Pneumococcal Serotype–specific Unresponsiveness in Vaccinated Child with Cochlear Implant

In silico identifi cation of a putative new paramyxovirus related to the Henipavirus A, et al. Beilong virus, a novel paramyxovirus with the largest genome of non-segmented negative-stranded RNA viruses. The complete genome sequence of J virus reveals a unique genome structure in the family Paramyxoviridae. sequence of a novel paramyxovirus, Tailam virus, discovered in Sikkim rats. and complete genome analysis of three novel paramyxoviruses, Tuhoko virus 1, 2 and 3, in fruit bats from China. Vi-PC, Tsoi HW, et al. Human parainfl uenza virus 4 outbreak and the role of diagnostic tests.lar epidemiology of human parainfl uenza virus 4 infections in Hong Kong: subtype 4B as common as subtype 4A. To the Editor: Approximately 100,000 persons worldwide have received cochlear implants for hearing loss, and more children now receive them than ever (1). Such children have a >30-fold increased risk for pneumococcal meningitis than the background rate (1,2). During 2006– 2010, children born in the United Kingdom were offered the 7-valent pneumococcal conjugate vaccine (PCV7) at 2, 4, and 13 months of age (3). Those at high risk for invasive pneumococcal disease (IPD) were additionally offered the 23-valent pneumococcal polysaccharide vaccine (PPV23) at 2–5 years (3). We describe a fully vaccinated child with a cochlear implant in whom recurrent pneumococcal meningitis developed, caused by a vaccine serotype (i.e., vaccine failure). The child continues to have nonprotective antibody concentrations against the infecting serotype, despite further pneumococcal vaccination. A previously healthy, appropriately vaccinated 23-month-old girl (Table) had a cochlear device implanted in the right ear after receiving (through the universal newborn hearing screening program) a diagnosis of profound, bilateral, sensorineural deafness. Two weeks later, she exhibited fever, lethargy, and drowsiness. On hospital admission, she had a peripheral blood leukocyte count of 19.3 × 10 9 cells/L, a neutrophil count of 17.0 × 10 9 cells/L, and C-reactive protein level 75 mg/L. Meningitis was diagnosed, and she received intravenous ceftriaxone but was too ill for a lumbar puncture. Blood cultures subsequently grew fully sensitive Streptococcus pneumoniae, later confi rmed as serotype 4 by the national reference laboratory. She was discharged after 14 days of receiving intravenous antimicrobial drugs without complications. At 24 months, she received a fourth dose of PCV7. Blood tests 1 month later showed good antibody responses to 6 PCV7 serotypes but not to serotype 4, which did not reach the putative protective level of >0.35 μg/ mL antibody threshold …