The changing epidemiology of parapneumonic empyema in children

Parapneumonic or post-pneumonic empyema (PPE) is a severe complication of invasive pneumonia, which has become dramatically more common in children worldwide over the past decade. Although death is uncommon in children from western countries, there is often significant associated morbidity and loss of quality of life, especially if there are associated problems related to lung necrosis. Streptococcus pneumoniae is the principal pathogen causing PPE and a high proportion is due to serotype 1. However, the currently licensed conjugate pneumococcal vaccine does not confer protection against this serotype. To address these problems, a vaccine that includes serotype 1 is required, together with the establishment of ongoing surveillance of serotype distribution associated with invasive pneumococcal disease.