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Association between respiratory syncytial virus activity and pneumococcal disease in infants: a time series analysis of US hospitalization data.

Weinberger DM, Klugman KP, Steiner CA, Simonsen L, Viboud C - PLoS Med. (2015)

Bottom Line: Finally, we observed a significant decline in RSV-coded hospitalizations in children aged <1 y following PCV7 introduction (-18.0%, 95% CI: -22.6%, -13.1%, for 2004/2005-2008/2009 versus 1997/1998-1999/2000).This study used aggregated hospitalization data, and studies with individual-level, laboratory-confirmed data could help to confirm these findings.Please see later in the article for the Editors' Summary.

View Article: PubMed Central - PubMed

Affiliation: Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America; Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland, United States of America.

ABSTRACT

Background: The importance of bacterial infections following respiratory syncytial virus (RSV) remains unclear. We evaluated whether variations in RSV epidemic timing and magnitude are associated with variations in pneumococcal disease epidemics and whether changes in pneumococcal disease following the introduction of seven-valent pneumococcal conjugate vaccine (PCV7) were associated with changes in the rate of hospitalizations coded as RSV.

Methods and findings: We used data from the State Inpatient Databases (Agency for Healthcare Research and Quality), including >700,000 RSV hospitalizations and >16,000 pneumococcal pneumonia hospitalizations in 36 states (1992/1993-2008/2009). Harmonic regression was used to estimate the timing of the average seasonal peak of RSV, pneumococcal pneumonia, and pneumococcal septicemia. We then estimated the association between the incidence of pneumococcal disease in children and the activity of RSV and influenza (where there is a well-established association) using Poisson regression models that controlled for shared seasonal variations. Finally, we estimated changes in the rate of hospitalizations coded as RSV following the introduction of PCV7. RSV and pneumococcal pneumonia shared a distinctive spatiotemporal pattern (correlation of peak timing: ρ = 0.70, 95% CI: 0.45, 0.84). RSV was associated with a significant increase in the incidence of pneumococcal pneumonia in children aged <1 y (attributable percent [AP]: 20.3%, 95% CI: 17.4%, 25.1%) and among children aged 1-2 y (AP: 10.1%, 95% CI: 7.6%, 13.9%). Influenza was also associated with an increase in pneumococcal pneumonia among children aged 1-2 y (AP: 3.2%, 95% CI: 1.7%, 4.7%). Finally, we observed a significant decline in RSV-coded hospitalizations in children aged <1 y following PCV7 introduction (-18.0%, 95% CI: -22.6%, -13.1%, for 2004/2005-2008/2009 versus 1997/1998-1999/2000). This study used aggregated hospitalization data, and studies with individual-level, laboratory-confirmed data could help to confirm these findings.

Conclusions: These analyses provide evidence for an interaction between RSV and pneumococcal pneumonia. Future work should evaluate whether treatment for secondary bacterial infections could be considered for pneumonia cases even if a child tests positive for RSV. Please see later in the article for the Editors' Summary.

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Variations between states and age groups in the change in rates of hospitalization for RSV or pneumococcal pneumonia after introduction of PCV7.Decline in the rate of (A) RSV hospitalizations and (B) pneumococcal pneumonia hospitalizations in each state for 2004/2005−2008/2009 compared with the average of 1997/1998−1999/2000 for children aged 0−11, 0−2, 3−11, and 12−23 mo. The IRRs are shown, with values below one indicating a decline compared with the baseline period. The size of the bubbles is proportional to the inverse variance (i.e., more confidence in larger bubbles). Fewer states were available for the analysis of children aged 0−2 and 3−11 mo. The lines demonstrate the difference in IRRs between children aged 0−2 and 3−11 mo. The colors differentiate the states.
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pmed-1001776-g004: Variations between states and age groups in the change in rates of hospitalization for RSV or pneumococcal pneumonia after introduction of PCV7.Decline in the rate of (A) RSV hospitalizations and (B) pneumococcal pneumonia hospitalizations in each state for 2004/2005−2008/2009 compared with the average of 1997/1998−1999/2000 for children aged 0−11, 0−2, 3−11, and 12−23 mo. The IRRs are shown, with values below one indicating a decline compared with the baseline period. The size of the bubbles is proportional to the inverse variance (i.e., more confidence in larger bubbles). Fewer states were available for the analysis of children aged 0−2 and 3−11 mo. The lines demonstrate the difference in IRRs between children aged 0−2 and 3−11 mo. The colors differentiate the states.

Mentions: We evaluated whether the incidence of RSV hospitalizations declined in the years following PCV7 introduction. Comparing the incidence of RSV hospitalizations in 2004/2005−2008/2009 with that in the 3 y prior to PCV7 introduction, there was a significant decline among < 1-y-old children (−18.0%, 95% CI: −22.6%, −13.1%) and a smaller decline among children aged 12−23 mo (−9.2%, 95% CI: −15.1%, −2.9%). The decline in RSV was most apparent among children aged 3−11 mo (−18.4%, 95% CI: −25.4%, −10.6%). This decline was evident by 2002/2003 (Figures 3 and 4). In comparison to in children aged 3−11 mo, the decline in RSV incidence in children aged 0−2 mo was more modest and not significant (−6.3%, 95% CI: −14.7%, 2.2%; Figures 3 and 4). These rates of decline among < 2-y-old children would translate to 9,970 (95% CI: 3,232, 15,960) fewer RSV hospitalizations per year if applied to the entire < 2-y-old population in the US (based on the disease rates and population size for 1997−1999).


