Pneumococcal Vaccine Reduces Hospitalization Rates

Beth Skwarecki

November 10, 2014

The introduction of pneumococcal conjugate vaccine (PCV) was linked to a decrease in hospitalizations for sinusitis among children younger than 2 years and pneumonia among children younger than 5 years in a retrospective population-based study in Sweden. The work was published online November 10 in Pediatrics.

"This study adds evidence that PCV vaccine (PCV7 and PCV13) prevents severe sinusitis and pneumonia, with implications for global child survival," write Ann Lindstrand, MD, MPH, from the Public Health Agency of Sweden and the Department of Public Health Sciences at the Karolinska Institutet in Stockholm, and colleagues. Pneumococcal disease causes more child deaths worldwide than any other vaccine-preventable disease, most of them in the form of pneumonia.

The investigators compared hospitalization rates before and after the vaccine's introduction in Stockholm County, Sweden, an area with a population of roughly 2 million, including 458,000 people younger than 18 years. The county began offering the PCV7 vaccine for children born in or after July 2007 and switched to PCV13 in 2010. Nationwide, PCV coverage is currently 98%.

The study included all children younger than 18 years in the county's three children's hospitals and an otorhinopharyngeal clinic who were hospitalized for sinusitis, bacterial pneumonia, or empyema. Investigators examined records for these conditions from 2003 to 2012, excluding the year the vaccine was introduced. Pyelonephritis was used as a control condition. Readmissions within 30 days were excluded.

The investigators validated the diagnoses by examining medical records for all 678 children with sinusitis and 100 children with pneumonia, excluding 76 in the sinusitis group.

Hospitalizations for children with sinusitis dropped from 70 to 24 cases per 100,000 person-years (risk ratio [RR], 0.34; 95% confidence interval [CI], 0.25 - 0.47; P < .001) in children younger than 2 years. Hospitalizations for pneumonia in the same age group decreased from 450 to 366 per 100,000 (RR, 0.81; 95% CI, 0.74 - 0.89; P < .001) and decreased from 250 to 212 per 100,000 (RR, 0.85; 95% CI, 0.76 - 0.94; P = .002) among children aged 2 to 5 years. There was no significant change in hospitalizations among children aged 5 to 18 years.

Rates of pyelonephritis, asthma, and obstructive bronchitis remained steady throughout the study period. Increases in empyema have been observed in other studies after pneumococcal vaccine introduction, but the change in empyema rates in this study was not statistically significant.

The authors note that limitations of the study include an inability to link cases with particular bacterial strains and that information on outpatient care was not included.

The study was supported by Stockholm County Council research funds and the Foundation Samariten, Sachs’ Children’s Hospital, Swedish Research Council, Swedish Foundation for Strategic Research, Knut and Alice Wallenberg Foundation, and Sven Jerrings Foundation. Dr. Lindstrand has received financial contributions for participation in conferences from GSK and Pfizer. She has also participated in a clinical vaccine trial in collaboration with GSK.

Pediatrics. Published online November 10, 2014. Abstract

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