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1 April 2006

Volume 42, Number 7
Clinical Infectious Diseases 2006;42:907–914
© 2006 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2006/4207-0003$15.00
DOI: 10.1086/500941
MAJOR ARTICLE

Emergence of Vaccine‐Related Pneumococcal Serotypes as a Cause of Bacteremia

Andrew P. Steenhoff,1,4

Samir S. Shah,1,4

Adam J. Ratner,1,5

Sujata M. Patil,2 and

Karin L. McGowan1,3

Divisions of 1Infectious Diseases, 2Biostatistics and Epidemiology and 3Clinical Microbiology Laboratory, The Children’s Hospital of Philadelphia, and 4Center for Clinical Epidemiology and Biostatistics and Departments of 1Pediatrics and 5Microbiology, University of Pennsylvania School of Medicine, Philadelphia

Background.The heptavalent pneumococcal conjugate vaccine (PCV7) has decreased the incidence of invasive pneumococcal disease among children in the United States. In the postlicensure period, the impact of non‐PCV7 serotypes against pediatric pneumococcal bacteremia is unknown.

Methods.Episodes of bacteremia due to Streptococcus pneumoniae and other respiratory pathogens (ORP), namely Neisseria meningitidis, Haemophilus influenzae, and Moraxella catarrhalis, were identified in children <18 years old at the Children’s Hospital of Philadelphia from January 1999 to May 2005. For pneumococci, serotype distribution and antibiotic resistance were compared.

Results.A total of 188 episodes of pneumococcal bacteremia and 55 episodes of ORP bacteremia were identified. By comparing data from 1999–2000 with data from 2001 to May 2005, we found that the incidence of pneumococcal bacteremia decreased by 57%. The incidence of bacteremia caused by ORPs was unchanged; 1.43 episodes (95% confidence interval [CI], 0.84–2.29 episodes) to 1.25 (95% CI, 0.88–1.71) per 10,000 emergency department visits. Vaccine serotypes caused 85% of episodes of bacteremia in 1999–2000, compared with 34% of episodes of bacteremia in 2001 to May 2005 ( ). The percentage of isolates nonsusceptible to penicillin increased from 25% to 39% ( ). The percentage of episodes of pneumococcal bacteremia caused by vaccine‐related serotypes—those of the same serogroup but not of the same serotype as PCV7—increased from 6% of episodes in the prelicensure period to 35% of episodes in the postlicensure period ( ). Rates of serotype pneumococcal bacteremia caused by nonvaccine serotypes were not statistically different between the 2 periods.

Conclusions.The overall incidence of pneumococcal bacteremia decreased by 57% after the introduction of PCV7. During the postlicensure period, there were significant decreases in the incidence of pneumococcal bacteremia caused by vaccine serotypes; however, rates of penicillin resistance and bacteremia due to vaccine‐related serotypes increased.

Received 1 October 2005; accepted 6 December 2005; electronically published 27 February 2006.

Reprints or correspondence: Dr. Andrew P. Steenhoff, Div. of Immunologic and Infectious Disease, The Children’s Hospital of Philadelphia, 12th Fl. Abramson Research Center, 3516 Civic Center Blvd., Philadelphia, PA 19104 ().

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