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PCV13 program reduced pneumonia hospitalizations, ambulatory visits
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There were lower rates of hospitalizations and ambulatory visits for pneumonia among children after the first 2 years of a 13-valent immunization program in Nicaragua, according to recent study findings published in The Pediatric Infectious Disease Journal.
Sylvia Becker-Dreps, MD, MPH, of the department of family medicine at the University North Carolina School of Medicine, Chapel Hill, and colleagues evaluated rates of pneumonia hospitalization, ambulatory visits for pneumonia and infant mortality during the pre-vaccine (2008-2010) and vaccine (2011-2012) periods to determine the effect of PCV13 (Prevnar 13, Pfizer).
Sylvia Becker-Dreps
During the pre-vaccine period, there were 1,578 pneumonia hospitalizations among infants and 602 among children aged 1 year compared with 716 pneumonia hospitalization among infants and 296 among children aged 1 year during the vaccine period.
During the pre-vaccine period, there were 12,301 ambulatory visits for pneumonia among infants and 10,441 for children aged 1 year compared with 7,291 ambulatory visits for pneumonia among infants and 5,817 among children aged 1 year during the vaccine period.
Infant deaths were also more common during the pre-vaccine period (n=339) compared with the vaccine period (n=155).“In summary, the findings of this post-licensure study support WHO recommendations to introduce PCVs to protect children from pneumonia,” the researchers wrote. “PCV immunization programs may also assist developing nations in the successful attainment of Millennium Development Goal Four, the reduction of infant mortality. Public health policymakers in other developing countries, especially those eligible for GAVI support, should work toward providing PCVs to their pediatric populations.”
Disclosure: The study was funded in part by the Investigator-Initiated Research Program, Pfizer Inc. Two researchers report financial ties with Merck and Pfizer. One researcher reports financial ties with Becton Dickinson, bioMérieux and Novartis Diagnostics.
Perspective
Back to TopMelissa Stockwell, MD, MPH, FAAP
Community-acquired pneumonia is a leading cause of mortality in children globally, but perhaps its greatest impact is in developing countries. Streptococcus pneumoniae plays a significant role in these infections, and the WHO recommends that pneumococcal conjugate vaccine (PCV) be included in childhood vaccination programs globally. The Global Alliance for Vaccines and Immunisation (GAVI) alliance was launched to fund vaccines for children in developing countries. In 2010, Nicaragua became the first nation eligible for GAVI alliance support to introduce routine PCV-13 (Prevnar 13, Pfizer) vaccination, the newest version of the conjugate pneumococcal vaccine.
In this study, Becker-Dreps and colleagues sought to assess health facility visits and infant mortality in an area of Nicaragua after the introduction of PCV-13 to the routine vaccination schedule. In comparing a period prior to (2008-2010) vs. after introduction (2011-2012) of PCV-13 they demonstrated decreases in pneumonia hospitalization of 33% in infants and 26% in one year-olds, in ambulatory visits for pneumonia of 13% in infants and 16% in one year-olds, and in all-cause infant mortality of 33%. They also observed lower rates of health care visits for pneumonia in older children who were not vaccinated.
This study adds to the body of literature of the clear impact of pneumococcal vaccination globally, and the urgent need to support vaccination programs in developing countries. It is also demonstrated that when resources are made available for important vaccination initiatives, high coverage levels can be achieved in a relatively short period of time with resultant direct health benefits. It is important to note that the series was a 3+0 schedule that lacked a booster dose. An important next step will be to either demonstrate the lasting immunity of the schedule without a booster or work to incorporate the booster dose into routine vaccination in developing countries.
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