Impact of Pneumococcal Conjugate Vaccines on the Incidence of Pneumonia in Hospitalized Children after Five Years of Its Introduction in Uruguay

Abstract

BackgroundData on the burden of pneumococcal disease and the most frequent serotypes demonstrated that invasive disease and pneumonia were important manifestations affecting children under 5 years of age. Therefore, pneumococcal diseases prevention became a public health priority. Uruguay was the first Latin American country to incorporate PCV7 into its National Immunization Program. The aim of this study is to compare the incidence rates for hospitalized pneumonia in children from the pre PCV introduction period and the following five years of PCVs application in Uruguay.Methods and FindingsPopulation-based surveillance of pneumonia hospitalization rates, in children, less than 14 years of age, had been performed prior pneumococcal vaccination, and continued following PCV7 introduction and PCV13 replacement, using the same methodology. Hospitalized children with pneumonia were enrolled from January 1, 2009 through December 31st, 2012. The study was carried out in an area with a population of 238,002 inhabitants of whom 18, 055 were under five years of age. Patients with acute lower respiratory infections for whom a chest radiograph was performed on admission were eligible. Digitalized radiographs were interpreted by a reference radiologist, using WHO criteria. Pneumonia was confirmed in 2,697 patients, 1,267 with consolidated and 1,430 with non consolidated pneumonia of which incidence decrease, between 2009 and 2012, was 27.3% and 46.4% respectively. 2001–2004 and 2009–2012 comparison showed a significant difference of 20.4% for consolidated pneumonia hospitalizations. A significant incidence decline was recorded among children 6 to 35 months of age.ConclusionsAn overall significant reduction in pneumonia hospitalizations was observed following the introduction of PCV7 and furthermore following the change to PCV13.

O impacto da vacina pneumocócica PCV10 na redução da mortalidade por pneumonia em crianças menores de um ano em Santa Catarina, Brasil

“…Em Gâmbia, um estudo randomizado com grupo controle acompanhou 22 mil crianças e evidenciou uma proteção conferida pela vacina PCV-9 contra pneumonia com confirmação radiológica de 27% em comparação com o grupo controle, reduzindo em 16% as mortes entre as crianças vacinadas 24 . No Uruguai, as taxas de hospitalização por pneumonia em crianças, menores de 14 anos de idade, apresentaram um declínio de 20,4% para internações por pneumonia comprovada, sendo significativa entre crianças de 6 a 35 meses de idade 25 . No Brasil, houve a redução da incidência de meningites por pneumococo por 100 mil menores de 1 ano de idade de 7,15 em 2010 para 5,7 em 2011, ano seguinte à implantação da vacina 26 .…”

“…Embora o impacto da vacina pneumocóci-ca venha se mostrando positivo no controle da pneumonia no Brasil e em outros países da Amé-rica Latina como Argentina, Uruguai e Chile, os sorotipos para compor a vacina precisam ser constantemente avaliados 25,27,28 . Apesar dessa avaliação não estar sendo realizada no Estado de Santa Cataria, um estudo realizado em Goiânia (Goiás), no início de 2011, descreve a redução na colonização pelos sorotipos vacinais de 44% nas crianças que receberam as três doses da vacina, o que não foi observado naquelas que receberam apenas uma dose ou não foram vacinadas 29 .…”

Effect of 7 and 13-Valent Pneumococcal Conjugate Vaccines Different Number of Doses for Pneumonia Control in 2008 and 2010 Birth Cohort Children

“…The same methodology has been employed in studies pre-and post-the introduction of PCV, the results of which have been already published [1] [2]. Briefly, all hospitalized children with an acute lower respiratory tract infection were eligible if an X-ray was ordered to confirm pneumonia.…”

“…However, information on the impact of both pneumococcal conjugate vaccines is scarce in Uruguay today. A four year population-based surveillance (2009-2013) of hospitalized children with pneumonia was carried out in a selected area of the northwest of Uruguay [2]. It was performed while the NIP was in progress, so it provided data on the vaccination status of in-patients with consolidated pneumonia.…”

New pneumococcal conjugate vaccine introductions in four sub-Saharan African countries: a cross-country analysis of health systems’ impacts

“…Previous studies either focused on demonstrating the health impact of PCV 4,5,[9][10][11] , or explored how new vaccines affected specific health system functions or vaccination coverage 12,13 . No research has evaluated the effects of adding PCV into EPI nor how it, as one component of the Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea 14 , may have affected wider health systems.…”