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Assessing the impact of the 13 valent pneumococcal vaccine on childhood empyema in Australia
  1. Roxanne Strachan1,
  2. Nusrat Homaira1,2,
  3. Sean Beggs3,4,
  4. Mejbah U Bhuiyan5,6,
  5. Gwendolyn L Gilbert7,
  6. Stephen B Lambert8,9,
  7. Kristine Macartney10,11,
  8. Helen Marshall12,13,
  9. Andrew C Martin14,
  10. Gabrielle B McCallum15,
  11. Angela McCullagh16,17,
  12. Tim McDonald18,
  13. Peter McIntyre10,19,
  14. Shahin Oftadeh20,
  15. Sarath Ranganathan21,22,
  16. Sadasivam Suresh23,
  17. Claire E Wainwright24,25,
  18. Angela Wilson26,
  19. Melanie Wong27,
  20. Thomas Snelling28,
  21. Adam Jaffé1,2
  1. 1 Department of Respiratory Medicine, Sydney Children’s Hospital Randwick, Randwick, New South Wales, Australia
  2. 2 School of Women’s and Children's Health, University of New South Wales—Kensington Campus, Sydney, New South Wales, Australia
  3. 3 Department of Paediatrics, Royal Hobart Hospital, Hobart, Tasmania, Australia
  4. 4 School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
  5. 5 Division of Paediatrics, School of Medicine, Faculty of Health and Medical Science, University of Western Australia, Crawley, Western Australia, Australia
  6. 6 Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, Western Australia, Australia
  7. 7 Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, New South Wales, Australia
  8. 8 School of Medicine, University of Queensland, UQ Child Health Research Centre, Brisbane, Queensland, Australia
  9. 9 Children’s Health Queensland, Queensland Paediatric Infectious Diseases Laboratory, Brisbane, Queensland, Australia
  10. 10 Infectious Diseases, Children’s Hospital at Westmead, Westmead, New South Wales, Australia
  11. 11 National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Westmead, New South Wales, Australia
  12. 12 Vaccinology and Immunology Research Trials Unit, Women's and Children's Hospital, Women's and Children’s Health Network, North Adelaide, South Australia, Australia
  13. 13 Child and Adolescent Health, Robinson Research Institute, The University of Adelaide, North Adelaide, South Australia, Australia
  14. 14 Paediatrics, Princess Margaret Hospital For Children, Perth, Western Australia, Australia
  15. 15 Child Health Division, Menzies School of Health Research, Darwin, Northern Territory, Australia
  16. 16 Respiratory and Sleep Medicine, Monash Children’s Hospital, Melbourne, Victoria, Australia
  17. 17 Paediatrics, Monash University, Clayton, Victoria, Australia
  18. 18 Paediatrics, Canberra Hospital, Canberra, Australian Capital Territory, Australia
  19. 19 Women's and Children's Health, University of Otago—Dunedin Campus, Dunedin, New Zealand
  20. 20 Centre for Infectious Diseases and Microbiology Laboratory Services, Institute of Clinical Pathology and Medical Research, Wentworthville, New South Wales, Australia
  21. 21 Paediatrics, The University of Melbourne Department of Paediatrics, Parkville, Victoria, Australia
  22. 22 Infection and Immunology, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
  23. 23 Department of Respiratory Medicine, Queensland Children's Hospital, South Brisbane, Queensland, Australia
  24. 24 Respiratory and Sleep Medicine, Queensland Children’s Hospital, South Brisbane, Queensland, Australia
  25. 25 Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
  26. 26 Department of Paediatrics, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
  27. 27 Immunology, The Children’s Hospital at Westmead, Westmead, New South Wales, Australia
  28. 28 School of Women's and Children's Health, The University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Roxanne Strachan, Department of Respiratory Medicine, Sydney Children's Hospital Randwick, Randwick, NSW 2031, Australia; roxanne.strachan{at}


Background Empyema is a serious complication of pneumonia frequently caused by Streptococcus pneumoniae (SP). We assessed the impact of the 13-valent pneumococcal conjugate vaccine (13vPCV) on childhood pneumonia and empyema after inclusion in the Australian National Immunisation Program.

Methods For bacterial pneumonia and empyema hospitalisations, we ascertained incidence rates (IRs) using the National Hospital Morbidity Database International Statistical Classification of Disease discharge codes and relevant population denominators, and calculated incidence rate ratios (IRR) comparing the 13vPCV period (June 2012–May 2017) with the 7vPCV period (June 2007–May 2011). Blood and pleural fluid (PF) cultures and PF PCR of 401 children with empyema from 11 Australian hospitals during the 13vPCV period were compared with our previous study in the 7vPCV period.

Findings Across 7vPCV and 13vPCV periods, IRs per million children (95% CIs) were 1605 (1588 to 1621) and 1272 (1259 to 1285) for bacterial pneumonia, and 14.23 (12.67 to 15.79) and 17.89 (16.37 to 19.42) for empyema hospitalisations. IRRs were 0.79 (0.78 to 0.80) for bacterial pneumonia and 1.25 (1.09 to 1.44) for empyema. Of 161 empyema cases with SP serotypes, 147 (91.3%) were vaccine types. ST3 accounted for 76.4% of identified serotypes in the 13vPCV period, more than double than the 7vPCV period (p<0.001); ST19A decreased from 36.4% to 12.4%. No cases of ST1 empyema were identified in the 13vPCV period versus 14.5% in the 7vPCV period.

Interpretation 13vPCV resulted in a significant reduction in all-cause hospitalisations for bacterial pneumonia but empyema hospitalisations significantly increased, with emergence of pneumococcal ST3 as the dominant serotype in empyema.

Trial registration number Australian and New Zealand Clinical Trial Registry ACTRN 12614000354684.

  • bacterial infection
  • empyema
  • respiratory infection

Data availability statement

Data are available upon reasonable request. Deidentified participant source data available upon reasonable request.

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Data availability statement

Data are available upon reasonable request. Deidentified participant source data available upon reasonable request.

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  • Twitter @MejbahBhuiyan, @sarathranganathan

  • Contributors RS, AJ and TS were responsible for the original conception and design of the study. RS, AJ, TS, SB, MUB, KM, HM, ACM, GBM, AM, TM, PM, SR, SS, CEW and AW were all equally responsible for the acquisition of data. RS, AJ, TS and NH performed the initial data analysed and drafted the initial manuscript. All authors contributed equally to the interpretation of the data, ongoing revision and final approval of the manuscript to be published.

  • Funding This study was funded by a research grant from the Australian National Health and Medical Research Council GNT1064841.

  • Disclaimer The NHMRC had no involvement in any aspect of this research, including study design, recruitment, data collection, data analysis and interpretation or writing up of results. The corresponding author had full access to all data in the study and had final responsibility for the decision to submit for publication.

  • Competing interests HM is an investigator on sponsored vaccine trials. Her institution receives funding from Pfizer and GSK for investigator-led research. She does not receive any personal payments from Industry.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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