Effect of 10-Valent Pneumococcal Vaccine on Pneumonia among Children, Brazil

Mello

Revista Paulista de Pediatria (English Edition)

et al. 2016

Objective:To describe and analyze the occurrence of hospitalizations for community-acquired pneumonia in children before and after the pneumococcal 10-valent conjugate vaccine implementation into the National Immunization Program.Methods:This is an ecological study that includes records of children younger than one year old, vaccinated and not vaccinated with the pneumococcal 10-valent conjugate vaccine in the periods pre- and post-inclusion of the vaccine in the National Immunization Program in the area covered by the Regional Health Superintendence of Alfenas, state of Minas Gerais, Brazil. Vaccination was considered as the exposure factor and hospitalization for community-acquired pneumonia as the endpoint, using secondary annual data by municipality. The prevalence ratio and its 95% confidence interval (95%CI) were used to verify the association between variables. The Z test was used to calculate the difference between proportions.Results:Considering the 26 municipalities of the Regional Health Superintendence of Alfenas, there was a significant reduction in hospitalizations for community-acquired pneumonia in children younger than one year of age, with prevalence ratio (PR)=0.81 (95%CI: 0.74-0.89; p<0.05), indicating a 19% lower prevalence of hospitalization for community-acquired pneumonia in the post-vaccination period.Conclusions:The results suggest the effectiveness of the pneumococcal 10-valent conjugate vaccine in preventing severe cases of community-acquired pneumonia in children younger than one year of age.

Section: Discussionsupporting

confidence: 91%

Impact of the pneumococcal 10-valent vaccine on reducing hospitalization for community-acquired pneumonia in children

Mello

Revista Paulista de Pediatria (English Edition)

et al. 2016

“…(4) In this sense, in 2010 the National Immunization Program included in the vaccination schedule 10-valent pneumococcal conjugate vaccine, which represented an important advance in Brazilian public health concerning prevention of invasive disease and other disease caused by S. pneumoniae. (17) However, it is worth to emphasizing that our study delineated tendencies of hospital morbidity related to bacterial pneumonia in 2000 to 2011, which did not permit to assess the effects of vaccination, from the two first months of life, throughout time series studies.…”

Section: Discussionmentioning

confidence: 99%

Análise da tendência das taxas de internações por pneumonia bacteriana em crianças e adolescentes

et al. 2015

Objective: To analyze distribution and tendency of hospital admissions rates for bacterial pneumonia in children and adolescents. Methods: This ecological, time series study included secondary data obtained from the Hospital Information System of the SUS. We calculated hospital admission coefficients for 10,000 inhabitants triennially. For the analysis of tendency, a model of polynomial regression was used. Results: Most hospital admissions occurred in the East health macro-region between the second and fourth triennial periods. Rates were higher for children age one to four years and in male patients throughout the study period. We observed an increased tendency toward hospital admission in children younger than one year. Conclusion: Hospital admission rates for pneumonia differ by health macro-region, age and sex. The region with the highest incidence was the East region, and boys aged one to four years were more affected. A growing tendency was seen in children younger than one year. ResumoObjetivo: Analisar a distribuição e a tendência das taxas de internações por pneumonia bacteriana em crianças e adolescentes. Métodos: Estudo ecológico de séries temporais com dados secundários obtidos no Sistema de Informações Hospitalares do Sistema Único de Saúde. Foram calculados coeficientes de internação para 10.000 habitantes, por triênio. Para análise de tendência utilizaram-se modelos de regressão polinomial. Resultados: As maiores taxas de internação ocorreram na Macrorregião de Saúde Oeste, entre o segundo e o quarto triênio. As taxas foram maiores na faixa etária de um a quatro anos e no sexo masculino, durante todo o período. Observou-se tendência crescente das internações em crianças menores de um ano. Conclusão: As taxas de internação por pneumonia diferem por macrorregional de saúde, idade e sexo, sendo maior na região oeste, em crianças do sexo masculino e com idade entre um e quatro anos, com tendência crescente entre os menores de um ano.

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

“…Estimates from time trend analyses have been more varied. For instance, a 13% reduction in clinical pneumonia in children <12 mo was found from a population-based surveillance study in Brazil (24), whereas estimates of ∼20% and 40% were found using administrative databases from Brazil and the United States, respectively (7,25). Aside from comparing estimates from time trend studies to randomized controlled trials, the best ground-truth estimate of vaccine impact that we can obtain is to quantify changes in morespecific categories of pneumococcal disease, where high-quality surveillance studies provide an estimate of the expected decline.…”

mentioning

confidence: 99%

Estimating the population-level impact of vaccines using synthetic controls

Bruhn

Hetterich²,

Schuck‐Paim³

et al. 2017

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.