The Indian Journal of Pediatrics

, Volume 77, Issue 12, pp 1387–1391 | Cite as

Childhood Pneumococcal Diseases and Serotypes: Can Vaccines Protect?

  • Kam Lun Hon
  • Margaret Ip
  • Kenneth Lee
  • Edmund Anthony Nelson
  • Ka Ho Eric Shea
  • Yiu Sang Tony Yuen
  • Ting Fan Leung
Original Article



To describe pneumococcal diseases in pediatric intensive care unit (PICU) and non-PICU patients.


The clinical, serotypes, and antibacterial sensitivity patterns of all children admitted to the pediatric wards (including PICU) of a university-affiliated teaching hospital from 2007 through 2009 with pneumococcal isolates were reviewed.


Twelve cases of pneumococcal disease in children from 2007 through 2009 were reported. Five patients were admitted to PICU and 7 were general pediatric admissions. Four patients (2 PICU and 2 general pediatric) had received full or partial 7-valent pneumococcal vaccinations. All four patients recovered following systemic antibiotic treatment without sequelae. The serotypes of all PICU and some general pediatric cases were available and included 3, 6B, 19A and 19F. All isolates were sensitive to vancomycin. 50% were intermediate resistant/resistant to penicillin and 17% resistant to cefotaxime. PICU cases required longer total hospital stay (23 days vs 5 days, p = 0.013). Three patients were ventilated and one received inotropic support. There was no death in this series.


Pneumococcal disease may develop despite prior vaccination. The expanded coverage of newer polyvalent pneumococcal vaccines might have prevented some, but not all, of these admissions.


Invasive S pneumoniae, Septicemia Antibiotic resistance 



KLH is the principal author, MIP is the microbiologist, KL is the pharmacist, EDN and TFL are the paediatricians caring for some of these patients. They contributed in the drafting and management of these patients.

KHES and YSTY were medical graduates of the Chinese University of Hong Kong. They helped with data collection for this research before their graduation.

Conflict of Interest

KLH has received travel support from Pfizer,Wyeth and GlaxoSmithKline.

MI has received funding and support from Wyeth for childhood respiratory disease surveillance studies and for consultancy, Daiichi Pharmaceuticals for adult respiratory disease studies, and has participated in antimicrobial studies funded by AstraZeneca, and Janssen Pharmaceuticals Ltd.

KL has received funding and support from GSK, Pfizer and Wyeth for health economic studies on vaccines, has participated in regional advisory boards funded by GSK, Pfizer and Wyeth and received travel support from GSK, Pfizer and Wyeth.

EASN has received funding and support from Merck and Wyeth for diarrhoeal and respiratory disease surveillance studies, has participated in a vaccine studies funded by Baxter, GlaxoSmithKline, MedImmune and Wyeth and has received lecture fees and travel support from GlaxoSmithKline, Merck, Intercell and Wyeth.


