The impact of pneumococcal vaccine in reducing pneumonia hospitalizations in children under 5 years old, in Santa Catarina, Brazil, 2006 a 2014

Vieira, Ilse Lisiane Viertel; Kupek, Emil

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Epidemiologia e Serviços de Saúde

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ORIGINAL ARTICLE • Epidemiol. Serv. Saúde 27 (4) • 2018 • https://doi.org/10.5123/S1679-49742018000400012 copy

The impact of pneumococcal vaccine in reducing pneumonia hospitalizations in children under 5 years old, in Santa Catarina, Brazil, 2006 a 2014^* * Article derived from the Ph.D. thesis entitled ‘Impact of conjugate vaccine against Streptococcus pneumoniae in children under Five years old in the state of Santa Catarina’, defended by Ilse Lisiane Viertel Vieira at the Santa Catarina Federal University Postgraduate Public Health Program in 2016.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

to analyze the impact of pneumococcal conjugate vaccine (PCV10) on pneumonia hospital admissions among children in Santa Catarina, Brazil, 2006-2014.

Methods:

this was an ecological study using data obtained from Brazilian National Health System Information Technology Department (Datasus) for 2006-2009 (pre-vaccination period) and 2010-2014 (post-vaccination period); time trends were evaluated using the Poisson regression coefficient.

Results:

in the comparison between pre- and post-vaccination periods, the percentage difference in the hospitalization rate for children under 1 year old ranged from -44.1% in the Western region to -1.4% in the Serrano Plateau region, and in children between 1-4 years old it ranged from -37.1% in the Northern Plateau region to 16.9% in the Serrano Plateau region (p<0.05); hospitalization rates in the state reduced by 23.3% in children under 1 year old and by 8.4% in those aged 1-4 years.

Conclusion:

a significant reduction in the rate of pneumonia hospitalization in children under 1 year old age was found, suggesting the effectiveness of the vaccine in reducing hospitalizations.

Keywords:
Pneumonia; Pneumococcal Vaccines; Hospitalization; Child

Regions	PCV10 implantation period
	Age (in years)		Pre			Implantation	Post
	Age (in years)		2007	2008	2009	2010	2011	2012	2013	2014
Western	<1	HRR^a (95%CI^c)	1.1	1.0	1.0	0.8^b	0.7^b	0.7^b	0.6^b	0.6^b
	<1	HRR^a (95%CI^c)	(1.0;1.2)	(0.9;1.1)	(0.9;1.0)	(0.7;0.8)	(0.7;0.8)	(0.7;0.8)	(0.6;0.7)	(0.6;0.7)
	1 a 4	HRR^a (95%CI^c)	1.2^b	1.2^b	1.3^b	1.2^b	1.0	1.0	0.9^b	0.9^b
	1 a 4	HRR^a (95%CI^c)	(1.1;1.3)	(1.1;1.3)	(1.2;1.4)	(1.1;1.2)	(0.9;1.0)	(0.9;1.0)	(0.8;0.9)	( 0.8;0.9)
Itajaí	<1	HRR^a (95%CI^c)	0.9	0.9^b	1.0	0.8^b	0. 8^b	0.9	0.7^b	0.6^b
	<1	HRR^a (95%CI^c)	(0.9;1.0)	(0.8;0.9)	(0.9;1.1)	(0.8;0.9)	(0.8;0.9)	(0.9;1.0)	(0.6;0.8)	(0.5;0.6)
	1 a 4	HRR^a (95%CI^c)	1.0	1.2^b	1.4^b	1.2^b	1.2^b	1.2^b	1.0	0.8^b
	1 a 4	HRR^a (95%CI^c)	(0.9;1.1)	(1.1;1.3)	(1.3;1.5)	(1.1;1.3)	(1.1;1.3)	(1.1;1.3)	(0.9;1.0)	(0.7;0.8)
Greater Florianópolis	<1	HRR^a (95%CI^c)	1.4^b	1.0	1.4^b	1.0	0.9	0.9	0.8^b	0.8^b
	<1	HRR^a (95%CI^c)	(1.1;1.6)	(0.8;1.2)	(1.1;1.6)	(0.8;1.2)	(0.7;1.1)	(0.8;1.1)	(0.7;0.9)	(0.6;0.9)
	1 a 4	HRR^a (95%CI^c)	1.2^b	1.2^b	2.1^b	1.5^b	1.5^b	1.2	1.3^b	1.2
	1 a 4	HRR^a (95%CI^c)	(1.1;1.4)	(1.1;1.5)	(1.8;2.4)	(1.3;1.7)	(1.3;1.7)	(1.0;1.4)	(1.1;1.5)	(1.00;1.4)
Serrano Plateau	<1	HRR^a (95%CI^c)	1.0	0.8^b	0.9	0.9	0.9	1.1	1.0	0.8^b
	<1	HRR^a (95%CI^c)	(0.8;1.2)	(0.7;0.9)	(0.8;1.1)	(0.7;1.0)	(0.7;1.0)	(0.9;1.3)	(0.9;1.2)	(0.7;0.9)
	1 a 4	HRR^a (95%CI^c)	1.0	0.8^b	1.0	1.1	1.2	1.2^b	1.3^b	1.0
	1 a 4	HRR^a (95%CI^c)	(0.9;1.2)	(0.7;0.9)	(0.9;1.2)	(0.9;1.2)	(1.0;1.3)	(1.1;1.4)	(1.1;1.5)	(0.9;1.2)
Northeast	<1	HRR^a (95%CI^c)	0.8^b	0.5^b	0.7^b	0.7^b	0.8^b	0.7^b	0.7^b	0.5^b
	<1	HRR^a (95%CI^c)	(0.7;0.9)	( 0.4;0.6)	(0.6;0.8)	(0.6;0.8)	(0.7;0.9)	(0.6;0.8)	(0.6;0.8)	(0.4;0.6)
	1 a 4	HRR^a (95%CI^c)	0.9	0.6^b	1.2^b	1.2^b	1.0	1.0	1.1	0.8^b
	1 a 4	HRR^a (95%CI^c)	(0.8;1.0)	(0.5;0.7)	(1.1;1.4)	(1.1;1.4)	(0.9;1.2)	(0.9;1.1)	(0.9;1.2)	(0.7;0.9)
Southern	<1	HRR^a (95%CI^c)	1.1	0.9	0.7^b	0.6^b	0.8^b	0.8^b	0.7^b	0.7^b
	<1	HRR^a (95%CI^c)	(0.9;1.2)	(0.8;1.0)	(0.6;0.8)	(0.6;0.9)	(0.7;0.9)	(0.7;0.9)	(0.6;0.8)	(0.6;0.8)
	1 a 4	HRR^a (95%CI^c)	1.3^b	1.2^b	1.3^b	1.1	1.1	1.3^b	1.2^b	1.2^b
	1 a 4	HRR^a (95%CI^c)	(1.1;1.4)	(1.1;1.3)	(1.1;1.4)	(1.0;1.2)	(1.0;1.3)	(1.1;1.4)	(1.1;1.3)	(1.1;1.3)
Northern Plateau	<1	HRR^a (95%CI^c)	0.8^b	0.6^b	0.8^b	0.5^b	0.5^b	0.7^b	0.7^b	0.5^b
	<1	HRR^a (95%CI^c)	(0.7;0.9)	(0.5;0.7)	(0.7;0.9)	(0.4;0.6)	(0.4;0.6)	(0.6;0.8)	(0.6;0.8)	(0.4;0.6)
	1 a 4	HRR^a (95%CI^c)	1.0	0.8^b	1.0	0.6^b	0.6^b	0.8^b	0.7^b	0.7^b
	1 a 4	HRR^a (95%CI^c)	(0.8;1.1)	(0.7;0.9)	(0.8;1.1)	(0.5;0.8)	(0.5;0.7)	(0.7;0.9)	(0.6;0.9)	(0.6;0.8)
Santa Catarina	<1	HRR^a (95%CI^c)	1.0	0.8^b	0.9^b	0.8^b	0.8^b	0.8^b	0.7^b	0.6^b
	<1	HRR^a (95%CI^c)	(0.9;1.0)	(0.8;0.9)	(0.9;0.9)	(0.7;0.8)	(0.7;0.8)	(0.7;0.8)	(0.6;0.7)	(0.5;0.6)
	1 a 4	HRR^a (95%CI^c)	1.1^b	1.1^b	1.3^b	1.1^b	1.0	1.1^b	1.0	0.9^b
	1 a 4	HRR^a (95%CI^c)	(1.0;1.2)	(1.0;1.1)	(1.2;1.3)	(1.1;1.2)	(1.0;1.1)	(1.0;1.1)	(0.9;1.0)	(0.8;0.9)

