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1D Spencer, 1D Cliff, 3J Paton, 2R Borrow, 2M Guiver, 2C Sheppard, 2P Kaye, 2R George. 1Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK; 2Health Protection Agency, London, UK; 3Glasgow University, Glasgow, UK

The incidence of paediatric empyema has risen dramatically over the past decade, although the reasons for this are unclear. Most cases are culture negative, but PCR and serotype-specific antigen ELISA show that most cases are related to infection with Streptococcus pneumoniae, with serotype 1 predominant. The heptavalent pneumococcal conjugate vaccine was introduced into the national immunisation schedule in September 2006. The vaccine does not contain antigen for serotype 1 and may predispose to replacement disease from non-vaccine serotypes. Enhanced national surveillance of paediatric pneumococcal empyema was introduced in parallel with vaccine introduction in collaboration between the Health Protection Agency and members of the British Paediatric Respiratory Society. Laboratory data for the first year of this programme for UK children under 17 years are presented. An initial screening PCR for pneumolysin is performed on all culture-negative specimens of empyema fluid. If positive, the specimens undergo serotyping using the Bio-Plex pneumococcal serotype assay for serotypes 1, 3, 4, 5, 6A, 6B, 7F/A, 8, 9V, 14, groups 18, 19A, 19F and 23F. The serotype could be determined on 79 specimens of empyema fluid. The median age at the time of sampling was 5.1 years (range 0.2−16.7). 58% (n  =  47) of samples came from children aged 5 years or under. Most samples were received in either December (n  =  12) or March (n  =  14), with the greatest proportion of specimens received from the Midlands (31%, n  =  25) and London (31%, n  =  25). Overall, serotype 1 was the most frequently detected serotype, found …

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