Project Name

The impact of a conjugate pneumococcal vaccine (Prevenar) on the epidemiology and aetiology of childhood pneumonia in the North East of England

Dates

12/10/2009 - 31/03/2011

Project Collaborators

http://www.hpa.org.uk/cfi/rsil/bordetella.htm

Funders

Wyeth Vaccines (now Pfizer Inc.)

Supported by NIHR UKCRN study portfolio (Proj. 7373)

http://public.ukcrn.org.uk/Search/StudyDetail.aspx?StudyID=7373

Project Description

Pneumonia is a common childhood condition with a severity that may range from the very mild to severe requiring ventilatory support and even systemic disease and death. A previous study on children with pneumonia seen in hospital in the North East of England carried out during 2001–2002 established an incidence of 144/100,000 children per year (338/100,000 for those under 5 years). Eighty-nine per cent of the children assessed were admitted to hospital.

Previous studies in America and Finland suggested that in children less than 2 years of age, Streptococcus pneumoniae causes up to 30% of pneumonia seen in hospital. Small studies in Britain have found evidence for pneumococcus in 20% and the previous local study suggested S. pneumoniae implicated in up to 28% of children presenting to hospital (unpublished data). The introduction of a new conjugate vaccine against S. pneumoniae, which is highly effective against invasive bacteraemia and meningitis in young children, has been found to decrease lobar pneumonia by 35% in the USA.

In order to understand the epidemiology of both empyema and pneumonia better, and to study the impact of the expected changes in the pneumococcal vaccination programme, it will be important to determine what proportion of pneumonia in children admitted to hospital is related to infection with S. pneumoniae, other bacteria or viruses.

Aims:

1. To evaluate the impact of a conjugate pneumococcal vaccine (Prevenar) on the epidemiology and aetiology of pneumonia in children in the North East of England.
2. To evaluate the association of nasopharyngeal carriage of S. pneumoniae serotype 1 in parents/carers with the occurrence of community acquired pneumonia (CAP) in their children.

Objectives:

In a group of children aged less than 16 years with pneumonia presented or admitted to hospitals in the North East of England, to:

• In the survey and study groups:

 Compare the incidence of childhood CAP before (Clark et al, 2007) and after the introduction of Prevenar into the primary immunisation schedule.

1. Identify the risk factors for progression to empyema thoracis based on demographic and social data.

• In the study group:

3.   Establish a bacterial pathogen in a subgroup of children using culture, serology, PCR, and urine antigen detection in order to:

1. Determine the percentage of CAP requiring admission to hospital is related to infection with S. pneumoniae serotype 1.
2. Determine the percentage of such cases which develop empyema thoracis.
3. Investigate whether nasopharyngeal carriage of this organism in parents/carers is associated with the occurrence of this infection in their children.

 Publication:

• Elemraid MA, Pollard K, Thomas MF, Gennery AR, Eastham KM, Rushton SP, Hampton F, Singleton P, Gorton R, Spencer DA, Clark JE. Validity of using Hospital Episode Statistics data on monitoring disease trends. Thorax 2011;66:827

Presentations:

• Impact of pneumococcal conjugate vaccination programme on the epidemiology and aetiology of childhood pneumonia in the North East of England.
• 06/2011           Research Masterclass, 29^th annual meeting of the European Society for Paediatrics Infectious Diseases (ESPID),The Hague,Holland

• Impact of heptavalent pneumococcal conjugate vaccine on the epidemiology of childhood pneumonia inNorthern England.

11/2010           British Paediatric Allergy, Immunology and Infectious Diseases Group,Edinburgh

Posters:

• Impact of heptavalent pneumococcal conjugate vaccine on the incidence of childhood pneumonia inNorthern England.

12/2011           British Thoracic Society Winter Meeting,London,UK 

• Clinical significance of inflammatory markers and radiological features in predicting the aetiology of community-acquired pneumonia in children.

10/2011           52nd annual meeting of the European Society for Paediatric Research,Newcastle,UK