Invasive pneumococcal diseases in children and adolescents--a single centre experience

Abstract

Background: S. pneumoniae is a major cause of meningitis, pneumonia and sepsis in children. In 2006 universal pneumococcal vaccination was recommended in Germany for all children up to their second birthday. We have compared the prevalence and outcome of IPD at a single hospital before and after the introduction of vaccination.

Findings: 55 cases of IPD were identified over an 11 year period. Almost half of the patients were younger than 2 years of age. Most of the children were affected by pneumonia. The second highest incidence seen was for meningitis and sepsis. 17 patients exhibited additional complications. Significant pre-existing and predisposing disorders, such as IRAK 4 defect, ALPS or SLE were identified in 4 patients. Complete recovery was seen in 78% of affected children; 11% had a fatal outcome and 11% suffered from long term complications. Only 31% overall had been vaccinated. The most common serotype was 14. Serotypes not covered by any of the current vaccines were also found. Antibiotic treatment commenced with cephalosporins in over 90%.

Conclusion: Frequency of IPD in our hospital did not decrease after initiation of the pneumococcal vaccination. This might be due to vaccinations not being administered satisfactorily as well as to poor education about the need of the vaccination. Pre-existing diseases must be monitored and treated accordingly and rare deficiencies taken into account when IPD takes a foudroyant course. In addition, antibiotic stewardship has been initiated at this hospital centre as a consequence of the high cephalosporin use detected in this study.

Figure 1

Radiological findings in three patients with invasive pneumococcal disease. a: Chest X-ray: Widespread, significant opacification of left hemithorax representing lobar pneumonia with effusion secondary to S. pneumoniae in a six year old girl. b: Coronary T1-weighted MRI after contrast agent injection: Subdural hygroma in the left hemisphere and increased meningeal enhancement in a one year old boy diagnosed with meningitis secondary to S. pneumoniae.c: T2-weighted MRI without contrast agent: Internal hydrocephalus and pronounced necrosis of the cerebral parenchyma (left > right) in a one month old girl, secondary to IPD with fatal outcome.

Figure 2

Clinical presentation of invasive pneumococcal disease in 55 children at the Hospital for Children and Adolescents, Department for Women and Child Health, University of Leipzig, Germany from 2001 to 2011.