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Yanai T, Yoshida S, Takeuchi M, Kawakami K. Pneumonia hospitalization after introduction of pneumococcal conjugate vaccine in Japan: Descriptive study using a nationwide claims database. Vaccine 2023:S0264-410X(23)00626-6. [PMID: 37286407 DOI: 10.1016/j.vaccine.2023.05.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/16/2023] [Accepted: 05/26/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND The pneumococcal conjugate vaccine (PCV) was introduced to children in Japan in February 2010 for PCV7 and February 2013 for PCV13. This study aimed to investigate the changes in child pneumonia hospitalization in Japan, before and after the introduction of PCV. METHODS We utilized the JMDC Claims Database, an insurance claims database in Japan, with a cumulative population of approximately 10.6 million as of 2022. We extracted data of approximately 3.16 million children below 15 years of age from January 2006 to December 2019, and evaluated the number of pneumonia hospitalizations per 1,000 persons per year. The primary analysis was a comparison of three categories according to PCVs: before PCV7, before PCV13, and after PCV13 (2006-2009, 2010-2012, and 2013-2019). The secondary analysis was an interrupted time series (ITS) analysis, assessing the slope change in pneumonia hospitalizations per month, with PCV introduction as an intervening factor. RESULTS The cases of pneumonia hospitalizations during the study period was 19,920 (0.6 %); 25 % of these were 0-1 years, 48 % were 2-4 years, 18 % were 5-9 years, and 9 % were 10-14 years. Pneumonia hospitalizations per 1000 population was 6.10 before PCV7 and 4.03 after PCV13, representing a 34 % decrease (p < 0.001). The reduction by age group was -30.1 % in 0-1 years, -20.3 % in 2-4 years, -41.7 % in 5-9 years, and -52.9 % in 10-14 years, significant reduction in all groups. ITS analysis showed a further reduction of -0.17 % per month after the introduction of PCV13 than that before PCV7 (p = 0.006). CONCLUSION Our study estimated 4-6 pneumonia hospitalizations per 1000 pediatric population in Japan, with a 34 % decrease after the introduction of PCV. This study examined the nationwide effectiveness of PCV, further studies are needed in all age groups.
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Affiliation(s)
- Takanori Yanai
- Department of Pharmacoepidemiology, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan
| | - Satomi Yoshida
- Department of Pharmacoepidemiology, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan
| | - Masato Takeuchi
- Department of Pharmacoepidemiology, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan.
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Chan KPF, Ma TF, Ip MSM, Ho PL. Invasive pneumococcal disease, pneumococcal pneumonia and all-cause pneumonia in Hong Kong during the COVID-19 pandemic compared with the preceding 5 years: a retrospective observational study. BMJ Open 2021; 11:e055575. [PMID: 34635536 PMCID: PMC8506049 DOI: 10.1136/bmjopen-2021-055575] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To compare the incidence and severity of invasive pneumococcal diseases (IPDs), pneumococcal pneumonia and all-cause pneumonia during the COVID-19 pandemic period with universal masking and social distancing with that of previous 5 years. DESIGN Retrospective observational study on incidence of IPDs, pneumococcal pneumonia and all-cause pneumonia between January 2015-December 2019 and March 2020-March 2021. January-February 2020 was excluded from analysis as it was treated as a transitional period between normal time and pandemic. SETTING Episode-based data by retrieval of hospitalisation records from the Hospital Authority's territory-wide electronic medical record database in Hong Kong. PARTICIPANTS Hospitalised patients with IPD (n=742), pneumococcal pneumonia (n=2163) and all-cause pneumonia (including COVID-19 pneumonia, n=453 999) aged 18 years or above. Control diagnoses were included to assess confounding from health-seeking behaviours. PRIMARY AND SECONDARY OUTCOMES Primary outcome is the incidence of diseases between two periods. Secondary outcomes include disease severity surrogated by length of stay and mortality. RESULTS Monthly average number of IPD, pneumococcal pneumonia and all-cause pneumonia hospitalisation significantly decreased by 88.9% (95% CI 79.8% to 98.0%, p<0.0005), 72.5% (95% CI 65.9% to 79.1%, p<0.0005) and 17.5% (95% CI 16.8% to 18.2%, p<0.0005), respectively. Changes in trend from January 2015-December 2019 to March 2020-March 2021 were -70% (95% CI -87% to -35%, p=0.0025), -43% (95% CI -59% to -19%, p=0.0014) and -11% (95% CI -13% to -10%, p<0.0005), respectively. Length of stay for IPD and pneumococcal pneumonia episodes were insignificantly different in the two periods. No reductions in hospitalisations for control diagnoses were observed. CONCLUSIONS Incidence of IPD, pneumococcal pneumonia and all-cause pneumonia decreased during the COVID-19 pandemic. This was observed with universal masking and social distancing. We postulated this is related to reduced transmission of respiratory viruses and bacteria.
