Streptococcus pneumoniae-associated hemolytic uremic syndrome Canadian Immunization Monitoring Program ACTive National Pediatric Surveillance (1991 to 2019)

Lauren Dagyung Lee; Nirma Khatri Vadlamudi; Katherine Yu; Manish Sadarangani; Nicole Le Saux; Joanne Embree; James D Kellner; Shaun K Morris; Scott A Halperin; Julie A Bettinger; for Members of the Canadian Immunization Monitoring Program, Active (IMPACT)

doi:10.1093/pch/pxae055

Streptococcus pneumoniae-associated hemolytic uremic syndrome Canadian Immunization Monitoring Program ACTive National Pediatric Surveillance (1991 to 2019)

Paediatr Child Health. 2024 Sep 20;30(2):78-82. doi: 10.1093/pch/pxae055. eCollection 2025 May.

Authors

Collaborators

for Members of the Canadian Immunization Monitoring Program, Active (IMPACT):
N Bridger, Cheryl Foo, S A Halperin, K A Top, R Thibeault, J Papenburg, M Lebel, N Le Saux, S Morris, J Embree, B Tan, Athena McConnell, T Jadavji, C Constantinescu, W Vaudry, D Scheifele, M Sadarangani, J Bettinger, L Sauvé

Affiliations

¹ Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
² Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.
³ Division of Infectious Diseases, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
⁴ Division of Infectious Diseases, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada.
⁵ Department of Pediatrics and Child Health, University of Winnipeg, Winnipeg, Manitoba, Canada.
⁶ Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
⁷ Alberta Children's Hospital, Calgary Zone, Alberta Health Services, Calgary, Alberta, Canada.
⁸ Division of Infectious Diseases, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
⁹ Canadian Center for Vaccinology, Halifax, Nova Scotia, Canada.
¹⁰ Department of Pediatrics, Dalhousie University and the IWK Health Centre Dalhousie University, Halifax, Nova Scotia, Canada.

Abstract

Objectives: Streptococcus pneumoniae-associated hemolytic uremic syndrome (SP-HUS) is an underreported cause of pediatric atypical HUS. This study describes the epidemiology of the largest Canadian case series of SP-HUS in comparison with non-HUS invasive pneumococcal disease (IPD).

Methods: The Canadian Immunization Monitoring Program, ACTive (IMPACT) is a national surveillance network for vaccine-preventable diseases. All confirmed IPD cases from 1991 through 2019 were included in the analysis. IPD cases with new HUS diagnoses were identified as SPHUS cases, and the rest as non-HUS IPD.

Results: There were 30 (0.4%) cases of SP-HUS amongst 6757 IPD cases. The median age of SP-HUS cases was 27.5 months, with no significant differences between SP-HUS and non-HUS cases in age or sex. Streptococcus pneumoniae serotypes 3 (30%) and 19A (26.7%) were more common in SP-HUS compared to non-HUS (P < 0.0001). Pneumonia was more frequently observed in SPHUS than in non-HUS (67% versus 26%; P < 0.0001). All SP-HUS cases were hospitalized, compared with 71% of non-HUS IPD cases (P = 0.0004). SP-HUS cases had a longer median hospital length of stay than non-HUS (23.5 versus 7 days; P < 0.0001) and a higher proportion required an Intensive Care Unit (ICU) admission (70% versus 15.5%; P < 0.0001). Moreover, ICU stays were longer in HUS cases compared with non-HUS cases (9 versus 3 days; P < 0.0001). All 30 SP-HUS patients survived while 3% of non-HUS cases died (P = 0.33).

Conclusions: SP-HUS was usually seen in IPD cases with pneumonia and was most commonly caused by serotypes 3 and 19A. ICU care was lengthy, hospital stay was longer. No deaths occurred among SP-HUS cases.

Keywords: Atypical hemolytic uremic syndrome; Canada; IMPACT; Invasive pneumococcal disease; Non-STEC hemolytic uremic syndrome.