Published online August 1, 2008
PEDIATRICS Vol. 122 No. 2 August 2008, pp. 229-237 (doi:10.1542/10.1542/peds.2007-3192)
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ARTICLE

Seasonal Invasive Pneumococcal Disease in Children: Role of Preceding Respiratory Viral Infection

Krow Ampofo, MB, BSa, Jeffrey Bender, MDa, Xiaoming Sheng, PhDb, Kent Korgenski, MS, MT(ASCP)c, Judy Daly, PhDc, Andrew T. Pavia, MDa and Carrie L. Byington, MDa

a Division of Pediatric Infectious Diseases, Department of Pediatrics
b Department of Family and Preventive Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah
c Primary Children's Medical Center, Intermountain Health Care, Salt Lake City, Utah

OBJECTIVE. Our objective was to demonstrate correlations between invasive pneumococcal disease in children and circulating respiratory viruses.

METHODS. This retrospective study included 6 winter respiratory viral seasons (2001–2007) in Intermountain Healthcare, an integrated health system in the Intermountain West, including Primary Children's Medical Center in Salt Lake City, Utah. Children <18 years of age who were hospitalized with either invasive pneumococcal disease in any Intermountain Healthcare facility or culture-confirmed invasive pneumococcal disease at Primary Children's Medical Center were included. We analyzed the correlation between invasive pneumococcal disease and circulating respiratory viruses.

RESULTS. A total of 435 children with invasive pneumococcal disease and 203 with culture-confirmed invasive pneumococcal disease were hospitalized in an Intermountain Healthcare facility or Primary Children's Medical Center during the study period. During the same period, 6963 children with respiratory syncytial virus, 1860 with influenza virus, 1459 with parainfluenza virus, and 818 with adenoviruses were evaluated at Primary Children's Medical Center. A total of 253 children with human metapneumovirus were identified during the last 5 months of the study. There were correlations between invasive pneumococcal disease and seasonal respiratory syncytial virus, influenza virus, and human metapneumovirus activity. The correlation with invasive pneumococcal disease was strong up to 4 weeks after respiratory syncytial virus activity. For influenza virus and human metapneumovirus, the correlations were strong at 2 weeks after activity of these viruses. Pneumonia was the most common clinical disease associated with culture-confirmed invasive pneumococcal disease, mostly attributable to serotypes 1, 19A, 3, and 7F.

CONCLUSIONS. In the post–pneumococcal conjugate vaccine era, seasonal increases in respiratory syncytial virus, influenza virus, and human metapneumovirus infections in children were associated with increased pediatric admissions with invasive pneumococcal disease, especially pneumonia caused by nonvaccine serotypes.

Key Words: invasive pneumococcal disease • respiratory viral infection • children

Abbreviations: PCMC—Primary Children's Medical Center • IH—Intermountain Healthcare • IPD—invasive pneumococcal disease • DFA—direct fluorescent antibody • ICD-9—International Classification of Diseases, Ninth Revision • IV—influenza virus • RSV—respiratory syncytial virus • PIV—parainfluenza virus • hMPV—human metapneumovirus • PCV-7—heptavalent pneumococcal conjugate vaccine • ABC—Active Bacterial Core

Accepted Dec 7, 2007.


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