title: Pneumococcal Pneumonia Requiring Hospitalization in US Children in the 13-Valent Pneumococcal Conjugate Vaccine Era.
abstract: The impact of PCV13 on a number of clinical aspects of pneumococcal pneumonia (PP) in children has not been reported. We compared the serotype distribution, antibiotic susceptibility, and outcomes of children with PP 4 years before and 4 years after the introduction of PCV13.
  We identified patients ≤18 years with PP at 8 children's hospitals in the United States (2006-2014). Pneumococcal isolates were collected prospectively. Serotyping and antibiotic susceptibility were performed in a central laboratory. Clinical and laboratory data were collected retrospectively. Annual pneumococcal pneumonia hospitalization rates per 100 000 admissions with 95% confidence intervals were calculated. Dichotomous variables were analyzed by χ2 test and continuous variables with Mann-Whitney U test.
  A total of 377 patients with PP requiring hospitalization were identified. Hospitalization rates of PP decreased from 53.6 to 23.3 per 100000 admissions post PCV13 (P < .0001). Complicated PP rates also decreased (P < .0001). Need for intensive care, mechanical ventilation, and invasive procedure remained unchanged after the introduction of PCV13. Comorbidities were more common among children with uncomplicated than complicated pneumonia (52.2% vs. 22.5%, P < .001). Overall, PCV13 serotypes 19A, 3, 7F, and 1 caused 80% of PP. Hospitalization rates of PCV13 serotype pneumonia decreased from 47.2 to 15.7 per 100000 admissions post PCV13. In 2014, the most common serotypes were 3, 19A and 35B.
  PP requiring hospitalization significantly decreased in children after PCV13 introduction. Complicated PP rates decreased steadily in 2011-2014. PCV13 serotypes 19A and 3 were still responsible for half of the cases of PP in 2011-2014.
authors.affiliation: Departments of Pediatrics of Baylor College of Medicine, Houston, Texas.
authors.forename: Liset
authors.initials: L
authors.lastname: Olarte
authors.affiliation: Ohio State University College of Medicine, Columbus.
authors.forename: William J
authors.initials: WJ
authors.lastname: Barson
authors.affiliation: Ohio State University College of Medicine, Columbus.
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Barson
authors.affiliation: University of Arkansas for Medical Sciences, Little Rock.
authors.forename: José R
authors.initials: JR
authors.lastname: Romero
authors.affiliation: Rady Children's Hospital San Diego, California.
authors.forename: John S
authors.initials: JS
authors.lastname: Bradley
authors.affiliation: Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Tina Q
authors.initials: TQ
authors.lastname: Tan
authors.affiliation: Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Laurence B
authors.initials: LB
authors.lastname: Givner
authors.affiliation: University of Southern California School of Medicine, Los Angeles; and.
authors.forename: Jill A
authors.initials: JA
authors.lastname: Hoffman
authors.affiliation: Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pennsylvania.
authors.forename: Philana Ling
authors.initials: PL
authors.lastname: Lin
authors.affiliation: Departments of Pediatrics of Baylor College of Medicine, Houston, Texas.
authors.forename: Kristina G
authors.initials: KG
authors.lastname: Hultén
authors.affiliation: Departments of Pediatrics of Baylor College of Medicine, Houston, Texas.
authors.forename: Edward O
authors.initials: EO
authors.lastname: Mason
authors.affiliation: Departments of Pediatrics of Baylor College of Medicine, Houston, Texas.
authors.forename: Sheldon L
authors.initials: SL
authors.lastname: Kaplan
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D006760:Hospitalization; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D022242:Pneumococcal Vaccines; D011018:Pneumonia, Pneumococcal / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D012189:Retrospective Studies; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification / Q000276:immunology / Q000302:isolation & purification; D014481:United States / Q000453:epidemiology
chemical_list: C538862:13-valent pneumococcal vaccine; D022242:Pneumococcal Vaccines
keywords: PCV13; Streptococcus pneumoniae; empyema; pneumococcal disease.; pneumonia