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Assessing the impact of the 13 valent pneumococcal vaccine on childhood empyema in Australia


Strachan, R and Homaira, N and Beggs, S and Bhuiyan, MU and Gilbert, GL and Lambert, SB and Macartney, K and Marshall, H and Martin, AC and McCallum, GB and McCullagh, A and McDonald, T and McIntyre, P and Oftadeh, S and Ranganathan, S and Suresh, S and Wainwright, CE and Wilson, A and Wong, M and Snelling, T and Jaffa, A, Assessing the impact of the 13 valent pneumococcal vaccine on childhood empyema in Australia, Thorax, 76, (5) pp. 487-493. ISSN 0040-6376 (2021) [Refereed Article]

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Author(s) (or their employer(s)) 2021.

DOI: doi:10.1136/thoraxjnl-2020-216032


Background: Empyema is a serious complication of pneumonia frequently caused by Streptococcus pneumoniae (SP). We assessed the impact of the 13-valent pneumococcal conjugate vaccine (13vPCV) on childhood pneumonia and empyema after inclusion in the Australian National Immunisation Program.

Methods: For bacterial pneumonia and empyema hospitalisations, we ascertained incidence rates (IRs) using the National Hospital Morbidity Database International Statistical Classification of Disease discharge codes and relevant population denominators, and calculated incidence rate ratios (IRR) comparing the 13vPCV period (June 2012-May 2017) with the 7vPCV period (June 2007-May 2011). Blood and pleural fluid (PF) cultures and PF PCR of 401 children with empyema from 11 Australian hospitals during the 13vPCV period were compared with our previous study in the 7vPCV period.

Findings: Across 7vPCV and 13vPCV periods, IRs per million children (95% CIs) were 1605 (1588 to 1621) and 1272 (1259 to 1285) for bacterial pneumonia, and 14.23 (12.67 to 15.79) and 17.89 (16.37 to 19.42) for empyema hospitalisations. IRRs were 0.79 (0.78 to 0.80) for bacterial pneumonia and 1.25 (1.09 to 1.44) for empyema. Of 161 empyema cases with SP serotypes, 147 (91.3%) were vaccine types. ST3 accounted for 76.4% of identified serotypes in the 13vPCV period, more than double than the 7vPCV period (p<0.001); ST19A decreased from 36.4% to 12.4%. No cases of ST1 empyema were identified in the 13vPCV period versus 14.5% in the 7vPCV period.

Interpretation: 13vPCV resulted in a significant reduction in all-cause hospitalisations for bacterial pneumonia but empyema hospitalisations significantly increased, with emergence of pneumococcal ST3 as the dominant serotype in empyema.

Item Details

Item Type:Refereed Article
Keywords:bacterial infection, empyema, respiratory infection
Research Division:Biomedical and Clinical Sciences
Research Group:Cardiovascular medicine and haematology
Research Field:Respiratory diseases
Objective Division:Health
Objective Group:Clinical health
Objective Field:Treatment of human diseases and conditions
UTAS Author:Beggs, S (Dr Sean Beggs)
ID Code:146581
Year Published:2021
Web of Science® Times Cited:7
Deposited By:Medicine
Deposited On:2021-09-14
Last Modified:2022-08-25

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