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Jarovsky D, Berezin EN. Impact of PCV10 on pediatric pneumococcal disease burden in Brazil: time for new recommendations? J Pediatr (Rio J) 2023; 99 Suppl 1:S46-S56. [PMID: 36495946 PMCID: PMC10066423 DOI: 10.1016/j.jped.2022.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/07/2022] [Accepted: 11/10/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To describe the impact of the 10-valent pneumococcal conjugate vaccine on the pediatric burden of pneumococcal infections, carriage, serotype replacement, and antimicrobial resistance in Brazil since its introduction in 2010. DATA SOURCE A narrative review of English, Spanish, and Portuguese articles published in online databases and in Brazilian epidemiological surveillance databases was performed. The following keywords were used: Streptococcus pneumoniae, pneumococcal disease, conjugate vaccine, PCV10, antimicrobial resistance, and meningitis. SUMMARY OF THE FINDINGS Declines in hospitalization rates of all-cause pneumonia occurred in the target age groups and some age groups not targeted by vaccination early after the use of PCV10. Large descriptive studies of laboratory-confirmed pneumococcal meningitis and hospital-based historical series of hospitalized children with IPD have evidenced a significant impact on disease burden, in-hospital fatality rates, and admission to the intensive care unit before and after the inclusion of the vaccine. Impact data on otitis media is limited and inconsistent; the main benefit remains the prevention of complicated diseases. During the late post-vaccine years, a significant and progressive increase in high-level penicillin non-susceptibility pneumococci has been described. Since 2014 serotype 19A has been the leading serotype in all ages and was responsible for 28.2%-44.6% of all IPD in children under 5 yrs. CONCLUSIONS PCV10 has performed a significant impact on IPD in Brazil since 2010, however, progress has been continuously hampered by replacement. Broader spectrum PCVs could provide expanded direct and indirect protection against ST19A and other additional serotypes of increasing importance if administered to children in the Brazilian National Immunization Program.
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Affiliation(s)
- Daniel Jarovsky
- Santa Casa de São Paulo Faculty of Medical Sciences, São Paulo, SP, Brazil; Santa Casa de São Paulo, São Paulo, SP, Brazil.
| | - Eitan Naaman Berezin
- Santa Casa de São Paulo Faculty of Medical Sciences, São Paulo, SP, Brazil; Santa Casa de São Paulo, São Paulo, SP, Brazil
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2
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Reyburn R, Tsatsaronis A, von Mollendorf C, Mulholland K, Russell FM. Systematic review on the impact of the pneumococcal conjugate vaccine ten valent (PCV10) or thirteen valent (PCV13) on all-cause, radiologically confirmed and severe pneumonia hospitalisation rates and pneumonia mortality in children 0-9 years old. J Glob Health 2023; 13:05002. [PMID: 36734192 PMCID: PMC9896304 DOI: 10.7189/jgoh.13.05002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Background There is an ongoing need to assess the impact of pneumococcal conjugate vaccines (PCVs) to guide the use of these potentially valuable but under-utilized vaccines against pneumonia, which is one of the most common causes of post-neonatal mortality. Methods We conducted a systematic review of the literature on PCV10 and PCV13 impact on all-cause, radiologically confirmed and severe pneumonia hospitalisation rates as well as all-cause and pneumonia-specific mortality rates. We included studies that were published from 2003 onwards, had a post-licensure observational study design, and reported on any of our defined outcomes in children aged between 0-9 years. We derived incidence rates (IRs), incidence rate ratios (IRRs) or percent differences (%). We assessed all studies for risk of bias using the Effective Public Health Practice Project (EPHPP) quality assessment tool. Results We identified a total of 1885 studies and included 43 comparing one or more of the following hospitalised outcomes of interest: all-cause pneumonia (n = 27), severe pneumonia (n = 6), all-cause empyema (n = 8), radiologically confirmed pneumonia (n = 8), pneumococcal pneumonia (n = 7), and pneumonia mortality (n = 10). No studies evaluated all-cause mortality. Studies were conducted in all WHO regions except South East Asia Region (SEAR) and low- or middle-income countries (LMICs) in the Western Pacific Region (WPR). Among children <5 years old, PCV impact ranged from 7% to 60% for all-cause pneumonia hospitalisation, 8% to 90% for severe pneumonia hospitalisation, 12% to 79% for radiologically confirmed pneumonia, and 45% to 85% for pneumococcal confirmed pneumonia. For pneumonia-related mortality, impact was found in three studies and ranged from 10% to 78%. No obvious differences were found in vaccine impact between PCV10 and PCV13. One study found a 17% reduction in all-cause pneumonia among children aged 5-9 years, while another found a reduction of 81% among those aged 5-17 years. A third study found a 57% reduction in all-cause empyema among children 5-14 years of age. Conclusion We found clear evidence of declines in hospitalisation rates due to all-cause, severe, radiologically confirmed, and bacteraemic pneumococcal pneumonia in children aged <5 years, supporting ongoing use of PCV10 and PCV13. However, there were few studies from countries with the highest <5-year mortality and no studies from SEAR and LMICs in the WPR. Standardising methods of future PCV impact studies is recommended.
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Affiliation(s)
- Rita Reyburn
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Anthea Tsatsaronis
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Claire von Mollendorf
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kim Mulholland
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia,London School of Hygiene and Tropical Medicine, London, UK
| | - Fiona M Russell
- Murdoch Children’s Research Institute, Melbourne, Victoria, Australia,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
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Zhu X, Li X. Pneumococcal vaccine effect on hospitalisation rates of pneumonia in children: A meta-analysis. Int J Clin Pract 2021; 75:e14739. [PMID: 34388857 DOI: 10.1111/ijcp.14739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/28/2021] [Accepted: 06/27/2021] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Since the appearance of the pneumococcal conjugate vaccine, the frequency of community-acquired pneumonia hospitalisations was decreased significantly especially in children below the age of 2 years, but its effects are still conflicting. This meta-analysis study was performed to assess the relationship between the effects of different types of pneumococcal conjugate vaccines compared with each other on the frequency of community-acquired pneumonia hospitalisations in children aged below 2 years. METHODS Through a systematic literature search up to December 2020, 20 studies were found recording relationships between the effects of different types of pneumococcal conjugate vaccines compared with each other on the frequency of community-acquired pneumonia hospitalisations in children aged below 2 years. Odds ratio (OR) with 95% confidence intervals (CIs) was calculated between different types of pneumococcal conjugate vaccines compared with each other on the frequency of community-acquired pneumonia hospitalisations in children below the age of 2 years using the dichotomous methods with a random or fixed-effect model. RESULTS The pneumococcal conjugate vaccine 10 was significantly related to a lower hospitalisation rate for pneumonia (OR, 0.64; 95% CI, 0.51-0.81, P < .001) compared with no vaccine and (OR, 0.78; 95% CI, 0.68-0.90, P < .001) compared with pneumococcal conjugate vaccine 7. The pneumococcal conjugate vaccine 13 was significantly related to a lower hospitalisation rate for pneumonia (OR, 0.63; 95% CI, 0.56-0.71, P < .001) compared with no vaccine and (OR, 0.56; 95% CI, 0.36-0.89, P = .01) compared with pneumococcal conjugate vaccine 7. The pneumococcal conjugate vaccine 13 was significantly related to a lower hospitalisation rate for pneumonia (OR, 0.67; 95% CI, 0.48-0.93, P = .02) compared with pneumococcal conjugate vaccine 10. CONCLUSIONS The pneumococcal conjugate vaccines 10 or 13 may have independent relationships in reducing the frequency of community-acquired pneumonia hospitalisations in children aged below 2 years compared with no vaccine or pneumococcal conjugate vaccines 7. Also, the pneumococcal conjugate vaccine 13 may have the same independent relationship compared with pneumococcal conjugate vaccines 10. Further studies are needed to solidify the findings to other vaccines to have evidence-based information that could help in establishing future immunisation strategies.
