Article Text

  1. B Rath1,
  2. G Mostafa1,
  3. H Burgmann2,
  4. H Kollaritsch3,
  5. G Burda1,
  6. G Trittenwein1
  1. 1Department of Pediatrics, Pediatric Intensive Care Unit, Medical University of Vienna, Vienna, Austria
  2. 2Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
  3. 3Department of Specific Prophylaxis and Tropical Medicine, Medical University of Vienna, Vienna, Austria


Background Because national immunization programs are not yet fully in place, invasive pneumococcal disease (IPD) remains a serious illness killing more children in Europe than all other vaccine preventable diseases. The heptavalent pneumococcal vaccine (7-vPC) has recently become part of the immunization schedule in Austria, but vaccination coverage remains low (around 10%).

Methods We report 2 cases of fatal pneumococcal meningoencephalitis in previously vaccinated children presenting to the Pediatric Intensive Care Unit in October 2007 and February 2008, both in critical condition. Past medical histories and immune status were within normal limits in both children, ages 5 months and 20 months. Antimicrobial therapy with amoxicillin/clavulanate was initiated <5 days after disease onset in both cases.

Results The serotypes were determined to be 9N and 7F, respectively, both susceptible to penicillins and 3rd generation cephalosporins. The first patient had received only the 2nd dose of 7-vPC, 10 days prior to onset of illness, the second patient had completed all 3 baseline immunizations, but was infected with a strain that is not covered by 7-vPC.

Conclusions In settings with low immunization coverage, IPD should remain on top of the list of differential diagnoses in <2-year-old children with mental status changes and fever, regardless of vaccination history. It is hoped that immunization coverage and herd immunity will increase, minimizing invasive disease with vaccine preventable pneumococci. Systematic surveillance of IPD in Austria has been in place since 1999 and will ensure that IPD strains are monitored, and vaccines may be adjusted as needed.

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