New Zealand paediatric pneumococcal HUS cases cluster after 2020, dominated by serotype 19A

A retrospective case series in Archives of Disease in Childhood described paediatric Streptococcus pneumoniae haemolytic uraemic syndrome (SpHUS) across changing pneumococcal conjugate vaccine eras in Aotearoa New Zealand. Investigators identified 39 children aged 0–15 years at the national paediatric tertiary referral centre between 2008 and 2024, examining presentation, serotypes, acute severity and long-term renal outcomes.

Of the 39 cases, 26 (67%) occurred during 2020–2024. Median age was 18 months, and Māori and Pacific children accounted for 24 cases (62%). Complicated pneumonia occurred in 36 children (92%). Serotype 19A accounted for 27 of 32 cases with serotype data (84%), including all 21 typed cases from 2020–2024. Most children were PCV-immunised (31/39); six of 32 infections involved vaccine-covered serotypes.

Intensive care was required in 35 cases (90%) and kidney replacement therapy in 31 (79%), for a median of 13 days. Two children died and two required kidney transplantation. Among 30 survivors with follow-up, 13 (43%) had chronic kidney disease.

The findings highlight severe acute disease and substantial longer-term renal morbidity, supporting continued surveillance and vaccine strategies responsive to local serotypes. However, this retrospective case series cannot establish vaccine effectiveness or causally attribute changes to vaccine policy. The supplied abstract provides no population incidence denominators, and serotype and survivor follow-up data were incomplete.