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Affiliation(s)
- Xiuling Zhu
- Department of Pediatrics, Yiwu Central Hospital, Zhejiang, China
| | - Xiaofei Li
- Department of Infectious Diseases, Yiwu Central Hospital, Zhejiang, China
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Chen Y, Roberts CS, Ou W, Petigara T, Goldmacher GV, Fancourt N, Knoll MD. Deep learning for classification of pediatric chest radiographs by WHO's standardized methodology. PLoS One 2021; 16:e0253239. [PMID: 34153076 PMCID: PMC8216551 DOI: 10.1371/journal.pone.0253239] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/31/2021] [Indexed: 11/05/2022] Open
Abstract
Background The World Health Organization (WHO)-defined radiological pneumonia is a preferred endpoint in pneumococcal vaccine efficacy and effectiveness studies in children. Automating the WHO methodology may support more widespread application of this endpoint. Methods We trained a deep learning model to classify pneumonia CXRs in children using the World Health Organization (WHO)’s standardized methodology. The model was pretrained on CheXpert, a dataset containing 224,316 adult CXRs, and fine-tuned on PERCH, a pediatric dataset containing 4,172 CXRs. The model was then tested on two pediatric CXR datasets released by WHO. We also compared the model’s performance to that of radiologists and pediatricians. Results The average area under the receiver operating characteristic curve (AUC) for primary endpoint pneumonia (PEP) across 10-fold validation of PERCH images was 0.928; average AUC after testing on WHO images was 0.977. The model’s classification performance was better on test images with high inter-observer agreement; however, the model still outperformed human assessments in AUC and precision-recall spaces on low agreement images. Conclusion A deep learning model can classify pneumonia CXR images in children at a performance comparable to human readers. Our method lays a strong foundation for the potential inclusion of computer-aided readings of pediatric CXRs in vaccine trials and epidemiology studies.
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Affiliation(s)
- Yiyun Chen
- Merck & Co., Inc., Kenilworth, New Jersey, United States of America
- * E-mail:
| | - Craig S. Roberts
- Merck & Co., Inc., Kenilworth, New Jersey, United States of America
| | - Wanmei Ou
- Merck & Co., Inc., Kenilworth, New Jersey, United States of America
| | - Tanaz Petigara
- Merck & Co., Inc., Kenilworth, New Jersey, United States of America
| | | | - Nicholas Fancourt
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Maria Deloria Knoll
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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5
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Ferreira MN, Netto EM, Nascimento-Carvalho CM. The impact of 10-valent pneumococcal conjugate vaccine upon hospitalization rate of children with pneumonia in different Brazilian administrative regions. Vaccine 2021; 39:2153-2164. [PMID: 33726954 DOI: 10.1016/j.vaccine.2021.02.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Streptococcus pneumoniae is the most frequent bacterial causative agent of pneumonia. Due to its significant contribution to the morbidity and mortality profile and the country's economy, the 10-valent pneumococcal vaccine (PCV10) was introduced in Brazil in 2010. Brazil is divided into five administrative regions which differ in social-economic indices among each other. Estimates of PCV10 impact on hospitalization rates due to pneumonia stratified by distinct Brazilian regions are limited. We assessed this issue. METHODS This is a population-based ecological investigation. Data about hospitalizations due to pneumonia, asthma or urinary tract infection (UTI) among patients aged under 20 years in the pre-exposure (2003-2009) and in the post-exposure (2011-2017) periods were retrieved from the National Health System - Hospital Information System (SIH-SUS) database. The total resident population by age group in each year was retrieved from the Brazilian Institute for Geography and Statistics database. Hospitalization rates were estimated for each Brazilian region and the rates obtained in the pre-exposure and in the post-exposure periods were compared by Prais-Winsten regression. The Human Development Index (HDI) evolved differently in the distinct regions during the study period. RESULTS Overall, hospitalization rates due to pneumonia declined by 34.5%. Similar trends were observed for hospitalization rates due to asthma and UTI. The same pattern was observed in each Brazilian region. However, the North region was the only one that presented an exponential incidence decline pattern, which could be explained by PCV10 implementation (declined by 10.8% in the quadratic regression, p < 0.01). Only in the North region, significant decline was observed among patients aged 0-4 years (-12.5%; p = 0.01), 5-9 years (-38.5%; p < 0.01) or 10-14 years (-10.7%; p = 0.03). CONCLUSION Significant variation in the downward trend of hospitalization rate was only found in the North region, which evolved from very low HDI in 2003; medium HDI in 2010 to high HDI in 2017.
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Affiliation(s)
- Mariana N Ferreira
- Department of Paediatrics, School of Medicine, Federal University of Bahia, Salvador, Brazil.
| | - Eduardo M Netto
- Infectious Diseases Unit, University Hospital, Federal University of Bahia, Salvador, Brazil
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6
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Carrasquilla G, Porras-Ramírez A, Martinez S, DeAntonio R, Devadiga R, Talarico C, Caceres DC, Castrejon MM, Juliao P. Trends in all-cause pneumonia and otitis media in children aged <2 years following pneumococcal conjugate vaccine introduction in Colombia. Hum Vaccin Immunother 2020; 17:1173-1180. [PMID: 32966144 PMCID: PMC8018459 DOI: 10.1080/21645515.2020.1805990] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
In Colombia, pneumococcal conjugate vaccines (PCVs) were implemented into the infant universal mass vaccination program in a stepwise manner; PCV-7 between 2009 and 2011 in different geographic regions/cities, with nationwide introduction of a 10-valent vaccine (PHiD-CV) in 2012. We aimed to describe trends in all-cause pneumonia mortality and overall mortality, and in the incidence of all-cause pneumonia and otitis media (OM) in Colombian children <2 y (y = years) of age, before and after PCV introduction. We obtained mortality and incidence data, nationally and for five major cities (Bogota, Medellin, Barranquilla, Cali and Cartagena) from 2005–2016 and 2008–2016, respectively, comparing mortality and incidence proportions in the post-PCV introduction period with those in the pre-PCV period. Overall mean reductions in all-cause pneumonia mortality was observed in the post-PCV period nationally (48.8%; 95%CI: 45.5–51.8%) and in four cities including Bogota (77.1%; 71.1–81.8%) and Medellin (56.4%; 44.1–65.9%); no substantial reduction was observed in Cartagena. Similar findings were observed for overall mortality. Reductions in all-cause pneumonia incidence were observed in Bogota (66.0%; 65.5–66.6%), Medellin (40.6%; 39.3–41.9%) and Cartagena (15.0%; 11.2–18.6%), while incidence increased in Barranquilla (78.5%; 68.4–89.2%) and Cali (125.5%; 119.2–132.0%). All-cause OM incidence fell in Medellin and Bogota (42.1–51.1%) but increased (95.8%) in Barranquilla. In conclusion, overall reductions in disease outcomes were observed following PCV introduction in most cities and nationwide. Decreasing trends in outcomes were observed prior to PCV introduction, and limited data points and data reporting issues may have influenced our results. (ClinicalTrials.gov: NCT02567747)
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Affiliation(s)
| | - Alexandra Porras-Ramírez
- ASIESALUD, Bogota, Colombia.,Grupo de Medicina Comunitaria y Salud Colectiva, Universidad El Bosque, Bogotá, Colombia
| | | | - Rodrigo DeAntonio
- Centro de Vacunación Internacional, S A Cevaxin, Panama City, Panama