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Affiliation(s)
| | - Ting-Fung Ma
- Department of Statistics, University of Wisconsin, Madison, Wisconsin, USA
| | - Mary Sau-Man Ip
- Department of Medicine, University of Hong Kong, Hong Kong, People's Republic of China
| | - Pak-Leung Ho
- Department of Microbiology, Queen Mary Hospital, University of Hong Kong, Hong Kong, People's Republic of China
- Carol Yu Centre for Infection, University of Hong Kong, Hong Kong, People's Republic of China
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Population-based estimates of the burden of pneumonia hospitalizations in Hong Kong, 2011-2015. Eur J Clin Microbiol Infect Dis 2019; 38:553-561. [PMID: 30684165 DOI: 10.1007/s10096-018-03459-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 12/17/2018] [Indexed: 12/11/2022]
Abstract
Up-to-date data on the burden of disease are important to identify patients with unmet needs and to optimize healthcare resources. We aimed to characterize the burden of pneumonia hospitalizations in Hong Kong and inform targeted healthcare policies for pneumonia control in the era of global aging. This was a population-based study using a territory-wide administrative electronic health record system that covers all public hospitals of Hong Kong. Patients admitted to public hospitals, from 2011 to 2015, with a diagnosis of pneumonia at discharge were identified based on the International Classification of Diseases-Ninth Revision-Clinical Modification Codes (480-486 and 487.0). Incidence, inpatient case-fatality, all-cause fatality, 28-day readmission, hospital length of stay, and healthcare costs were assessed for seven age strata. We identified 323,992 patients (median age 80 years, 44.4% female) with hospitalized pneumonia (organism unspecified 84.2%; bacterial pneumonia 12.3%; viral pneumonia 2.5%; others 1.0%). Annual incidence was 955.1 per 100,000 population, with a 10.6% decrease from 2011 to 2015. Case-fatality, all-cause fatality, and 28-days readmission risks were 13.8, 21.6, and 19.5%, respectively. The average hospital length of stay was 14.1 days with corresponding direct costs of $9348 USD per episode in the monetary value of 2015. Individuals aged ≥ 65 years accounted for over 75% of pneumonia-related hospitalizations, 90% of deaths, and the majority of healthcare costs. Hospitalized pneumonia represents a considerable health and economic burden in Hong Kong, especially in older adults. The study provides a population-level baseline estimate for further cost-effective evaluation of targeted strategies for pneumonia control.
