In a context of the emergence of nonvaccine serotypes, has the long-term protective outcome of 13-valent pneumococcal conjugate vaccine (PCV13) on community-acquired pneumonia in children eroded?
This time-series analysis of an 8-year prospective multicenter study finds a significant decrease in the frequency of community-acquired pneumonia over 4 years after PCV13 implementation, followed by a slight increase thereafter. The frequency of the most severe cases decreased more markedly, without any rebound.
Seven years after PVC13 implementation, the protection against pneumonia seems unthreatened by the increase in nonvaccine serotypes recently reported in several countries.
In several countries, 5 years after 13-valent pneumococcal conjugate vaccine (PCV13) implementation, serotype replacement has been reported for invasive pneumococcal disease, which raises concerns about the long-term outcome of PCV13 implementation. The long-term effect of vaccination on community-acquired pneumonia (CAP) remains unknown.
To assess the long-term outcome of PCV13 implementation on CAP in children.
Design, Setting, and Participants
This quasi-experimental, population-based, interrupted time-series analysis was based on a prospective multicenter study conducted from June 2009 to May 2017 in 8 French pediatric emergency departments. All patients 15 years and younger with chest radiography–confirmed CAP were included.
Main Outcomes and Measures
The number of CAP cases per 1000 pediatric emergency department visits over time, analyzed using a segmented regression model, adjusted for influenza-like illness syndromes.
We enrolled 12 587 children with CAP, including 673 cases of CAP with pleural effusion (5.3%), 4273 cases of CAP requiring hospitalization (33.9%), 2379 cases of CAP with high inflammatory biomarkers (18.9%), and 221 cases of proven pneumococcal CAP (1.8%). The implementation of PCV13 in 2010 was followed by a sharp decrease in the frequency of CAP (−0.8% per month [95% CI, −1.0% to −0.5% per month]), from 6.3 to 3.5 cases of CAP per 1000 pediatric emergency department visits until May 2014, then a slight increase since June 2014 (0.9% per month [95% CI, 0.4%-1.4% per month]), until 3.8 cases of CAP per 1000 pediatric emergency department visits in May 2017. There were marked immediate decreases in cases of CAP with pleural effusion (−48% [95% CI, −84% to −12%]), CAP requiring hospitalization (−30% [95% CI, −56% to −5%]), and CAP with high inflammatory biomarkers (−30% [95% CI, −54% to −6%]), without any rebound thereafter.
Conclusions and Relevance
The changes associated with PCV13 use 7 years after implementation remain substantial, especially for CAP with pleural effusion, CAP requiring hospitalization, and CAP with high inflammatory biomarkers. Emerging non-PCV13 serotypes may be less likely involved in severe CAP than invasive pneumococcal disease.
Ouldali N, Levy C, Minodier P, et al. Long-term Association of 13-Valent Pneumococcal Conjugate Vaccine Implementation With Rates of Community-Acquired Pneumonia in Children. JAMA Pediatr. Published online February 04, 2019. doi:10.1001/jamapediatrics.2018.5273
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