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Epidemiology of childhood invasive pneumococcal disease in Australia: a prospective cohort study
  1. Linny Kimly Phuong1,2,
  2. Abigail Cheung3,
  3. Tiarni Templeton4,
  4. Tamrat Abebe5,
  5. Zanfina Ademi5,6,
  6. Jim Buttery2,7,
  7. Julia Clark4,8,
  8. Theresa Cole2,9,10,
  9. Nigel Curtis2,7,
  10. Hazel Dobinson11,
  11. Nadha Shahul Hameed12,
  12. Hayley Hernstadt13,
  13. Samar Ojaimi14,15,
  14. Ella Grace Sharp16,
  15. Praisoody Sinnaparajar16,
  16. Sophie Wen4,8,
  17. Andrew Daley2,17,
  18. Brendan McMullan18,
  19. Amanda Gwee1,2,7
  1. 1Antimicrobials Theme Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
  2. 2Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
  3. 3Department of Allergy and Clinical Immunology, Women’s and Children’s Hospital, Adelaide, South Australia, Australia
  4. 4Infection Management Prevention Service, Queensland Children’s Hospital, Brisbane, Queensland, Australia
  5. 5Health Economics and Policy Evaluation Research (HEPER), Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
  6. 6School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  7. 7Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital, Parkville, Victoria, Australia
  8. 8University of Queensland, Brisbane, Queensland, Australia
  9. 9Department of Allergy and Immunology, Royal Children’s Hospital, Melbourne, Victoria, Australia
  10. 10Infection & Immunity Theme Group, Murdoch Children’s Research Institute, Parkville, Victoria, Australia
  11. 11Department of Paediatrics and Child Health, Te Whatu Ora Health New Zealand Capital, Coast and Hutt Valley, Wellington, Lower Hutt, New Zealand
  12. 12School of Medicine, Monash University, Clayton, Victoria, Australia
  13. 13Department of Paediatrics, Monash Children’s Hospital, Monash Health, Clayton, Victoria, Australia
  14. 14Department of Paediatrics, Monash University, Clayton, Victoria, Australia
  15. 15Monash Pathology, Monash Health, Clayton, Victoria, Australia
  16. 16Department of Immunology and Infectious Diseases, Sydney Children’s Hospital, Sydney, New South Wales, Australia
  17. 17Department of Microbiology, Royal Children's Hospital, Melbourne, Victoria, Australia
  18. 18Paediatric Infectious Diseases, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
  1. Correspondence to Dr Linny Kimly Phuong; linny.phuong{at}mcri.edu.au

Abstract

Background The widespread use of pneumococcal conjugate vaccines (PCV) has changed the epidemiology of invasive pneumococcal disease (IPD) in children globally.

Methods Multicentre prospective audit of IPD episodes from five paediatric hospitals in Australia over 5.5 years between 2016 and June 2021. Children (<18 years) with Streptococcus pneumoniae isolated from a sterile site were included.

Results There were 377 IPD episodes in 375 children: 338 (90%) had received ≥3 PCV doses; 42 (11%) had IPD risk factors. The most common presentations were complicated pneumonia (254, 67%), bacteraemia (65, 17%) and meningitis (29, 8%). Five (1%) children died.

Serotype information was available for 230 (61%) episodes; 140 (61%) were 13vPCV vaccine serotypes (VTs). The majority (85%) of episodes of complicated pneumonia were due to a VT; predominantly 3, 19A, 19F. Children with risk factors were more likely to present with bacteraemia ± sepsis (42% vs 12%) and to have a non-vaccine serotype (NVT) (74% vs 32%). Resistance to ceftriaxone (meningitis cut-off) occurred in 17% of 23B isolates (n=12) and accounted for 22% (5/23) of meningitis cases.

Conclusions Complicated pneumonia is the most common IPD presentation. NVTs account for the majority of bacteraemia and meningitis episodes. High rates of ceftriaxone resistance for NVT 23B support the addition of vancomycin for empiric treatment of suspected meningitis.

  • Infectious Disease Medicine
  • Paediatrics
  • Communicable Diseases
  • Epidemiology

Data availability statement

Data are available upon reasonable request. Further data (including a table) available on ‘vaccine failures’ as per Response to Reviewer’s document if requested by the Editors.

https://doi.org/10.1136/archdischild-2024-327497

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    Data availability statement

    Data are available upon reasonable request. Further data (including a table) available on ‘vaccine failures’ as per Response to Reviewer’s document if requested by the Editors.

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    Footnotes

    • X @drlinnykp, @nigeltwitt

    • Contributors LKP drafted and finalised the manuscript; and was also involved in data entry and cleaning. LKP was also involved in the analysis of the data throughout the drafting process. AC, TT, HD, NSH, SO, EGS, PS were involved in original data entry for all cases. JB, JC, TC, NC, SW, AD, ZA, BM and AG were involved in the critical analysis for important intellectual content. TA and ZA conducted the statistical analysis for the study and oversaw the interpretation of this data. HH was involved in the original conceptualisation of the study. AG is the guarantor for the study.

    • Funding This study did not receive formal funding. However, the lead investigator (LP) was supported by a Royal Australasian College of Physicians (RACP) Fellowship Research Grant.

    • Competing interests None declared.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.