Are risk factors associated with invasive pneumococcal disease according to different serotypes?

ABSTRACT

The aim of this study was to investigate risk factors for the most common serotypes of invasive pneumococcal disease (IPD). A total of 293 IPD cases were analyzed in children aged 3-59 mo in a community with intermediate vaccination coverage with the 7-valent pneumococcal vaccine (PCV7). IPD cases were reviewed during 2007-2009 in two pediatric hospitals in Catalonia (Spain). A multivariate analysis using unconditional logistic regression was performed to estimate the adjusted odds ratio. PCV7 coverage was 45.4%. Pneumonia with empyema (64.5%) was the most frequent clinical manifestation. The most common serotypes were serotype 1 (21.2%), 19A (16.0%), 3 (12.6%) and 7F/A (6.8%). 70.0% of serotypes found were included in the 13-valent conjugate vaccine (PCV13), 39.2% in the 10-valent conjugate vaccine and 8.1% in the PCV7. PCV7 was protective in IPD cases due to PCV7-serotypes (aOR 0.15, 95% CI0.04-0.55). Serotype 1 was positively associated with attending day care or school (aOR 3.55, 95% CI 1.21-10.38) and age 24-59 mo (aOR 7.70, 95% CI2.70-21.98). Serotype 19A was positively associated with respiratory infection in the previous month (aOR 2.26, 95% CI 1.03-4.94), non-penicillin susceptible IPD (aOR 1.89, 95% CI1.13-3.16) and negatively associated with age 24-59 mo (aOR 0.19, 95% CI0.09-0.41). Serotype 3 was positively associated with vaccination (aOR 4.87, 95% CI2.05-11.59). No factors were associated with serotype 7F/A. Vaccination with pneumococcal vaccines including more serotypes may reduce the risk of disease in our setting.