Contemporary dataset reveals burden of paediatric pneumococcal disease

By Joanna Lyford, Senior medwireNews Reporter

Children with chronic or immunocompromising medical conditions continue to be at increased risk for developing pneumococcal disease in the current era of universal immunisation, US researchers report.

The risk of invasive pneumococcal disease (IPD) was increased up to 40 times in these children compared with the general age-matched population, leading the authors to call for more work to define at-risk groups.

Risk groups are currently defined as immunocompetent children with chronic heart and lung disease, diabetes mellitus, cerebrospinal fluid leaks, or cochlear implants; children with defects in host defences; and those with anatomic or functional asplenia or human immunodeficiency virus infection.

In this study, Stephen Pelton (Boston University Schools of Medicine and Public Health, Massachusetts) and colleagues analysed insurance data from 2007 to 2010 to define the risk of pneumonia in children aged under 18 years with and without these conditions.

Approximately 26.5 million person–years of observation was included; around 8% of children had one or more “at risk” or “high risk” conditions.

Rate ratios for IPD were 1.8 in children aged under 5 years and 3.3 for children aged 5 to 17 years for those with versus without any at-risk/high-risk condition, report Pelton and co-authors in Clinical Infectious Diseases.

The rate ratios were even higher in the subgroup of children with high-risk conditions, at 11.2 and 40.1 for under-5s and 5 to 17-year olds, respectively.

The likelihood of IPD and pneumococcal pneumonia was also increased among children with severe asthma, with rate ratios of up to 8.8 in younger children and 11.7 in older children, depending on asthma severity.

Among children with at-risk/high-risk conditions, the risk for pneumococcal pneumonia increased in a stepwise manner with each additional condition. In younger children, rate ratios increased from 2.1 for those with one condition to 13.4 for those with three or more conditions; in older children the ratio ratios rose from 2.4 to 33.1. A similar pattern was seen for IPD.

The researchers conclude that children with at-risk and high-risk conditions continue to face an increased burden of pneumococcal disease despite universal immunisation, an issue that requires further research and understanding.

“Children with multiple at-risk conditions or moderate/severe asthma also are at elevated risk and warrant consideration for immunoprophylaxis”, they add.

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