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Moral L, Toral T, Marco N, Clavijo A, Canals F, Forniés MJ, González MC, Moral J, Márquez M, Lucas R, Caballero M, Huertas AM, García-Avilés B, Belda M. Epidemiology of pediatric parapneumonic pleural effusion during 13-valent pneumococcal conjugate vaccine implementation. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022:S2529-993X(22)00175-7. [PMID: 35985928 DOI: 10.1016/j.eimce.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 01/07/2022] [Accepted: 01/17/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The reported incidence of parapneumonic pleural effusion, including empyema, has shown fluctuations in the last decades. It has been related to the implementation of different types of conjugate pneumococcal vaccines. METHODS We have retrospectively reviewed data from all 10 public hospitals in Alicante Province (Spain) covering a population of 279,000 children under 15 years of age, between 2010 and 2018. Effusions less than 10 mm (PE-) and those of 10 mm or more (PE+) were separated. RESULTS A total of 366 episodes of parapneumonic pleural effusion have been analyzed, 178 PE- (48.6%) and 188 PE+ (51.4%), with a median age of 4 years (interquartile range: 2-7 years) and marked seasonality with the maximum in winter and the minimum in summer. A culture proven bacterial agent was identified in 34 patients (9.3%), mainly Streptococcus pneumoniae (24 patients) followed by Streptococcus pyogenes (7 patients). The most frequent S. pneumoniae serotype was 19A (6 patients) and 3 vaccine failures were observed. The mean annual incidence rate was 14.3 cases per 100,000 children under 15 years of age (7.0 for PE- and 7.3 for PE+). No significant changes were observed in incidence over time, but noticeable differences in incidence were observed in different health departments. CONCLUSIONS We have not found temporal variations in incidence of parapneumonic effusion despite the implementation of the 13-valent pneumococcal conjugate vaccine. The unexplained disparity in incidence between close departments is noteworthy.
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Affiliation(s)
- Luis Moral
- Unidad de Neumología y Alergología Pediátrica, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain.
| | - Teresa Toral
- Unidad de Neumología y Alergología Pediátrica, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Nuria Marco
- Servicio de Pediatría, Hospital Vega Baja, Orihuela, Alicante, Spain
| | - Agustín Clavijo
- Servicio de Pediatría, Hospital Marina Baixa, Villajoyosa, Alicante, Spain
| | - Francisco Canals
- Servicio de Pediatría, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | - María José Forniés
- Servicio de Pediatría, Hospital Universitario Virgen de la Salud, Elda, Alicante, Spain
| | | | - Jorge Moral
- Facultad de Medicina, Universidad Miguel Hernández, Sant Joan d'Alacant, Alicante, Spain
| | - Marta Márquez
- Servicio de Pediatría, Hospital General Universitario de Alicante, Alicante, Spain
| | - Raquel Lucas
- Servicio de Pediatría, Hospital Marina Salud, Denia, Alicante, Spain
| | - María Caballero
- Servicio de Pediatría, Hospital Universitario del Vinalopó, Elche, Alicante, Spain
| | - Ana María Huertas
- Servicio de Pediatría, Hospital Universitario del Vinalopó, Elche, Alicante, Spain
| | - Belén García-Avilés
- Servicio de Pediatría, Hospital Clínico Universitario de Sant Joan d'Alacant, Sant Joan d'Alacant, Alicante, Spain
| | - Mónica Belda
- Servicio de Pediatría, Hospital Virgen de los Lirios, Alcoy, Alicante, Spain
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Epidemiología del derrame pleural paraneumónico en la infancia durante la implementación de la vacuna antineumocócica conjugada de 13 serotipos. Enferm Infecc Microbiol Clin 2022. [DOI: 10.1016/j.eimc.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Eichler N, Joseph L, Megged O, Goldberg S, Picard E. The impact of pneumococcal conjugate vaccine on the prevalence and severity of hospitalizations for pneumonia in children. Eur J Clin Microbiol Infect Dis 2022; 41:439-444. [PMID: 34997390 DOI: 10.1007/s10096-021-04386-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 11/20/2021] [Indexed: 11/03/2022]
Abstract
Pneumococcal conjugate vaccines (PCV) were introduced into the Israeli national immunization plan starting with the heptavalent PCV7 in 2009 and then PCV13 in the late 2010. The objective of this study was to determine the vaccines' impact on hospitalization rates for community-acquired pneumonia on the severity of the pneumonia episodes and upon pneumococcal serotype distribution. We retrospectively reviewed all children hospitalized in our institution with pneumonia, aged between 1 and 16 years, between the years 2006 and 2015. Demographic, clinical, and laboratory data between three time periods: pre-PCV, PCV7, and PCV13, were compared. During the study period, 1375 children were hospitalized with pneumonia. A gradual decline in hospitalization rates due to pneumonia was observed starting in 2006 in the pre-PCV period and continued until after the introduction of PCV13. A similar trend was observed in pneumonias with a culture positive for S. pneumoniae. Pleural effusion was observed in 24% of all pneumonias, and this percentage was stable throughout the study period. The average age at hospitalization increased during the study period, as did the average duration of hospital stay. Pneumococcal serotypes included in the vaccine were isolated less frequently during the study and non-vaccine serotypes tended to appear more frequently. Pediatric pneumonia hospitalization rates continued to decline since the introduction of PCV without increasing the frequency of complications. Pneumococcal serotype distribution shifted in parallel. Our findings confirm the efficacy of PCV and support the evidence to include more serotypes in the next generation of PCV.