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Qu F, Weschler LB, Sun Y, Sundell J. High pneumonia lifetime-ever incidence in Beijing children compared with locations in other countries, and implications for national PCV and Hib vaccination. PLoS One 2017; 12:e0171438. [PMID: 28166256 PMCID: PMC5293229 DOI: 10.1371/journal.pone.0171438] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 01/20/2017] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES To compare the proportion of Beijing children who have ever had pneumonia (%Pneumonia) to those in other locations, and to estimate by how much national vaccine coverage with Pneumococcal Conjugate Vaccine (PCV) and Haemophilus Influenzae Type b (Hib) could reduce Beijing %Pneumonia. METHODS %Pneumonia was obtained for each age group from 1 to 8 years inclusive from 5,876 responses to a cross-sectional questionnaire. Literature searches were conducted for world-wide reports of %Pneumonia. Previous vaccine trials conducted worldwide were used to estimate the pneumococcal (S. pneumoniae) and Hib (H. influenzae) burdens and %Pneumonia as well as the potential for PCV and Hib vaccines to reduce Beijing children's %Pneumonia. FINDINGS The majority of pneumonia cases occurred by the age of three. The cumulative %Pneumonia for 3-8 year-old Beijing children, 26.9%, was only slightly higher than the 25.4% for the discrete 3 year-old age group, similar to trends for Tianjin (China) and Texas (USA). Beijing's %Pneumonia is disproportionally high relative to its Gross National Income (GNI) per capita, and markedly higher than %Pneumonia in the US and other high GNI per capita countries. Chinese diagnostic guidelines recommend chest X-ray confirmation while most other countries discourage it in favor of clinical diagnosis. Literature review shows that chest X-ray confirmation returns far fewer pneumonia diagnoses than clinical diagnosis. Accordingly, Beijing's %Pneumonia is likely higher than indicated by raw numbers. Vaccine trials suggest that national PCV and Hib vaccination could reduce Beijing's %Pneumonia from 26.9% to 19.7% and 24.9% respectively. CONCLUSION National PCV and Hib vaccination programs would substantially reduce Beijing children's pneumonia incidence.
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Affiliation(s)
- Fang Qu
- China Meteorological Administration Training Centre, China Meteorological Administration, Beijing, China
- Department of Building Science, Tsinghua University, Beijing, China
| | - Louise B. Weschler
- Independent Researcher, Colts Neck, New Jersey, United States of America
| | - Yuexia Sun
- School of Environmental Science and Engineering, Tianjin University, Tianjin, China
| | - Jan Sundell
- Department of Building Science, Tsinghua University, Beijing, China
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DeAntonio R, Yarzabal JP, Cruz JP, Schmidt JE, Kleijnen J. Epidemiology of community-acquired pneumonia and implications for vaccination of children living in developing and newly industrialized countries: A systematic literature review. Hum Vaccin Immunother 2016; 12:2422-40. [PMID: 27269963 PMCID: PMC5027706 DOI: 10.1080/21645515.2016.1174356] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
This systematic review evaluated the epidemiology of community-acquired pneumonia in children <6 y of age within 90 developing and newly industrialized countries. Literature searches (1990–2011), based on MEDLINE, EMBASE, Cochrane, CAB Global Health, WHO, UNICEF, country-specific websites, conferences, health-technology-assessment agencies, and the reference lists of included studies, yielded 8,734 records; 62 of 340 studies were included in this review. The highest incidence rate among included studies was 0.51 episodes/child-year, for children <5 y of age in Bangladesh. The highest prevalence was in Chinese children <6 months of age (37.88%). The main bacterial pathogens were Streptococcus pneumoniae, Haemophilus influenzae and Mycoplasma pneumoniae and the main viral pathogens were respiratory syncytial virus, adenovirus and rhinovirus. Community-acquired pneumonia remains associated with high rates of morbidity and mortality. Improved and efficient surveillance and documentation of the epidemiology and burden of community-acquired pneumonia across various geographical regions is warranted.
