Hospitalized children with pneumonia in Uruguay: Pre and post introduction of 7 and 13-valent pneumococcal conjugated vaccines into the National Immunization Program

Basic Sciences Program, PNUD/National University, Hidalgos 532, Montevideo CEP 11300, Uruguay.
Vaccine (Impact Factor: 3.62). 06/2012; 30(33):4934-8. DOI: 10.1016/j.vaccine.2012.05.054
Source: PubMed

ABSTRACT Streptococcus pneumoniae pneumonia burden in children was poorly defined in Uruguay. A three-year population-based surveillance demonstrated the impact of the pneumonia in hospitalized children of less than five years of age. To control these diseases in March 2008, Uruguayan health authorities decided to incorporate PCV7 to the National Immunization Program administered at 2, 4 and 12 months of age (2+1 schedule). Objective: To compare the incidence of consolidated pneumonia hospitalization in children less than five years of age before and after pneumococcal conjugate vaccine implementation.
Same methodology of the prevaccination study was employed. The surveillance was carried out at the same four hospitals covering a population of 229,128 inhabitants (2004 Census) of whom 10.2% were under five years of age. Clinical data, vaccination status and digitization of their chest X-rays were recorded. A pediatric radiologist blinded to the clinical diagnosis interpreted the digital images according WHO definitions. Bacterial etiology was investigated in blood and/or in pleural fluid.
Between January 1st 2009 and June 30th 2011 patients were enrolled. Out of 23,445 children<5 years of age, 1224 were hospitalized with pneumonia (430 consolidated pneumonias and 794 non consolidated pneumonias). Pleural effusion was recorded in 89 patients. In 48 consolidated pneumonias S. pneumoniae etiology was recognized. Post vaccination incidence rate of consolidated pneumonia in patients aged 12-23 months showed a significant reduction (44.9%) if we compare it with the incidence of pneumonia hospitalization in the previous study. In March 2010, PCV13 replaced PCV7. Compliance of PCV7/13 globally was 92% but the vaccination status varied among the surveyed patients because two catch-ups were carried out in addition to the routine cohort vaccination. From 2009 1st semester to 2011 1st semester incidence rates decline reached 59%.
To date, the ongoing surveillance documented a significant decline on incidence of hospitalizations for consolidated pneumonia in children younger than 24 months of age, confirming the success of the 2+1 vaccination schedule.

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    • "[22] zanotowali o 41,2% redukcję hospitalizacji i o 38,6% redukcję zapaleń płuc wśród dzieci panamskich, Hortal i wsp. [23] o 44,9% wśród dzieci poniżej 5 lat w Urugwaju, a Elemraid i wsp. [24] ponad o 30% wśród dzieci poniżej 2 lat w północno-wschodniej Anglii. "
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    ABSTRACT: Pneumococcal vaccination, despite the effort of the medical community aimed at intro- ducing it as obligatory, still remains in the Polish vaccination schedule as recommended, and thus have to be paid by parents. 490 healthy children (47.55% boys, 52.45% girls) were observed for the first two years of life. From those, 86 were vaccinated against pneumococcal infection. The chi-square test and odds ratio (OR) were performed for intergroup comparison of the prevalence of upper respiratory tract infections (URTIs), lower respiratory tract infec- tions (LRTIs), and acute otitis media (AOM). Logistic regression models and the Mantel- Haenszel test for repeated tests for independence were applied for URTI, LRTI, and AOM risk assessment vs. the analysed variables. The results were presented in the raw form and adjusted for breastfeeding, OR and 95% confidence intervals. Pneumococcal vaccination statistically significantly reduced the incidence of URTIs where OR = 0.53 (0.17–0.9); p = 0.03 and of LRTIs where OR = 0.59 (0.35–0.97); p = 0.04. Moreover, hospitalization and antibiotic therapy were less frequent in vaccinated child- ren (26.7% vs. 88.98% and 80.23% vs. 88.61% respectively). Breastfeeding longer than 6 months significantly reduced the occurrence of URTIs where OR = 0.53 (0.36–0.78); p = 0.001 and of AOM where OR = 0.59 (0.37–0.94); p = 0.02 aswell as frequency of antibiotic therapy during first 24 months of life where OR = 0.26 (0.15–0.46); p<0.001. Both pneumococcal vaccination and breastfeeding have additive beneficial effects, especially in prevention of URTIs where p=0.02 and LRTIs where p = 0.08. Pneumococcal vaccination was broadly expected to become included in the compul- sory vaccination schedule. Obtained results seem to formulate another argument in favour of introducing the pneumococcal vaccination as compulsory in the Polish vaccina- tion schedule and promoting breastfeeding.
    Pediatria polska 12/2014; 89(6):423-430.
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    • "Two mathematical models estimated that PCV13 introduction to NIPs will significantly decrease cases of IPD, pneumonia and otitis media in Europe [24], and IPD incidence in the UK [25], despite potential serotype replacement. Indeed, early data from countries having introduced PCV13 in 2010 such as the UK, Norway, USA, Uruguay and Spain support this prediction [13] [22] [26] [27]. In 2010, IPD incidence per 100,000 population in children <2 years, 2–4 years and <5 years in Israel were 49.3, 17.9 and 29.2, respectively. "
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    ABSTRACT: The 7-valent pneumococcal conjugated vaccine (PCV7) was introduced to the Israeli national immunization plan (NIP) in July 2009 (administered at age 2, 4 and 12 months), with a fast reduction of invasive pneumococcal disease (IPD) caused by PCV7 serotypes. Starting in November 2010, PCV13 gradually replaced PCV7. To report the impact of PCV7/PCV13 sequential introduction on IPD in Israeli children <5 years. An ongoing nationwide, prospective, population-based, active surveillance. All IPD episodes (Streptococcus pneumoniae isolated from blood and/or cerebrospinal fluid) from July 2004 through June 2013 were included. Overall, 2670 IPD episodes were recorded. Incidence of IPD caused by PCV7+6A serotypes during the PCV13 period vs. pre-PCV period decreased by 95% (Incidence Rate Ratio [IRR]=0.05; 95% CI=0.03-0.09). This reduction was observed in a two-step manner: 90% in the PCV7-period and further 5% in the PCV13-period. The rates of IPD caused by the 5 additional PCV13-serotypes (1, 3, 5, 7F, 19A; 5VT) increased initially by 47%, but subsequently decreased by 79%, resulting in an overall 70% reduction during the entire study period (IRR=0.30; 0.21-0.44). A two-fold increase in non-PCV13 serotypes IPD was observed (IRR=2.43; 1.73-3.66). In total, a 63% reduction of all-serotype IPD episodes was observed in children <5 years (69% and 48% in children <2 and 2-4 years old, respectively). After initiation of PCV NIP, a rapid and substantial 2-step IPD reduction was observed in children <5 years. The serotype-specific rate reduction reflected the sequential introduction of PCV7/PCV13.
    Vaccine 03/2014; 32(27). DOI:10.1016/j.vaccine.2014.03.065 · 3.62 Impact Factor
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