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Pneumococcal Conjugate Vaccines Are Protective Against Respiratory Syncytial Virus Hospitalizations in Infants: A

Huong Le¹, Heather Gidding^2,3,4,5, Christopher C Blyth^1,6,7,8

¹Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Australia.

Open Forum Infectious Diseases

|May 1, 2023

Insights

Pneumococcal conjugate vaccines (PCV) significantly reduced respiratory syncytial virus (RSV) hospitalizations in Western Australian infants. This real-world evidence supports PCV programs for preventing severe RSV infections in children.

Area of Science:

Pediatric Infectious Diseases
Vaccinology
Public Health

Background:

Pneumococcal conjugate vaccines (PCV) have demonstrated efficacy in reducing respiratory syncytial virus (RSV) risk in clinical trials.
Real-world effectiveness of PCV on RSV hospitalizations in infants requires further investigation.

Purpose of the Study:

To assess the real-world effectiveness of infant pneumococcal conjugate vaccination (PCV) in reducing RSV-related hospitalizations among Western Australian infants.

Main Methods:

Population-based cohort study (2000-2012) linking immunization, hospitalization, and demographic data.
Cox proportional hazard models analyzed time-varying PCV exposure against RSV hospitalization in the first 12 months of life.
Adjustments were made for perinatal and sociodemographic factors.

Main Results:

RSV hospitalization rates were highest in infants aged 0-5 months and significantly higher in Aboriginal infants.
Following universal PCV funding in 2005, 3-dose PCV coverage reached 85% for Aboriginal and 73% for non-Aboriginal infants.
Receipt of ≥3 PCV doses was associated with a 30% reduction in RSV hospitalization for Aboriginal infants and a 21% reduction for non-Aboriginal infants.

Conclusions:

Universal childhood PCV vaccination may reduce severe RSV infections in infants.
Findings are significant for countries considering the implementation of PCV programs, especially prior to RSV vaccine introduction.

Read full analysis

Abstract

Background:

Pneumococcal conjugate vaccines (PCV) reduced the risk of respiratory syncytial virus (RSV) in a randomized clinical trial. We aimed to assess the real-world effectiveness of PCV on RSV-hospitalizations among Western Australian infants.

Methods:

We conducted a population-based cohort study of births during 2000-2012, using probabilistically linked individual-level immunization, hospitalization, respiratory microbiology testing, and perinatal data. We performed Cox proportional hazard models with time-varying exposure (receipt of infant PCV doses) against the first RSV-confirmed hospitalization 0-12 months adjusted for perinatal and sociodemographic factors.

Results:

From 360 994 children, 3-dose PCV coverage in Aboriginal infants ranged from 29% to 51% in 2001-2004 when PCV was funded for Aboriginal children only. Following universal funding in 2005, coverage increased to 85% for Aboriginal and 73% for non-Aboriginal infants. RSV-hospitalization rates were highest in young infants aged 0-5 months (22.5/1000 child-years) and >2 times higher in Aboriginal infants than in non-Aboriginal infants. Receipt of ≥3 PCV doses in the universal funded period was associated with a 30% reduction in RSV-hospitalization in Aboriginal infants (adjusted hazard ratio, aHR 0.70 [95% confidence interval, CI 0.46-1.06]) and 21% reduction in non-Aboriginal infants (aHR 0.79 [95% CI 0.63-0.99]) compared with unvaccinated infants.

Conclusions:

Prior to the introduction of RSV vaccines, our study suggests that universal childhood PCV vaccination may result in a reduction in severe RSV infections in children and may be important for countries that are yet to consider PCV programs.

Keywords:

infant off-target vaccine effect pneumococcal conjugate vaccines record linkage respiratory syncytial virus

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