To provide epidemiological data on community-acquired pneumonia (CAP) and complicated CAP, a retrospective study was conducted on a partially vaccinated paediatric population. Data from children hospitalized for CAP in Tuscan hospitals between January 1st, 1999 and December 31st, 2009 were analysed. A total of 5,450 children with CAP were hospitalized. Annual hospitalization rates for CAP did not change significantly over the study period (χ2 for trend= 0.652; p=0.419). The total annual hospitalization rate for pneumococcal CAP varied according to age (28.04 per 100,000 children aged ≤ 5 years, 10.06 per 100,000 children aged 6–12 years and 0.98 per 100,000 children aged ≥ 13years). Hospitalization rates for pneumococcal CAP increased from 12.84 (95% CI:7.35–18.34) in 2001 to 45.4 (95%CI:35.93–54.90) per 100,000 children aged ≤ 5 years in 2009 (p<0.0001). In addition, a significant increase of hospitalization rates for complicated CAP (from 6.07 in 1999 to 13.66 in 2009 per 100,000 children; P<0.0001) and pneumococcal complicated CAP (from 0.19 in 1999 to 3.41 in 2009 per 100,000 children) over the study period were highlighted. Our epidemiological data confirm the decision to introduce the PCV13 vaccine, to satisfy the need to prevent a wider group of pneumococcal serotypes.
FarhaTThomsonAH. The burden of pneumonia in children in the developed world. Paediatr Respir Rev2005; 6:76–82.
2.
SimonsenLTaylorRJYoung-XuYHaberMMayLKlugmanKP. Impact of pneumococcal conjugate vaccination of infants on pneumonia and influenza hospitalization and mortality in all age groups in the United States. MBio2011; 25:e00309–10.
3.
LeeGELorchSASheffler-CollinsSKronmanMPShahSS. National hospitalization trends for pediatric pneumonia and associated complications. Pediatrics2010; 126:204–13.
4.
HendricksonDJBlumbergDAJoadJPJhawarSMcDonaldRJ. Five-fold increase in pediatric parapneumonic empyema since introduction of pneumococcal conjugate vaccine. Pediatr Infect Dis J2008; 27:1030–2.
5.
RoxburghCSYoungsonGGTownendJATurnerSW. Trends in pneumonia and empyema in Scottish children in the past 25 years. Arch Dis Child2008; 93:316–8.
6.
DiasRCaniçaM. Invasive pneumococcal disease in Portugal prior to and after the introduction of pneumococcal heptavalent conjugate vaccine. FEMS Immunol Med Microbiol2007; 51:35–42.
7.
BernaolaIEAristegui FernándezJHerranz AguirreMGarcía CalvoCFernández PérezC; Grupo de Estudio de Enfermedad Invasora Neumocócica en el País Vasco-Navarra. Study of the incidence of invasive pneumococcal disease in neonates and children aged less than 5 years in the Basque country and Navarre (Spain). Esp Pediatr2002; 57:301–9.
8.
AnsaldiFSticchiLDurandoPCarloniROrestePVercelliMCrovariPIcardiG. Decline in pneumonia and acute otitis media after the introduction of childhood pneumococcal vaccination in Liguria, Italy. J Int Med Res2008; 36:1255–60.
9.
DurandoPCrovariPAnsaldiF. Collaborative Group for Pneumococcal Vaccination in Liguria. Universal childhood immunisation against Streptococcus pneumoniae: the five-year experience of Liguria Region, Italy. Vaccine2009; 27:3459–62.
10.
TardivoSPoliAZermanT. Invasive pneumococcal infections in infants up to three years of age: results of a longitudinal surveillance in North-East Italy. Ann Ig2009; 21:619–28.
11.
AzzariCMoriondoMIndolfiGBeccioliniLde MartinoMRestiM. Molecular detection methods and serotyping performed directly on clinical samples improve diagnostic sensitivity and reveal increased incidence of invasive disease by Streptococcus pneumoniae in Italian children. J Med Microbiol2008; 57:1205–12.
12.
RestiMMoriondoMCortimigliaM; Italian Group for the Study of Invasive Pneumococcal Disease. Community-acquired bacteremic pneumococcal pneumonia in children: diagnosis and serotyping by real-time polymerase chain reaction using blood samples. Clin Infect Dis2010; 51:1042–9.
13.
CuttsFTZamanSMEnwereG; Gambian Pneumococcal Vaccine Trial Group. Efficacy of nine-valent pneumococcal conjugate vaccine against pneumonia and invasive pneumococcal disease in The Gambia: randomised, double-blind, placebo-controlled trial. Lancet2005; 365:1139–46.
14.
KlugmanKPMadhiSAHuebnerREKohbergerRMbelleNPierceN; Vaccine Trialists Group. A trial of a 9-valent pneumococcal conjugate vaccine in children with and those without HIV infection. N Engl J Med2003; 349:1341–8.
