Pleural Empyema in Tijuana, Mexico, and the impact of Pneumococcal Conjugate Vaccines: Twenty Years of Active vs. Passive Surveillance Incorporating PCR - Evidence Supporting the Need for Enhanced Active Monitoring and Molecular Diagnosis.
Lopatynsky-Reyes, E. Z.; Rodriguez-Valencia, J. A.; Chacon-Cruz, E.
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In Tijuana General Hospital, Mexico, pleural empyema (PE) was monitored through passive surveillance (2000 - 2005), active surveillance with PCR (2005 - 2018), and again through passive surveillance (2022 - 2024). The implementation of active surveillance combined with molecular diagnostics markedly improved pathogen detection and enabled assessment of the 7-valent (PCV7, 2005 - 2012) and 13-valent (PCV13, 2012 - 2018) pneumococcal conjugate vaccines. This strategy yielded precise insights into the etiology of PE in children and adolescents, enhanced antimicrobial susceptibility profiling to guide antibiotic therapy, and provided strong evidence supporting the high effectiveness of PCV13. This study also provides insights towards promoting evidence-based decision-making towards effectiveness and safety outcomes of vaccines and potential new implementations to the national immunization program. The thirteen years of active surveillance were approved by the Institutional Review Board (IRB) of Hospital General de Tijuana. Because one of the objectives of this study was to compare passive and active surveillance, the use of data obtained from hospital records for passive surveillance was also reviewed and approved by the IRB. Patient identities were never disclosed, and no biological samples were retained for future analyses.
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