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Affiliation(s)
- Noam Eichler
- Pediatric Pulmonology Institute, Shaare Zedek Medical Center, affiliated with The Hebrew University, School of Medicine, Jerusalem, Israel
| | - Leon Joseph
- Pediatric Pulmonology Institute, Shaare Zedek Medical Center, affiliated with The Hebrew University, School of Medicine, Jerusalem, Israel
| | - Orli Megged
- Pediatric Infectious Unit, Shaare Zedek Medical Center, affiliated with The Hebrew University, School of Medicine, Jerusalem, Israel
| | - Shmuel Goldberg
- Pediatric Pulmonology Institute, Shaare Zedek Medical Center, affiliated with The Hebrew University, School of Medicine, Jerusalem, Israel
| | - Elie Picard
- Pediatric Pulmonology Institute, Shaare Zedek Medical Center, affiliated with The Hebrew University, School of Medicine, Jerusalem, Israel.
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Zhou G, Liu K, Ji X, Fen Y, Gu Y, Ding H. Diagnosis of parapneumonic pleural effusion with serum and pleural fluid Activin A. Clinics (Sao Paulo) 2022; 77:100133. [PMID: 36375297 PMCID: PMC9661670 DOI: 10.1016/j.clinsp.2022.100133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim is to evaluate the diagnostic value of Activin A levels in serum and pleural fluid on Parapneumonic Pleural Effusion (PPE). METHODS The authors collected serum and pleural fluid from 86 PPE and 37 Non-PPE (NPPE) patients. Including Activin A, levels of biomarkers such as Lactate Dehydrogenase (LDH), Procalcitonin (PCT), and C-Reactive Protein (CRP) were measured. All factors were calculated for association with days after admission. The diagnostic potential of biomarkers on PPE was considered by Receiver Operating Characteristic (ROC) curve analysis. RESULTS Levels of Activin A in serum and pleural fluid of PPE patients were significantly higher than those of the NPPE patients. Moreover, concentrations of Activin A in pleural fluid showed a more obvious relevant days after admission. ROC curve analysis found that Activin A in pleural fluid had AUCs of 0.899 with 93% sensitivity and 84% specificity for PPE diagnosis. CONCLUSION Activin A in pleural fluid correlated with disease severity could act to diagnose PPE.
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Affiliation(s)
- Guanghui Zhou
- Department of Pulmonary & Critical Care Medicine, The Affiliated Yixing People's Hospital of Jiangsu University, Yixing, China
| | - Kan Liu
- Department of Pulmonary & Critical Care Medicine, The Affiliated Yixing People's Hospital of Jiangsu University, Yixing, China
| | - Xiuhai Ji
- Department of Oncology, Affiliated Taicang Hospital of Traditional Chinese Medicine, Taicang, China
| | - Yan Fen
- Department of Pulmonary & Critical Care Medicine, The Affiliated Yixing People's Hospital of Jiangsu University, Yixing, China
| | - Yinjie Gu
- Department of Oncology, Affiliated Taicang Hospital of Traditional Chinese Medicine, Taicang, China.
| | - Hui Ding
- Department of Pulmonary & Critical Care Medicine, The Affiliated Yixing People's Hospital of Jiangsu University, Yixing, China.