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Affiliation(s)
| | | | | | | | - Jos Kleijnen
- d School for Public Health and Primary Care (CAPHRI), Maastricht University , Maastricht , The Netherlands.,e Kleijnen Systematic Reviews Ltd , York , United Kingdom
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Ho YC, Lee PL, Wang YC, Chen SC, Chen KT. The economic burden of childhood invasive pneumococcal diseases and pneumonia in Taiwan: Implications for a pneumococcal vaccination program. Hum Vaccin Immunother 2016; 11:1081-7. [PMID: 25874476 PMCID: PMC4514427 DOI: 10.1080/21645515.2015.1023969] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Invasive pneumococcal disease (IPD) and pneumonia are the major causes of morbidity and deaths in children in the world. The management of IPD and pneumonia is an important economic burden on healthcare systems and families. The aim of this study was to assess the economic burden of IPD and pneumonia among younger children in Taiwan. We used a cost-illness approach to identify the cost categories for analysis in this study according to various perspectives. We obtained data of admission, outpatient, and emergency department visit data from the National Health Insurance Research (NHIR) database for children <5 y of age between January 2008 and December 2008. A prospective survey was administered to the families of patients to obtain detailed personal costs. All costs are presented in US dollars and were estimated by extrapolating 2008 cost data to 2013 price levels. We estimated the number of pneumococcal disease cases that were averted if the PCV-13 vaccine had been available in 2008. The total annual social and hospital costs for IPD were US $4.3 million and US $926,000, respectively. The total annual social and hospital costs for pneumonia were US $150 million and US $17 million, respectively. On average, families spent US $653 or US $218 when their child was diagnosed with IPD or pneumonia, respectively. This cost is approximately 27%–81% of the monthly salary of an unskilled worker. In conclusion, a safe and effective pediatric pneumococcal vaccine is needed to reduce the economic burden caused by pneumococcal infection.
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Affiliation(s)
- Yi-Chien Ho
- a Department of Cosmetic Applications and Management/Holistic Education Center; Cardinal Tien Junior College of Healthcare and Management ; Taipei , Taiwan
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Cheong KN, Chiu SS, Chan BWK, To KKW, Chan ELY, Ho PL. Severe macrolide-resistant Mycoplasma pneumoniae pneumonia associated with macrolide failure. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2014; 49:127-30. [PMID: 25556047 DOI: 10.1016/j.jmii.2014.11.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 09/23/2014] [Accepted: 11/05/2014] [Indexed: 10/24/2022]
Abstract
We investigated differences in outcomes between 68 children hospitalized with macrolide-sensitive Mycoplasma pneumoniae pneumonia (MSMP group) and 25 children hospitalized with macrolide-resistant M. pneumoniae pneumonia (MRMP group). In the MRMP group, 19 children received macrolides and clinical failure occurred in six of which five had pneumonia progression during therapy.
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Affiliation(s)
- Kai-Ning Cheong
- Department of Pediatrics and Adolescent Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Susan S Chiu
- Department of Pediatrics and Adolescent Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Betsy Wai-Ka Chan
- Department of Microbiology and Carol Yu Centre for Infection, The University of Hong Kong, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Kelvin Kai-Wang To
- Department of Microbiology and Carol Yu Centre for Infection, The University of Hong Kong, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Eunice Lai-Yin Chan
- Department of Pediatrics and Adolescent Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Pak-Leung Ho
- Department of Microbiology and Carol Yu Centre for Infection, The University of Hong Kong, Queen Mary Hospital, Hong Kong Special Administrative Region, China.
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Becker-Dreps S, Amaya E, Liu L, Rocha J, Briceño R, Moreno G, Alemán J, Hudgens MG, Woods CW, Weber DJ. Impact of a combined pediatric and adult pneumococcal immunization program on adult pneumonia incidence and mortality in Nicaragua. Vaccine 2014; 33:222-7. [PMID: 25444795 DOI: 10.1016/j.vaccine.2014.10.073] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 09/20/2014] [Accepted: 10/06/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND In 2010, Nicaragua implemented an adult immunization program with the 23-valent pneumococcal polysaccharide vaccine (PPSV-23) and a pediatric immunization program with the 13-valent pneumococcal conjugate vaccine (PCV-13). We assessed incidence rates of ambulatory visits and hospitalizations for pneumonia and pneumonia-related mortality in adults over the age of 50 years before and after the program's implementation in the Department of León, Nicaragua. METHODS We collected visit diagnoses from all 107 public health facilities between 2008 and 2012 in León. We compared incidence rates of ambulatory visits for pneumonia, pneumonia hospitalizations, and pneumonia-related mortality in the pre-vaccine (2008-2009) and vaccine (2011-2012) periods among older adults using Poisson regression with generalized estimating equations (GEE), controlling for age group, municipality, and proportions of adults who were immunized against influenza. Exposure time was estimated by official municipality population estimates. RESULTS We did not observe lower incidence rates of ambulatory visits or hospitalizations for pneumonia among adults during the vaccine period versus the pre-vaccine period. However, pneumonia-related mortality was lower in the vaccine period versus the pre-vaccine period, with an adjusted incidence rate ratio (IRRa) of 0.73 (0.56, 0.94) among adults aged 50-64 years, and 0.55 (0.43, 0.70) among adults aged ≥65 years. CONCLUSIONS These early results following introduction of a combined pediatric and adult pneumococcal immunization program in Nicaragua show a probable impact of the program on the reduction of pneumonia-related deaths in older adults, but a less clear impact on the reduction of health facility visits for pneumonia.
