Significant impact of pneumococcal conjugate vaccination on pediatric parapneumonic effusion

Italy 2006-2018

Chiara Azzari, Daniele Serranti, Francesco Nieddu, Maria Moriondo, Arianna Casini, Lorenzo Lodi, Fernando M de Benedictis, Elisa De Vitis, Federica Cavone, Martina Cortimiglia, Giuseppe Indolfi, Enrico Lombardi, Ines Carloni, Renato Cutrera, Ersilia Lucenteforte, Massimo Resti, Silvia Ricci

Research output: Contribution to journalArticle

Abstract

Etiology and serotyping of parapneumonic effusion (PPE) and the impact of vaccination was evaluated over a 12-year period, before and after the PCV13 introduction (2011) for Italian children From 0 to 16 years of age. Five hundred and two children were evaluated; 226 blood and 356 pleural fluid samples were obtained and tested using Realtime-PCR and culture. In the pre-PCV13 era S. pneumoniae was the most frequent pathogen identified (64/90; 71.1%) with a large predominance of serotypes 1 (42.4%), 3 (23.7%), 7F (5.1%) and 19A (11.9%). The impact of vaccination, calculated on children 0-8 years of age, demonstrated a significant reduction of PPE: with an incidence rate of 2.82 (95%CL 2.32-3.41) in the pre-PCV13 era and an age-standardized rate (ASR) of 0.66 (95% CL 0.37-1.99) in the post-PCV13 era, p < 0.0001. No increase in non-PCV13 serotypes was recorded. S. pneumoniae remained the most frequent pathogen identified in the post-PCV13 era in unvaccinated children with an unchanged serotype distribution: respectively 26/66 (39.4%), 25/66 (37.9%), 5/66 (7.6%), and 4/66 (6.1%) for 1, 3, 7F and 19A. On the other hand 7F and 19A disappeared in vaccinated children and serotype 1 and 3 decreased by 91.8% and 31.5%, respectively. Realtime PCR was significantly more sensitive than culture both in pleural fluid (79.7% vs 12.5%) and in blood (17.8% vs 7.4%). In conclusion, our findings indicate that routine immunization with PCV13 has significantly reduced the burden of childhood PPE in vaccinated children, without increasing PPE due to other bacteria and without serotype shift. Moreover, the impact of PCV13 may be underestimated due to the increase in pneumococcal surveillance in Italy. Data has also shown that Real-time PCR is an essential tool to better define the etiology of PPE and to monitor vaccination plans. Longer studies will be necessary to evaluate the role of herd protection in PPE prevention.

Original languageEnglish
JournalVaccine
DOIs
Publication statusE-pub ahead of print - Apr 10 2019

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Italy
Vaccination
vaccination
Pediatrics
serotypes
pneumonia
etiology
Pneumonia
Serotyping
Polymerase Chain Reaction
pathogens
monitoring
blood
childhood
Real-Time Polymerase Chain Reaction
Immunization
immunization
quantitative polymerase chain reaction
herds
Serogroup

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Significant impact of pneumococcal conjugate vaccination on pediatric parapneumonic effusion : Italy 2006-2018. / Azzari, Chiara; Serranti, Daniele; Nieddu, Francesco; Moriondo, Maria; Casini, Arianna; Lodi, Lorenzo; de Benedictis, Fernando M; De Vitis, Elisa; Cavone, Federica; Cortimiglia, Martina; Indolfi, Giuseppe; Lombardi, Enrico; Carloni, Ines; Cutrera, Renato; Lucenteforte, Ersilia; Resti, Massimo; Ricci, Silvia.

In: Vaccine, 10.04.2019.

