertheless, all-serotypes complications increased. The likely cause was that non-PCV13 serotypes (associated with meningitis) are on the rise.
authors.affiliation: From the *Pediatrics Department, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain; †Biomedical School, Universidad Europea de Madrid, Madrid, Spain; ‡Pediatrics, Tropical and Infectious Diseases Department, Hospital Universitario La Paz, Madrid, Spain; §Microbiology Department, Laboratory BR, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain; ¶Pediatrics Department, Hospital Universitario Ramón y Cajal, Madrid, Spain; and ‖Regional Public Health Laboratory, Comunidad de Madrid, Madrid, Spain.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Tagarro
authors.forename: Patricia
authors.initials: P
authors.lastname: Bote
authors.forename: Aida
authors.initials: A
authors.lastname: Sánchez
authors.forename: Enrique
authors.initials: E
authors.lastname: Otheo
authors.forename: Juan-Carlos
authors.initials: JC
authors.lastname: Sanz
authors.forename: David
authors.initials: D
authors.lastname: Sanz-Rosa
mesh_terms: D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011008:Pneumococcal Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D022242:Pneumococcal Vaccines; D012189:Retrospective Studies; D013296:Streptococcus pneumoniae
chemical_list: C538862:13-valent pneumococcal vaccine; D022242:Pneumococcal Vaccines