LB-3. Reductions in Invasive and non-invasive pneumo-related US Hospital Admissions only Two Years after PCV13 Introduction: Evidence of Substantial Direct and Indirect (Herd) Benefits
Session: Oral Abstract Session: Late Breaker Oral Abstracts
Saturday, October 5, 2013: 10:54 AM
Room: The Moscone Center: 102 (Gateway Ballroom)
Background: Beginning March 2010, 13-valent pneumococcal conjugate vaccine (PCV13) replaced the 7-valent (PCV7) vaccine for pediatric use in the U.S. We modeled timely ICD9-coded electronic health records from hospital discharges to study the effectiveness of PCV13 in reducing pneumococcal-related disease burden over the first 2 years in all age groups.

Method:   We accessed a privately held 20% inpatient ICD9-coded database, projected to national figures.  We also modeled medical claims data to assess trends in the uptake of PCV13 vaccine doses in children <5.  For 2005-2012 we modeled monthly numbers of invasive pneumococcal disease (IPD), lobar pneumonia, empyema and all-cause pneumonia hospitalizations, controlling for influenza incidence.  Finally, we computed the PCV13-attributable risk reduction by age: <2, 2-4, 5-17, 18-49, 40-64, and 65+ years.   

Result:     By mid-winter 2011-12 ~50% of all children <5 years had achieved putatively protective PCV13 doses.  By then, IPD hospitalizations had declined from the 2007-09 baseline level by 59% (33-74%) in children <5 years and by 25% (11-36%) in adults. For lobar pneumonia, significant reductions of 22% to 44% obtained in all age groups except toddlers.  For empyema, a 42% (17-60%) reduction obtained in all pediatric age groups (no reduction in adults). For allcause pneumonia, a 19% (20-27%) reduction occurred in children <5, corresponding to 22,000 pediatric pneumonia hospitalizations avoided (no reduction in adults).  No reduction obtained for the negative control outcome urinary tract infections (1%, -3 to 5%).   

Conclusion: The rapid PCV13 uptake led to substantial reductions in invasive and non-invasive pneumococcus-related outcomes after only 2 years.  For IPD our observed reduction was in agreement with IPD trends recently reported from CDC’s ABC laboratory surveillance data; however, we went further by demonstrating a substantial effect on all pneumonia hospitalizations in young children.  The IPD reduction in both vaccinated children and unvaccinated adults demonstrated that substantial herd immunity achieved from the primary vaccine program and extensive catch-up vaccination was rapidly established.   As 100% government hospital databases become available up to 2012 these near-real time results can be validated.

Lone Simonsen, PhD1,2, Keith Klugman, MD, PhD, FIDSA3,4,5, Robert Taylor, PhD1, Cynthia Schuck, PhD1, Roger Lustig, BA1 and Michael Haber, PhD3, (1)Sage Analytica, Bethesda, MD, (2)Department Of Global Health, George Washington Univ. Dept Global Health, School of Public Health and Health Services., Washington, DC, (3)Emory University, Atlanta, GA, (4)Hubert Department Of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, (5)Pneumonia, Bill & Melinda Gates Foundation, Seattle, WA

Disclosures:

L. Simonsen, Pfizer: Grant Investigator, Grant recipient

K. Klugman, None

R. Taylor, Pfizer: Grant Investigator, Educational grant

C. Schuck, None

R. Lustig, None

M. Haber, None

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