Regions	Pneumonia hospitalization rate in children under 1 year old^a					Pneumonia hospitalization rate in children aged 1-4 years old^a
Regions	Pre-vaccination period	95%CI^b	Post-vaccination period	95%CI^b	Reduction %	Pre-vaccination period	95%CI^b	Post-vaccination period	95%CI^b	Reduction %
Western	84.1	81.9;86.2	58.3	56.8;59.9	-44.1	22.8	22.3;23.3	19.0	18.6;19.5	-20.0
Itajaí	53.8	52.2;55.4	43.6	42.4;44.9	-23.3	15.4	14.9;15.8	14.3	13.9;14.7	-7.3
Greater Florianópolis	19.4	18.2;20.6	14.4	13.5;15.3	-34.6	6.4	6.0;6.7	6.2	5.8;6.5	-3.3
Serrano Plateau	61.7	58.0;65.5	60.9	57.5;64.3	-1.4	14.7	13.9;15.6	17.7	16.8;18.6	16.9
Northeast	31.3	29.7;32.9	27.3	26.1;28.6	-14.6	9.0	8.6;9.4	9.8	9.4;10.2	8.2
Southern	42.5	40.6;44.4	33.9	32.4;35.4	-25.5	12.2	11.6;12.5	12.1	11.6;12.5	-0.0
Northern Plateau	40.6	37.9;43.2	28.9	26.9;31.0	-40.2	12.5	11.8;13.2	9.2	8.6;9.7	-37.0
Total	49,8	49,0;50,5	38,2	37,6;38,8	-23,3	14,1	13,9;14,3	13,0	12,8;13,1	-8,4

Secretaria de Vigilância em Saúde e Ambiente - Ministério da Saúde do Brasil SRTVN Quadra 701, Via W5 Norte, Lote D, Edifício P0700, CEP: 70719-040, +55 61 3315-3464, Fax: +55 61 3315-3464 - Brasília - DF - Brazil
E-mail: ress.svs@gmail.com

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[1] Correspondence: Ilse Lisiane Viertel Vieira - Rua São Pedro, No. 425, apto. 803, Balneário, Florianópolis, SC, Brazil. CEP: 88075-520. E-mail: iviertel@gmail.com