15.
KoshyEMurrayJBottleASharlandMSaxenaS. Impact of the seven-valent pneumococcal conjugate vaccination (PCV7) programme on childhood hospital admissions for bacterial pneumonia and empyema in England: national time-trends study, 1997–2008. Thorax2010; 65:770–4.
16.
GrijalvaCGNuortiJPZhuYGriffinMR. Increasing incidence of empyema complicating childhood community-acquired pneumonia in the United States. Clin Infect Dis2010; 50:805–13.
17.
AmpofoKPaviaATChrisS. The changing epidemiology of invasive pneumococcal disease at a tertiary childrens hospital through the 7-valent pneumococcal conjugate vaccine era: a case for continuous surveillance. Pediatr Infect Dis J2012; 31:228–34.
18.
GrijalvaCGNuortiJPArbogastPGMartinSWEdwardsKMGriffinMR. Decline in pneumonia admissions after routine childhood immunisation with pneumococcal conjugate vaccine in the USA: a time-series analysis. Lancet2007; 369:1179–86.
19.
SenstadACSurénPBrautesetLErikssonJRHøibyEAWathneKO. Community-acquired pneumonia (CAP) in children in Oslo, Norway. Acta Paediatr2009; 98:332–6.
20.
WeiglJAPuppeW.BelkeO. Neusüss J, Bagci F, Schmitt HJ. Population-based incidence of severe pneumonia in children in Kiel, Germany. Klin Pediatr2005; 217:211–19.
21.
ClarkJEHammalDHamptonFSpencerDParkerL. Epidemiology of community-acquired pneumonia in children seen in hospital. Epdemiol Infect2007; 135:262–9.
22.
TanakaJIshiwadaNWadaAChangBHishikiHKurosakiTKohnoY. Incidence in childhood penumonia and serotype and sequence-type distribution in Streptococcus penumoniae isolates in Japan. Epidemiol Infect2011; 30: 1–11.
23.
MarcheseAEspositoSCoppoERossiGATozziARomanoMDa DaltLSchitoGCPrincipiN. Detection of Streptococcus pneumoniae and identification of pneumococcal serotypes by real-time polymerase chain reaction using blood samples from Italian children ≤ 5 years of age with community-acquired pneumonia. Microbiog Drug Resist2011; 17:419–24.
24.
CDC. Pneumonia hospitalization among young children before and after introduction of pneumococcal conjugate vaccine. United States, 1997–2006. MMWR2009; 58:1–4.
25.
KaplanSLMasonEOJrWaldER. Decrease of invasive pneumococcal infections in children among 8 children's hospitals in the United States after the introduction of the 7-valent pneumococcal conjugate vaccine. Pediatrics2004; 113:443–9.
26.
De WalsPBoulianneNSévinEDeceuninckGBoulianneN. Uptake of pneumococcal conjugate vaccine: methodological issues in measurement and impact of publicly funded programs. Can J Public Health2009; 100:413–6.
27.
JardineAMenziesRIMcIntyrePB. Reduction in hospitalizations for pneumonia associated with the introduction of a pneumococcal conjugate vaccination schedule without a booster dose in Australia. Pediatr Infect Dis J2010; 29:607–12.
28.
HicksLAHarrisonLHFlanneryB. Incidence of pneumococcal disease due to non-pneumococcal conjugate vaccine (PCV7) serotypes in the United States during era of widespread of PCV7 vaccination, 1998–2004. J Infect Dis2007; 196:1346–54.
29.
StenhoffAPShanSSRatnerAJPatilSMMcGowanKL. Emergence of vaccine-related pneumococcal serotypes as a cause of bacteremia. Clin Infect Dis2006; 42:907–14.
30.
JonesRNJacobsMRSaderHS. Evolving trends in streptococcis pneumonia resistance: implications for therapy of community-acquired bacterial pneumonia. Int J Anitmicrobi Agents2010; 36:197–204.
31.
D AnconaFSalmasoSBaraleA; Italian PNC-Euro working group. Incidence of vaccine preventable pneumococcal invasive infections and blood culture practices in Italy. Vaccine2005; 23:2494–500.
32.
LiSTTancrediDJ. Empyema hospitalizations increased in US children despite pneumococcal conjugate vaccine. Pediatrics2010; 125:26–33.
33.
QuanHParsonsGAGhaliWA. Validity of procedure codes in International classification of disease revision, clinical modification administrative data. Med Care2004; 42:801–9.
34.
BonsignoriFChiappiniEFrenosSPeraldoMGalliLde MartinoM. Hospitalization rates for complicated and uncomplicated chickenpox in a poorly vaccinated pediatric population. Infection2007; 35:444–50.
