Thanks to the use of the pneumococcal conjugate vaccine, we have made major strides in reducing the amount of invasive pneumococcal disease (IPD) as well as pneumonia due to this pathogen. But do those inroads hold up when a child has asthma? To answer that question, Castro-Rodriguez et al (10.1542/peds.2019-1200) performed a systematic review and subsequent meta-analysis of cohort or case-control studies found in 4 electronic databases. The primary outcomes studied in this review were cases of IPD and pneumonia with secondary outcomes being admissions, length of stay, costs, and other metrics of morbidity. IPD cases increased significantly in the children with asthma compared to the healthy controls despite their having received PCV vaccine.
So why is this happening and what can be done about it? While the authors suggested in their discussion of their findings the possibility of giving the 23 valent pneumococcal polysaccharide vaccine (PPSV23) to all children with asthma, we also asked infectious disease specialist Dr. Tina Tan to share with us her perspective on this review article in an accompanying commentary (10.1542/peds.2019-3360). She agrees with the seriousness of the association found, and while not mandating all children with asthma get PPSV23, she reinforces the importance of children with asthma being up to date with receipt of the full series of PCV-13 vaccinations. Inject some time into reading this meta-analysis and commentary but only after you have made sure all your patients with asthma are up to date on their PCV-13 vaccination schedule.