  1. 1.
    Pneumococcal vaccines. WHO position paper. Weekly Epidemiological Record 1999; 74(23):177–83.Google Scholar
  2. 2.
    Ip M, Chau SS, Chi F, Cheuk ES, Ma H, Lai RW, et al. Longitudinally tracking fluoroquinolone resistance and its determinants in penicillin-susceptible and -nonsusceptible Streptococcus pneumoniae isolates in Hong Kong, 2000 to 2005. Antimicrob Agents Chemother. 2007;51(6):2192–4.CrossRefPubMedGoogle Scholar
  3. 3.
    Ip M, Nelson EA, Cheuk ES, Sung RY, Li A, Ma H, et al. Serotype distribution and antimicrobial susceptibilities of nasopharyngeal isolates of Streptococcus pneumoniae from children hospitalized for acute respiratory illnesses in Hong Kong. J Clin Microbiol. 2007;45(6):1969–71.CrossRefPubMedGoogle Scholar
  4. 4.
    Giebink GS. The prevention of pneumococcal disease in children. N Engl J Med. 2001;345(16):1177–83.CrossRefPubMedGoogle Scholar
  5. 5.
    Kyaw MH, Jones IG, Campbell H. Prevention of pneumococcal disease in children. Pneumococcal conjugate vaccines: their use globally could have a major impact on public health. Acta Paediatr. 2001;90(5):473–6.CrossRefPubMedGoogle Scholar
  6. 6.
    Kyaw MH, Lynfield R, Schaffner W, Craig AS, Hadler J, Reingold A, et al. Effect of introduction of the pneumococcal conjugate vaccine on drug-resistant Streptococcus pneumoniae. N Engl J Med. 2006;354(14):1455–63 [Erratum appears in N Engl J Med. 2006 Aug 10;355[6]:638].CrossRefPubMedGoogle Scholar
  7. 7.
    Musher DM. Pneumococcal vaccine–direct and indirect (“herd”) effects. N Engl J Med. 2006;354(14):1522–4.CrossRefPubMedGoogle Scholar
  8. 8.
    Morgenstern D, Garcia-Curiel CS. Clarifications about pneumococcal vaccines. Am J Health-Syst Pharm. 2010;67(3):183.CrossRefPubMedGoogle Scholar
  9. 9.
    Ip M, Lyon DJ, Yung RW, Tsang L, Cheng AF. Introduction of new clones of penicillin-nonsusceptible Streptococcus pneumoniae in Hong Kong. J Clin Microbiol. 2002;40(4):1522–5.CrossRefPubMedGoogle Scholar
  10. 10.
    Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing, Twentieth informational supplement, 20th ed. M100-S20. Clinical and Laboratory Standards Institute, Wayne, Pa.Google Scholar
  11. 11.
    O’Halloran DM, Cafferkey MT. Multiplex PCR for identification of seven Streptococcus pneumoniae serotypes targeted by a 7-valent conjugate vaccine. J Clin Microbiol. 2005;43(7):3487–90.CrossRefPubMedGoogle Scholar
  12. 12.
    Pichichero ME, Casey JR. Emergence of a multiresistant serotype 19A pneumococcal strain not included in the 7-valent conjugate vaccine as an otopathogen in children. JAMA. 2007;298(15):1772–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Fenoll A, Granizo JJ, Aguilar L, Gimenez MJ, Aragoneses-Fenoll L, Hanquet G, et al. Temporal trends of invasive Streptococcus pneumoniae serotypes and antimicrobial resistance patterns in Spain from 1979 to 2007. J Clin Microbiol. 2009;47(4):1012–20.CrossRefPubMedGoogle Scholar
  14. 14.
    Harrison CJ, Woods C, Stout G, Martin B, Selvarangan R. Susceptibilities of Haemophilus influenzae, Streptococcus pneumoniae, including serotype 19A, and Moraxella catarrhalis paediatric isolates from 2005 to 2007 to commonly used antibiotics. J Antimicrob Chemother. 2009;63(3):511–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Hon KL, Hung E, Tang J, Chow CM, Leung TF, Cheung KL, et al. Premorbid factors and outcome associated with respiratory virus infections in a pediatric intensive care unit. Pediatr Pulmonol. 2008;43(3):275–80.CrossRefPubMedGoogle Scholar
  16. 16.
    Hon KL, Leung AK. Severe childhood respiratory viral infections. Adv Pediatr. 2009;56(1):47–73.CrossRefPubMedGoogle Scholar
  17. 17.
    Theodoratou E, Johnson S, Jhass A, Madhi SA, Clark A, Boschi-Pinto C, et al. The effect of Haemophilus influenzae type b and pneumococcal conjugate vaccines on childhood pneumonia incidence, severe morbidity and mortality. Int J Epidemiol. 2010;39 Suppl 1:i172–85.CrossRefPubMedGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2010

Authors and Affiliations

  • Kam Lun Hon
    • 1
  • Margaret Ip
    • 2
  • Kenneth Lee
    • 3
  • Edmund Anthony Nelson
    • 1
  • Ka Ho Eric Shea
    • 4
  • Yiu Sang Tony Yuen
    • 4
  • Ting Fan Leung
    • 1
  1. 1.Department of Pediatrics, Prince of Wales HospitalThe Chinese University of Hong KongShatinHong Kong
  2. 2.Department of Microbiology, Prince of Wales HospitalThe Chinese University of Hong KongShatinHong Kong
  3. 3.Department of Pharmacy, Prince of Wales HospitalThe Chinese University of Hong KongShatinHong Kong
  4. 4.Prince of Wales HospitalThe Chinese University of Hong KongShatinHong Kong

Personalised recommendations