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Quantifying risks and interventions that have affected the burden of lower respiratory infections among children younger than 5 years: an analysis for the Global Burden of Disease Study 2017. THE LANCET. INFECTIOUS DISEASES 2020; 20:60-79. [PMID: 31678026 PMCID: PMC7185492 DOI: 10.1016/s1473-3099(19)30410-4] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/13/2019] [Accepted: 07/05/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite large reductions in under-5 lower respiratory infection (LRI) mortality in many locations, the pace of progress for LRIs has generally lagged behind that of other childhood infectious diseases. To better inform programmes and policies focused on preventing and treating LRIs, we assessed the contributions and patterns of risk factor attribution, intervention coverage, and sociodemographic development in 195 countries and territories by drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) LRI estimates. METHODS We used four strategies to model LRI burden: the mortality due to LRIs was modelled using vital registration data, demographic surveillance data, and verbal autopsy data in a predictive ensemble modelling tool; the incidence of LRIs was modelled using population representative surveys, health-care utilisation data, and scientific literature in a compartmental meta-regression tool; the attribution of risk factors for LRI mortality was modelled in a counterfactual framework; and trends in LRI mortality were analysed applying changes in exposure to risk factors over time. In GBD, infectious disease mortality, including that due to LRI, is among HIV-negative individuals. We categorised locations based on their burden in 1990 to make comparisons in the changing burden between 1990 and 2017 and evaluate the relative percent change in mortality rate, incidence, and risk factor exposure to explain differences in the health loss associated with LRIs among children younger than 5 years. FINDINGS In 2017, LRIs caused 808 920 deaths (95% uncertainty interval 747 286-873 591) in children younger than 5 years. Since 1990, there has been a substantial decrease in the number of deaths (from 2 337 538 to 808 920 deaths; 65·4% decrease, 61·5-68·5) and in mortality rate (from 362·7 deaths [330·1-392·0] per 100 000 children to 118·9 deaths [109·8-128·3] per 100 000 children; 67·2% decrease, 63·5-70·1). LRI incidence declined globally (32·4% decrease, 27·2-37·5). The percent change in under-5 mortality rate and incidence has varied across locations. Among the risk factors assessed in this study, those responsible for the greatest decrease in under-5 LRI mortality between 1990 and 2017 were increased coverage of vaccination against Haemophilus influenza type b (11·4% decrease, 0·0-24·5), increased pneumococcal vaccine coverage (6·3% decrease, 6·1-6·3), and reductions in household air pollution (8·4%, 6·8-9·2). INTERPRETATION Our findings show that there have been substantial but uneven declines in LRI mortality among countries between 1990 and 2017. Although improvements in indicators of sociodemographic development could explain some of these trends, changes in exposure to modifiable risk factors are related to the rates of decline in LRI mortality. No single intervention would universally accelerate reductions in health loss associated with LRIs in all settings, but emphasising the most dominant risk factors, particularly in countries with high case fatality, can contribute to the reduction of preventable deaths. FUNDING Bill & Melinda Gates Foundation.
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8
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Affiliation(s)
- Trevor Duke
- Centre for International Child Health, Department of Paediatrics, University of Melbourne, and Murdoch Children's Research Institute, Intensive Care Unit, Royal Children's Hospital, Melbourne, VIC 3052, Australia; School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea.
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9
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Nieminen H, Rinta-Kokko H, Jokinen J, Puumalainen T, Moreira M, Borys D, Schuerman L, Palmu AA. Effectiveness of the 10-valent pneumococcal conjugate vaccine among girls, boys, preterm and low-birth-weight infants - Results from a randomized, double-blind vaccine trial. Vaccine 2019; 37:3715-3721. [PMID: 31122856 DOI: 10.1016/j.vaccine.2019.05.033] [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: 09/19/2018] [Revised: 04/25/2019] [Accepted: 05/09/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Several studies have shown differences in susceptibility to infections and immune response to vaccines by sex. Prematurely born infants are at higher risk for pneumococcal diseases, with lower effectiveness for some vaccines compared to term infants. We have reported the effectiveness of the 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV10) on several endpoints in the Finnish Invasive Pneumococcal disease (FinIP) vaccine trial. Now, we present the results of a post-hoc analysis evaluating PHiD-CV10 effectiveness in subgroups by sex, gestational age, and birth weight. METHODS The FinIP trial was a phase III/IV cluster-randomized, double-blind trial. Infants enrolled < 7 months of age received PHiD-CV10 in two thirds of clusters (3 + 1 or 2 + 1 schedule) and hepatitis B vaccine as control in remaining third. Outcome data included invasive pneumococcal disease, pneumonia, tympanostomy tube placements, and antimicrobial purchases collected through national, routinely used health registers. Negative binomial model was used in the incidence and vaccine effectiveness estimation, and differences in incidences between subgroups were tested among control children. RESULTS Of the 30,527 infants enrolled 51% were boys. The incidences of hospital-diagnosed pneumonia and otitis-related outcomes were higher among boys in control groups. There were no significant sex differences in the vaccine effectiveness estimates. Altogether, 1519 (5%) infants were born before 37th gestational week. The incidences of pneumonia outcomes were higher among premature infants when compared to term infants. The vaccine effectiveness estimates among preterm infants were not statistically significant except for antimicrobial purchases, but all point estimates were at the same level among preterm infants as among term infants. There was no significant difference between 2 + 1 and 3 + 1 schedules in any of the subgroups analysed. CONCLUSION PHiD-CV10 had a similar effectiveness in both sexes, and seemed to be protective in preterm infants. TRIAL REGISTRATION ClinicalTrials.gov NCT00861380 and NCT00839254.
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Affiliation(s)
- H Nieminen
- Department of Public Health Solutions, National Institute for Health and Welfare, FinnMedi I, Biokatu 6, FI-33520 Tampere, Finland.
| | - H Rinta-Kokko
- Department of Public Health Solutions, National Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland
| | - J Jokinen
- Department of Public Health Solutions, National Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland
| | - T Puumalainen
- Department of Health Security, National Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland
| | - M Moreira
- GSK, Avenue Fleming 20, B-1300 Wavre, Belgium
| | - D Borys
- GSK, Avenue Fleming 20, B-1300 Wavre, Belgium
| | - L Schuerman
- GSK, Avenue Fleming 20, B-1300 Wavre, Belgium
| | - A A Palmu
- Department of Public Health Solutions, National Institute for Health and Welfare, FinnMedi I, Biokatu 6, FI-33520 Tampere, Finland
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10
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Arbo A, Lovera D, Martínez-Cuellar C. Mortality Predictive Scores for Community-Acquired Pneumonia in Children. Curr Infect Dis Rep 2019; 21:10. [PMID: 30834468 DOI: 10.1007/s11908-019-0666-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW The use of severity score for the staging of pneumonias has emerged as a necessity for the physician caring for this disease. Although there are several established prognostic scoring systems for community-acquired pneumonia in adults, the availability for children are scarce. RECENT FINDINGS Recently, scoring system for risk stratification of children with pneumonia were developed in low- and middle-income countries. They use clinical variables that represent known risk factors for severe outcomes of respiratory illness in children, such as hypoxemia, chest indrawing, refusal to feed, malnutrition, age, and stage of HIV disease among others factors. Although they showed good discriminating power and are very useful in low-resource settings, the characteristics of the patients, the local epidemiology of concurrent diseases, the social conditions, and the facilities of the hospitals make them not applicable to developed countries. A new prognostic scale for estimating mortality based on the modified PIRO scale used in adults with pneumonia can be useful for developed countries. Although several scoring systems for the estimation of mortality in childhood CAP were developed in the last years, most of them come from developing countries and the results are not applicable to patients with pneumonia in developed countries. Prospective studies applying scores adapted to the reality of the developed countries are needed.
