The impact of the pneumococcal conjugate vaccines on the incidence of community-acquired alveolar pneumonia in premature compared with in term-born infants. Issue 4 (28th January 2022)

• Record Type: Journal Article
• Authors: Faingelernt, Yaniv; Dagan, Ron; Givon-Lavi, Noga; van der Beek, Bart Adriaan; Ben-Shimol, Shalom; Shany, Eilon; Greenberg, David
• Is Part Of: Vaccine. Volume 40:Issue 4(2022)
• Page Start: 568
• Page End: 573
• Publication Date: 2022-01-28
• Subjects: Premature -- Community-acquired pneumonia, Streptococcus pneumoniae -- Pneumococcal vaccine; PCV pneumococcal conjugate vaccine -- CAAP community-acquired alveolar pneumonia -- WGA weeks gestational age -- RSV respiratory syncytial virus -- PICU pediatric intensive care unit -- SUMC Soroka University Medical Center -- IRR incidence rate ratio -- CI confidence interval -- PER pediatric emergency room -- RSVIG RSV immune globulin; Vaccines -- Periodicals; 615.372
• DOI: 10.1016/j.vaccine.2021.12.025
• Languages: English
• ISSNs: 0264-410X

Abstract

Highlights: PCV7/13 introduction reduced alveolar pneumonia (CAAP) in young children in Israel. The extent of the decline in children born prematurely in unknown. PCV7/PCV13 impacted CAAP rates in both term and preterm children. Pre-PCV in Israel, CAAP rates in preterm children was higher than in term children. Post PCV7/13 CAAP rates in term and preterm children were similar, closing gaps. Abstract: Background: Preterm-born children are prone to respiratory infections and complications during infancy and early childhood. In Israel, pneumococcal conjugated vaccines (PCVs) were introduced in 2009–2010, with high vaccination coverage. We assessed the impact of PCV implementation on community-acquired alveolar pneumonia (CAAP) in children < 2 years old born prematurely, in comparison with term born infants. Methods: We conducted a prospective, active, population-based surveillance of children < 2 years old with radiologically-proven CAAP, visiting the only regional medical center. CAAP incidence in the pre-PCV and post-PCV eras were compared in early premature (29–32 weeks gestational age [WGA]), late premature (33–36 WGA) and term-born infants (>36 WGA). Results: Of 214, 947 births during the study period, 6'791 CAAP episodes were diagnosed; 211, 653 and 5, 806 were in early premature, late premature and term infants, respectively. After PCV implementation, overall CAAP visits were reduced by 44% (95% CI 36–51): 60%, 21% and 45% among those born early preterm, late preterm and at term, respectively (statistically significant for children born early preterm and at term). For outpatients, the respective rate reductions were 79%, 40% and 65% (statistically significant for the children born at term). Importantly, the mean annual rates in the post-PCV period became similar in all 3 groups. The rate reductions among the hospitalized children were lower those that among the non-hospitalized children, with reductions of 56%, 16% and 33% for the three groups, respectively (statistically significant for early preterm and at term children). Conclusions: CAAP reduction trends after PCV implementation for preterm-born infants were similar to those for term-born infants. Whether this was because of similar direct PCV- protection, because of indirect (herd) protection or both, is unclear. Post-PCV implementation, the gaps in CAAP rates between infants born prematurely and at term were reduced.