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. 2021 Sep 1;224(12 Suppl 2):S228-S236.
doi: 10.1093/infdis/jiab134.

High Prevalence of Vaccine-Type Infections Among Children with Pneumococcal Pneumonia and Effusion After 13-Valent Pneumococcal Conjugate Vaccine Introduction in the Dominican Republic

Sana S Ahmed  1   2 , Fernanda C Lessa  2 , Hilma Coradin  3 , Jacqueline Sánchez  3 , Maria da G Carvalho  2 , Elizabeth Soda  2 , Chabela Peña  3 , Josefina Fernández  3 , Doraliza Cedano  3 , Cynthia G Whitney  2 , Jesús Feris-Iglesias  3
Affiliations

High Prevalence of Vaccine-Type Infections Among Children with Pneumococcal Pneumonia and Effusion After 13-Valent Pneumococcal Conjugate Vaccine Introduction in the Dominican Republic

Sana S Ahmed et al. J Infect Dis. .

Abstract

Background: In 2013, the Dominican Republic introduced 13-valent pneumococcal conjugate vaccine (PCV13) using a 3-dose schedule (at 2, 4 and 12 months of age). We evaluated the impact of PCV13 on serotypes causing pneumococcal pneumonia with pleural effusion.

Methods: Surveillance data after PCV13 introduction (July 2014 to June 2016) were compared with data before PCV13 introduction (July 2009 to June 2011). Cases were defined as radiologic evidence of pneumonia with pleural effusion in a child aged <15 years. Pneumococcus was detected in pleural fluid by either culture or polymerase chain reaction, and serotyping was performed. The Ministry of Health's PCV13 uptake data for 2014-2016 were obtained.

Results: The prevalence of pneumococcus among cases was similar before and after PCV13 introduction (56.4% and 52.8%, respectively). The proportion of pneumococcal cases caused by vaccine serotypes was 86% for children <2 years old both before and PCV13 introduction. Compared with before PCV13, serotype 14 accounted for a smaller (28% vs 13%, respectively; P = .02) and serotype 1 for a larger (23% vs 37%; P = .09) proportion of pneumococcal cases after PCV13 introduction. National uptake for the first, second, and third PCV13 doses was 94%, 81%, and 28%, respectively, in 2014 and 75%, 61%, and 26% in 2015.

Discussion: While the decrease in pneumococcal pneumonia with pleural effusion caused by serotype 14 may reflect an early effect of PCV13 implementation, other vaccine serotypes, including serotype 1, are not well controlled. Better PCV13 coverage for all 3 doses is needed.

Keywords: 13-valent pneumococcal vaccine; Dominican Republic; pleural effusion; pneumococcal pneumonia.

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Figures

Figure 1.
Figure 1.
Pneumonia with pleural effusion cases captured by the surveillance system during the pre–13-valent pneumococcal conjugate vaccine (PCV13) period (1 July 2009 to 30 June 2011) (A) and the post-PCV13 period (1 July 2014 to 30 June 2016) (B) in Santo Domingo, Dominican Republic.
Figure 2.
Figure 2.
Prevalence of 13-valent pneumococcal conjugate vaccine (PCV13)–type infections among children with pneumococcal pneumonia with pleural effusion before and after PCV13 introduction by age group, Santo Domingo, Dominican Republic.
Figure 3.
Figure 3.
Prevalence of serotypes among children with pneumococcal pneumonia with pleural effusions, before and after introduction of 13-valent pneumococcal conjugate vaccine (PCV13). A, Serotype distribution. B, Serotype 1 by age group. C, Serotype 14 by age group. Abbreviation: PCR, polymerase chain reaction.
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