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Affiliation(s)
- Antonio Arbo
- Department of Pediatric, Instituto de Medicina Tropical, Avda. Venezuela y Florida, Asunción, Paraguay. .,Institute of Tropical Medicine, Asunción, Paraguay. .,National University of Asuncion, San Lorenzo, Paraguay.
| | - Dolores Lovera
- Institute of Tropical Medicine, Asunción, Paraguay.,National University of Asuncion, San Lorenzo, Paraguay
| | - Celia Martínez-Cuellar
- Institute of Tropical Medicine, Asunción, Paraguay.,National University of Asuncion, San Lorenzo, Paraguay
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Mrkvan T, Pelton SI, Ruiz-Guiñazú J, Palmu AA, Borys D. Effectiveness and impact of the 10-valent pneumococcal conjugate vaccine, PHiD-CV: review of clinical trials and post-marketing experience. Expert Rev Vaccines 2019; 17:797-818. [PMID: 30185083 DOI: 10.1080/14760584.2018.1516551] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Pneumococcal diseases (including septicemia, meningitis, pneumonia, and upper respiratory infections) constitute a major public health problem. The World Health Organization recommends pneumococcal conjugate vaccine immunization of young children worldwide. AREAS COVERED We reviewed evidence on the effects of the 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV), which is used in childhood immunization programs in over 45 countries or regions. The effectiveness of PHiD-CV against invasive pneumococcal disease (IPD), pneumonia, and acute otitis media was assessed. We also present its effect on pneumococcal nasopharyngeal carriage (NPC) and indirect effects (herd protection) among unvaccinated individuals. EXPERT COMMENTARY Results from randomized, double-blind trials and post-marketing studies in various countries provide evidence of the protective efficacy, effectiveness, and impact of PHiD-CV against pneumococcal diseases. Data from different geographic locations also show reductions in NPC of vaccine pneumococcal serotypes, laying the foundation for indirect protection against pneumococcal disease. In countries where PHiD-CV is included in childhood immunization programs, there are signs of herd protection for vaccine serotypes among unvaccinated individuals. Although increases in non-vaccine serotype IPD and NPC rates were observed, there was an overall reduction of pneumococcal disease.
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Affiliation(s)
| | - Stephen I Pelton
- b Maxwell Finland Laboratory for Infectious Diseases , Boston University , Boston , MA , USA
| | | | - Arto A Palmu
- c Department of Public Health Solutions , National Institute for Health and Welfare , Tampere , Finland
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12
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13
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Kupek E, Viertel I. Postintroduction Study of Cost-Effectiveness of Pneumococcal Vaccine PCV10 from Public Sector Payer's Perspective in the State of Santa Catarina, Brazil. Value Health Reg Issues 2018; 17:109-114. [PMID: 29772472 DOI: 10.1016/j.vhri.2017.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 11/27/2017] [Accepted: 12/01/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To evaluate cost-effectiveness of 10-valent pneumococcal conjugate vaccine in the routine immunization program for children younger than 5 years in Brazil by a postintroduction study. METHODS Ecological study of prevaccine (2006-2009) versus postvaccine (2011-2014) period related the changes in mortality rate and hospitalization rate to direct cost of pneumonia treatment from the payer's perspective to estimate the cost-effectiveness regarding lives saved, life-years gained, and disability-adjusted life-year for children younger than 5 years in the southern Brazilian state of Santa Catarina. All-cause pneumonia (ICD-10 J12-J18) deaths, hospital admissions, and associated costs were retrieved from the Brazilian Ministry of Health official Web site. Life expectancy at birth, population, ambulatory costs, cost savings, and plausible range of these parameters were used from published sources. Computer simulations with sensitivity analysis were performed to obtain the cost-effectiveness estimates. RESULTS About 27 lives were saved and 2573 hospitalizations averted by the 10-valent pneumococcal conjugate vaccine vaccination in the 2011 to 2014 period at the cost of US $24,348 per life-year gained and US $27,748 per disability-adjusted life-year. The latter cost is 81% of Brazilian gross domestic product per capita over the same period. CONCLUSIONS The vaccine was very cost-effective according to the World Health Organization criterion.
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Affiliation(s)
- Emil Kupek
- Department of Public Health, Center for Health Sciences, Federal University of Santa Catarina, Florianopolis, Brazil.
| | - Ilse Viertel
- Graduate School of Community Health, Center for Health Sciences, Federal University of Santa Catarina, Florianopolis, Brazil
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Lara C, De Graeve D, Franco F. Cost-Effectiveness Analysis of Pneumococcal and Influenza Vaccines Administered to Children Less Than 5 Years of Age in a Low-Income District of Bogota, Colombia. Value Health Reg Issues 2018; 17:21-31. [PMID: 29626706 DOI: 10.1016/j.vhri.2018.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 12/19/2017] [Accepted: 01/09/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND The Colombian health authorities introduced the pneumococcal conjugated vaccine and the seasonal influenza vaccine into the national immunization schedule for children in 2009 and 2007, respectively. Despite this, the health authorities continue to be concerned about the high economic and disease burden among children from low-income households caused by these vaccine-preventable diseases. OBJECTIVES 1) To evaluate the potential health outcomes of four vaccination strategies for subsidized children younger than 5 years in a low-income district in Colombia from a public, direct medical health care perspective. 2) To perform univariate, multivariate, and probabilistic sensitivity analysis to evaluate the robustness of these results. METHODS We built a Markov deterministic cohort model to evaluate five consecutive cohorts across four alternative situations: 1) no vaccination; 2) vaccination with the 10-valent pneumococcal conjugate vaccine (PCV10 vaccine); 3) vaccination with the trivalent inactivated vaccine (TIV) annually; and 4) combined vaccination with PCV10 vaccine and TIV. RESULTS The introduction of PCV10 vaccine and TIV and their combined use in particular would be highly cost-effective in comparison to no vaccination. For the combined vaccination with PCV10 vaccine and TIV, the incremental cost-effectiveness ratio would be $1,280 per disability-adjusted life-year (DALY) averted, the total incremental cost of the vaccination program would be $776,800, and it would avert four deaths and 332 DALYs for the five cohorts. CONCLUSIONS The introduction of PCV10 vaccine and TIV would be highly cost-effective from a public, direct medical health care perspective. Despite these results, we have not observed decreases in severity or hospitalizations. Our findings highlight the need for further studies of the immunization campaign indicators and socioeconomic indicators for this low-income community.
