{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T21:53:00Z","timestamp":1788126780737,"version":"build-2803163510"},"reference-count":20,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,2,18]],"date-time":"2025-02-18T00:00:00Z","timestamp":1739836800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Pfizer","award":["#61123731"],"award-info":[{"award-number":["#61123731"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: Pleural effusion represents an accumulation of fluid in the pleural cavity, frequently associated with pneumonia. There has been a gradual increase in cases among children in recent years, with a notable rise during the post-pandemic period, potentially due to immune debt, decreased vaccination coverage, and changes in pathogen dynamics. Methods: We enrolled 66 children with pleural effusion treated at the Children\u2019s Emergency Clinical Hospital, Brasov, between January 2019 and September 2024. We analyzed the data on demographics, symptoms, vaccination status, hospitalization, and treatments to assess the trends in the incidence and clinical features. Results: The median age was 5 years (ranging from 3 months to 17 years). Most patients were male (57.5%) from rural areas (34.8%). Only 40.9% fulfilled the vaccination schedule of Romania. We observed a rise in hospitalizations in the last two years, with 16 cases in 2023 and 15 in 2024, and most were being admitted in April (15.5%). Patients mainly had severe (36%) and medium (26%) acute respiratory failure. S. pneumoniae was the most common isolate with two cases each of serotype 1, 14, and 23A, and one case each of serotype 3, 31, and 34, followed by H. influenzae and P. aeruginosa. Treatment was mostly with ceftriaxone (69.6%), Vancomycin (63.6%), Meropenem (53.0%), and Teicoplanin (25.7%). Some children required thoracic drainage (34.8%). Complications like pneumothorax (16.6%), polyserositis (4.5%), and pneumomediastinum (3.0%) were found. Conclusions: The rise in pleural effusion cases may be influenced by various factors, such as changes in pathogen behavior or host immune responses following the pandemic. Further research is needed to understand these potential mechanisms. The emergence of non-PCV20 strains and the common occurrence of serotype 3 infections point out the need to study serotype trends and evaluate whether expanding vaccine programs could be beneficial.<\/jats:p>","DOI":"10.3390\/children12020242","type":"journal-article","created":{"date-parts":[[2025,2,18]],"date-time":"2025-02-18T06:41:12Z","timestamp":1739860872000},"page":"242","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Pediatric Pleural Effusion and Pneumococcal Vaccination Trends in the Pre- and Post-COVID Era: A Single-Centre Retrospective Study"],"prefix":"10.3390","volume":"12","author":[{"given":"Denisa Lavinia","family":"Atanasiu","sequence":"first","affiliation":[{"name":"Emergency Clinical Hospital for Children Brasov, Brasov 500063, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Mitrica","sequence":"additional","affiliation":[{"name":"Emergency Clinical Hospital for Children Brasov, Brasov 500063, Romania"},{"name":"Faculty of Medicine, Transylvania University of Brasov, Brasov 500036, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luciana","family":"Petrescu","sequence":"additional","affiliation":[{"name":"Emergency Clinical Hospital for Children Brasov, Brasov 500063, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oana","family":"Falup-Pecurariu","sequence":"additional","affiliation":[{"name":"Emergency Clinical Hospital for Children Brasov, Brasov 500063, Romania"},{"name":"Faculty of Medicine, Transylvania University of Brasov, Brasov 500036, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Bleotu","sequence":"additional","affiliation":[{"name":"Emergency Clinical Hospital for Children Brasov, Brasov 500063, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raluca Ileana","family":"Lixandru","sequence":"additional","affiliation":[{"name":"Emergency Clinical Hospital for Children Brasov, Brasov 500063, Romania"},{"name":"Faculty of Medicine, Transylvania University of Brasov, Brasov 500036, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Greenberg","sequence":"additional","affiliation":[{"name":"Soroka Medical Centre, Ben Gurion University, Beer-Sheva 8410501, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Grecu","sequence":"additional","affiliation":[{"name":"Emergency Clinical Hospital for Children Brasov, Brasov 500063, Romania"},{"name":"Faculty of Medicine, Transylvania University of Brasov, Brasov 500036, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,18]]},"reference":[{"key":"ref_1","first-page":"41","article-title":"Evaluation and outcomes of pediatric pleural effusions in over 10 years in Northwest, Iran","volume":"2","author":"Bilan","year":"2014","journal-title":"Int. J. Pediatr."},{"key":"ref_2","first-page":"365","article-title":"Pleural effusion in children: A review article and literature review","volume":"3","author":"Afsharpaiman","year":"2016","journal-title":"Int. J. Med. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2704","DOI":"10.1016\/j.vaccine.2019.04.012","article-title":"Significant impact of pneumococcal conjugate vaccination on pediatric parapneumonic effusion: Italy 2006\u20132018","volume":"37","author":"Azzari","year":"2019","journal-title":"Vaccine"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1528","DOI":"10.1093\/infdis\/jiad188","article-title":"Burden of respiratory syncytial virus in the European Union: Estimation of RSV-associated hospitalizations in children under 5 years","volume":"228","author":"Spreeuwenberg","year":"2023","journal-title":"J. Infect. Dis."