Impact of ten-valent pneumococcal conjugate vaccine on pneumonia in Finnish children in a nation-wide population-based study

• Published in: PloS one Vol. 12; no. 3; p. e0172690
• Main Authors: Palmu, Arto A, Rinta-Kokko, Hanna, Nohynek, Hanna, Nuorti, J Pekka, Kilpi, Terhi M, Jokinen, Jukka
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 01.03.2017; Public Library of Science (PLoS)
• Subjects: Age; Age Factors; Biology and Life Sciences; Care and treatment; Child; Child, Preschool; Children; Conjugate vaccines; Empyema; Female; Finland - epidemiology; Follow-Up Studies; Generalized linear models; Haemophilus influenzae; Health aspects; Health surveillance; Hospitalization; Hospitals; Humans; Immunization; Infant; Infectious diseases; Influenza; Low income groups; Male; Medicine and Health Sciences; Models, Biological; Mortality; National Health Programs; Patient admissions; People and Places; Pneumococcal Vaccines - administration & dosage; Pneumonia; Pneumonia, Pneumococcal - epidemiology; Pneumonia, Pneumococcal - prevention & control; Poisson density functions; Population; Population studies; Population-based studies; Public health; Reduction; Registries; Regression analysis; Regression models; Risk factors; Statistical analysis; Streptococcus infections; Streptococcus pneumoniae; Surveillance; Vaccination; Vaccines; Finland
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0172690

The ten-valent pneumococcal conjugate vaccine (PCV10) was introduced into the Finnish National Vaccination Program (NVP) in September 2010 using a 2+1 schedule (3, 5, 12 months). We estimated the direct and indirect effects of PCV10 on pneumonia among children to evaluate the public health impact of the vaccine. We conducted a nation-wide population-based, observational study comparing rates of pneumonia in children before and after the NVP introduction. For the total (direct and indirect) effect, the cohort of vaccine-eligible children (born June 1, 2010 or later) was followed until the end of 2013 (age range 3-42 months). For the indirect effect, a cohort of older children (age range 7-71 months) not eligible for the PCV vaccination was followed from 2011 to 2013. Both cohorts were compared with two season- and age-matched reference cohorts before NVP introduction. Hospitals' in- and outpatient discharge notifications with ICD-10 diagnoses compatible with pneumonia (J10.0, J11.0, J12-J18, J85.1 or J86) as set by the hospital pediatricians were collected from the national Care Register. The main outcome was hospital-treated primary pneumonia (HTPP), defined as primary diagnosis of pneumonia after in-patient hospitalization. We compared rates of pneumonia in the NVP target and reference cohorts by using Poisson regression models. The rate of HTPP episodes was 5.3/1000 person-years in the combined reference cohorts and 4.1/1000 person-years in the target cohort vaccine-eligible children. Compared with the reference cohort, the relative rate reduction in target cohort was 23% (95%CI 18-28) and the absolute reduction 1.3/1000 person-years. In the indirect effect evaluation, we observed continued increase in HTPP incidence until 2011 with a subsequent reduction of 18% (95%CI 10-25) during years 2012 to 2013. Number of empyema diagnoses remained low. A substantial decrease in pneumonia rates was observed both among vaccine-eligible children and among older, unvaccinated children after PCV10 introduction.