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Affiliation(s)
- Carlos Lara
- Department of Economics, University of Antwerp, Antwerp, Belgium.
| | - Diana De Graeve
- Department of Economics, University of Antwerp, Antwerp, Belgium
| | - Fabian Franco
- Department of Finance, Hospital la Victoria, Bogota, D.C., Colombia
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Pneumococcal Vaccination and Pneumonia Associated With Pleural Effusion in a Pediatric Population. Pediatr Infect Dis J 2018; 37:e87-e92. [PMID: 28938258 DOI: 10.1097/inf.0000000000001798] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim was to assess the effect of the nonsystematic pneumococcal conjugate vaccine (PCV) on incidence of pneumonia associated with parapneumonic pleural effusion (PPE) in vaccinated and unvaccinated children. METHODS Cases were patients <15 years of age who had been diagnosed with pneumonia associated with PPE in a tertiary hospital in Navarra (Spain) between 1995 and 2014. The population <15 years of age and covered by the public health service was used as reference. The vaccination status of the cases and population was obtained from computerized medical records. Logistic regression analyses included vaccination status, age group and time periods: prevaccine (1995-2001) and vaccination with PCV7 (2002-2010) and PCV13 (2011-2014). RESULTS A total of 321 cases of PPE were included. The risk of PPE increased between the prevaccine and PCV7 period (adjusted odds ratio [OR], 3.34; 95% confidence interval [CI]: 2.37-4.71), while vaccination with PCV7 was found to be an independent risk factor (OR, 1.44; 95% CI: 1.09-1.89) in the same analysis. In the PCV13 period, the risk of PPE returned to the prevaccination incidence level among children vaccinated with PCV13 (OR, 1.07; 95% CI: 0.56-2.04), while unvaccinated children (OR, 1.69; 95% CI: 0.96-2.98) and overall those vaccinated with PCV7 (OR, 3.64; 95% CI: 2.15-6.17) maintained an increased risk of PPE. CONCLUSION The nonsystematic introduction of PCV7 was followed by an increased incidence of PPE. The subsequent introduction of PCV13 was associated with a return to the incidence level in the prevaccine period, mainly in children vaccinated with PCV13.
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Alicino C, Paganino C, Orsi A, Astengo M, Trucchi C, Icardi G, Ansaldi F. The impact of 10-valent and 13-valent pneumococcal conjugate vaccines on hospitalization for pneumonia in children: A systematic review and meta-analysis. Vaccine 2017; 35:5776-5785. [DOI: 10.1016/j.vaccine.2017.09.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 08/28/2017] [Accepted: 09/01/2017] [Indexed: 10/18/2022]
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17
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Andrade AL, Afonso ET, Minamisava R, Bierrenbach AL, Cristo EB, Morais-Neto OL, Policena GM, Domingues CMAS, Toscano CM. Direct and indirect impact of 10-valent pneumococcal conjugate vaccine introduction on pneumonia hospitalizations and economic burden in all age-groups in Brazil: A time-series analysis. PLoS One 2017; 12:e0184204. [PMID: 28880953 PMCID: PMC5589174 DOI: 10.1371/journal.pone.0184204] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 08/18/2017] [Indexed: 01/15/2023] Open
Affiliation(s)
- Ana Lucia Andrade
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil
- * E-mail:
| | - Eliane T. Afonso
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil
- Faculty of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil
- Department of Medicine, Pontifical Catholic University of Goiás, Goiânia, Goiás, Brazil
| | - Ruth Minamisava
- School of Nursing, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Ana Luiza Bierrenbach
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil
| | | | - Otaliba L. Morais-Neto
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Gabriela M. Policena
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Carla M. A. S. Domingues
- National Immunization Program, Secretariat for Health Surveillance, Ministry of Health, Brasília, Federal District, Brazil
| | - Cristiana M. Toscano
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil
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18
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Nunes SEA, Minamisava R, Vieira MADS, Itria A, Pessoa VP, Andrade ALSSD, Toscano CM. Hospitalization costs of severe bacterial pneumonia in children: comparative analysis considering different costing methods. EINSTEIN-SAO PAULO 2017; 15:212-219. [PMID: 28767921 PMCID: PMC5609619 DOI: 10.1590/s1679-45082017gs3855] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 04/07/2017] [Indexed: 11/21/2022] Open
Abstract
Objective To determine and compare hospitalization costs of bacterial community-acquired pneumonia cases via different costing methods under the Brazilian Public Unified Health System perspective. Methods Cost-of-illness study based on primary data collected from a sample of 59 children aged between 28 days and 35 months and hospitalized due to bacterial pneumonia. Direct medical and non-medical costs were considered and three costing methods employed: micro-costing based on medical record review, micro-costing based on therapeutic guidelines and gross-costing based on the Brazilian Public Unified Health System reimbursement rates. Costs estimates obtained via different methods were compared using the Friedman test. Results Cost estimates of inpatient cases of severe pneumonia amounted to R$ 780,70/$Int. 858.7 (medical record review), R$ 641,90/$Int. 706.90 (therapeutic guidelines) and R$ 594,80/$Int. 654.28 (Brazilian Public Unified Health System reimbursement rates). Costs estimated via micro-costing (medical record review or therapeutic guidelines) did not differ significantly (p=0.405), while estimates based on reimbursement rates were significantly lower compared to estimates based on therapeutic guidelines (p<0.001) or record review (p=0.006). Conclusion Brazilian Public Unified Health System costs estimated via different costing methods differ significantly, with gross-costing yielding lower cost estimates. Given costs estimated by different micro-costing methods are similar and costing methods based on therapeutic guidelines are easier to apply and less expensive, this method may be a valuable alternative for estimation of hospitalization costs of bacterial community-acquired pneumonia in children.
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Affiliation(s)
- Sheila Elke Araujo Nunes
- Universidade Estadual da Região Tocantina do Maranhão, Imperatriz, MA, Brazil.,Universidade Federal de Goiás, Goiânia, GO, Brazil
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Masters IB, Isles AF, Grimwood K. Necrotizing pneumonia: an emerging problem in children? Pneumonia (Nathan) 2017; 9:11. [PMID: 28770121 PMCID: PMC5525269 DOI: 10.1186/s41479-017-0035-0] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 06/22/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND In children, necrotizing pneumonia (NP) is an uncommon, severe complication of pneumonia. It is characterized by destruction of the underlying lung parenchyma resulting in multiple small, thin-walled cavities and is often accompanied by empyema and bronchopleural fistulae. REVIEW NP in children was first reported in children in 1994, and since then there has been a gradual increase in cases, which is partially explained by greater physician awareness and use of contrast computed tomography (CT) scans, and by temporal changes in circulating respiratory pathogens and antibiotic prescribing. The most common pathogens detected in children with NP are pneumococci and Staphylococcus aureus. The underlying disease mechanisms are poorly understood, but likely relate to multiple host susceptibility and bacterial virulence factors, with viral-bacterial interactions also possibly having a role. Most cases are in previously healthy young children who, despite adequate antibiotic therapy for bacterial pneumonia, remain febrile and unwell. Many also have evidence of pleural effusion, empyema, or pyopneumothorax, which has undergone drainage or surgical intervention without clinical improvement. The diagnosis is generally made by chest imaging, with CT scans being the most sensitive, showing loss of normal pulmonary architecture, decreased parenchymal enhancement and multiple thin-walled cavities. Blood culture and culture and molecular testing of pleural fluid provide a microbiologic diagnosis in as many as 50% of cases. Prolonged antibiotics, draining pleural fluid and gas that causes mass effects, and maintaining ventilation, circulation, nutrition, fluid, and electrolyte balance are critical components of therapy. Despite its serious nature, death is uncommon, with good clinical, radiographic and functional recovery achieved in the 5-6 months following diagnosis. Increased knowledge of NP's pathogenesis will assist more rapid diagnosis and improve treatment and, ultimately, prevention. CONCLUSION It is important to consider that our understanding of NP is limited to individual case reports or small case series, and treatment data from randomized-controlled trials are lacking. Furthermore, case series are retrospective and usually confined to single centers. Consequently, these studies may not be representative of patients in other locations, especially when allowing for temporal changes in pathogen behaviour and differences in immunization schedules and antibiotic prescribing practices.
