Incidence of invasive pneumococcal disease in children with commercial insurance or Medicaid coverage in the United States before and after the introduction of 7- and 13-valent pneumococcal conjugate vaccines during 1998–2018

Abstract

Background Invasive pneumococcal disease (IPD) is a major cause of pediatric morbidity and mortality. Pneumococcal conjugate vaccines (PCVs) were introduced in the US in 2000 (PCV7) and 2010 (PCV13). This study estimated the annual incidence rates (IRs) and time trends of IPD to quantify the burden of disease in children before and after the introduction of PCV7 and PCV13 in the US. Methods IPD episodes were identified in the IBM MarketScan Commercial and Medicaid Databases using claims with International Classification of Diseases 9/10th Revision, Clinical Modification codes. Annual IRs were calculated as the number of IPD episodes/100,000 person-years (PYs) for children < 18 years and by age group (< 2, 2–4, and 5–17 years). National estimates of annual IPD IRs were extrapolated using Census Bureau data. Interrupted time series (ITS) analyses were conducted to assess immediate and gradual changes in IPD IRs before and after introduction of PCV7 and PCV13. Results In commercially insured children, IPD IRs decreased from 9.4 to 2.8 episodes/100,000 PY between the pre-PCV7 (1998–1999) and late PCV13 period (2014–2018) overall, and from 65.6 to 11.6 episodes/100,000 PY in children < 2 years. In the Medicaid population, IPD IRs decreased from 11.3 to 4.2 episodes/100,000 PY between the early PCV7 (2001–2005) and late PCV13 period overall, and from 42.6 to 12.8 episodes/100,000 PY in children < 2 years. The trends of IRs for meningitis, bacteremia, and bacteremic pneumonia followed the patterns of overall IPD episodes. The ITS analyses indicated significant decreases in the early PCV7 period, increases in the late PCV7 and decreases in the early PCV13 period in commercially insured children overall. However, increases were also observed in the late PCV13 period in children < 2 years. The percentage of cases with underlying risk factors increased in both populations. Conclusions IRs of IPD decreased from 1998 to 2018, following introduction of PCV7 and PCV13, with larger declines during the early PCV7 and early PCV13 periods, and among younger children. However, the residual burden of IPD remains substantial. The impact of future PCVs on IPD IRs will depend on the proportion of vaccine-type serotypes and vaccine effectiveness in children with underlying conditions.

Cost-Effectiveness Analysis of Routine Use of 15-Valent Pneumococcal Conjugate Vaccine in the US Pediatric Population

“…Proportions of patients with meningitis who develop PMS, including neurological deficits and hearing loss, were obtained from a systematic literature review by Jit et al (2010) [ 36 ]. The age-specific incidence rates of all-cause inpatient and all-cause outpatient pneumonia were obtained from US claims data analysis by Tong et al (2018) and Hu et al (2020) [ 12 , 37 ]. The incidence rates of pneumococcal AOM were estimated by multiplying the incidence rates of all-cause AOM published by Hu et al (2022) [ 38 ].…”

“…The case fatality rates for IPD were obtained from the studies by Olarte et al (2015) and Moore et al (2015) and published statistics by the CDC ABC surveillance ( Table 1 ) [ 40 , 41 , 42 ]. The case fatality rates for all-cause inpatient pneumonia were obtained from the analysis based on the US population conducted by Hu et al (2020) and Wuerth et al (2016) [ 37 , 43 ].…”

“…Direct medical costs included costs related to the treatment of patients with IPD, pneumonia, AOM and PMS ( Table 4 ). Direct medical costs for PDs was estimated for each episode of disease and they differed by PD type and age [ 60 , 61 ]. Direct medical costs for PMS were estimated based on the lifetime costs from the CDC report and was annualized to estimate the annual medical cost for both neurologic deficits and hearing loss.…”

“… Abbreviations: IPD = invasive pneumococcal disease; AOM = acute otitis media; PMS = post meningitis sequelae. Notes: a—The Centers for Disease Control and Prevention Active Bacterial Core (CDC ABC) surveillance report 2018 [ 35 ]; b—The data source for pediatric (<18 years) all-cause pneumonia incidence was based on an analysis of the MarketScan commercial claims database from 2018 [ 37 ]. c—The incidence rates of age stratified all-cause inpatient and outpatient pneumonia in adults were obtained from Tong et al, 2018 for the year 2014 [ 12 ].…”

“…h—The CFR of IPD for the adult population were from CDC ABC surveillance data [ 40 ]. i—Case fatality rates for children <18 years of age are derived from Hu et al, 2018 [ 37 ]. j—Case fatality rates for individuals over 18 years old are from Wuerth et al, 2016 [ 43 ].…”