Elsevier

Vaccine

Volume 32, Issue 35, 31 July 2014, Pages 4495-4499
Vaccine

Impact of 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) on childhood pneumonia hospitalizations in Brazil two years after introduction

https://doi.org/10.1016/j.vaccine.2014.06.042Get rights and content

Highlights

  • Childhood pneumonia hospitalization decreased after PHiD-CV introduction.

  • Incidence of all non-respiratory admissions remained stable between 2002 and 2012.

  • This data is an evidence of the health public impact of this new pneumococcal vaccine.

Abstract

Introduction

Pneumococcal disease is a major public health problem worldwide. From March to September of 2010, 10-valent pneumococcal non-typeable Haemophilus influenzae protein conjugate vaccine (PHiD-CV) was introduced in the Brazilian childhood National Immunization Program (NIP) in all 27 Brazilian states. The aim of the present study is to report national time-trends in incidence of hospital admissions for childhood pneumonia in Brazil before and after two years of introduction of this new pneumococcal conjugate vaccine.

Methods

Analysis of hospitalization data of children aged 0–4 years in Brazilian public health system with an admission diagnosis of pneumonia from 2002 to 2012 was performed comparing pre (2002–2009) and post-vaccination periods (2011–2012). Hospital number of admission due to pneumonia and all non-respiratory diseases were obtained from DATASUS, the Brazilian government open-access public health database system. Incidence of pneumonia hospitalization was compared to incidence of all non-respiratory admissions.

Results

Admission rates for pneumonia decreased steadily from 2010 to 2012. In children aged less than four years, incidence of pneumonia hospitalizations decreased 12.65% when pre (2002–2009) and post-vaccination introduction periods (2011–2012) were compared and adjusted for seasonality and secular-trend (p < 0.001). On the other hand, non-respiratory admission rates remained stable comparing both periods (p = 0.39).

Conclusion

Childhood pneumonia hospitalization rates were fluctuating prior to 2010 and decreased significantly in the two years after PHiD-CV introduction. Conversely, rate of non-respiratory admissions has shown no decrease. These data are an evidence of the effectiveness and public health impact of this new pneumococcal vaccine.

Introduction

Globally, pneumonia is still the leading cause of deaths in children, particularly in those under 5 years of age [1]. Bacterial pneumonia continues to be a major public health problem, especially in developing countries [2]. Although community-acquired pneumonias may also be caused by other bacteria and viruses (or even in association between them), Streptococcus pneumoniae remains the most common pathogen [3], [4]. According to estimates, 13 million cases of pneumococcal pneumonia occur every year worldwide in children aged 1–59 months, which cause more than 700,000 deaths [5].

Vaccination with the goal of preventing infection by S. pneumoniae is a practice adopted in several countries, including Brazil [6]. The introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) has shown great efficacy against the more severe forms of pneumonia and invasive pneumococcal disease (IPD). Although efficacy and effectiveness data for PCV7 is well characterized, vaccine effectiveness data for PHiD-CV remain limited as a result of its more recent introduction into national programs [7].

In 2010, PHiD-CV was introduced in Brazilian NIP from March to September for children aged less than 24 months, with a recommended schedule of 3 doses at 2, 4 and 6 months of age, with one booster dose between 12 and 15 months. For infants aged between 7 and 11 months, two doses and a booster between 12 and 15 months were recommended. For infants receiving PHiD-CV only in their second year of life, only one dose was recommended. In 2011 and 2012, coverage of PHiD-CV was, respectively, 81.65% and 88.39%, according to data from the Brazilian Ministry of Health. This data is calculated by proportion of children aged less than one year which received the third dose of PHiD-CV [8]. No previous pneumococcal vaccine was available free of charge through the public vaccination system for Brazilian children. PCV7 was only offered previously for children with special comorbitidies. After 2011, the 13-valent pneumococcal conjugate vaccine (PCV13) has been available to a limited subset of the population who could afford paying for it through the private health system.