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Affiliation(s)
- I. Brent Masters
- Department of Respiratory and Sleep Medicine, Lady Cilento Children’s Hospital, South Brisbane, QLD Australia
| | - Alan F. Isles
- Department of Respiratory and Sleep Medicine, Lady Cilento Children’s Hospital, South Brisbane, QLD Australia
| | - Keith Grimwood
- School of Medicine and Menzies Health Institute Queensland, Gold Coast campus, Griffith University, Building G40, Southport Gold Coast, QLD Australia
- Departments of Infectious Diseases and Paediatrics, Gold Coast Health, Southport Gold Coast, QLD Australia
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Bardach AE, Rey-Ares L, Calderon Cahua M, Ciapponi A, Cafferata ML, Cormick G, Gentile Á. Burden of Culture-Confirmed Pediatric Pneumococcal Pneumonia in Latin America and the Caribbean: A Systematic Review and Meta-Analysis. Value Health Reg Issues 2017; 14:41-52. [PMID: 29254541 DOI: 10.1016/j.vhri.2017.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 03/11/2017] [Accepted: 04/09/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND Pneumococcal pneumonia (PP) causes almost one in five deaths in children younger than 5 years worldwide. In Latin America and the Caribbean (LAC), pneumonia causes 14% of all deaths. Although pneumococcal disease is a vaccine-preventable disease that accounts for a significant proportion of this burden, the decision-making process to introduce pneumococcal conjugate vaccines in official schedules is still complex in LAC. Confirmed PP cases and epidemiology are the basis for broader projections. OBJECTIVE To gather all the information available in the LAC region to assist decision makers. METHODS We performed a systematic review of studies of consolidating and culture-confirmed pediatric PP in LAC (2000-2016) using a generic academic Internet search and search engines without language restrictions. Pairs of reviewers independently selected and assessed the studies' methodological quality. We analyzed meta-information on pneumococcal serotypes available from the SIREVA laboratory-based surveillance system. RESULTS A total of 35 out of 750 initially identified studies were included. In the age group between 0 and 59 years, the incidence of culture-confirmed PP ranged from 10.2 to 43.0/100,000 children, with a pooled incidence of 20.4/100,000 children (95% confidence interval 0.0-123.2). Mortality ranged from 0.4 to 5.7/100,000 children, and the pooled mortality was 2.9/100,000 children (95% confidence interval 0.3-8.2). The pooled serotype distribution from surveillance data showed that serotypes 14, 1, and 6B were the most frequent serotypes in LAC, all included in licensed vaccines. CONCLUSIONS Studies on confirmed pediatric PP were scarce in LAC in 2000 to 2016. Epidemiology indicators and health resource use are still poorly defined.
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Affiliation(s)
- Ariel Esteban Bardach
- Institute for Clinical Effectiveness and Health Policy, National Scientific and Technical Research Council, Argentina.
| | - Lucila Rey-Ares
- Institute for Clinical Effectiveness and Health Policy, National Scientific and Technical Research Council, Argentina
| | - María Calderon Cahua
- Institute for Clinical Effectiveness and Health Policy, National Scientific and Technical Research Council, Argentina
| | - Agustín Ciapponi
- Institute for Clinical Effectiveness and Health Policy, National Scientific and Technical Research Council, Argentina
| | - María Luisa Cafferata
- Institute for Clinical Effectiveness and Health Policy, National Scientific and Technical Research Council, Argentina
| | - Gabriela Cormick
- Institute for Clinical Effectiveness and Health Policy, National Scientific and Technical Research Council, Argentina
| | - Ángela Gentile
- Children's Hospital "Dr Ricardo Gutierrez", Buenos Aires, Argentina
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Sartori AL, Minamisava R, Bierrenbach AL, Toscano CM, Afonso ET, Morais-Neto OL, Antunes JLF, Cristo EB, Andrade AL. Reduction in all-cause otitis media-related outpatient visits in children after PCV10 introduction in Brazil. PLoS One 2017; 12:e0179222. [PMID: 28594913 PMCID: PMC5464612 DOI: 10.1371/journal.pone.0179222] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 05/25/2017] [Indexed: 11/19/2022] Open
Abstract
Few studies have reported the effect of 10-valent pneumococcal conjugate vaccine (PCV10) on otitis media (OM) in infants. In particular, no population-based study in upper-middle income countries is available. In 2010, Brazil introduced PCV10 into its routine National Immunization Program using a 3+1 schedule. We measured the impact of PCV10 on all-cause OM in children. An interrupted time-series analysis was conducted in Goiânia/Brazil considering monthly rates (per 100,000) of all-cause OM outpatient visits in children aged 2–23 months. We used case-based data from the Outpatient Visits Information System of the Unified Health System coded for ICD-10 diagnosis for the period of August/2008 to July/2015. As a comparator, we used rates of outpatient visits due to all-other causes. The relative reduction of all-cause OM and all-other causes of outpatient visits were calculated as the difference between the predicted and observed cumulative rates of the PCV10 post-vaccination period. We then subtracted the relative reduction of all-other causes of outpatient visits from all-cause OM to obtain the impact of PCV10 on OM. In total, 6,401 OM outpatient visits were recorded in 4,793 children aged 2–23 months. Of these, 922 (19.2%) children had more than one OM episode. A significant reduction in all-cause OM visits was observed (50.7%; 95%CI: 42.2–59.2%; p = 0.013), while the reduction in visits due to all-other causes was 7.7% (95% CI 0.8–14.7%; p<0.001). The impact of PCV10 on all-cause OM was thus estimated at 43.0% (95%CI 41.4–44.5). This is the first study to show significant PCV10 impact on OM outpatient visits in infants in a developing country. Our findings corroborate the available evidence from developed countries.
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Affiliation(s)
- Ana L. Sartori
- Department of Community Health, Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Brazil
- Institute of Health Sciences, Federal University of Mato Grosso, Sinop, Brazil
| | - Ruth Minamisava
- School of Nursing, Federal University of Goiás, Goiânia, Brazil
| | - Ana L. Bierrenbach
- Department of Community Health, Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Brazil
| | - Cristiana M. Toscano
- Department of Community Health, Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Brazil
| | - Eliane T. Afonso
- School of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Otaliba L. Morais-Neto
- Department of Community Health, Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Brazil
| | | | - Elier B. Cristo
- Advisor of the Secretariat of Health, São Paulo, São Paulo, Brazil
| | - Ana Lucia Andrade
- Department of Community Health, Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Brazil
- * E-mail:
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Corrêa RDA, José BPDS, Malta DC, Passos VMDA, França EB, Teixeira RA, Camargos PAM. Carga de doença por infecções do trato respiratório inferior no Brasil, 1990 a 2015: estimativas do estudo Global Burden of Disease 2015. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2017; 20Suppl 01:171-181. [DOI: 10.1590/1980-5497201700050014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 03/08/2017] [Indexed: 11/22/2022] Open
Abstract
RESUMO: Introdução: Infecções do trato respiratório inferior (ITRi) apresentam incidência e mortalidade significativas no mundo. Este artigo apresenta o impacto das ITRi na carga de doença, segundo as métricas utilizadas no estudo Global Burden of Disease 2015 (GBD 2015) para o Brasil, em 1990 e 2015. Métodos: Análise de estimativas do GBD 2015: anos de vida perdidos por morte prematura (YLLs), anos vividos com incapacidade (YLDs) e anos de vida perdidos por morte ou incapacidade (DALYs = YLLs + YLDs). Resultados: As ITRi foram a terceira causa de mortalidade no Brasil em 1990 e 2015, com 63,5 e 47,0 mortes/100 mil habitantes, respectivamente. Embora o número absoluto de óbitos tenha aumentado 26,8%, houve redução de 25,5% nas taxas de mortalidade padronizadas por idade, sendo a redução mais marcante em menores de 5 anos. Também houve redução progressiva da carga da doença, expressa em DALYs. Discussão: Apesar da redução da carga da doença no período, as ITRi foram importante causa de incapacidade e a terceira causa de mortes no Brasil em 2015. O aumento do número de óbitos ocorreu devido ao aumento e envelhecimento populacional. A redução das taxas de mortalidade acompanhou a melhora das condições socioeconômicas, do acesso mais amplo aos cuidados de saúde, da disponibilidade nacional de antibióticos e das políticas de vacinação adotadas no país. Conclusão: Apesar das dificuldades socioeconômicas vigentes, constatou-se uma redução progressiva da carga das ITRi, principalmente na mortalidade e na incapacidade, e entre os menores de cinco anos de idade.