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Affiliation(s)
| | - Erick Amaya
- National Autonomous University of Nicaragua, León, Nicaragua
| | - Lan Liu
- UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Julio Rocha
- Hospital Escuela Oscar Danilo Rosales Argüello (HEODRA), León, Nicaragua
| | - Rafaela Briceño
- Sistemas Locales de Atención Integral a la Salud, León (SILAIS-León), León, Nicaragua
| | - Gilberto Moreno
- Sistemas Locales de Atención Integral a la Salud, León (SILAIS-León), León, Nicaragua
| | - Jorge Alemán
- Hospital Escuela Oscar Danilo Rosales Argüello (HEODRA), León, Nicaragua
| | | | | | - David J Weber
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Changes in childhood pneumonia and infant mortality rates following introduction of the 13-valent pneumococcal conjugate vaccine in Nicaragua. Pediatr Infect Dis J 2014; 33:637-42. [PMID: 24445827 DOI: 10.1097/inf.0000000000000269] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In 2010, Nicaragua became the first developing nation to add 13-valent pneumococcal conjugate vaccine (PCV-13) to its national immunization schedule, using a "3+0" dosing schedule. We assessed changes in incidence rates of health facility visits for childhood pneumonia and infant mortality after PCV-13 introduction in the Department of León, Nicaragua. METHODS We collected visit diagnoses from all 107 public health facilities in León between 2008 and 2012. We compared rates of pneumonia hospitalizations, ambulatory visits for pneumonia and infant mortality during the prevaccine (2008-2010) and vaccine (2011-2012) periods among different age groups of children using generalized estimating equations, accounting for clustering by municipality. Exposure time was estimated by official municipality population estimates. RESULTS The adjusted incidence rate ratio for pneumonia hospitalization in the vaccine versus prevaccine period was 0.67 (0.59-0.75) among infants and 0.74 (0.67-0.81) among 1-year olds. The adjusted incidence rate ratio for ambulatory visits for pneumonia was 0.87 (0.75-1.01) among infants, and 0.84 (0.74, 0.95) among 1-year olds. The adjusted incidence rate ratio for infant mortality was 0.67 (0.57-0.80). We also observed lower rates of health facility visits for pneumonia among age groups (2- to 4-year old and 5- to 14-year old) not eligible to receive PCV-13. CONCLUSIONS Within the first 2 years of a PCV-13 immunization program in Nicaragua, we observed lower rates of hospitalizations and ambulatory visits for pneumonia among children of all ages and a lower infant mortality rate. Lower rates of pneumonia among age groups not eligible to receive PCV-13 suggest an indirect effect of the vaccine.
