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Reductions in Childhood Pneumonia Mortality After Vaccination in the United States
Angel Paternina-Caicedo1, Adrian D Smith2, Jeanine Buchanich3
1From the Escuela de Medicina, Universidad del Sinu, Cartagena, Bolivar, Colombia.
Insights
Pneumococcal conjugate vaccines (PCV7 and PCV13) significantly reduced pneumonia and meningitis deaths in US children. These vaccines demonstrated substantial mortality reductions, highlighting their public health impact.
Area of Science:
- Pediatric Infectious Diseases
- Vaccinology
- Public Health Surveillance
Background:
- Pneumococcal pneumonia and meningitis pose significant mortality risks to young children.
- The introduction of pneumococcal conjugate vaccines (PCV7 and PCV13) aimed to mitigate these risks.
- Understanding the impact of these vaccines on mortality trends is crucial for public health policy.
Purpose of the Study:
- To quantify the reduction in pneumococcal pneumonia and meningitis mortality in US children following the widespread adoption of PCV7 and PCV13.
- To estimate the impact of PCV7 and PCV13 on all-cause pneumonia and meningitis mortality rates.
- To compare the effectiveness of PCV7 and PCV13 in reducing child mortality.
Main Methods:
- Utilized interrupted time-series negative binomial regression to analyze US mortality data from 1994 to 2017.
- Adjusted models for trends, seasonality, PCV7/PCV13 coverage, and Hib vaccine coverage.
- Calculated percent reduction in mortality relative to a no-vaccination scenario using incidence risk ratios.
Main Results:
- PCV7 introduction was associated with a 13% reduction in all-cause pneumonia mortality and a 19% reduction in all-cause meningitis mortality in children aged 0-59 months.
- PCV13 introduction showed a 21% reduction in all-cause pneumonia mortality and a 22% reduction in all-cause meningitis mortality in the same age group.
- PCV13 demonstrated greater reductions in all-cause pneumonia mortality compared to PCV7, particularly in infants aged 6-11 months.
Conclusions:
- The widespread implementation of PCV7 and PCV13 in the United States has been linked to significant decreases in child mortality from all-cause pneumonia.
- These findings underscore the effectiveness of pneumococcal conjugate vaccines in reducing vaccine-preventable deaths in pediatric populations.
- Continued surveillance and vaccination efforts are essential to maintain and enhance these public health gains.
Background:
We aim to estimate the magnitude of the reduction in pneumococcal pneumonia and meningitis mortality after the mass introduction of pneumococcal conjugate vaccine (PCV)7 and PCV13 in children in the United States.
Methods:
We assessed the trends in mortality rates from pneumococcal pneumonia and meningitis, in the United States between 1994 and 2017. We fitted an interrupted time-series negative binomial regression model (adjusted by trend, seasonality, PCV7/PCV13 coverage, and H. influenzae type b vaccine coverage) to estimate the counterfactual rates without vaccination. We reported a percent reduction in mortality estimates relative to the projected no-vaccination scenario, using the formula 1 minus the incidence risk ratio, with 95% confidence intervals (CIs).
Results:
Between 1994 and 1999 (the prevaccination period), the all-cause pneumonia mortality rate for 0-1-month-old children was 2.55 per 100,00 pop., whereas for 2-11 months-old children, this rate was 0.82 deaths per 100,000 pop. During the PCV7-period in 0-59-month-old children in the United States, the adjusted reduction of all-cause pneumonia was 13% (95% CI: 4-21) and 19% (95% CI: 0-33) of all-cause meningitis For PCV13, the reductions in this age group were 21% (95% CI: 4-35) for all-cause pneumonia mortality and 22% (95% CI: -19 to 48) for all-cause meningitis mortality. PCV13 had greater reductions of all-cause pneumonia than PCV13 in 6-11-month-old infants.
Conclusions:
The universal introduction of PCV7, and later PCV13, for children 0-59 months old in the United States was associated with decreases in mortality due to all-cause pneumonia.
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