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Influence of pneumococcal vaccines and respiratory syncytial virus on alveolar pneumonia, Israel.

Weinberger DM, Givon-Lavi N, Shemer-Avni Y, Bar-Ziv J, Alonso WJ, Greenberg D, Dagan R - Emerging Infect. Dis. (2013)

Bottom Line: PCV was associated with significant declines in radiologically confirmed alveolar pneumonia (RCAP) among patients <6 months, 6-17 months, and 18-35 months of age (-31% [95% CI -51% to -15%], -41% [95% CI -52 to -32%], and -34% [95% CI -42% to -25%], respectively).Respiratory syncytial virus (RSV) activity was associated with strong increases in RCAP incidence, with up to 44% of cases attributable to RSV among infants <6 months of age and lower but significant impacts in older children.Seasonal variations, particularly in RSV activity, masked the impact of 7-valent PCVs, especially for young children in the first 2 years after vaccine introduction.

View Article: PubMed Central - PubMed

Affiliation: Yale School of Public Health, New Haven,Connecticut 06520-8034, USA. daniel.weinberger@yale.edu

ABSTRACT
Postlicensure surveillance of pneumonia incidence can be used to estimate whether pneumococcal conjugate vaccines (PCVs) affect incidence. We used Poisson regression models that control for baseline seasonality to determine the impact of PCVs and the possible effects of variations in virus activity in Israel on these surveillance estimates. PCV was associated with significant declines in radiologically confirmed alveolar pneumonia (RCAP) among patients <6 months, 6-17 months, and 18-35 months of age (-31% [95% CI -51% to -15%], -41% [95% CI -52 to -32%], and -34% [95% CI -42% to -25%], respectively). Respiratory syncytial virus (RSV) activity was associated with strong increases in RCAP incidence, with up to 44% of cases attributable to RSV among infants <6 months of age and lower but significant impacts in older children. Seasonal variations, particularly in RSV activity, masked the impact of 7-valent PCVs, especially for young children in the first 2 years after vaccine introduction.

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PCV uptake and decline in RCAP incidence 2004–05 through 2011–12, southern Israel. A) Uptake of >2 PCV doses among Bedouin and Jewish children 6–17 months of age. Black line indicates overall uptake; shaded areas show the proportion receiving >2 doses of PCV7 (light gray), >2 doses of PCV13 (dark gray), or >1 doses of PCV7 and 1 dose of PCV13 (medium gray). Dotted line indicates 85% uptake of any PCV. B) Unadjusted incidence rate ratio for RCAP comparing the incidence in each July–June year with the average for 2004–05 through 2007–08. RCAP, radiologically confirmed alveolar pneumonia; PCV, pneumococcal conjugate vaccine; PCV7, 7-valent PCV; PCV13, 13-valent PCV.
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Figure 1: PCV uptake and decline in RCAP incidence 2004–05 through 2011–12, southern Israel. A) Uptake of >2 PCV doses among Bedouin and Jewish children 6–17 months of age. Black line indicates overall uptake; shaded areas show the proportion receiving >2 doses of PCV7 (light gray), >2 doses of PCV13 (dark gray), or >1 doses of PCV7 and 1 dose of PCV13 (medium gray). Dotted line indicates 85% uptake of any PCV. B) Unadjusted incidence rate ratio for RCAP comparing the incidence in each July–June year with the average for 2004–05 through 2007–08. RCAP, radiologically confirmed alveolar pneumonia; PCV, pneumococcal conjugate vaccine; PCV7, 7-valent PCV; PCV13, 13-valent PCV.

Mentions: Unadjusted incidence rate ratios were calculated by determining the incidence in a given year (July–June) or given season (November–April or May–October) and dividing it by the mean incidence of the corresponding prevaccine period. To estimate the effects of RSV, influenza, and vaccine uptake on RCAP incidence, we fit a Poisson regression (log-link) model using PROC GENMOD in SAS version 9.2 (SAS Institute, Cary, NC, USA). The outcome variable was the weekly incidence of RCAP. The predictor variables were weekly activity of influenza and RSV among Jewish and Bedouin children (as described above), an indicator variable for ethnicity; sine and cosine terms that had frequencies of 52.25 and 26.125 weeks and varied between ethnic groups; and a binary variable that indicated whether the PCV vaccination program in the Jewish or Bedouin population had reached maturation. The vaccination program was considered to be mature when at least 85% of the Jewish or Bedouin populations 6–17 months of age had received at least 2 doses of any PCV (85% was chosen to indicate an immunization program with stable rates [Figure 1]). We also considered using vaccine uptake as a continuous variable in the model, but the relationship between vaccine uptake and incidence appeared to have a threshold effect, as might be expected given the role of herd immunity (Technical AppendixFigure 1).