Research output: Contribution to journalArticle

Azzari, C, Serranti, D, Nieddu, F, Moriondo, M, Casini, A, Lodi, L, de Benedictis, FM, De Vitis, E, Cavone, F, Cortimiglia, M, Indolfi, G, Lombardi, E, Carloni, I, Cutrera, R, Lucenteforte, E, Resti, M & Ricci, S 2019, 'Significant impact of pneumococcal conjugate vaccination on pediatric parapneumonic effusion: Italy 2006-2018', Vaccine. https://doi.org/10.1016/j.vaccine.2019.04.012
Azzari, Chiara ; Serranti, Daniele ; Nieddu, Francesco ; Moriondo, Maria ; Casini, Arianna ; Lodi, Lorenzo ; de Benedictis, Fernando M ; De Vitis, Elisa ; Cavone, Federica ; Cortimiglia, Martina ; Indolfi, Giuseppe ; Lombardi, Enrico ; Carloni, Ines ; Cutrera, Renato ; Lucenteforte, Ersilia ; Resti, Massimo ; Ricci, Silvia. / Significant impact of pneumococcal conjugate vaccination on pediatric parapneumonic effusion : Italy 2006-2018. In: Vaccine. 2019.
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title = "Significant impact of pneumococcal conjugate vaccination on pediatric parapneumonic effusion: Italy 2006-2018",
abstract = "Etiology and serotyping of parapneumonic effusion (PPE) and the impact of vaccination was evaluated over a 12-year period, before and after the PCV13 introduction (2011) for Italian children From 0 to 16 years of age. Five hundred and two children were evaluated; 226 blood and 356 pleural fluid samples were obtained and tested using Realtime-PCR and culture. In the pre-PCV13 era S. pneumoniae was the most frequent pathogen identified (64/90; 71.1{\%}) with a large predominance of serotypes 1 (42.4{\%}), 3 (23.7{\%}), 7F (5.1{\%}) and 19A (11.9{\%}). The impact of vaccination, calculated on children 0-8 years of age, demonstrated a significant reduction of PPE: with an incidence rate of 2.82 (95{\%}CL 2.32-3.41) in the pre-PCV13 era and an age-standardized rate (ASR) of 0.66 (95{\%} CL 0.37-1.99) in the post-PCV13 era, p < 0.0001. No increase in non-PCV13 serotypes was recorded. S. pneumoniae remained the most frequent pathogen identified in the post-PCV13 era in unvaccinated children with an unchanged serotype distribution: respectively 26/66 (39.4{\%}), 25/66 (37.9{\%}), 5/66 (7.6{\%}), and 4/66 (6.1{\%}) for 1, 3, 7F and 19A. On the other hand 7F and 19A disappeared in vaccinated children and serotype 1 and 3 decreased by 91.8{\%} and 31.5{\%}, respectively. Realtime PCR was significantly more sensitive than culture both in pleural fluid (79.7{\%} vs 12.5{\%}) and in blood (17.8{\%} vs 7.4{\%}). In conclusion, our findings indicate that routine immunization with PCV13 has significantly reduced the burden of childhood PPE in vaccinated children, without increasing PPE due to other bacteria and without serotype shift. Moreover, the impact of PCV13 may be underestimated due to the increase in pneumococcal surveillance in Italy. Data has also shown that Real-time PCR is an essential tool to better define the etiology of PPE and to monitor vaccination plans. Longer studies will be necessary to evaluate the role of herd protection in PPE prevention.",
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T1 - Significant impact of pneumococcal conjugate vaccination on pediatric parapneumonic effusion

T2 - Italy 2006-2018

AU - Azzari, Chiara

AU - Serranti, Daniele

AU - Nieddu, Francesco

AU - Moriondo, Maria

AU - Casini, Arianna

AU - Lodi, Lorenzo

AU - de Benedictis, Fernando M

AU - De Vitis, Elisa

AU - Cavone, Federica

AU - Cortimiglia, Martina

AU - Indolfi, Giuseppe

AU - Lombardi, Enrico

AU - Carloni, Ines

AU - Cutrera, Renato

AU - Lucenteforte, Ersilia

AU - Resti, Massimo

AU - Ricci, Silvia

N1 - Copyright © 2019. Published by Elsevier Ltd.

