(*equal contribution)
Introduction: Invasive pneumococcal disease remains a major cause of morbidity and mortality in children.
Objectives: To compare the incidence of community acquired bacteremia (CAB) in children before and after the introduction of the pneumococcal conjugate vaccine into the national vaccination program.
Materials and methods: Retrospective chart review of all children aged 0-18 years who arrived at three tertiary care paediatric hospitals between 1/2007-12/2015 with CAB. Patient charts were retrieved for demographic, clinical and microbiological data, final diagnoses and outcome.
Results 554 children were included. Significant reduction was found in admission rate due to pneumococcal bacteremia (54% reduction), lower respiratory infections (43% reduction) and CAB (22% reduction). Streptococcus pneumoniae was the most common pathogen in both periods, isolated in 46.6% of cases. The relative proportion of Streptococcus pneumoniae decreased in the post-Prevnar period (from 60.9% to 35.5%), as of other pathogens increased, including Staphylococcus aureus (7.1% to 15.7%) and Streptococcus pyogenes (3.4% to 6.9%)
The frequency of penicillin non-susceptible Streptococcus pneumoniae isolates decreased significantly (from 10.7% to 3.2%, p < 0.05).
Meningitis was the final diagnosis in 31(5.6%) of patients, of them 18 (58.1%) were of pneumococcal meningitis, 9 (50%) in the pre-Prevnar period. Overall mortality rate was 0.36%.
Conclusion: Prevnar vaccine significantly changed the epidemiology of CAB in children in Israel. S. pneumoniae became less common, as other bacteria, specifically S. aureus, became more frequent. Continuous surveillance studies are important to evaluate the adequacy of the current diagnostic and therapeutic approach to children with suspected CAB.
