448. Impact of a pediatric PCV-13 immunization program on hospitalizations and outpatient visits for pneumonia in Nicaragua
Session: Poster Abstract Session: Pneumococcal Vaccine in Children and Adults
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • 448_IDW_LAYOUT.pdf (1.1 MB)
  • Background: While lower rates of community-acquired pneumonia among children have been observed in high-income countries following pneumococcal conjugate vaccine (PCV) introduction, little is known about PCV impact in lower-income countries. In 2010, Nicaragua became the first GAVI-eligible nation to add PCV-13 to its national pediatric immunization schedule, using a "3 + 0" scheme. Our goal was to examine changes in health facility visits for pneumonia following PCV-13 introduction in the State of León, Nicaragua.

    Methods: Visit diagnoses at all 107 public health facilities in the State before and after PCV-13 introduction were collected. Pneumonia was diagnosed by criteria from the Health Ministry's Clinical Management Guide, including confirmation of infiltrate on chest radiograph in the hospital setting. Official population estimates were used as exposure time. Vaccine coverage for the full course among infants was 63% in 2011 and 97% in 2012. Generalized estimating equations were used to estimate incidence rate ratios (IRR) of pneumonia hospitalizations and outpatient visits in the vaccine (2011-2012) and pre-vaccine periods (2008-2010), accounting for clustering by municipality.

     

    Results: Numbers of total health facility visits for pneumonia and changes in rates of hospitalizations and outpatient visits for pneumonia are shown below.

    Rates of hospitalizations and outpatient visits for pneumonia in the vaccine period (2011-2012) vs. the pre-vaccine period (2008-2010) 

    Age Group

    IRRa* Hospitalizations for Pneumonia

    IRRa† Outpatient Visits  for Pneumonia

    Infants                            

    0.66 (0.58, 0.76)

    0.83 (0.65, 1.05)

    1 year old

    0.67 (0.61, 0.72)

    0.77 (0.64, 0.93)

    2-4 years old

    0.68 (0.59, 0.78)

    0.88 (0.70, 1.10)

    5-14 years old

    0.81 (0.71, 0.92)

    0.95 (0.76, 1.18)

    *Adjusted by vaccine coverage and distance of patient's household from hospital.

    †Adjusted by vaccine coverage.

    Conclusion: Following PCV-13 introduction in this low-middle income country, we observed fewer hospitalizations for pneumonia among immunization-eligible age groups and fewer outpatient visits for pneumonia among children one year of age. Fewer pneumonia hospitalizations observed in age groups not eligible to receive PCV-13 (2-4 years old and 5-14 years old) suggest an indirect effect of the vaccine.  

    Sylvia Becker-Dreps, MD, MPH1, Erick Amaya, PhD2, Lan Liu, BS3, Gilberto Moreno, MD, MPH4, Julio Rocha, RN, MPH5, Rafaela Briceño, MD, MPH6, Michael G. Hudgens, PhD3, Jorge Alemán, MD7, Christopher Woods, MD, MPH, FIDSA8 and David J. Weber, MD, MPH, FIDSA, FSHEA9, (1)Family Medicine, University of North Carolina At Chapel Hill, Chapel Hill, NC, (2)Microbiology, Universidad Nacional Autonoma de Nicaragua, León, León, Nicaragua, (3)Biostatistics, UNC Gillings School of Global Public Health, Chapel Hill, NC, (4)Epidemiology, Sistemas Locales de Atención Integral de Salud, León, Nicaragua, León, Nicaragua, (5)Epidemiology, Hospital Escuela Óscar Danilo Rosales Argüello, Leon, Nicaragua, (6)Epidemiology, Sistemas Locales de Atención Integral de Salud, León, Nicaragua, (7)Pediatrics, Hospital Escuela Óscar Danilo Rosales Argüello, León, Nicaragua, (8)Duke University Medical Center, Durham, NC, (9)University of North Carolina, Chapel Hill, NC

    Disclosures:

    S. Becker-Dreps, Pfizer: Investigator-initiated grant recipient, Research grant

    E. Amaya, None

    L. Liu, None

    G. Moreno, None

    J. Rocha, None

    R. Briceño, None

    M. G. Hudgens, None

    J. Alemán, None

    C. Woods, Novartis Diagnostics: Grant Investigator, Research grant
    Becton Dickinson: Scientific Advisor, Consulting fee
    GenMark: Investigator, Research support
    bioMerieux: Consultant, Consulting fee
    Cubist: Investigator, Research support
    Roche: Investigator, Research grant and Research support

    D. J. Weber, Pfizer: Consultant and Speaker's Bureau, Consulting fee and Speaker honorarium
    Merck: Consultant and Speaker's Bureau, Consulting fee and Speaker honorarium

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.