Analysis of Invasive Pneumococcal Infections Due to 13-Pneumococcal Conjugate Vaccine Serotypes at 8 US Children’s Hospitals During 2014 to 2016

Abstract

Background. The 13-Valent Pneumococcal Conjugate Vaccine (PCV13) was licensed in 2010 and is directed against serotypes (ST)1,3, 4, 5, 6A, 6B, 7F, 9 V, 14, 18C, 19A, 19F, and 23F. Details of cases of invasive pneumococcal disease (IPD) due to PCV13 ST since 2010 in the US are sparse. We describe IPD cases due to PCV13 ST seen at 8 US children's hospitals over years 2014 to 2016 which may aid in understanding why some IPD cases due to these ST have persisted. Methods. Children with IPD have been prospectively identified at 8 children's hospitals in the US since 1993. Data from 2014 through 2016 were analyzed. Demographic, clinical data and number and dates of PCV doses were collected on case report forms and isolates were sent to a central laboratory for serotyping. PCV doses are counted if IPD occurred > 2 weeks After a dose. Results. PCV13 ST accounted for 19.7% (27/137), 26.8% (30/112) and 26% (33/127) of IPD cases in 2014, 2015 and 2016, respectively. ST 3, 19A and 19F accounted for 90% of the PCV13 ST IPD cases. >50% of the children had received ≤2 doses of PCV13 prior to IPD. (Table) Of the 30 children with 0 doses of PCV, 15 were of an age at diagnosis for which ≥ 2 doses of PCV was recommended. An underlying condition was noted in 18. For PCV13 ST, the types of IPD were pneumonia (n = 39), mastoiditis (n =15), bacteremia (n = 15), meningitis (n = 12) and other sites of infection (n = 9). Whereas the numbers of yearly cases were similar for ST3 (12, 10, 13) and ST19A (8, 10, 6), the numbers for 19F increased slightly (3, 8, 10). Conclusion. Four to 6 years After PCV13 was introduced, PCV13 ST (especially ST 3, 19A and 19F) accounted for about 25% of IPD in children. For all of the PCV13 ST, over half of these IPD cases occurred in children who had received ≤ 2 doses of the recommended PCV schedule; 25% of cases occurred in children who had not received any doses but were of the age at diagnosis that at least 2 PCV doses should have been received. Additional PCV13 ST IPD cases may be preventable if the PCV13 schedule is followed as recommended.