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Forster J, Piazza G, Goettler D, Kemmling D, Schoen C, Rose M, Streng A, Liese JG. Effect of Prehospital Antibiotic Therapy on Clinical Outcome and Pathogen Detection in Children With Parapneumonic Pleural Effusion/Pleural Empyema. Pediatr Infect Dis J 2021; 40:544-549. [PMID: 33395211 DOI: 10.1097/inf.0000000000003036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Parapneumonic pleural effusion and pleural empyema (PPE/PE) are complications of community-acquired pneumonia. The objective of this study was to analyze prehospital antibiotic therapy (PH-ABT) of children with PPE/PE and investigate its effects on clinical outcome and pathogen detection. METHODS Prospective nationwide active surveillance in Germany between October 2010 and June 2018. Children and adolescents <18 years of age with pneumonia-associated PE or PPE requiring drainage or with persistence of PPE/PE >7 days were included. RESULTS A total of 1724 children with PPE/PE were reported, of whom 556 children (32.3% of 1719 with available data) received PH-ABT. Children with PH-ABT had a shorter median hospital length of stay (15 vs. 18 days, P < 0.001), a longer time from onset of symptoms until hospital discharge (25 vs. 23 days, P = 0.002), a lower rate of intensive care unit admission (58.3% vs. 64.4%, P = 0.015) and fewer infectious complications (5.9% vs. 10.0%; P = 0.005). Bacterial pathogens in blood or pleural fluid culture were detected in 597 (34.5%) of 1513 children. Positive culture results were less frequent in children with than without PH-ABT (81/466 [17.4%] vs. 299/1005 [29.8%]; P < 0.001), whereas detection rates in pleural fluid samples by polymerase chain reaction were similar (91/181 [50.3%] vs. 220/398 [55.3%]; P = 0.263). CONCLUSIONS In children with PPE/PE, PH-ABT significantly reduced the overall rate of bacterial pathogen detection by culture, but not by polymerase chain reaction. PH-ABT was associated with a lower rate of infectious complications but did not affect the overall duration of disease. We therefore speculate that the duration of PPE/PE is mainly a consequence of an infection-induced inflammatory process, which can only partially be influenced by antibiotic treatment.
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Affiliation(s)
- Johannes Forster
- From the University of Wuerzburg, Institute of Hygiene and Microbiology, Wuerzburg, Germany
| | - Giuseppina Piazza
- From the University of Wuerzburg, Institute of Hygiene and Microbiology, Wuerzburg, Germany
- Department of Pediatrics, University Hospital of Wuerzburg, Wuerzburg, Germany
- Klinikum Stuttgart, Olgahospital- Pediatric Pulmonology, Stuttgart, Germany
| | - David Goettler
- Department of Pediatrics, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Daniel Kemmling
- Department of Pediatrics, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Christoph Schoen
- From the University of Wuerzburg, Institute of Hygiene and Microbiology, Wuerzburg, Germany
| | - Markus Rose
- Klinikum Stuttgart, Olgahospital- Pediatric Pulmonology, Stuttgart, Germany
| | - Andrea Streng
- Department of Pediatrics, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - Johannes G Liese
- Department of Pediatrics, University Hospital of Wuerzburg, Wuerzburg, Germany
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Valdivielso Martínez AI, Ramos Fernández JM, Pérez Frías J, Moreno Pérez D. Influence of pneumococcal vaccination on the hospitalization of healthy pediatric patients due to typical Community-Acquired Pneumonia. Int J Infect Dis 2020; 98:194-199. [PMID: 32553718 DOI: 10.1016/j.ijid.2020.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION Community-Acquired Pneumonia (CAP) is one of the most frequent causes of hospital admission in children. Our objective is to measure the impact of the introduction of pneumococcal conjugate vaccines on the hospitalization of previously healthy children due to CAP. METHOD From 2011 to 2016, a partially retrospective, prospective, and descriptive study was carried out on healthy pediatric patients (3 months-14 years old) with CAP, who required hospital admission. Clinical, epidemiological, and demographic characteristics were collected, and vaccination status was obtained from medical records. RESULTS A total of 292 cases were included, with a mean age of 33.4 months, 54% males. There was a progressive and significant 42% decrease in the number of admissions each year, without significant changes in the annual percentage of parapneumonic pleural effusion (PPE). Fifty-six percent of patients were immunized with a pneumococcal conjugate vaccine (PCV). The percentage of children who were not vaccinated decreased by 14%, and the coverage with PCV-13 increased by 46%. This revealed a significant increase of PPE in vaccinated patients with PCV-7 (63%) compared with unvaccinated (45%) and with PCV-13 (57%), without association with the presence of severe PPE. Moreover, no significant differences in severity or hospital stay were observed in unvaccinated patients, compared to those who were vaccinated. In >2-year-olds, we observed a significant increase in PPE (59%) compared to 45% in younger children. CONCLUSIONS The increase in vaccination coverage with PCV-13 resulted in a decrease in hospitalizations due to CAP and PPE. Vaccination with PCV-7 is associated in our sample with an increase in PPE but not with severe PPE nor an increase in the hospital stay. There was an epidemiological shift of severe forms of pneumonia and empyema at later ages (>2 years).
