Journal
HUMAN VACCINES & IMMUNOTHERAPEUTICS
Volume 16, Issue 6, Pages 1446-1453Publisher
TAYLOR & FRANCIS INC
DOI: 10.1080/21645515.2019.1690884
Keywords
Conjugate vaccines; pneumococcal vaccines; invasive pneumococcal disease; pneumonia; pneumococcus; Streptococcus pneumoniae; vaccination; Spain
Categories
Funding
- Instituto de Salud Carlos III (Intensificacion Actividad Investigadora) [PI07/0069, PI10/00540, PI16/01478, PI16/01569]
- Grupo Gallego de Genetica Vacunas Infecciones y Pediatria [2016-PG071, REDES 2016GI-1344 G3VIP, ED341D R2016/021]
- Pfizer
- Instituto de Salud Carlos III [PI07/0069, PI10/00540, PI16/01478, PI16/01569]
- Instituto de Salud Carlos III (Proyecto de Investigacion en Salud, Accion Estrategica en Salud) [PI07/0069, PI10/00540, PI16/01478, PI16/01569]
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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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