Pediatric Head and Neck Complications of Invasive Streptococcus pneumoniae before and after PCV7 Vaccination

Abstract

Objectives:

Discuss pediatric head and neck complications of invasive pneumococcal infections including the incidence, mean hospital cost, length of stay, and admittance from the emergency department before and after the PCV7 vaccine.

Methods:

A retrospective cross-sectional analysis of the National Inpatient Database yielded (N = 31,738) pediatric incident reports involving meningitis, mastoiditis, otitis media, periorbital cellulitis, sigmoid sinus thrombosis, and bezold abscess due to invasive Streptococcus pneumoniae infections. Each report was analyzed for incidence, length of stay, mean hospital cost, and admittance from the emergency room. Finally, we calculated the expected annual incidence of each complication via least squares analysis to determine the expected incidence if the vaccine was not administered.

Results:

We identified a significant decrease in the incidence of all described complications after the introduction of the PCV7 vaccine and also when compared to our predicted incidence calculations. Emergency department admittance for bezold abscess, periorbital cellulitis, mastoiditis, sigmoid sinus thrombosis and meningitis were significantly increased in the pediatric age group (ages 1-4) (P < .05). Furthermore, there was a significant increase the hospital charge to provide care for each of the described conditions (P < .05).

Conclusions:

The PCV7 vaccine produced a measurable reduction in invasive pediatric pneumococcal complications of the head and neck. However, our data suggests these benefits were also met with increased emergency department admittance, hospital costs, and length of stay, each of which may be due to selection of a more invasive species.