In Canada, PHiD-CV introduction was associated with lower incidence of IPD compared to PCV7 [9]. Data on the impact of the PHiD-CV effect in Brazil is limited. Some regional studies have examined the effects of PHiD-CV on pneumonia in Brazil, but no previous research has yet described the national impact of the vaccine [10], [11].

The main aim of the present study is to assess incidence of pneumonia admissions in children younger than four years, prior and after the introduction of PHiD-CV in NIP.

Section snippets

Materials and methods

The present study is a retrospective analysis of data from DATASUS, data processing of the department of Brazilian Public Health System. This public health system provides a broad coverage of Brazilian population.

Information was obtained from the DATASUS database http://www2.datasus.gov.br/DATASUS/index.php?area=0203 (last accessed in January, 11th, 2014) through the Health Information section. DATASUS is a National database that contains information on environmental factors, epidemiology and

Results

From 2002 to 2012, 15,147,996 admissions were identified in children younger than four years of age. Pneumonia accounted for 23.20% (3514,750) of these cases and the main finding was that its incidence of annual and monthly admission showed a 12.65% decrease when comparisons were made between the pre and post-vaccination periods in children aged less than four years. In children aged less than one year and from one to four years, reduction found was 10.38% and 14.16%, respectively.

As shown in

Discussion

Most studies about incidence of pneumonia admission in Brazilian children are also based in DATASUS database which may bias comparison to other Brazilian studies [2], [15]. However, similar incidence of pneumonia admissions in infants and preschool children was also found elsewhere [16].

Childhood pneumonia hospitalization rates were oscillating prior to 2010 and decreased 12.65% in patients under 4 years of age following the introduction of PHiD-CV in the NIP. To our knowledge, this current

Conclusions

The introduction of PHiD-CV in Brazil was associated with an approximate 12% decrease in hospitalizations labeled as pneumonia in children younger than 4 years of age. Given that obtaining data from a huge country like Brazil is not easy to be collected prospectively and that the literature on this topic worldwide is rather scarce, national data bases such as this should be explored in retrospective manner in order to generate hypotheses and field information to help redirect or confirm public

Contributions of each author

All authors have approved the final version of our manuscript. The following authors: Marcelo C. Scotta, Tiago N. Veras, Fernando P. Polack, Paulo M. Pitrez, Marcus H. Jones, Renato T. Stein and Leonardo A. Pinto had active role in conception and design of our study. Paula C. Klein and Virginia Tronco collected data, Tiago N. Veras checked data quality and Rita Mattiello analyzed them. Marcelo C. Scotta and Leonardo A. Pinto had more active role in drafting the article and all other authors

Funding

Most authors declare that our study had no funding. First author is supported by Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul (FAPERGS) as scholarship student.

Conflict of interest statement

The authors declare no conflict of interests.

Acknowledgements

The authors acknowledge the Brazilian Health Institutions that have developed DATASUS database and make it available for universities and researchers: Department of Informatics of Unified Health System and Brazilian Ministry of Health.

References (23)

  • I. Rudan et al.

    Epidemiology and etiology of childhood pneumonia in 2010: estimates of incidence, severe morbidity, mortality, underlying risk factors and causative pathogens for 192 countries

    J Glob Health

    (2013)
  • Cited by (45)

    • Impact of pneumococcal conjugate vaccine on pneumonia hospitalization and mortality in children and elderly in Ecuador: Time series analyses

      2020, Vaccine
      Citation Excerpt :

      Several countries with high uptake of PCVs in children have demonstrated impressive reductions in the incidence of IPD [6–9]. Reductions in rates of childhood pneumonia have also been remarkable, being demonstrated by studies conducted in both developed [10–15] and developing countries [16–23]. PCVs also protect against nasopharyngeal carriage, which drives transmission of pneumococcus.

    • Pneumonia in Children

      2019, Kendig's Disorders of the Respiratory Tract in Children
    View all citing articles on Scopus
    1

    Tel.: +55 51 3320 3000 internal code 3353.

    2

    Tel.: +55 47 3145 1600.

    3

    Tel.: +54 11 4634 0070.

    4

    Tel.: +1 615 322 7311.

    View full text