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Pneumococcal haemolytic uraemic syndrome in the postvaccine era
  1. Jolie Lawrence1,
  2. Amanda Gwee2,3,4,
  3. Catherine Quinlan1,3,4
  1. 1 Department of Nephrology, Royal Children’s Hospital, Parkville, Victoria, Australia
  2. 2 Department of General Medicine, Royal Children’s Hospital, Parkville, Victoria, Australia
  3. 3 Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
  4. 4 Kidney Development, Disease and Regeneration, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
  1. Correspondence to Dr. Jolie Lawrence, Department of Nephrology, Royal Children’s Hospital, Parkville, VIC 3052, Australia; jolie.lawrence{at}


Objective Pneumococcal infection is a leading cause of haemolytic uraemic syndrome (HUS) and is potentially vaccine preventable. Published data suggest high mortality and poor renal outcomes. The introduction of the 7-valent pneumococcal conjugate vaccine (PCV) has seen the emergence of disease caused by non-vaccine strains, particularly 19A. We sought to describe serotype prevalence and outcomes, particularly after the introduction of the 13-valent PCV.

Design and setting We performed a retrospective chart review, using hospital medical records to identify cases of HUS in a tertiary paediatric hospital in Australia over a 20-year period (January 1997–December 2016). Associated pneumococcal infection was identified, and serotype data were categorised according to vaccine era: prevaccine (January 1997–December 2004), PCV7 (January 2005–June 2011) and PCV13 (July 2011–December 2016).

Results We identified 66 cases of HUS. Pneumococcal infection was proven in 11 cases, representing 4% (1/26) of cases prior to the introduction of PCV7, 20% (3/15) in the PCV7 era and 28% (7/25) in the PCV13 era. Subtype 19A was the most prevalent pneumococcal serotype (6/11). All four patients who received PCV7 were infected with a non-vaccine serotype. Four of the five patients who received PCV13 were classed as vaccine failures. Median follow-up was 14 (range 1–108) months. Chronic kidney disease was the most common complication (4/7). We observed no mortality, neurological sequelae or progression to end-stage kidney disease.

Conclusions Serotype 19A is most commonly associated with pneumococcal HUS, despite the introduction of the 13-valent vaccine. Chronic kidney disease is a significant complication of pneumococcal HUS.

  • general paediatrics
  • infectious diseases
  • nephrology
  • immunisation
  • intensive care

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  • Contributors JL: conceptualised and designed the study, collected data, carried out the initial analyses, drafted the initial manuscript and approved the final manuscript as submitted. AG and CQ: conceptualised and designed the study, critically reviewed and revised the manuscript and approved the final manuscript as submitted. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Ethics approval was obtained from the Royal Children’s Hospital Human Research Ethics Committee (HREC 36185A).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data collected for this case series are summarised in the article.