Uptake of pneumococcal conjugate vaccine among children in the 1998-2002 United States birth cohorts
ABSTRACT Routine childhood immunization with pneumococcal conjugate vaccines (PCV7s) began in 2000 in the United States. Despite vaccine shortages, reductions in invasive pneumococcal disease occurred rapidly during 2000-2002. Age-appropriate PCV7 coverage was estimated and characteristics associated with undervaccination were identified for children in the 1998-2002 birth cohorts.
Data were analyzed for 85,135 children aged 19-35 months in the 2001-2004 National Immunization Surveys. To obtain PCV7 coverage estimates by birth cohorts, a pooled analysis was conducted by combining individual survey years that sampled children with appropriate birth dates. Logistic regression models were used to identify factors associated with age-appropriate vaccination.
The proportion of children receiving the primary 3-dose PCV7 series by age 12 months increased from 45.5% (+/-0.6) among children born in 2000 to 62.1% (+/-0.7) among those born in 2002. By age 24 months, an estimated 30.7% (+/-0.6), 38.0% (+/-0.6), and 49.0% (+/-1.1) of children born in 2000, 2001 and 2002, respectively, had received all four PCV7 doses; however, only 15.0% (+/-0.4), 16.1% (+/-0.4) and 24.4% (+/-0.6) of children were age-appropriately immunized. Among children born in 1998 and 1999, 10.1% +/-0.5) and 37.6% (+/-0.7), respectively, received one or more catch-up doses during their second year of life. Lower age-appropriate PCV7 coverage was independently associated with black race, Hispanic ethnicity, receiving vaccinations from public health providers, and low household income.
The dramatic reductions in pneumococcal-related diseases from direct and indirect vaccine effects occurred when few children had received the recommended complete vaccine schedule, and there were substantial racial and socioeconomic disparities in coverage.
Full-textDOI: · Available from: Stacey W Martin, May 28, 2015
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ABSTRACT: Analysis of US claims data from April 2010 to June 2011 estimated that 39% of the 13-valent pneumococcal conjugate vaccine (PCV13) catch-up eligible cohort would ever receive the catch-up vaccination; a previous analysis assumed 87%. This updated figure was applied to a previously published 10-year Markov model while holding all other inputs constant. Our model estimated that the catch-up program as currently implemented is estimated to prevent an additional 1.7 million cases of disease in children aged ≤ 59 months over a 10-year period, compared with routine PCV13 vaccination with no catch-up program. Because 39% catch-up uptake is less than the level of completion of the 4-dose primary PCV13 series, vaccine-preventable cases of pneumococcal disease and related deaths could be decreased further with additional uptake of catch-up vaccination in the catch-up eligible cohort.BMC Infectious Diseases 08/2012; 12:175. DOI:10.1186/1471-2334-12-175 · 2.56 Impact Factor
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ABSTRACT: Respiratory syncytial virus (RSV) is the most common cause of severe respiratory illness in infants. To help direct targeted interventions and future RSV vaccine programs, we examined risk of RSV-related hospitalization by infant age and birth month. We conducted Poisson regression analyses to evaluate birth-month as a risk factor for RSV-related pediatric hospitalizations (identified by any mention of ICD-9-CM diagnosis codes: 466.11, 480.1, or 079.6) from State Inpatient Data (SID) in Arizona, Iowa, New York, Oregon, and Wisconsin between July 1996 - June 2006. We used an age cohort approach to compute total relative risk of RSV during the first year of life. We identified 82,296 RSV-related infant hospital admissions, corresponding to 13.9 per 1,000 person-years among infants less than 12 months of age. Of these, 42% of the patients were female and 73% were <6 months old. One-month old infants born in January were ~10 times more at risk for RSV-related hospitalization than 1-month old infants born in October (RR: 9.8, [7.8, 12.4]). Across the first year of life, infants born in December and January had a 2- and 3-fold higher risk, respectively, of an RSV-related hospitalization event than infants born in July. Birth-month and age at admission impacted the risk of RSV-related hospitalization within the first year of life in 5 states we investigated. As RSV vaccine candidates are currently under investigation in clinical trials, our findings help identify ideal RSV vaccine schedules to prevent early and severe events while improving the use of expensive prophylactic drugs.The Pediatric Infectious Disease Journal 01/2014; 33(6). DOI:10.1097/INF.0000000000000250 · 3.14 Impact Factor
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ABSTRACT: Vaccine coverage estimates lag by years in the US. Commercially available medical claims databases contain timely records of childhood vaccinations given in physician offices. We used such data to track the replacement of the 7-valent pneumococcal conjugate vaccine (PCV7) by PCV13, a new vaccine active against 6 additional serotypes, starting in March 2010. We developed an age cohort model to compute vaccination coverage over time. We used age-stratified, national projections of monthly PCV7 and PCV13 doses administered to children <5 years based on physicians' office claims, January 2008-May 2012. We assumed doses were given on schedule, and tracked cumulative numbers of doses given to aging monthly cohorts to estimate the percentage of children fully PCV13-immunized. To account for children uninsured or in the Vaccines for Children program, estimates were projected using National Immunization Survey coverage data. PCV7 was phased out by June 2010. By March 2012, 82% of children 6-23 months were fully immunized with PCV13 and 42% of toddlers aged 15-59 months had received a catch-up PCV13 dose. For children aged 6-59 months, protective PCV13 coverage levels reached 33% and 56% by March 2011 and 2012, respectively, and were projected to reach 88% by March 2014. Our estimates for children aged 0-59 and 24-59 months were consistent with CDC's Immunization Information System sentinel sites data for 2011-2012. By using a simple analytic approach to compute vaccine coverage in aging cohorts from claims data, we show that PCV13 coverage rose rapidly as the PCV7 program was replaced. These estimates, validated against a CDC sentinel surveillance system in 8 states, should enable early documentation of the PCV13 impact on pneumococcal disease in the US. Moreover, they demonstrate the feasibility of tracking uptake patterns in near real-time even with simple summary counts of medical claims data.Vaccine 10/2013; 31(50). DOI:10.1016/j.vaccine.2013.10.038 · 3.49 Impact Factor