Significant decline in pneumonia admission rate after the introduction of routine 2+1 dose schedule heptavalent pneumococcal conjugate vaccine (PCV7) in children under 5 years of age in Kielce, Poland

Abstract

International audienceThis study was performed to estimate the effect of heptavalent pneumococcal conjugate vaccine (PCV7) on the pneumonia admission rate in children younger than 5 years of age, after the introduction of routine 2+1 dose schedule immunization. We compared the pneumonia admission rate (number of cases per 1,000 population) 2 years before and 2 years after the introduction of PCV7 in 2006. Only children with radiologically confirmed pneumonia were analyzed. The vaccination rate in the analyzed periods was around 99%. In the period preceding the implementation of PCV7, the average pneumonia admission rate was 41.48/1,000 and 6.15/1,000 for 1-year-old and 2-4-year-old children, respectively. Statistical analysis showed a significant fall in this rate in two consecutive years after PCV7 implementation ( < 0.0000001 for 1-year-old and = 0.011 for 2-4-year-old children, respectively). In the first year of vaccination, the admission number decreased in these two groups by about 65 and 23%, respectively. In the second year, only a few percent fall in the admission rate was noted. In children younger than 2 years of age, the age group targeted for vaccination, pneumonia-related healthcare utilization declined substantially following PCV7 introduction. These results suggest that PCV7 may play an important role in reducing the burden of pneumonia in Poland

State of the art paper Routine infant immunization with the 7- and 13-valent pneumococcal conjugate vaccines: current perspective on reduced-dosage regimens

“…Patrzałek et al investigated the influence of pneumococcal vaccination on the radiologically confirmed pneumonia admission rates in the hospital [8]. The results compare well with the 3+1 PCV7 dosing schedule [35][36][37].…”

“…Since PCV7 has been documented to be effective when given in a 2+1 dosing schedule, a few studies have compared the immunogenicity data when PCV13 and PCV7 are given in accordance with this dosing regimen [8,9,12,19].…”

“…In such countries, the ACIP adopted the manufacturers' recommended schedule since the pre-licensure development program for PCV7 did not include studies to assess the immunogenicity of a 2+1 reduced dosage schedule [6]. However, in a number of other countries, a reduced 2-dose schedule (2+1) for this vaccines has been adopted [7][8][9].…”

Recent trends in epidemiology of invasive pneumococcal disease in Poland

“…Additionally, PCV13 is recommended for everyone from the second month of life onward, and PPV23 for persons more than two years old, according to the Summary of Product Characteristics [6]. There are also some local initiatives, as in Kielce city, where the authorities decided to offer free vaccination for all children under two years of age, living within the city borders [7]. Moreover, according to the data provided by the National Institute of Public Health-National Institute of Hygiene, every year the number of parents who decide to vaccinate their children has increased, namely, 139,039 in 2010, 159,166 in 2011 and 173,248 in 2012, children below 15 years old completed their vaccination programs (primary or reinforcing) [8][9][10].…”

Lessons Learnt after the Introduction of the Seven Valent‑Pneumococcal Conjugate Vaccine Toward Broader Spectrum Conjugate Vaccines

“…[44] In Poland, the two infant doses schedule of PCV7 was found to be efficacious for reduction of CAP in children. [45] A significant impact of pediatric vaccination on reduction in hospitalization for alveolar pneumonia in adults in the US has been recently shown and more than 90% of the reduction in hospitalization for pneumonia attributable to the vaccine is the reduction in disease in adults due to herd protection. [46] The effect of PCV7 on AOM In a randomized clinical trial conducted in Finland in which the bacterial etiology of AOM was determined by myringotomy, the efficacy of PCV7 in preventing culture-confirmed, vaccine serotype AOM episodes was 57% (95% CI, 44-67%): the overall net reduction in AOM caused by any pneumococcal serotype was 34% (95% CI, 21-45%).…”