Impact of pneumococcal conjugate vaccine uptake on childhood pneumonia mortality across income levels in Brazil, Colombia, and Peru

Invasive Pneumococcal Disease Characterization in Adults and Subgroups aged < 60 years and ≥ 60 years in Bogota, Colombia

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The clinical burden of IPD is high in the elderly and adults with comorbidities

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IPD placed a high burden on healthcare resources in the adult population

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The most common types causing IPD in adults were similar to those found in children

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Policy makers should consider pneumococcal vaccination for populations at risk

Background

Methods

Results

Conclusions

Sex-differences in incidence of hospitalizations and in hospital mortality of community-acquired pneumonia among children in Spain: a population-based study

The aim of this study is to examine trends from 2016 to 2019 in the incidence of hospitalizations and in-hospital mortality (IHM) of subjects < 18 years with community-acquired pneumonia (CAP), assessing possible sex differences. We used Spanish national hospital discharge data to select all patients < 18 years with CAP. We identified 43,511 children (53% boys) hospitalized with CAP. The incidence of CAP was significantly higher in boys than in girls, with an age-adjusted incidence rate ratio of 1.05 (95%CI 1.03-1.07) for boys compared to girls, and rose from 126 per 100,000 children in 2016 to 131 in 2019 (p < 0.0001). There were no sex differences in isolated pathogens, comorbidities, length of hospital stay, or IHM. Variables independently associated with IHM were age 10 to 17 years, congenital heart disease, neurological diseases, and use of invasive mechanical ventilation. Asthma was a protective factor for IHM among girls.

CONCLUSION

The incidence of hospital admissions for CAP was higher among boys than among girls and rose significantly from 2016 to 2019. There were no sex differences in hospital outcomes. Age 10 to 17 years, congenital heart disease, neurological diseases, and use of mechanical ventilation were risk factors for IHM in both sexes, while asthma was a protective factor among girls. No differences were found in IHM over time.

WHAT IS KNOWN

• Community-acquired pneumonia is one of the most common reasons for hospitalizations among children. • There are few studies that allow to know the evolution of community-acquired pneumonia in children.

WHAT IS NEW

• Incidence of hospital admissions for community-acquired pneumonia was higher in boys than girls and it rose significantly from 2016 to 2019. • Age 10 to 17 years, congenital heart disease, neurological diseases and use of mechanical ventilation were risk factors for in-hospital mortality in both sexes.

Laboratory-based surveillance in Latin America: attributes and limitations in evaluation of pneumococcal vaccine impact

Disease surveillance data are needed to monitor trends in disease activity, inform decision-making in public health and evaluate disease prevention/control measures. The Sistema Regional de Vacunas (SIREVA) supports laboratory-based surveillance of invasive pneumococcal disease (IPD) in Latin American countries, providing information on identification, distribution, and anti-microbial susceptibility of pneumococcal strains. We estimated the proportion of pneumococcal meningitis and sepsis/bacteremia cases captured by SIREVA, by comparing the number of SIREVA-reported isolates in Argentina, Brazil, Chile, Colombia, Ecuador and Mexico with the estimated expected number of cases based on regional estimates of disease incidence. In all six countries, the number of isolates reported by SIREVA was consistently lower than the number of cases expected, across all years with data available. The proportion of SIREVA-reported isolates was highest in Chile (43–83%) and lowest in Mexico (1.4–3.5%). Passive surveillance systems such as SIREVA are important tools for monitoring circulating strains that could be related to pneumococcal disease, but our results show that SIREVA is likely to underestimate pneumococcal disease incidence. This under-reporting will limit the precision of surveillance data in monitoring changes in the incidence of IPD after vaccine introduction, and this should be considered when assessing the impact of vaccination programs.

What is the context?

Infectious disease surveillance is an important epidemiological tool to monitor the health of a population.

Surveillence can be used to detect trends in disease activity and to trigger disease control measures.

In Latin America, the SIREVA surveillance system monitors occurrence of bacterial pneumonia, sepsis/bacteremia and meningitis.

However, passive surveillence systems may understimate disease occurrence.

What is new?

We compared the number of isolates of invasive pneumococcal disease (IPD), specifically meningitis and sepsis/bacteremia, in children aged <5 years reported in SIREVA data in six countries in Latin America with the expected number of cases based on regional estimates of IPD incidence.

Our results show that the number of isolates reported by SIREVA was consistently lower than the estimated number of cases, across all six countries and all the years available.

The percent difference between SIREVA-reported isolates and estimated number of cases was variable between countries, ranging from 43-83% in chile to 1.4-3.5% in Mexico.

What is the impact?

Passive surveillance systems such as SIREVA are important tools for monitoring disease incidence, but they are likely to underestimate pneumococcal disease occrruence.

This under-reporting will limit the precision of surveillance data in monitoring changes in disease incidence after vaccine introduction, and this needs to be considered when assessing vaccine impact.

Estimated impact of the pneumococcal conjugate vaccine on pneumonia mortality in South Africa, 1999 through 2016: An ecological modelling study

BACKGROUND

Data on the national-level impact of pneumococcal conjugate vaccine (PCV) introduction on mortality are lacking from Africa. PCV was introduced in South Africa in 2009. We estimated the impact of PCV introduction on all-cause pneumonia mortality in South Africa, while controlling for changes in mortality due to other interventions.

METHODS AND FINDINGS

We used national death registration data in South Africa from 1999 to 2016 to assess the impact of PCV introduction on all-cause pneumonia mortality in all ages, with the exclusion of infants aged <1 month. We created a composite (synthetic) control using Bayesian variable selection of nondiarrheal, nonpneumonia, and nonpneumococcal deaths to estimate the number of expected all-cause pneumonia deaths in the absence of PCV introduction post 2009. We compared all-cause pneumonia deaths from the death registry to the expected deaths in 2012 to 2016. We also estimated the number of prevented deaths during 2009 to 2016. Of the 9,324,638 deaths reported in South Africa from 1999 to 2016, 12·6% were pneumonia-related. Compared to number of deaths expected, we estimated a 33% (95% credible interval (CrI) 26% to 43%), 23% (95%CrI 17% to 29%), 25% (95%CrI 19% to 32%), and 23% (95%CrI 11% to 32%) reduction in pneumonia mortality in children aged 1 to 11 months, 1 to 4 years, 5 to 7 years, and 8 to 18 years in 2012 to 2016, respectively. In total, an estimated 18,422 (95%CrI 12,388 to 26,978) pneumonia-related deaths were prevented from 2009 to 2016 in children aged <19 years. No declines were estimated observed among adults following PCV introduction. This study was mainly limited by coding errors in original data that could have led to a lower impact estimate, and unmeasured factors could also have confounded estimates.

CONCLUSIONS

This study found that the introduction of PCV was associated with substantial reduction in all-cause pneumonia deaths in children aged 1 month to <19 years. The model predicted an effect of PCV in age groups who were eligible for vaccination (1 months to 4 years), and an indirect effect in those too old (8 to 18 years) to be vaccinated. These findings support sustaining pneumococcal vaccination to reduce pneumonia-related mortality in children.