Effectiveness of the 10-Valent Pneumococcal Conjugate Vaccine (PCV-10) in Children in Chile: A Nested Case-Control Study Using Nationwide Pneumonia Morbidity and Mortality Surveillance Data

Díaz, Janepsy; Terrazas, Solana; Bierrenbach, Ana Luiza; Toscano, Cristiana M.; Alencar, Gizelton Pereira; Álvarez, Andrés; Valenzuela, María Teresa; Andrus, Jon Kim; Aguila, Roberto del; Hormázabal, Juan Carlos; Araya, Pamela; Pidal, Paola; Matus, Cuauhtémoc Ruiz; Oliveira, Lúcia Helena de

doi:10.1371/journal.pone.0153141

Cited by 36 publications

(37 citation statements)

References 24 publications

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“…We get some approximation from randomized controlled trials and case-control analyses, both of which provide an estimate of the direct protection obtained by receiving the vaccine, although these do not capture the indirect effect of the vaccine that results from disrupting transmission. The estimates of the PCV-related reduction in hospitalizations of infants for all-cause pneumonia produced by the synthetic controls approach are larger than the both 10% against clinical pneumonia found by a randomized controlled trial in Latin America (12) and the 11% reduction in pneumonia hospitalizations in children less than 2 y of age found by a case-control study in Chile (23). Given that trend analyses capture both direct and indirect effects of the vaccine, it is reasonable that our estimates would be larger than those found by clinical trials or case-control studies, which only capture direct effects.…”

contrasting

confidence: 56%

Estimating the population-level impact of vaccines using synthetic controls

Bruhn

Hetterich²,

Schuck‐Paim³

et al. 2017

Proc. Natl. Acad. Sci. U.S.A.

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When a new vaccine is introduced, it is critical to monitor trends in disease rates to ensure that the vaccine is effective and to quantify its impact. However, estimates from observational studies can be confounded by unrelated changes in healthcare utilization, changes in the underlying health of the population, or changes in reporting. Other diseases are often used to detect and adjust for these changes, but choosing an appropriate control disease a priori is a major challenge. The “synthetic controls” (causal impact) method, which was originally developed for website analytics and social sciences, provides an appealing solution. With this approach, potential comparison time series are combined into a composite and are used to generate a counterfactual estimate, which can be compared with the time series of interest after the intervention. We sought to estimate changes in hospitalizations for all-cause pneumonia associated with the introduction of pneumococcal conjugate vaccines (PCVs) in five countries in the Americas. Using synthetic controls, we found a substantial decline in hospitalizations for all-cause pneumonia in infants in all five countries (average of 20%), whereas estimates for young and middle-aged adults varied by country and were potentially influenced by the 2009 influenza pandemic. In contrast to previous reports, we did not detect a decline in all-cause pneumonia in older adults in any country. Synthetic controls promise to increase the accuracy of studies of vaccine impact and to increase comparability of results between populations compared with alternative approaches.

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contrasting

confidence: 56%

Estimating the population-level impact of vaccines using synthetic controls

Bruhn

Hetterich²,

Schuck‐Paim³

et al. 2017

Proc. Natl. Acad. Sci. U.S.A.

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“…Before-after was the most common study design, and surveillance the most common data source used in the reported studies (Table 1). A total of 6 studies analyzed mortality: 2 evaluated PCV impact on pneumococcal meningitis deaths [19, 20], 2 evaluated impact on all-cause deaths [21, 22], and 3 analyzed deaths due to pneumonia [22–24]. …”

Section: Resultsmentioning

confidence: 99%

Impact and Effectiveness of 10 and 13-Valent Pneumococcal Conjugate Vaccines on Hospitalization and Mortality in Children Aged Less than 5 Years in Latin American Countries: A Systematic Review

et al. 2016

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BackgroundSeveral Latin American and Caribbean (LAC) countries have introduced pneumococcal conjugate vaccine (PCV-10 or PCV-13) in their routine national immunization programs.ObjectivesWe aimed to summarize the evidence of PCV impact and effectiveness in children under 5 years old in the LAC Region.MethodsWe conducted a systematic review of the literature on impact or effectiveness of PCVs on deaths or hospitalizations due to invasive pneumococcal disease (IPD), pneumonia, meningitis and sepsis. We searched Medline, WoS, Lilacs, Scopus, Central and gray literature published in any language from 2009 to January 2016. We included studies addressing the outcomes of interest in children in the target age group, and with the following designs: randomized trials, cohort or case-control, interrupted time series with at least three data points before and after the intervention, and before-after studies. Screening of citations, data extraction, and risk of bias assessment were conducted in duplicate by independent reviewers, according to the study protocol registered on PROSPERO. Descriptive analysis of the effectiveness measurements and sensitivity analysis were conducted. Effectiveness is reported as 1-OR or 1-RR for case control or cohort/clinical trials, and as percent change of disease incidence rates for before-after studies.ResultsWe identified 1,085 citations, 892 from databases and 193 from other sources. Of these, 22 were further analyzed. Studies were from Brazil, Chile, Uruguay, Argentina, Peru and Nicaragua. Effectiveness ranged from 8.8–37.8% for hospitalizations due to X-ray confirmed pneumonia, 7.4–20.6% for clinical pneumonia, and 13.3–87.7% for meningitis hospitalizations, and 56–83.3% for IPD hospitalization, varying by age, outcome definition, type of vaccine and study design.ConclusionsAvailable evidence to date indicates significant impact of both PCV-10 and PCV-13 in the outcomes studied, with no evidence of the superiority of one vaccine over the other on pneumonia, IPD or meningitis hospitalization reduction in children under 5 years old.

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“…Esta reducción alcanza a 61,9% en niños bajo 2 años de edad 6 . Por otra parte, en un estudio caso control en niños vacunados con PCV10 se pudo estimar una efectividad de la vacuna de 20,7% para prevenir eventos de neumonía y de 71,5% para muertes por neumonía 7 . Luego de la introducción de la vacuna, en personas mayores de 60 años el número de casos anuales de ENI notificados al ISP no se ha modificado.…”

Section: Impacto En Chileunclassified