},{"key":"ref_5","unstructured":"Populatia Rezidenta Dup\u0103 Grupa de Varsta, pe Medii de Rezidenta si Sexe (2024, November 20). INS\u2014Directia Judeteana de Statistica BRASOV. Available online: https:\/\/brasov.insse.ro\/recensaminte\/."},{"key":"ref_6","unstructured":"Municipality of Municipiul Brasov (2024, November 22). AdminStat Romania. Available online: https:\/\/ugeo.urbistat.com\/AdminStat\/en\/ro\/demografia\/popolazione\/brasov\/8\/3."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"104638","DOI":"10.1016\/j.idnow.2022.12.003","article-title":"Immune debt: Recrudescence of disease and confirmation of a contested concept","volume":"53","author":"Cohen","year":"2023","journal-title":"Infect. Dis. Now"},{"key":"ref_8","first-page":"e360-70","article-title":"Changes in the incidence of invasive disease due to Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis during the COVID-19 pandemic in 26 countries and territories in the Invasive Respiratory Infection Surveillance Initiative: A prospective analysis of surveillance data","volume":"3","author":"Brueggemann","year":"2021","journal-title":"Lancet Digit. Health"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1016\/j.idnow.2021.05.004","article-title":"Pediatric Infectious Disease Group (GPIP) position paper on the immune debt of the COVID-19 pandemic in childhood, how can we fill the immunity gap?","volume":"51","author":"Cohen","year":"2021","journal-title":"Infect. Dis. Now"},{"key":"ref_10","first-page":"e943312-1","article-title":"Outbreaks of post-pandemic childhood pneumonia and the re-emergence of endemic respiratory infections","volume":"29","author":"Parums","year":"2023","journal-title":"Med. Sci. Monit. Int. J. Exp. Clin. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"6243","DOI":"10.1016\/j.vaccine.2016.10.062","article-title":"Changes in empyema among US children in the pneumococcal conjugate vaccine era","volume":"34","author":"Wiese","year":"2016","journal-title":"Vaccine"},{"key":"ref_12","unstructured":"(2024, November 25). Centrul National de Supraveghere si Control al Bolilor Transmisibile\u2014Estimarea Acoperirii Vaccinale. Institutul National de Sanatate Publica Romania. Available online: https:\/\/www.cnscbt.ro\/index.php\/analiza-date-supraveghere\/evaluarea-acoperirii-vaccinale."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1016\/j.vaccine.2019.10.056","article-title":"Increase in Streptococcus pneumoniae serotype 3 associated parapneumonic pleural effusion\/empyema after the introduction of PCV13 in Germany","volume":"38","author":"Streng","year":"2020","journal-title":"Vaccine"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1038\/s41541-023-00715-w","article-title":"Emerging vaccine strategies against the incessant pneumococcal disease","volume":"8","author":"Duke","year":"2023","journal-title":"npj Vaccines"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1128\/CMR.00018-12","article-title":"Pediatric invasive pneumococcal disease in the United States in the era of pneumococcal conjugate vaccines","volume":"25","author":"Tan","year":"2012","journal-title":"J. Clin. Microbiol."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Hurst, J.H., Shaik-Dasthagirisaheb, Y.B., Truong, L., Boiditswe, S.C., Patel, S.M., Gilchrist, J., Maciejewski, J., Luinstra, K., Smieja, M., and Steenhoff, A.P. (2024). Serotype epidemiology and antibiotic resistance of pneumococcal isolates colonizing infants in Botswana (2016\u20132019). PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0302400"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2135","DOI":"10.1093\/cid\/ciy920","article-title":"Effectiveness of 13-valent pneumococcal conjugate vaccine against invasive disease caused by serotype 3 in children: A systematic review and meta-analysis of observational studies","volume":"68","author":"Sings","year":"2019","journal-title":"Clin. Infect. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1097\/INF.0000000000004359","article-title":"Empiric Antibiotic Therapy in 1402 Children with Parapneumonic Effusion\/Pleural Empyema in Germany: A Long-term Surveillance Study","volume":"43","author":"Forster","year":"2024","journal-title":"Pediatr. Infect. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1016\/j.rmr.2020.04.010","article-title":"Antibiotic strategy in pleural empyema in children: Consensus by the DELPHI method","volume":"37","author":"Leoni","year":"2020","journal-title":"Rev. Mal. Respir."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e407","DOI":"10.1097\/INF.0000000000004061","article-title":"Current Management of Pediatric Parapneumonic Pleural Effusions and Pleural Empyema","volume":"42","author":"Forster","year":"2023","journal-title":"The Pediatr. Infect. Dis."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/2\/242\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:36:44Z","timestamp":1760027804000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/2\/242"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,18]]},"references-count":20,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["children12020242"],"URL":"https:\/\/doi.org\/10.3390\/children12020242","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,18]]}}}