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Le CF, Jefferies JM, Yusof MYM, Sekaran SD, Clarke SC. The epidemiology of pneumococcal carriage and infections in Malaysia. Expert Rev Anti Infect Ther 2014; 10:707-19. [DOI: 10.1586/eri.12.54] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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The Health Economic Impact of Universal Infant Vaccination with the 10-Valent Pneumococcal Nontypeable Haemophilus influenzae Protein D Conjugate Vaccine as Compared with 13-Valent Pneumococcal Conjugate Vaccine in Hong Kong. Value Health Reg Issues 2013; 2:64-74. [DOI: 10.1016/j.vhri.2013.01.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Nair H, Simões EA, Rudan I, Gessner BD, Azziz-Baumgartner E, Zhang JSF, Feikin DR, Mackenzie GA, Moiïsi JC, Roca A, Baggett HC, Zaman SM, Singleton RJ, Lucero MG, Chandran A, Gentile A, Cohen C, Krishnan A, Bhutta ZA, Arguedas A, Clara AW, Andrade AL, Ope M, Ruvinsky RO, Hortal M, McCracken JP, Madhi SA, Bruce N, Qazi SA, Morris SS, El Arifeen S, Weber MW, Scott JAG, Brooks WA, Breiman RF, Campbell H. Global and regional burden of hospital admissions for severe acute lower respiratory infections in young children in 2010: a systematic analysis. Lancet 2013; 381:1380-1390. [PMID: 23369797 PMCID: PMC3986472 DOI: 10.1016/s0140-6736(12)61901-1] [Citation(s) in RCA: 526] [Impact Index Per Article: 47.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The annual number of hospital admissions and in-hospital deaths due to severe acute lower respiratory infections (ALRI) in young children worldwide is unknown. We aimed to estimate the incidence of admissions and deaths for such infections in children younger than 5 years in 2010. METHODS We estimated the incidence of admissions for severe and very severe ALRI in children younger than 5 years, stratified by age and region, with data from a systematic review of studies published between Jan 1, 1990, and March 31, 2012, and from 28 unpublished population-based studies. We applied these incidence estimates to population estimates for 2010, to calculate the global and regional burden in children admitted with severe ALRI in that year. We estimated in-hospital mortality due to severe and very severe ALRI by combining incidence estimates with case fatality ratios from hospital-based studies. FINDINGS We identified 89 eligible studies and estimated that in 2010, 11·9 million (95% CI 10·3-13·9 million) episodes of severe and 3·0 million (2·1-4·2 million) episodes of very severe ALRI resulted in hospital admissions in young children worldwide. Incidence was higher in boys than in girls, the sex disparity being greatest in South Asian studies. On the basis of data from 37 hospital studies reporting case fatality ratios for severe ALRI, we estimated that roughly 265,000 (95% CI 160,000-450,000) in-hospital deaths took place in young children, with 99% of these deaths in developing countries. Therefore, the data suggest that although 62% of children with severe ALRI are treated in hospitals, 81% of deaths happen outside hospitals. INTERPRETATION Severe ALRI is a substantial burden on health services worldwide and a major cause of hospital referral and admission in young children. Improved hospital access and reduced inequities, such as those related to sex and rural status, could substantially decrease mortality related to such infection. Community-based management of severe disease could be an important complementary strategy to reduce pneumonia mortality and health inequities. FUNDING WHO.
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Affiliation(s)
- Harish Nair
- Centre for Population Health Sciences, Global Health Academy, The University of Edinburgh, Edinburgh, UK; Public Health Foundation of India, New Delhi, India.
| | - Eric Af Simões
- University of Colorado Denver and Children's Hospital, Denver, CO, USA; The University of Padjadjaran, Bandung, Indonesia
| | - Igor Rudan
- Centre for Population Health Sciences, Global Health Academy, The University of Edinburgh, Edinburgh, UK
| | | | - Eduardo Azziz-Baumgartner
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Jian Shayne F Zhang
- School of Population Health, The University of Melbourne, VIC, Australia; Social Insurance Fund Management Centre, Jiangsu, China
| | - Daniel R Feikin
- Centers for Disease Control and Prevention, Nairobi, Kenya; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Grant A Mackenzie
- Child Survival Theme, The Gambia Unit, Medical Research Council, Banjul, The Gambia
| | - Jennifer C Moiïsi
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Anna Roca
