Increase in severe pneumonia in children may be caused by vaccine

By Jeremy Laurance, Health Editor
Monday, 14 April 2008

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Cases of a life-threatening form of pneumonia that affects the young are rising rapidly in Britain. It now affects around 1,000 children a year. The cause of the increase is unknown but experts fear a vaccine in the immunisation programme could be contributing.

This severe pneumonia infects the lining of the lungs called the pleura, making it hard to breathe. It requires hospital admission to drain the chest cavity. The children affected are frightened and in pain and many und-ergo surgery to scrape out the contents of the pleura ­ a process called surgical debridement.

Child health specialists say cases of the pneumonia, known as serotype 1, have risen tenfold in a decade. They warn that a vaccine against pneumococcal disease called Prevnar, introduced in 2006, could be fuelling the rise.

The vaccine is given at two, four and 13 months and provides protection against seven of the commonest types of pneumonia. It is safe and highly effective ­ cases of invasive pneumococcal disease caused by the serotypes covered by the vaccine have fallen by 90 per cent in two years. But there are more than 90 known strains of the bacterium that causes pneumonia. When one is eliminated, it creates an opportunity for another to take its place. In the US, where Prevenar was introduced in 2000, researchers have reported an emergence of "sero-replacement" disease ­ types of pneumonia not covered by the vaccine.

David Spencer, consultant respiratory paediatrician at the Freeman Hospital, Newcastle upon Tyne, will present figures on the growth in pneumococcal disease to the Royal College of Paediatrics annual conference in York today. He said: "It looks as if serotype one is becoming more virulent. We have had four cases in the past week in Newcastle with empyema [the accumulation of septic fluid in the pleural cavity]. These children are seriously ill and suffer a lot of pain."

Serotype 1's rise in the UK began 15 years ago, long before the Prevenar vaccine was introduced. Although its increase in the past could not be explained by the vaccine, Dr Spencer said evidence from the US suggests it is a risk in the future.

"I contacted the Health Protection Agency [HPA] 18 months ago and expressed concern that there was a potential for the vac-cine to make things worse. The increase in other sero-types in the US may be due to the vaccine there." The HPA immediately expanded its surveillance programme, Dr Spencer said.

Linda Glennie, head of research at the Meningitis Research Foundation, which is funding the surveillance programme with the HPA, said the challenge was to keep one step ahead of nature. "The Prevenar vaccine saves lives. Other strains are starting to increase but the number of cases prevented hugely outweighs cases increased."

Two companies are wor-king on vaccines to protect against up to 13 serotypes of the disease, including serotype 1. But they are at least two years away, Dr Glennie said. The ultimate goal would be a vaccine for all pneumococcal disease.

'Two GPs and a nurse said my son had a virus' - Robbie Barnes, 18 months

Eighteen-month-old Robbie Barnes started vomiting just over two weeks ago. His mother Vanessa thought he had a virus.

Vanessa, 36, from Middlesbrough, said: "He is normally fit, running all over the place. He had a temperature, vomited the next day ­ and it went on.

"I took him to an emergency doctor twice and to my GP, where I saw the practice nurse. They all said it was a virus and it would go in a few days. He couldn't sleep because he was struggling to breathe."

In desperation, Vanessa took him to their local A&E department, where an X-ray revealed severe pneumonia. "I was devastated. I was expecting a chest infection but not pneumonia," she said.

Robbie was put on oxygen. His lungs were so badly infected he was transferred to the Freeman Hospital in Newcastle upon Tyne, where surgeons operated to clean out pus and septic fluid gathered in the pleural cavity between the chest wall and lungs.

Vanessa said: "He is a lot perkier now. He is still a bit wobbly on his feet because he has got no strength. He is on the mend ­ but it was all quite frightening."