The impact of pneumococcal conjugate vaccine on community-acquired pneumonia hospitalizations in children with comorbidity

Abstract

The burden of community-acquired pneumonia (CAP) in high-income countries is still significant. The introduction of pneumococcal conjugate vaccines (PCV) has reduced the overall need for hospitalization for CAP. However, it is not clear whether children with underlying disease also have benefitted from the PCV immunization programme. Children 0 to <5 years of age hospitalized with CAP and discharged with an ICD-10 code of J13-J18.9 between November 1, 2005, and April 30, 2007 (pre-vaccination period), and November 1, 2010, and April 30, 2012 (post-vaccination period), were eligible for this study. Data on hospitalization and discharge diagnoses were retrieved from the Hospital Registry. In addition, chart review was performed in 50% of the patients. Our result confirmed a decrease in hospitalization rate for CAP in the PCV13 period. Chart review revealed that half of the patients had underlying comorbidity and these children had more severe symptoms and required longer hospital stay. Intensive care was provided to less than 10% of the children and mostly for children with an underlying neurological disease. Conclusions: We show that all children have benefitted from the reduction of CAP hospitalization after introduction of PCV. Our finding emphasizes the importance of children with chronic diseases receiving adequate vaccinations that may protect from lower respiratory diseases. What is known? • Community-acquired pneumonia is a leading infectious cause of hospitalizations and death among children <5 years of age globally • Pneumococcal conjugate vaccine reduces the hospitalizations of all-cause pneumonia What is new? • We show that also children with underlying comorbidities have benefitted from PCV immunization with a reduction of CAP hospitalization • We show that approximately half of all children hospitalized with CAP also have underlying comorbidities.

Vaccine Immunity in Children After Hematologic Cancer Treatment: A Retrospective Single-center Study

“…34 Pneumococcal vaccination also reduces the number of hospitalizations due to IPD in patients with comorbidities, such as cancer. 35 Moreover, a study in adults showed that influenza and pneumococcal vaccinations were immunogenic when administered early in the course of disease, ideally 4 to 6 weeks (at least 2 weeks) before starting the chemotherapy and, if not possible, 3 months after the end of chemotherapy. 36 Several other studies suggest that vaccination with PCV13 directly after completion of chemotherapy is safe and highly effective to prevent IPD without age restriction.…”

“…It has also been reported that children undergoing therapy for an ALL have a relative risk of 11.4 times of developing an invasive pneumococcal disease (IPD) during the first 2 years post-cancer diagnosis compared with healthy children 34 . Pneumococcal vaccination also reduces the number of hospitalizations due to IPD in patients with comorbidities, such as cancer 35 . Moreover, a study in adults showed that influenza and pneumococcal vaccinations were immunogenic when administered early in the course of disease, ideally 4 to 6 weeks (at least 2 weeks) before starting the chemotherapy and, if not possible, 3 months after the end of chemotherapy 36 .…”

Higher Hospitalization Rate for Lower Airway Infection in Transfusion-Naïve Thalassemia Children

“…The comorbidities included were asthma (ICD-9-CM: 493), diabetes mellitus (DM) (ICD-9-CM: 450), chronic lung disease (ICD-9-CM: 770.7), heart failure (ICD-9-CM: 428), epilepsy (ICD-9-CM: 345), and chronic kidney disease (CKD) (ICD-9-CM: 580∼589), diagnosed once at hospitalization or at least thrice in the outpatient department in 1 year. These medical conditions were proved to be risk factors of pneumonia (18,19). The propensity score was calculated using the Statistical Analysis System 9.4 program (SAS Institute, Cary, North Carolina, USA).…”

Sex-differences in incidence of hospitalizations and in hospital mortality of community-acquired pneumonia among children in Spain: a population-based study

“…Many pathogens are responsible for CAP in children, including Streptococcus pneumonia and Haemophilus influenzae . Several viral pathogens have also been acknowledged as important pathogens for CAP, including influenza virus, respiratory syncytial virus, and adenoviruses [ 5 ]. In any case, it must be considered that conventional microbiological studies can identify the etiology in only a limited number of patients [ 6 , 7 ].…”