Kids With Asthma at Greater Risk for Pneumococcal Disease

Children with asthma are at much greater risk for invasive pneumococcal disease (IPD), even if they have received the pneumococcal conjugate vaccine (PCV), a systematic review and meta-analysis have found.

Jose A. Castro-Rodriguez, MD, PhD, from the Pontificia Universidad Católica de Chile, Santiago, Chile, and colleagues published their findings online December 16 in Pediatrics.

"Our review and meta-analysis revealed that children with asthma who received PCV as part of their regular immunization schedules still have 90% higher odds of IPD than children without asthma," write the authors.

The researchers conducted a search of four electronic databases, including MEDLINE and Cochrane, which included 123 studies published through October 2018. All included studies involved children with and without asthma who were diagnosed with IPD (defined as isolation of Streptococcus pneumoniae from a normally sterile fluid), and who had already received a 7-,10-, or 13-valent PCV. Four studies met the inclusion criteria and were included in the final analysis.

Castro-Rodriguez and colleagues found that, compared with healthy controls, children with asthma were 90% more likely to develop IPD, even after vaccination with PCV and regardless of corticosteroid therapy (odds ratio, 1.90; I² = 1.7%).

Citing results from previous studies in this area, the researchers recognize that circumstances contributing to the development of IPD among children with asthma are variable, including S. pneumoniae colonization rates and varying levels of sero-antibodies following vaccination with PCV.

Further, the authors suggest that children with asthma who are treated with inhaled corticosteroids may have diminished mucosal immunity in the oropharynx. When coupled with impaired airway clearance, this may leave them more susceptible to pneumococcal disease.

The authors note that current guidelines from the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) recommend that, in addition to four doses of PCV13, a supplemental 23-valent pneumococcal polysaccharide vaccine (PPSV23) be administered to children with asthma, but only if they are receiving high-dose oral steroids.

The authors acknowledge that before major changes to public policy can be recommended, further research in this area is needed given that these findings were based on only a small number of studies with variable study design and reporting methodology.

"If further confirmed in large, independent studies, these findings would suggest that children with asthma ≥ 2 years of age should receive PPSV23 after their regular PCV vaccination schedule irrespective of the use of high-dose oral steroids indicated in the current CDC and AAP guidelines," write Castro-Rodriguez and colleagues.

The study was funded by the Chilean Comisión Nacional de Investigación Científica y Tecnológica and the US National Institutes of Health (NIH). The authors have disclosed no relevant financial relationships.

Pediatrics. 2019;144:e20191200. Abstract

Follow Medscape on Facebook, Twitter, Instagram, and YouTube.