Pediatric patients with chronic medical conditions may have higher risk of invasive pneumococcal disease

1. Children and adolescents with chronic medical conditions have a significantly higher risk of invasive pneumococcal disease, particularly those who are immunocompromised or have multiple comorbidities.

2. These findings support strengthening pneumococcal vaccination strategies for older children and adolescents with chronic medical conditions who remain vulnerable despite routine early childhood immunization.

Evidence Rating Level: 2 (Good)

This retrospective cohort study evaluated the risk of pneumococcal disease among individuals younger than 19 years with chronic medical conditions (CMCs) in Japan. Using the JMDC longitudinal insurance claims database, the authors analyzed data from over 12.2 million children and adolescents between 2006 and 2022 to compare rates of invasive pneumococcal disease (IPD) and non-bacteremic pneumonia, acute otitis media, or sinusitis (NBP/AOM/sinusitis) in those with versus without CMCs. Seventeen predefined CMCs were identified using ICD-10 codes, and outcomes were assessed annually. Adjusted incidence rate ratios were estimated using multivariable Poisson regression models controlling for age and sex. Children with at least one CMC had substantially higher rates of IPD and NBP/AOM/sinusitis compared with healthy peers. The risk of IPD increased markedly with the number of CMCs, with particularly high incidence rate ratios among immunocompromised individuals and those with two or more CMCs. Infants and younger children with immunocompromising conditions demonstrated the highest absolute IPD rates. In contrast, while NBP/AOM/sinusitis risk was elevated in children with CMCs, the magnitude of risk did not increase substantially with additional comorbidities. Elevated risks persisted across vaccine eras and during the COVID-19 period. The authors conclude that children and adolescents with CMCs represent a high-risk population for pneumococcal disease and may benefit from expanded and targeted pneumococcal vaccination strategies beyond early childhood.

Click here to read this study in BMJ Open

Image: PD

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