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Affiliation(s)
- Ana Isabel Valdivielso Martínez
- Pediatría Distrito Sanitario Málaga-Guadalhorce, Pediatría Hospital Regional Universitario de Málaga, Programa del Doctorado de Universidad de Ciencias de la Salud.
| | - Jose Miguel Ramos Fernández
- Facultativo Especialista de Área de Neuropediatría, Pediatría Hospital Materno-Infantil Regional Universitario de Málaga, Grupo de Investigación IBIMA; Departamento de Pediatría y Farmacología, Facultad de Medicina, Universidad de Málaga
| | - Javier Pérez Frías
- Facultativo Especialista de Área de Neumología pediátrica, Pediatría Hospital Materno-Infantil Regional Universitario de Málaga, Grupo de Investigación IBIMA; Profesor Catedrático del Departamento de Pediatría y Farmacología, Facultad de Medicina, Universidad de Málaga
| | - David Moreno Pérez
- Departamento de Pediatría y Farmacología, Facultad de Medicina, Universidad de Málaga; Infectología Pediátrica e Inmunodeficiencias, UGC Pediatría, Hospital Materno-Infantil, Hospital Regional Universitario de Málaga, Málaga, Spain; Grupo de Investigación IBIMA; Red de Investigación Translacional en Infectología Pediátrica (RITIP)
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Increase in Streptococcus pneumoniae serotype 3 associated parapneumonic pleural effusion/empyema after the introduction of PCV13 in Germany. Vaccine 2019; 38:570-577. [PMID: 31735502 DOI: 10.1016/j.vaccine.2019.10.056] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/19/2019] [Accepted: 10/21/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Pediatric pneumococcal pneumonia complicated by parapneumonic pleural effusion/empyema (PPE/PE) remains a major concern despite general immunization with pneumococcal conjugate vaccines (PCVs). METHODS In a nationwide pediatric hospital surveillance study in Germany we identified 584 children <18 years of age with bacteriologically confirmed PPE/PE from October 2010 to June 2018. Streptococcus pneumoniae was identified by culture and/or PCR of blood samples and/or pleural fluid and serotyped. RESULTS S. pneumoniae was identified in 256 of 584 (43.8%) children by culture (n = 122) and/or PCR (n = 207). The following pneumococcal serotypes were detected in 114 children: serotype 3 (42.1%), 1 (25.4%), 7F (12.3%), 19A (7.9%), other PCV13 serotypes (4.4%) and non-PCV13 serotypes (7.9%). Between October 2010 and June 2014 serotype 1 (38.1%) and serotype 3 (25.4%) were most prevalent, whereas between July 2014 and June 2018 serotype 3 (62.7%) and non-PCV13 serotypes (15.7%) were dominant. Compared to children with other pneumococcal serotypes, children with serotype 3 associated PPE/PE were younger (median 3.2 years [IQR 2.1-4.3 years] vs. median 5.6 years [IQR 3.8-8.2 years]; p < 0.001) and more frequently admitted to intensive care (43 [89.6%] vs. 48 [73.8%]; p = 0.04). Seventy-six of 114 (66.7%) children with pneumococcal PPE/PE had been vaccinated with pneumococcal vaccines. Thirty-nine of 76 (51.3%) had received a vaccine covering the serotype detected. Thirty of these 39 breakthrough cases were age-appropriately vaccinated with PCV13 and considered vaccine failures, including 26 children with serotype 3, three children with serotype 19A and one child with serotype 1. CONCLUSION Following the introduction of PCV13 in general childhood vaccination we observed a strong emergence of serotype 3 associated PPE/PE in the German pediatric population, including a considerable number of younger children with serotype 3 vaccine breakthrough cases and failures. Future PCVs should not only cover newly emerging serotypes, but also include a more effective component against serotype 3.
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