Influence of pneumococcal vaccination on the hospitalization of healthy pediatric patients due to typical Community-Acquired Pneumonia

• Published in: International journal of infectious diseases 2020-09, Vol.98, p.194-199
• Main Authors: Valdivielso Martínez, Ana Isabel, Ramos Fernández, Jose Miguel, Pérez Frías, Javier, Moreno Pérez, David
• Format: Article
• Language: English
• Subjects: Pneumococcal conjugates vaccines; Pneumonia in children
• ISSN: 1201-9712; 1878-3511
• DOI: 10.1016/j.ijid.2020.06.034

•The vaccination of healthy children with pneumococcal vaccines has been followed by a decrease in hospital admissions due to pneumonia and pleural effusion.•After the introduction of pneumococcal vaccines, severe forms of pneumonia and empyema have been displaced in children older than 2 years.•Vaccination with heptavalent pneumococcal vaccine is associated with a higher risk of pleural effusion, but not with longer hospitalization. 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. 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. 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. 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).