PEDIATRICS Vol. 108 No. 2 August 2001, p. e23
ELECTRONIC ARTICLE:
Serotype Prevalence of Occult Pneumococcal Bacteremia
Received Nov 20, 2000; accepted Mar 26, 2001.
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From the * Divisions of Emergency Medicine and Objective. The licensure and use of a
pneumococcal conjugate vaccine that is immunogenic in children who are
younger than 2 years may affect the epidemiology of occult bacteremia.
This study was conducted to determine the serotype prevalence of
Streptococcus pneumoniae isolates from children with
occult bacteremia and to document the proportion that would be covered
by the recently licensed heptavalent pneumococcal conjugate
vaccine.
Methods. A cohort of 5901 children who were 2 to 24 months
of age and had a temperature of Results. The study population consisted of 5901 patients.
The overall rate of occult bacteremia was 1.9% (95% confidence
interval [CI]: 1.5-2.3). S pneumoniae accounted for
92 of 111 isolates (82.9%; 95% CI: 74.6-89.4) in children with
occult bacteremia. Eight pneumococcal serotypes were represented: 6A
(2%), 9V (6%), 19F (6%), 18C (8%), 4 (9%), 6B (13%), 23F (15%),
and 14 (42%). Serotypes 14, 6B, and 23F accounted for 69.3% (95% CI:
58.6-78.7) of typed isolates. In the cohort, 97.7% (95% CI:
92-99.7) of isolated serotypes are represented in the newly licensed
heptavalent pneumococcal conjugate vaccine. The single isolated
serotype that would not have been covered by the currently licensed
heptavalent pneumococcal conjugate vaccine was 6A.
Conclusions. S pneumoniae accounts for the
vast majority of bacterial pathogens in children with occult
bacteremia. As indicated by the results of this study, the heptavalent
pneumococcal conjugate vaccine may prevent the majority of occult
pneumococcal bacteremia episodes. The 2 cases of bacteremia with a
serotype that would not have been included in the vaccine both were due
to serotype 6A. It has been noted that there is potential nonvaccine
serotype and subgroup cross-protection (6A from 6B) afforded to
children who are immunized with the heptavalent vaccine. The high
potential efficacy of the heptavalent pneumococcal conjugate vaccine
for strains that cause occult bacteremia in our population may have a
profound effect on the treatment of children with fever without a
source. There has been an alarming and rapid emergence of
antibiotic-resistant pneumococcal strains. Less pressure to use
broad-spectrum antibiotics, which in turn causes further antibiotic
resistance, should result. Laboratory testing and hospitalization also
should be reduced. The prevalence rates determined by this study may be
used as baseline data for comparison of serotype rates of occult
pneumococcal bacteremia after widespread use of the heptavalent
vaccine.
Immunologic
and Infectious Diseases, Children's Hospital of Philadelphia,
University of Pennsylvania, School of Medicine, Philadelphia,
Pennsylvania.
39.0°C evaluated with a blood
culture at an urban tertiary care children's hospital emergency
department was studied to determine the prevalence of S
pneumoniae serotypes. Patients were excluded if their immune
system was suppressed, they had a diagnosis of a focal infection, they
were evaluated by lumbar puncture, they were admitted to the hospital,
or they died during initial evaluation. Blood cultures were inoculated into pediatric blood culture bottles and processed using an automated carbon dioxide monitoring system. All pneumococcal isolates were serotyped on the basis of capsular swelling with type-specific antisera
(Quellung reaction).
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