P-436. Epidemiology of Pediatric Invasive Pneumococcal Disease in an Inner-City Tertiary Care Center: A 13-Year Study and Post-Pandemic Insights

TL;DR

This study examines changes in pediatric invasive pneumococcal disease rates before and after the pandemic in Detroit, finding a post-pandemic resurgence linked to lower vaccination rates.

Contribution

The study provides post-pandemic insights into IPD epidemiology and highlights the impact of vaccination gaps on disease resurgence.

Findings

IPD incidence decreased during the pandemic but rebounded to 1.7 per 1,000 admissions in 2022.

Post-pandemic periods saw a significant increase in unimmunized children compared to pre-pandemic periods.

Low pneumococcal titers were found in 51% of tested children, including those fully immunized.

Abstract

Invasive pneumococcal disease (IPD) remains a significant cause of morbidity and mortality in children. While global IPD incidence declined during the COVID-19 pandemic due to mitigation measures, a resurgence followed the relaxation of these interventions. The primary objective is to describe the epidemiology of IPD at Children hospital, Detroit before and after the COVID-19 pandemic, including clinical manifestations, microbiology, treatment, and clinical outcomes.

A retrospective chart review of IPD patients ≤21 years of age admitted between January 2010 & February 2024. Patients were categorized into 2 groups: pre-pandemic (2016-2020) and pandemic/post-pandemic (2020-2024)

143 cases were included. IPD incidence decreased during the pandemic (2020-2021) but rebounded in 2022, increasing from 0.6-0.8 to 1.7 per 1,000 admissions. Most cases (66.4%) were ≤ 5 years; 88 (61.5%) were males. 77 (53.8%) were previously healthy and 10 (6.9%) had sickle cell disease. Bacteremia (n=117, 82%) and complicated pneumonia (n=37, 25.9%) were the most common presentations. High susceptibility was observed for ceftriaxone (n=95/98, 97%) and penicillin (n=90/100, 90%) in non-meningitis isolates. However, susceptibilities were lower for ceftriaxone (18/22, 82%) and penicillin (15/22, 68%) in meningitis isolates.

Pneumococcal serotyping was performed in 11/143 (7.7%) cases; 63.6% were non PCV-13 vaccine serotypes. Low pneumococcal titers were found in 19/37 (51%) tested; 15/19 (79 %) were fully immunized. Titers for PCV7/PCV13 vaccine serotypes were low despite vaccinations.

No statistically significant differences were observed between the two periods regarding age, gender, or clinical presentation (p= >0.05). However, the proportion of unimmunized children increased significantly in the post-pandemic period (n=8/43, 18.6%) compared to pre-pandemic period (n=2/49, 4.1%; p=0.04).

IPD incidence increased significantly post-pandemic, potentially due to decreased vaccination rates during the pandemic/post pandemic period. Recognizing these epidemiological shifts and addressing vaccination gaps with use of updated vaccine are critical to preventing future IPD outbreaks.

Jocelyn Y. Ang, MD, astellas: Honoraria|astellas: speaker bureau|Eli Lilly and Company: Grant/Research Support|F. Hoffmann-La Roche Ltd: Grant/Research Support|Pfizer, Inc.: Honoraria