Association between respiratory syncytial virus activity and pneumococcal disease in infants: a time series analysis of US hospitalization data.

Weinberger DM, Klugman KP, Steiner CA, Simonsen L, Viboud C - PLoS Med. (2015)

Variations between states and age groups in the change in rates of hospitalization for RSV or pneumococcal pneumonia after introduction of PCV7.Decline in the rate of (A) RSV hospitalizations and (B) pneumococcal pneumonia hospitalizations in each state for 2004/2005−2008/2009 compared with the average of 1997/1998−1999/2000 for children aged 0−11, 0−2, 3−11, and 12−23 mo. The IRRs are shown, with values below one indicating a decline compared with the baseline period. The size of the bubbles is proportional to the inverse variance (i.e., more confidence in larger bubbles). Fewer states were available for the analysis of children aged 0−2 and 3−11 mo. The lines demonstrate the difference in IRRs between children aged 0−2 and 3−11 mo. The colors differentiate the states.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4285401&req=5

pmed-1001776-g004: Variations between states and age groups in the change in rates of hospitalization for RSV or pneumococcal pneumonia after introduction of PCV7.Decline in the rate of (A) RSV hospitalizations and (B) pneumococcal pneumonia hospitalizations in each state for 2004/2005−2008/2009 compared with the average of 1997/1998−1999/2000 for children aged 0−11, 0−2, 3−11, and 12−23 mo. The IRRs are shown, with values below one indicating a decline compared with the baseline period. The size of the bubbles is proportional to the inverse variance (i.e., more confidence in larger bubbles). Fewer states were available for the analysis of children aged 0−2 and 3−11 mo. The lines demonstrate the difference in IRRs between children aged 0−2 and 3−11 mo. The colors differentiate the states.
Mentions: We evaluated whether the incidence of RSV hospitalizations declined in the years following PCV7 introduction. Comparing the incidence of RSV hospitalizations in 2004/2005−2008/2009 with that in the 3 y prior to PCV7 introduction, there was a significant decline among < 1-y-old children (−18.0%, 95% CI: −22.6%, −13.1%) and a smaller decline among children aged 12−23 mo (−9.2%, 95% CI: −15.1%, −2.9%). The decline in RSV was most apparent among children aged 3−11 mo (−18.4%, 95% CI: −25.4%, −10.6%). This decline was evident by 2002/2003 (Figures 3 and 4). In comparison to in children aged 3−11 mo, the decline in RSV incidence in children aged 0−2 mo was more modest and not significant (−6.3%, 95% CI: −14.7%, 2.2%; Figures 3 and 4). These rates of decline among < 2-y-old children would translate to 9,970 (95% CI: 3,232, 15,960) fewer RSV hospitalizations per year if applied to the entire < 2-y-old population in the US (based on the disease rates and population size for 1997−1999).

Bottom Line: Finally, we observed a significant decline in RSV-coded hospitalizations in children aged <1 y following PCV7 introduction (-18.0%, 95% CI: -22.6%, -13.1%, for 2004/2005-2008/2009 versus 1997/1998-1999/2000).This study used aggregated hospitalization data, and studies with individual-level, laboratory-confirmed data could help to confirm these findings.Please see later in the article for the Editors' Summary.

View Article: PubMed Central - PubMed

Affiliation: Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America; Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland, United States of America.

ABSTRACT

Background: The importance of bacterial infections following respiratory syncytial virus (RSV) remains unclear. We evaluated whether variations in RSV epidemic timing and magnitude are associated with variations in pneumococcal disease epidemics and whether changes in pneumococcal disease following the introduction of seven-valent pneumococcal conjugate vaccine (PCV7) were associated with changes in the rate of hospitalizations coded as RSV.

Methods and findings: We used data from the State Inpatient Databases (Agency for Healthcare Research and Quality), including >700,000 RSV hospitalizations and >16,000 pneumococcal pneumonia hospitalizations in 36 states (1992/1993-2008/2009). Harmonic regression was used to estimate the timing of the average seasonal peak of RSV, pneumococcal pneumonia, and pneumococcal septicemia. We then estimated the association between the incidence of pneumococcal disease in children and the activity of RSV and influenza (where there is a well-established association) using Poisson regression models that controlled for shared seasonal variations. Finally, we estimated changes in the rate of hospitalizations coded as RSV following the introduction of PCV7. RSV and pneumococcal pneumonia shared a distinctive spatiotemporal pattern (correlation of peak timing: ρ = 0.70, 95% CI: 0.45, 0.84). RSV was associated with a significant increase in the incidence of pneumococcal pneumonia in children aged <1 y (attributable percent [AP]: 20.3%, 95% CI: 17.4%, 25.1%) and among children aged 1-2 y (AP: 10.1%, 95% CI: 7.6%, 13.9%). Influenza was also associated with an increase in pneumococcal pneumonia among children aged 1-2 y (AP: 3.2%, 95% CI: 1.7%, 4.7%). Finally, we observed a significant decline in RSV-coded hospitalizations in children aged <1 y following PCV7 introduction (-18.0%, 95% CI: -22.6%, -13.1%, for 2004/2005-2008/2009 versus 1997/1998-1999/2000). This study used aggregated hospitalization data, and studies with individual-level, laboratory-confirmed data could help to confirm these findings.

Conclusions: These analyses provide evidence for an interaction between RSV and pneumococcal pneumonia. Future work should evaluate whether treatment for secondary bacterial infections could be considered for pneumonia cases even if a child tests positive for RSV. Please see later in the article for the Editors' Summary.

Show MeSH
Related in: MedlinePlus