The national programme for enhanced pneumococcal

Project Name

The national programme for enhanced pneumococcal surveillance of complicated pneumococcal pneumonia and empyema in UK children.
 

 

Dates

01/09/2008 - 01/08/2016

Project Collaborators

http://www.bprs.co.uk/index.php

http://www.gla.ac.uk/schools/medicine/

http://www.well.ox.ac.uk/hill-2

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

Funders

Wyeth Vaccines (now Pfizer Inc.)

Supported by NIHR UKCRN study portfolio (Proj. 7229)

http://public.ukcrn.org.uk/Search/StudyDetail.aspx?StudyID=7229

Project Description

 

  The incidence of paediatric empyema thoracis has risen dramatically over the last decade and Streptococcus pneumoniae serotype 1 has been identified as the principal pathogen in the UK. Various suggestions have been proposed to explain the observed rise in incidence including changes in diagnostic criteria and referral practice, and alterations in pathogen virulence. At present there is insufficient evidence in favour of any single hypothesis.

The 7-valent pneumococcal conjugate vaccine was introduced into the national immunisation schedule September 2006. This vaccine does not offer protection against serotype 1 disease. It has been suggested that introduction of this vaccine may lead to a further increase in pneumococcal disease. This might occur as a result of progressive increase in serotype 1 disease as well as an increase in disease due to other non-vaccine pneumococcal serotypes. There is some evidence that this phenomenon is already beginning to occur in the United States.

This project is intended to monitor the changing incidence of pneumococcal empyema thoracis in children throughout the UK, to determine the prevalence of different pneumococcal serotypes over time and to explore epidemiological and genetic factors. It represents collaboration between clinicians, microbiologists, epidemiologists, genetic scientists and those with expertise in biological modelling in an effort to elucidate the mechanisms responsible for this phenomenon.

We propose to explore the following hypotheses:

  1. That the incidence of pneumococcal empyema will continue to increase in British children. That the increase will occur as a result of a progressive increase in serotype 1 disease which commenced before the introduction of the conjugate vaccine, as well as increase in disease from other non-vaccine serotypes.
  2. That antibiotic treatment in primary care influences disease progression.
  3. That space-time patterning of empyema cases will be related to environmental exposure to air-born pollutants.
  4. That spatial patterning of empyema cases will be related to socio-economic factors.
  5. That certain gene polymorphisms will be associated with an increased risk of development of pneumococcal empyema

In order to explore these hypotheses in detail it will be necessary to:

  1. Investigate the existence of spatial and temporal variation in incidence and clustering of cases of empyema.

  1. Identify and monitor potential risk factors predisposing to the development of empyema.

  1. Closely monitor changes in the prevalence of different pneumococcal serotypes causing complicated pneumonia and empyema in children.

  1. Monitor changes in the incidence and severity of empyema thoracis over time.

  1. Relate these changes to the introduction of the 7 valent conjugate pneumococcal vaccine into the routine childhood immunisation programme in the UK, and to the possible introduction of future vaccines with extended coverage against other pneumococcal serotypes.

  1. Relate these changes to the national guidance aimed at reducing the use of antibiotics for simple respiratory tract infections in primary care.

  1. Investigate links between the incidence of empyema and socio-economic indicators and environmental predictors.

  1. Develop data collection systems which will facilitate the performance of future multi-centre studies to compare current and future medical and surgical interventions in the management of complicated pneumonia and empyema in children.

  1. Audit outcomes according to variations in clinical management across the UK.

  1.  Investigate gene polymorphisms that may influence susceptibility to the development of invasive pneumococcal disease (IPD) and empyema in children.

 Output

Abstracts

DA Spencer, MF Thomas, C Sheppard, M Guiver, R George, R Gorton, JY Paton, C Simmister, D Cliff, MA Elemraid, JE Clark, SP Rushton. Emergence of pneumococcal serotype 19A as a cause of severe complicated pneumonia with empyema in children in England. Accepted British Thoracic Society Winter Meeting, London, December 2011   

MF Thomas, C Simmister, D Cliff, MA Elemraid, JE Clark, SP Rushton, R Gorton, JY Paton, DA Spencer. Comparison of primary pleural drainage strategies in paediatric empyema. Accepted British Thoracic Society Winter Meeting, London, December 2011   

MF Thomas, C Sheppard, M Guiver, R George, C Simmister, D Cliff, R Gorton, MA Elemraid, JE Clark, SP Rushton, JY Paton, DA Spencer .Changes in pneumococcal serotype distribution of paediatric empyema in the age of pneumococcal conjugate vaccines. Accepted British Thoracic Society Winter Meeting, London, December 2011   

Thomas MF, Rushton SP, Shirley MDF, Elemraid MA, Clark JE, Gorton R, Spencer DA. Understanding the changing epidemiology of paediatric empyema: the relationship with pneumonia.  Poster presentation, Health Protection 2011, Warwick, September 2011

Thomas MF, Blain AP, Shirley MDF, Simmister C, Elemraid MA, Gorton R, Pearce MS, Clark JE, Rushton SP, Spencer DA. Geographical variation in the risk of childhood pneumonia and relationships to socio-economic and health deprivation. Poster presentation, European Respiratory Society Annual Congress, Amsterdam, September 2011

Spencer DA, CloseAJ, Simmister C, Cliff D, Elemraid MA, Clark JE, Rushton SP, Thomas MF. Limited impact of the 7-valent pneumococcal vaccine on paediatric empyema in the North of England. Elite poster presentation European Society of Paediatric Infectious Diseases Congress, the Hague, June 2011

Spencer DA, CloseAJ, Simmister C, Cliff D, Elemraid MA, Clark JE, Rushton SP, Thomas MF. Impact of the 13-valent pneumococcal vaccine on the incidence of paediatric empyema in the North of England. Elite poster presentation European Society of Paediatric Infectious Diseases Congress, the Hague, June 2011

Thomas MF, Simmister C, Rushton SP, Spencer DA. The changing incidence of paediatric empyema in NE England 2006 – 2010. Poster presentation, British Thoracic Society Winter Meeting, London, December 2010

Thomas MF, Cliff D, Rushton SP, Gorton R, Shirley MDF, Clark J, Spencer DA. Trends in paediatric pneumonia and empyema in England 1997-2006.  Oral presentation, European Respiratory Society Annual Congress, Barcelona, September 2010

Sheppard C, Thomas MF, Cliff D, Guiver M, Spencer DA, Slack M, George R.Change in pneumococcal serotypes detected in empyema in the UK children from the enhanced surveillance programme 2006-2009. Oral presentation European Society of Paediatric Infectious Diseases Congress, Nice, May 2010

Thomas MF, Sheppard C, Cliff D, Guiver M, George R, Spencer DA. Pneumococcal serotypes causing empyema in UK children from the enhanced surveillance programme 2006-2009. Oral and poster presentation at ISPPD-10, Tel Aviv, March 2010

Thomas MF, Cliff D, Beaton S, Rushton S, Paton J, Spencer DA. Paediatric empyema management in the UK. Oral presentation, BTS Winter Meeting, London, December 2009

Papers

Thomas MF, Spencer DA. Management and complications of pneumonia. Paediatr and Child Health. 2011; 21: 207-12