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Cohen R, Cohen JF, Chalumeau M, Levy C. Impact of pneumococcal conjugate vaccines for children in high- and non–high-income countries. Expert Rev Vaccines 2017; 16:625-640. [DOI: 10.1080/14760584.2017.1320221] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Robert Cohen
- Université Paris Est, IMRB-GRC GEMINI, Créteil, France
- ACTIV, Association Clinique et Thérapeutique Infantile du Val de Marne, Saint-Maur des Fossés, France
- Clinical Research Center (CRC), Centre Hospitalier Intercommunal Créteil, France
- Unité Court Séjour, Petits Nourrissons, Service de Néonatologie, Centre Hospitalier Intercommunal Créteil, France
| | - Jérémie François Cohen
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris Descartes University, INSERM U1153, Paris, France
- Service de Pédiatrie Générale, Hôpital Necker-Enfants Malades; AP-HP; Université Paris Descartes, Paris, France
| | - Martin Chalumeau
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris Descartes University, INSERM U1153, Paris, France
- Service de Pédiatrie Générale, Hôpital Necker-Enfants Malades; AP-HP; Université Paris Descartes, Paris, France
| | - Corinne Levy
- Université Paris Est, IMRB-GRC GEMINI, Créteil, France
- ACTIV, Association Clinique et Thérapeutique Infantile du Val de Marne, Saint-Maur des Fossés, France
- Clinical Research Center (CRC), Centre Hospitalier Intercommunal Créteil, France
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Impact of ten-valent pneumococcal conjugate vaccine on pneumonia in Finnish children in a nation-wide population-based study. PLoS One 2017; 12:e0172690. [PMID: 28249015 PMCID: PMC5332024 DOI: 10.1371/journal.pone.0172690] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 02/08/2017] [Indexed: 12/29/2022] Open
Abstract
Background The ten-valent pneumococcal conjugate vaccine (PCV10) was introduced into the Finnish National Vaccination Program (NVP) in September 2010 using a 2+1 schedule (3, 5, 12 months). We estimated the direct and indirect effects of PCV10 on pneumonia among children to evaluate the public health impact of the vaccine. Methods We conducted a nation-wide population-based, observational study comparing rates of pneumonia in children before and after the NVP introduction. For the total (direct and indirect) effect, the cohort of vaccine-eligible children (born June 1, 2010 or later) was followed until the end of 2013 (age range 3–42 months). For the indirect effect, a cohort of older children (age range 7–71 months) not eligible for the PCV vaccination was followed from 2011 to 2013. Both cohorts were compared with two season- and age-matched reference cohorts before NVP introduction. Hospitals’ in- and outpatient discharge notifications with ICD-10 diagnoses compatible with pneumonia (J10.0, J11.0, J12-J18, J85.1 or J86) as set by the hospital pediatricians were collected from the national Care Register. The main outcome was hospital-treated primary pneumonia (HTPP), defined as primary diagnosis of pneumonia after in-patient hospitalization. We compared rates of pneumonia in the NVP target and reference cohorts by using Poisson regression models. Results The rate of HTPP episodes was 5.3/1000 person-years in the combined reference cohorts and 4.1/1000 person-years in the target cohort vaccine-eligible children. Compared with the reference cohort, the relative rate reduction in target cohort was 23% (95%CI 18–28) and the absolute reduction 1.3/1000 person-years. In the indirect effect evaluation, we observed continued increase in HTPP incidence until 2011 with a subsequent reduction of 18% (95%CI 10–25) during years 2012 to 2013. Number of empyema diagnoses remained low. Conclusions A substantial decrease in pneumonia rates was observed both among vaccine-eligible children and among older, unvaccinated children after PCV10 introduction.
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Estimating the population-level impact of vaccines using synthetic controls. Proc Natl Acad Sci U S A 2017; 114:1524-1529. [PMID: 28154145 DOI: 10.1073/pnas.1612833114] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
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.
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Timeliness and risk factors associated with delay for pneumococcal conjugate 10-valent routine immunization in Brazilian children. Vaccine 2017; 35:1030-1036. [DOI: 10.1016/j.vaccine.2017.01.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 01/04/2017] [Accepted: 01/05/2017] [Indexed: 11/21/2022]
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de Oliveira LH, Camacho LAB, Coutinho ESF, Martinez-Silveira MS, Carvalho AF, Ruiz-Matus C, Toscano CM. Impact and Effectiveness of 10 and 13-Valent Pneumococcal Conjugate Vaccines on Hospitalization and Mortality in Children Aged Less than 5 Years in Latin American Countries: A Systematic Review. PLoS One 2016; 11:e0166736. [PMID: 27941979 PMCID: PMC5152835 DOI: 10.1371/journal.pone.0166736] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 11/02/2016] [Indexed: 12/22/2022] Open
Abstract
Background Several Latin American and Caribbean (LAC) countries have introduced pneumococcal conjugate vaccine (PCV-10 or PCV-13) in their routine national immunization programs. Objectives We aimed to summarize the evidence of PCV impact and effectiveness in children under 5 years old in the LAC Region. Methods We conducted a systematic review of the literature on impact or effectiveness of PCVs on deaths or hospitalizations due to invasive pneumococcal disease (IPD), pneumonia, meningitis and sepsis. We searched Medline, WoS, Lilacs, Scopus, Central and gray literature published in any language from 2009 to January 2016. We included studies addressing the outcomes of interest in children in the target age group, and with the following designs: randomized trials, cohort or case-control, interrupted time series with at least three data points before and after the intervention, and before-after studies. Screening of citations, data extraction, and risk of bias assessment were conducted in duplicate by independent reviewers, according to the study protocol registered on PROSPERO. Descriptive analysis of the effectiveness measurements and sensitivity analysis were conducted. Effectiveness is reported as 1-OR or 1-RR for case control or cohort/clinical trials, and as percent change of disease incidence rates for before-after studies. Results We identified 1,085 citations, 892 from databases and 193 from other sources. Of these, 22 were further analyzed. Studies were from Brazil, Chile, Uruguay, Argentina, Peru and Nicaragua. Effectiveness ranged from 8.8–37.8% for hospitalizations due to X-ray confirmed pneumonia, 7.4–20.6% for clinical pneumonia, and 13.3–87.7% for meningitis hospitalizations, and 56–83.3% for IPD hospitalization, varying by age, outcome definition, type of vaccine and study design. Conclusions Available evidence to date indicates significant impact of both PCV-10 and PCV-13 in the outcomes studied, with no evidence of the superiority of one vaccine over the other on pneumonia, IPD or meningitis hospitalization reduction in children under 5 years old.
