TY - JOUR T1 - Invasive Pneumococcal Disease After Implementation of 13-Valent Conjugate Vaccine JF - Pediatrics JO - Pediatrics SP - 210 LP - 217 DO - 10.1542/peds.2014-0473 VL - 134 IS - 2 AU - Tam, Pui-Ying Iroh AU - Madoff, Lawrence C. AU - Coombes, Brandon AU - Pelton, Stephen I. Y1 - 2014/08/01 UR - http://pediatrics.aappublications.org/content/134/2/210.abstract N2 - OBJECTIVE: To examine whether there is a different clinical profile and severity of invasive pneumococcal disease (IPD) in children caused by nonvaccine types in the era of 13-valent pneumococcal conjugate vaccine (PCV13).METHODS: Observational study of childhood IPD in Massachusetts based on state public health surveillance data comparing pre-PCV13 (2007–2009) and post-PCV13 (2010–2012) eras.RESULTS: There were 168 pre-PCV13 cases of IPD and 85 post-PCV13 cases of IPD in Massachusetts children ≤5 years of age. PCV13 serotypes declined by 18% in the first 2 years after PCV13 use (P = .011). In the post-PCV13 phase, a higher proportion of children were hospitalized (57.6% vs 50.6%), and a higher proportion of children had comorbidity (23.5% vs 19.6%). Neither difference was statistically significant, nor were comparisons of IPD caused by vaccine and nonvaccine types. Children with comorbidities had higher rates of IPD caused by a nonvaccine type (27.6% vs 17.2%; P = .085), were more likely to be hospitalized (80.4% vs 50%; P &lt; .0001), and were more likely to have a longer hospital stay (median of 3 days vs 0.5 days; P = .0001).CONCLUSIONS: Initial data suggest that nonvaccine serotypes are more common in children with underlying conditions, who have greater morbidity from disease. In the post-PCV13 era, a larger proportion of patients are hospitalized, but mortality rates are unchanged. Routine vaccination with PCV13 may not be enough to reduce the risk in patients with comorbidity. ER -