- Barcelona Centre for International Health Research (CRESIB), Hospital Clínic/IDIBAPS, Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde da Manhiça, Ministerio de Saúde, Maputo, Mozambique
| | - Henry C Baggett
- International Emerging Infections Program, Global Disease Detection Regional Centre, Thailand MOPH-US CDC Collaboration, Nonthaburi, Thailand
| | - Syed Ma Zaman
- Child Survival Theme, The Gambia Unit, Medical Research Council, Banjul, The Gambia; Health Protection Services Colindale, Health Protection Agency, London, UK
| | - Rosalyn J Singleton
- Arctic Investigations Program, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Anchorage, AK, USA; Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Marilla G Lucero
- Research Institute for Tropical Medicine, Department of Health, Alabang, Muntinlupa, Philippines
| | - Aruna Chandran
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Angela Gentile
- Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina
| | - Cheryl Cohen
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Sandringham, South Africa; School of Public Health and Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Zulfiqar A Bhutta
- Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Adriano Arguedas
- Instituto de Atención Pediatrica, Universidad de Ciencias Médicas de Centro América, San José, Costa Rica
| | | | | | - Maurice Ope
- East African Community Secretariat, Arusha, Tanzania
| | | | - María Hortal
- Program for Basic Sciences Development, National University/PNUD, Montevideo, Uruguay
| | - John P McCracken
- Center for Health Studies, Universidad del Valle de Guatemala, Guatemala
| | - Shabir A Madhi
- Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Sandringham, South Africa; Department of Science and Technology, and National Research Foundation: Vaccine Preventable Diseases, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Shamim A Qazi
- Department of Maternal, Neonatal and Child and Adolescent Health, WHO, Geneva, Switzerland
| | | | - Shams El Arifeen
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - J Anthony G Scott
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - W Abdullah Brooks
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Harry Campbell
- Centre for Population Health Sciences, Global Health Academy, The University of Edinburgh, Edinburgh, UK
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Ho PL, Chiu SS, Chan MY, Ang I, Chow KH, Lau YL. Changes in nasopharyngeal carriage and serotype distribution of antibiotic-resistant Streptococcus pneumoniae before and after the introduction of 7-valent pneumococcal conjugate vaccine in Hong Kong. Diagn Microbiol Infect Dis 2011; 71:327-34. [DOI: 10.1016/j.diagmicrobio.2011.09.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Revised: 08/30/2011] [Accepted: 09/07/2011] [Indexed: 10/16/2022]
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Summary of invasive pneumococcal disease burden among children in the Asia-Pacific region. Vaccine 2010; 28:7589-605. [PMID: 20674872 DOI: 10.1016/j.vaccine.2010.07.053] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Revised: 07/14/2010] [Accepted: 07/18/2010] [Indexed: 11/22/2022]
Abstract
Invasive pneumococcal disease (IPD) burden is significant in the Asia-Pacific region. This review describes the epidemiology and Streptococcus pneumoniae (SP) serotype distribution of IPD in children in the Asia-Pacific region from studies published from 1999 to 2010. IPD incidence varies widely in Asia-Pacific countries depending on the method of surveillance, the population studied, and the time period. Incidences are highest for younger children, with rates near 100-200 cases per 100,000 children aged <1 or 2 years. Incidences of preventable disease are estimated to be 6-200 cases per 100,000. Heptavalent pneumococcal conjugate vaccine (PCV7) serotype coverage shows a very wide range over the Asia-Pacific region. Ten countries have high vaccine serotype coverage (>70%), and six countries have low vaccine serotype coverage (<50%). The majority of SP serotypes in children with IPD in most countries in the Asia-Pacific region are susceptible to penicillin (intermediate and resistant <50%); a few countries have SP serotypes with high level resistance to penicillin (intermediate and resistant >50%). Japan, Taiwan, and Thailand have high PCV7 serotype coverage. Countries with low pneumococcal resistance to antimicrobials have shown increasingly higher nonsusceptibility with time. National vaccination programmes that include PCV7, 10-valent pneumococcal conjugate vaccine (PCV), or 13-valent PCV would significantly affect IPD burden in children aged <5 years in the Asia-Pacific region, as well as the burden of penicillin-nonsusceptible IPD.
