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Routine infant vaccination of pneumococcal conjugate vaccines has decreased pneumonia across all age groups in
I Rivero-Calle1,2, J Pardo Seco1, P F Raguindin1
1Genetics, Vaccines and Pediatric Infectious Diseases Research Group (GENVIP), Hospital Clínico Universitario and Universidad de Santiago de Compostela (USC) , Galicia, Spain.
Insights
Pneumococcal conjugate vaccines (PCVs) reduced pneumococcal pneumonia hospitalizations in Spain. However, all-cause pneumonia hospitalizations increased, particularly in the elderly, despite PCV infant immunization programs.
Area of Science:
- * Public Health
- * Epidemiology
- * Vaccinology
Background:
- * Pneumococcal conjugate vaccines (PCVs) have demonstrated efficacy in preventing pneumonia and invasive pneumococcal diseases since the early 2000s.
- * Galicia, Spain, implemented a routine infant PCV immunization program in 2011, marking the first such stable program in the country.
Purpose of the Study:
- * To evaluate the direct and indirect effects of PCV vaccination on all-cause pneumonia hospitalizations across various age demographics in Galicia.
- * To analyze trends in all-cause pneumonia, pneumococcal pneumonia, and invasive pneumococcal disease hospitalizations before and after PCV introduction.
Main Methods:
- * Ecological study design utilizing a hospital-based disease registry to calculate annual hospitalization rates.
- * Comparison of hospitalization rates for all-cause pneumonia, pneumococcal pneumonia, and pneumococcal invasive diseases across three distinct periods: pre-vaccination (1998-2003), early-vaccination (2005-2009), and routine-vaccination (2011-2015).
Main Results:
- * A significant net increase in all-cause pneumonia hospitalizations was observed, rising from 20.6/10,000 pre-PCV to 28.4/10,000 during the routine vaccination period (+32.7%, p < .0001), primarily driven by the elderly population (>64 years).
- * A substantial net reduction in hospitalized pneumococcal pneumonia incidence occurred, decreasing from 6.3/10,000 pre-PCV to 2.4/10,000 during routine vaccination (-57.9%, p < .0001).
- * The elderly (>64 years) constituted the majority (67.3%) of all-cause pneumonia hospitalizations.
Conclusions:
- * Routine infant PCV vaccination appears effective in reducing pneumococcal pneumonia hospitalizations in both infants and the elderly population.
- * A paradoxical increase in all-cause pneumonia hospitalizations was noted in Galicia, predominantly linked to an escalating number of cases within the elderly demographic.
- * Further investigation is warranted to understand the factors contributing to the rise in all-cause pneumonia hospitalizations among the elderly despite PCV implementation.
Abstract:
Since the early 2000s, pneumococcal conjugate vaccines (PCVs) have been shown to be effective in the prevention of pneumonia and invasive pneumococcal diseases. In 2011, the Galician region incorporated PCV in the routine infant immunization, the very first stable program in Spain. We aim to assess direct and indirect benefits of PCV vaccination on all-cause pneumonia in the region across different age groups using an ecological study design. For this, we calculated the annual hospitalization rates using a hospital-based disease registry. We identified all-cause pneumonia, pneumococcal pneumonia and pneumococcal invasive diseases within the registry. Hospitalization rates were computed and compared across three study periods: pre-vaccination (1998-2003), early-vaccination (2005-2009) and routine-vaccination (2011-2015). Across Northern Spain, we identified 114,873 all-cause pneumonia hospitalizations, of which 24,808 were further diagnosed with pneumococcal pneumonia. The majority were elderly > 64 years (67.3%). Hospitalizations from all-cause pneumonia had a net increase from 20.6 (pre-PCV) and 21.4/10,000 (early) to 28.4/10,000 (routine) (+32.7%, p < .0001), this is attributed to the huge number of cases in the elderly age group. In contrast, a net reduction of incidence of hospitalized pneumococcal pneumonia was observed from 6.3/10,000 (pre-PCV) and 5.7/10,000 (early) to 2.4/10,000 (routine) cases (-57.9%, p < .0001). Thus, routine infant vaccination may have resulted to an overall decline of pneumococcal pneumonia in infants, as well as in elderly age groups. However, a paradoxical increase on all-cause pneumonia was observed in Galicia, mostly attributed to the growing number of cases in the elderly population.
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