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Affiliation(s)
- Lucia Helena de Oliveira
- Immunization Unit/FGL, Pan American Health Organization, World Health Organization (PAHO), Washington DC, United States of America
- * E-mail:
| | - Luiz Antonio B. Camacho
- Department of Epidemiology and Quantitative Methods in Health, National Public Health School (ENSP), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | - Evandro S. F. Coutinho
- Department of Epidemiology and Quantitative Methods in Health, National Public Health School (ENSP), Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
| | | | - Ana Flavia Carvalho
- Vaccine Advocacy and Education, Sabin Vaccine Institute, Washington DC, United States of America
| | - Cuauhtemoc Ruiz-Matus
- Immunization Unit/FGL, Pan American Health Organization, World Health Organization (PAHO), Washington DC, United States of America
| | - Cristiana M. Toscano
- Institute of Tropical Pathology and Public Health (IPTSP), Federal University of Goias (UFG), Goiânia, Goiás, Brazil
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Schuck-Paim C, Taylor RJ, Simonsen L, Lustig R, Kürüm E, Bruhn CAW, Weinberger DM. Challenges to estimating vaccine impact using hospitalization data. Vaccine 2016; 35:118-124. [PMID: 27899227 PMCID: PMC5664940 DOI: 10.1016/j.vaccine.2016.11.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 11/04/2016] [Accepted: 11/08/2016] [Indexed: 11/05/2022]
Abstract
Because the real-world impact of new vaccines cannot be known before they are implemented in national programs, post-implementation studies at the population level are critical. Studies based on analysis of hospitalization rates of vaccine-preventable outcomes are typically used for this purpose. However, estimates of vaccine impact based on hospitalization data are particularly prone to confounding, as hospitalization rates are tightly linked to changes in the quality, access and use of the healthcare system, which often occur simultaneously with introduction of new vaccines. Here we illustrate how changes in healthcare delivery coincident with vaccine introduction can influence estimates of vaccine impact, using as an example reductions in infant pneumonia hospitalizations after introduction of the 10-valent pneumococcal conjugate vaccine (PCV10) in Brazil. To this end, we explore the effect of changes in several metrics of quality and access to public healthcare on trends in hospitalization rates before (2008–09) and after (2011–12) PCV10 introduction in 2010. Changes in infant pneumonia hospitalization rates following vaccine introduction were significantly associated with concomitant changes in hospital capacity and the fraction of the population using public hospitals. Importantly, reduction of pneumonia hospitalization rates after PCV10 were also associated with the expansion of outpatient services in several Brazilian states, falling more sharply where primary care coverage and the number of health units offering basic and emergency care increased more. We show that adjustments for unrelated (non-vaccine) trends commonly employed by impact studies, such as use of single control outcomes, are not always sufficient for accurate impact assessment. We discuss several ways to identify and overcome such biases, including sensitivity analyses using different denominators to calculate hospitalizations rates and methods that track changes in the outpatient setting. Employing these practices can improve the accuracy of vaccine impact estimates, particularly in evolving healthcare settings typical of low- and middle-income countries.
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Affiliation(s)
| | | | - Lone Simonsen
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | | | - Esra Kürüm
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States; Department of Statistics, University of California, Riverside, CA, United States
| | - Christian A W Bruhn
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States
| | - Daniel M Weinberger
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States
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Wysocki J, Brzostek J, Konior R, Panzer FG, François NA, Ravula SM, Kolhe DA, Song Y, Dieussaert I, Schuerman L, Borys D. Antibody persistence and immunologic memory in children vaccinated with 4 doses of pneumococcal conjugate vaccines: Results from 2 long-term follow-up studies. Hum Vaccin Immunother 2016; 13:661-675. [PMID: 27736293 PMCID: PMC5360132 DOI: 10.1080/21645515.2016.1241919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
To investigate long-term antibody persistence following the administration of the 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV), we present results of 2 follow-up studies assessing antibody persistence following 2 3+1 schedules up to 4 (NCT00624819 – Study A) and 5 years (NCT00891176 – Study B) post-booster vaccination. In Study A, antibody persistence was measured one, 2 and 4 years post-booster in children previously primed and boosted with PHiD-CV, or primed with the 7-valent pneumococcal conjugate vaccine (7vCRM) and boosted with either PHiD-CV or 7vCRM. In Study B, PHiD-CV was co-administered with meningococcal vaccines, and pneumococcal antibody persistence was measured 2, 3 and 5 years post-booster. An age-matched control group, unvaccinated against Streptococcus pneumoniae, was enrolled in Study A, allowing assessment of immunologic memory by administration of one dose of PHiD-CV to both primed (4 years post-booster) and unprimed 6-year-old children. Four years post-booster (Study A), antibody concentrations and opsonophagocytic activity (OPA) titers remained higher compared to the pre-booster timepoint, with no major differences between the 3 primed groups. Antibody persistence was also observed in Study B, with minimal differences between groups. The additional PHiD-CV dose administered 4 years post-booster in Study A elicited more robust immune responses in primed children than in unprimed children. Long-term serotype-specific antibody persistence and robust immunologic memory responses observed in these 2 studies suggest induction of long-term protection against pneumococcal disease after PHiD-CV vaccination.
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Affiliation(s)
- Jacek Wysocki
- a Department of Preventive Medicine , Poznan University School of Medical Sciences , Poznan , Poland
| | - Jerzy Brzostek
- b Pediatrics Department , Zespol Opieki Zdrowotnej w Debicy , Debica , Poland
| | - Ryszard Konior
- c Neuro-infection and Pediatric Neurology , John Paul II Hospital , Cracow , Poland
| | - Falko G Panzer
- d Gemeinschaftspraxis für Kinder- und Jugendmedizin , Mannheim , Germany
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Abstract
Pneumococcal infections continue to cause significant morbidity and mortality in patients throughout the world. This microorganism remains the most common bacterial cause of community-acquired pneumonia and is associated with a considerable burden of disease and health-care costs in both developed and developing countries. Emerging antibiotic resistance has been a concern because of its potential negative impact on the outcome of patients who receive standard antibiotic therapy. However, there have been substantial changes in the epidemiology of this pathogen in recent years, not least of which has been due to the use of pneumococcal conjugate vaccines in children, with subsequent herd protection in unvaccinated adults and children. Furthermore, much recent research has led to a better understanding of the virulence factors of this pathogen and their role in the pathogenesis of severe pneumococcal disease, including the cardiac complications, as well as the potential role of adjunctive therapy in the management of severely ill cases. This review will describe recent advances in our understanding of the epidemiology, virulence factors, and management of pneumococcal community-acquired pneumonia.
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Affiliation(s)
- Charles Feldman
- Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand Medical School, Johannesburg, South Africa
| | - Ronald Anderson
- Institute for Cellular and Molecular Medicine, Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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31
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Impact of the introduction of the pneumococcal conjugate vaccine in the Brazilian routine childhood national immunization program. Vaccine 2016; 34:2766-78. [DOI: 10.1016/j.vaccine.2016.04.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 03/18/2016] [Accepted: 04/04/2016] [Indexed: 11/20/2022]
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