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Lee KKC, Rinaldi F, Chan MKU, Chan STH, So TMT, Hon EKL, Lee VWY. Economic evaluation of universal infant vaccination with 7vPCV in Hong Kong. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2009; 12 Suppl 3:S42-S48. [PMID: 20586981 DOI: 10.1111/j.1524-4733.2009.00626.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate the clinical and economic benefits of routine infant vaccination with seven-valent pneumococcal conjugate vaccine (7vPCV) in Hong Kong. METHODS A decision-analytic model was populated with local age-specific incidence data to simulate the expected health outcomes resulting from 7vPCV vaccination of a birth cohort of 57,100 children compared with an unvaccinated cohort over a 10-year horizon. Primary analyses were conducted from a payer perspective, using local inpatient and outpatient costs associated with the treatment of pneumococcal disease. Vaccine efficacy rates were consistent with results from pivotal clinical trials. The reduction in adult invasive pneumococcal disease (IPD) and associated cost avoidance due to the indirect effect of vaccination were estimated in line with published overseas rates. RESULTS Universal 7vPCV vaccination was estimated to prevent 524 cases of IPD and more than 2580 cases of otitis media in the birth cohort over a 10-year period, leading to a reduction of HK$28.7 million (US$3.7 million) in direct medical costs. Additional cost savings from the indirect prevention of 919 adult cases of IPD during this time period also resulted. Overall, 7vPCV vaccination was estimated to have an incremental cost per life-year gained of HK$50,456 (US$6460) from a payer perspective or HK$46,308 (US$5929) when both direct and indirect costs were included. CONCLUSION With reference to the World Health Organization's threshold for cost-effectiveness, results from this study indicate that routine infant vaccination with 7vPCV is a cost-effective intervention because of the added cost savings resulting from the indirect effect of vaccination on adult disease.
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Affiliation(s)
- Kenneth K C Lee
- School of Pharmacy, Chinese University of Hong Kong, Shatin, N.T., Hong Kong, China.
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Bravo LC. Overview of the disease burden of invasive pneumococcal disease in Asia. Vaccine 2009; 27:7282-91. [PMID: 19393708 DOI: 10.1016/j.vaccine.2009.04.046] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Accepted: 04/16/2009] [Indexed: 11/27/2022]
Abstract
This paper represents a collaborative effort by the Asian Strategic Alliance for Pneumococcal Disease Prevention (ASAP) Working Group to collate data on the disease burden due to invasive pneumococcal disease (IPD) in participating Asian countries and territories; namely, Hong Kong, India, Indonesia, Korea, Macau, Malaysia, Pakistan, the Philippines, Singapore, Sri Lanka, Taiwan and Thailand. A review of both published and unpublished data revealed that the incidence of IPD in some countries is well documented by way of large, long-duration studies, while in other countries, much of the available data have been extrapolated from international studies or have come from small population studies of limited geographical coverage. This paper confirms that data regarding the incidence of IPD in Asia are grossly lacking and reinforces the need for urgent and more substantial studies.
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Affiliation(s)
- L C Bravo
- National Institute of Health, University of the Philippines Manila, 623 Pedro Gil Street, Ermita 1000 Manila, Philippines.
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CHAN-YEUNG M, LAI CK, CHAN KS, CHEUNG AH, YAO TJ, HO AS, KO FW, YAM LY, WONG PC, TSANG KW, LAM WK, HO JC, CHU CM, YU WC, CHAN HS, IP MS, HUI DS, TAM CY. The burden of lung disease in Hong Kong: A report from the Hong Kong Thoracic Society. Respirology 2008; 13 Suppl 4:S133-65. [DOI: 10.1111/j.1440-1843.2008.01394.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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DNA typing of cytological samples for retrospective identification of an early case of Panton-Valentine leucocidin-positive, community-associated methicillin-resistant Staphylococcus aureus pneumonia. J Clin Microbiol 2008; 46:2457-8. [PMID: 18495861 DOI: 10.1128/jcm.00283-08] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This paper describes a fatal case of culture-confirmed, community-associated methicillin-resistant Staphylococcus aureus (MRSA) pneumonia in an 8-month-old child in Hong Kong in 2001. Stored cytological materials prepared from the pleural fluid were retrieved for molecular analysis. The result indicates the presence of a Panton-Valentine leucocidin-positive, spa type 019 MRSA.
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