Influence of pneumococcal vaccines and respiratory syncytial virus on alveolar pneumonia, Israel.

Weinberger DM, Givon-Lavi N, Shemer-Avni Y, Bar-Ziv J, Alonso WJ, Greenberg D, Dagan R - Emerging Infect. Dis. (2013)

PCV uptake and decline in RCAP incidence 2004–05 through 2011–12, southern Israel. A) Uptake of >2 PCV doses among Bedouin and Jewish children 6–17 months of age. Black line indicates overall uptake; shaded areas show the proportion receiving >2 doses of PCV7 (light gray), >2 doses of PCV13 (dark gray), or >1 doses of PCV7 and 1 dose of PCV13 (medium gray). Dotted line indicates 85% uptake of any PCV. B) Unadjusted incidence rate ratio for RCAP comparing the incidence in each July–June year with the average for 2004–05 through 2007–08. RCAP, radiologically confirmed alveolar pneumonia; PCV, pneumococcal conjugate vaccine; PCV7, 7-valent PCV; PCV13, 13-valent PCV.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3713978&req=5

Figure 1: PCV uptake and decline in RCAP incidence 2004–05 through 2011–12, southern Israel. A) Uptake of >2 PCV doses among Bedouin and Jewish children 6–17 months of age. Black line indicates overall uptake; shaded areas show the proportion receiving >2 doses of PCV7 (light gray), >2 doses of PCV13 (dark gray), or >1 doses of PCV7 and 1 dose of PCV13 (medium gray). Dotted line indicates 85% uptake of any PCV. B) Unadjusted incidence rate ratio for RCAP comparing the incidence in each July–June year with the average for 2004–05 through 2007–08. RCAP, radiologically confirmed alveolar pneumonia; PCV, pneumococcal conjugate vaccine; PCV7, 7-valent PCV; PCV13, 13-valent PCV.
Mentions: Unadjusted incidence rate ratios were calculated by determining the incidence in a given year (July–June) or given season (November–April or May–October) and dividing it by the mean incidence of the corresponding prevaccine period. To estimate the effects of RSV, influenza, and vaccine uptake on RCAP incidence, we fit a Poisson regression (log-link) model using PROC GENMOD in SAS version 9.2 (SAS Institute, Cary, NC, USA). The outcome variable was the weekly incidence of RCAP. The predictor variables were weekly activity of influenza and RSV among Jewish and Bedouin children (as described above), an indicator variable for ethnicity; sine and cosine terms that had frequencies of 52.25 and 26.125 weeks and varied between ethnic groups; and a binary variable that indicated whether the PCV vaccination program in the Jewish or Bedouin population had reached maturation. The vaccination program was considered to be mature when at least 85% of the Jewish or Bedouin populations 6–17 months of age had received at least 2 doses of any PCV (85% was chosen to indicate an immunization program with stable rates [Figure 1]). We also considered using vaccine uptake as a continuous variable in the model, but the relationship between vaccine uptake and incidence appeared to have a threshold effect, as might be expected given the role of herd immunity (Technical AppendixFigure 1).

Bottom Line: PCV was associated with significant declines in radiologically confirmed alveolar pneumonia (RCAP) among patients <6 months, 6-17 months, and 18-35 months of age (-31% [95% CI -51% to -15%], -41% [95% CI -52 to -32%], and -34% [95% CI -42% to -25%], respectively).Respiratory syncytial virus (RSV) activity was associated with strong increases in RCAP incidence, with up to 44% of cases attributable to RSV among infants <6 months of age and lower but significant impacts in older children.Seasonal variations, particularly in RSV activity, masked the impact of 7-valent PCVs, especially for young children in the first 2 years after vaccine introduction.

View Article: PubMed Central - PubMed

Affiliation: Yale School of Public Health, New Haven,Connecticut 06520-8034, USA. daniel.weinberger@yale.edu

ABSTRACT
Postlicensure surveillance of pneumonia incidence can be used to estimate whether pneumococcal conjugate vaccines (PCVs) affect incidence. We used Poisson regression models that control for baseline seasonality to determine the impact of PCVs and the possible effects of variations in virus activity in Israel on these surveillance estimates. PCV was associated with significant declines in radiologically confirmed alveolar pneumonia (RCAP) among patients <6 months, 6-17 months, and 18-35 months of age (-31% [95% CI -51% to -15%], -41% [95% CI -52 to -32%], and -34% [95% CI -42% to -25%], respectively). Respiratory syncytial virus (RSV) activity was associated with strong increases in RCAP incidence, with up to 44% of cases attributable to RSV among infants <6 months of age and lower but significant impacts in older children. Seasonal variations, particularly in RSV activity, masked the impact of 7-valent PCVs, especially for young children in the first 2 years after vaccine introduction.

Show MeSH
Related in: MedlinePlus