PY - 2019/4/10

Y1 - 2019/4/10

N2 - Etiology and serotyping of parapneumonic effusion (PPE) and the impact of vaccination was evaluated over a 12-year period, before and after the PCV13 introduction (2011) for Italian children From 0 to 16 years of age. Five hundred and two children were evaluated; 226 blood and 356 pleural fluid samples were obtained and tested using Realtime-PCR and culture. In the pre-PCV13 era S. pneumoniae was the most frequent pathogen identified (64/90; 71.1%) with a large predominance of serotypes 1 (42.4%), 3 (23.7%), 7F (5.1%) and 19A (11.9%). The impact of vaccination, calculated on children 0-8 years of age, demonstrated a significant reduction of PPE: with an incidence rate of 2.82 (95%CL 2.32-3.41) in the pre-PCV13 era and an age-standardized rate (ASR) of 0.66 (95% CL 0.37-1.99) in the post-PCV13 era, p < 0.0001. No increase in non-PCV13 serotypes was recorded. S. pneumoniae remained the most frequent pathogen identified in the post-PCV13 era in unvaccinated children with an unchanged serotype distribution: respectively 26/66 (39.4%), 25/66 (37.9%), 5/66 (7.6%), and 4/66 (6.1%) for 1, 3, 7F and 19A. On the other hand 7F and 19A disappeared in vaccinated children and serotype 1 and 3 decreased by 91.8% and 31.5%, respectively. Realtime PCR was significantly more sensitive than culture both in pleural fluid (79.7% vs 12.5%) and in blood (17.8% vs 7.4%). In conclusion, our findings indicate that routine immunization with PCV13 has significantly reduced the burden of childhood PPE in vaccinated children, without increasing PPE due to other bacteria and without serotype shift. Moreover, the impact of PCV13 may be underestimated due to the increase in pneumococcal surveillance in Italy. Data has also shown that Real-time PCR is an essential tool to better define the etiology of PPE and to monitor vaccination plans. Longer studies will be necessary to evaluate the role of herd protection in PPE prevention.

AB - Etiology and serotyping of parapneumonic effusion (PPE) and the impact of vaccination was evaluated over a 12-year period, before and after the PCV13 introduction (2011) for Italian children From 0 to 16 years of age. Five hundred and two children were evaluated; 226 blood and 356 pleural fluid samples were obtained and tested using Realtime-PCR and culture. In the pre-PCV13 era S. pneumoniae was the most frequent pathogen identified (64/90; 71.1%) with a large predominance of serotypes 1 (42.4%), 3 (23.7%), 7F (5.1%) and 19A (11.9%). The impact of vaccination, calculated on children 0-8 years of age, demonstrated a significant reduction of PPE: with an incidence rate of 2.82 (95%CL 2.32-3.41) in the pre-PCV13 era and an age-standardized rate (ASR) of 0.66 (95% CL 0.37-1.99) in the post-PCV13 era, p < 0.0001. No increase in non-PCV13 serotypes was recorded. S. pneumoniae remained the most frequent pathogen identified in the post-PCV13 era in unvaccinated children with an unchanged serotype distribution: respectively 26/66 (39.4%), 25/66 (37.9%), 5/66 (7.6%), and 4/66 (6.1%) for 1, 3, 7F and 19A. On the other hand 7F and 19A disappeared in vaccinated children and serotype 1 and 3 decreased by 91.8% and 31.5%, respectively. Realtime PCR was significantly more sensitive than culture both in pleural fluid (79.7% vs 12.5%) and in blood (17.8% vs 7.4%). In conclusion, our findings indicate that routine immunization with PCV13 has significantly reduced the burden of childhood PPE in vaccinated children, without increasing PPE due to other bacteria and without serotype shift. Moreover, the impact of PCV13 may be underestimated due to the increase in pneumococcal surveillance in Italy. Data has also shown that Real-time PCR is an essential tool to better define the etiology of PPE and to monitor vaccination plans. Longer studies will be necessary to evaluate the role of herd protection in PPE prevention.

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