Streptococcus pneumoniae haemolytic uraemic syndrome in Aotearoa New Zealand across changing pneumococcal conjugate vaccine eras

Objective To describe the epidemiology, clinical features, microbiology and outcomes of paediatric Streptococcus pneumoniae haemolytic uraemic syndrome (SpHUS) in Aotearoa New Zealand across changing pneumococcal conjugate vaccine (PCV) eras. Design Retrospective case series. Setting National paediatric tertiary referral centre, New Zealand. Patients Children aged 0–15 years with SpHUS between 2008 and 2024. Main outcome measures Clinical presentation, microbiology and serotype distribution, acute severity and long-term renal outcomes. Results 39 cases were identified; 26/39 (67%) occurred between 2020 and 2024. Median age was 18 months, with 26/39 (67%) aged <2 years. Māori and Pacific children comprised 24/39 (62%) of cases. Complicated pneumonia was the predominant presentation (36/39, 92%). Among 32 cases with serotype data, 27/32 (84%) were serotype 19A, including 21/21 cases from 2020 to 2024. Most children were PCV-immunised (31/39, 79%), with 6/32 (19%) infected with vaccine-covered serotypes. Disease severity was high: 35/39 (90%) required intensive care and 31/39 (79%) required kidney replacement therapy (median 13 days). Mortality was 2/39 (5%) and 2/39 (5%) required kidney transplantation. Among survivors with follow-up, 13/30 (43%) had chronic kidney disease. Conclusions SpHUS in New Zealand has increased since 2020, during a period of rising invasive pneumococcal disease, predominantly involving serotype 19A, with high acute severity and substantial long-term kidney morbidity. The burden is disproportionately borne by Māori and Pacific children, highlighting the need for ongoing surveillance and vaccine strategies responsive to local epidemiology.