Pediatric patients with asthma who receive pneumococcal conjugate vaccine (PCV) as part of their regular immunization schedule still have a higher risk for invasive pneumococcal disease (IPD) compared with children without asthma, according to study results published in Pediatrics.

Investigators conducted a review and meta-analysis by searching 4 electronic databases to assess the risk for IPD or pneumonia in children with asthma after the introduction of PCV. The researchers selected all cohort studies or case-control studies of pneumonia or IPD in populations of patients who had already received PCV (mainly, the 7-valent pneumococcal conjugate vaccine), but not the 23-valent pneumococcal polysaccharide vaccine, and in which data were reported in both children with asthma and control individuals.

All the studies were independently reviewed by 2 different reviewers. The primary study outcomes included the occurrence of IPD and pneumonia. Secondary outcomes were mortality, hospitalizations, admission to the intensive care unit, length of hospital stay, use of respiratory support, additional use of medication, and costs. Of the 125 studies analyzed, 5 met inclusion criteria. Of those 5 studies, 3 retrospective cohorts (approximately 26 million person-years) and 1 case-control study (N=3294 children) qualified for the meta-analysis.

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Results demonstrated that children with asthma had a 90% higher odds for IPD compared with healthy control individuals (95% CI, 1.63-2.11; P =.40). In addition, pneumonia was more common in pediatric patients with asthma than in control individuals, with 1 study reporting that pneumonia-associated costs increased with the severity of an individual’s asthma ($100,000, $172,002, and $638,452 per 100,000 person-years for mild, moderate, and severe asthma, respectively).

A major limitation of the current meta-analysis is the fact that none of the studies included information on asthma therapy or treatment adherence.

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The investigators concluded that additional research is warranted to evaluate the need for supplemental 23-valent polysaccharide vaccination in children with asthma, regardless of their current use of high-dose oral corticosteroids.


Castro-Rodriguez JA, Abarca K, Forno E. Asthma and the risk of invasive pneumococcal disease: a meta-analysis. Pediatrics. 2020;145(1):e20191200.