TY - JOUR
T1 - Incremental effectiveness of 23-valent pneumococcal polysaccharide vaccine against pneumonia hospitalisation among Australian Indigenous children
T2 - A record linkage study
AU - Kabir, Alamgir
AU - Randall, Deborah
AU - Newall, Anthony T.
AU - Moore, Hannah C.
AU - Jayasinghe, Sanjay
AU - Fathima, Parveen
AU - Liu, Bette
AU - McIntyre, Peter
AU - Gidding, Heather F.
N1 - Funding Information:
This project was funded by the Population Health Research Network (PHRN), a capability of the Commonwealth Government National Collaborative Research Infrastructure Strategy and Education Investment Fund Super Science Initiative, and a National Health and Medical Research Council (NHMRC) project grant (APP1082342). A. Kabir is supported by a University International Postgraduate Scholarship (UIPA) from UNSW. H. Gidding is supported by an NHMRC Fellowship.
Funding Information:
Authors acknowledge the staff at the Population Health Research Network (PHRN) and participating PHRN data linkage and infrastructure nodes (the Western Australian Data Linkage Branch, the NSW Centre for Health Record Linkage, and the Australian Institute for Health and Welfare), and the WA and Commonwealth Departments of Health and NSW Ministry of Health who provided advice and data from the following collections: inpatient hospitalisations, registries of births, deaths and marriages, midwives/perinatal datasets, disease notification registers, and Australian Childhood Immunisation Register (ACIR). The Authors also acknowledge the people of New South Wales and Western Australia whose data were used for this project. The Aboriginal and Torres Strait Islander community and members of the Aboriginal Immunisation Research Group are acknowledged for their contribution to this research project. AK, DR, ATN, HM, SJ, PM and HG conceptualised and designed the study, and reviewed and revised the manuscript. AK conducted the analysis and drafted the initial manuscript. All authors provided expert advice on the study design, critically reviewed the study results, analysis methods and the initial draft of manuscript. As the final manuscript has not been submitted, all authors have not reviewed the final manuscript. This project was funded by the Population Health Research Network (PHRN), a capability of the Commonwealth Government National Collaborative Research Infrastructure Strategy and Education Investment Fund Super Science Initiative, and a National Health and Medical Research Council (NHMRC) project grant (APP1082342). A. Kabir is supported by a University International Postgraduate Scholarship (UIPA) from UNSW. H. Gidding is supported by an NHMRC Fellowship.
Publisher Copyright:
© 2023
PY - 2023/8/23
Y1 - 2023/8/23
N2 - Background: The impact of pneumococcal conjugate vaccines (PCVs) on pneumonia in children is well-documented but data on 23-valent pneumococcal polysaccharide vaccine (PPV23) are lacking. Between 2001 and 2011, Indigenous children in Western Australia (WA) were recommended to receive PPV23 at 18–24 months of age following 3 doses of 7-valent PCV. We evaluated the incremental effectiveness of PPV23 against pneumonia hospitalisation. Methods: Indigenous children born in WA between 2001 and 2012 who received PCV dose 3 by 12 months of age were followed from 18 to 60 months of age for the first episode of pneumonia hospitalisation (all-cause and 3 subgroups: presumptive pneumococcal, other specified causes, and unspecified). We used Cox regression modelling to estimate hazard ratios (HRs) for pneumonia hospitalisation among children who had, versus had not, received PPV23 between 18 and 30 months of age after adjustment for confounders. Results: 11,120 children had 327 first episodes of all-cause pneumonia hospitalisation, with 15 (4.6%) coded as presumptive pneumococcal, 46 (14.1%) as other specified causes and 266 (81.3%) unspecified. No statistically significant reduction in all-cause pneumonia was seen with PPV23 (HR 1.11; 95% CI: 0.87–1.43), but the direction of the association differed for presumptive pneumococcal (HR 0.47; 95% CI: 0.16–1.35) and specified (HR 0.89; 95% CI: 0.49–1.62) from unspecified causes (HR 1.13; 95% CI: 0.86–1.49). During the baseline period before PPV23 vaccination (12–18 months), all-cause pneumonia risk was higher among PPV23-vaccinated than unvaccinated children (RR: 1.73; 95% CI: 1.30–2.28). Conclusion: In this high-risk population, no statistically significant incremental effect of a PPV23 booster at 18–30 months was observed against hospitalised all-cause pneumonia or the more specific outcome of presumptive pneumococcal pneumonia. Confounding by indication may explain the slight trend towards an increased risk against all-cause pneumonia. Larger studies with better control of confounding are needed to further inform PPV23 vaccination.
AB - Background: The impact of pneumococcal conjugate vaccines (PCVs) on pneumonia in children is well-documented but data on 23-valent pneumococcal polysaccharide vaccine (PPV23) are lacking. Between 2001 and 2011, Indigenous children in Western Australia (WA) were recommended to receive PPV23 at 18–24 months of age following 3 doses of 7-valent PCV. We evaluated the incremental effectiveness of PPV23 against pneumonia hospitalisation. Methods: Indigenous children born in WA between 2001 and 2012 who received PCV dose 3 by 12 months of age were followed from 18 to 60 months of age for the first episode of pneumonia hospitalisation (all-cause and 3 subgroups: presumptive pneumococcal, other specified causes, and unspecified). We used Cox regression modelling to estimate hazard ratios (HRs) for pneumonia hospitalisation among children who had, versus had not, received PPV23 between 18 and 30 months of age after adjustment for confounders. Results: 11,120 children had 327 first episodes of all-cause pneumonia hospitalisation, with 15 (4.6%) coded as presumptive pneumococcal, 46 (14.1%) as other specified causes and 266 (81.3%) unspecified. No statistically significant reduction in all-cause pneumonia was seen with PPV23 (HR 1.11; 95% CI: 0.87–1.43), but the direction of the association differed for presumptive pneumococcal (HR 0.47; 95% CI: 0.16–1.35) and specified (HR 0.89; 95% CI: 0.49–1.62) from unspecified causes (HR 1.13; 95% CI: 0.86–1.49). During the baseline period before PPV23 vaccination (12–18 months), all-cause pneumonia risk was higher among PPV23-vaccinated than unvaccinated children (RR: 1.73; 95% CI: 1.30–2.28). Conclusion: In this high-risk population, no statistically significant incremental effect of a PPV23 booster at 18–30 months was observed against hospitalised all-cause pneumonia or the more specific outcome of presumptive pneumococcal pneumonia. Confounding by indication may explain the slight trend towards an increased risk against all-cause pneumonia. Larger studies with better control of confounding are needed to further inform PPV23 vaccination.
KW - Data linkage
KW - Indigenous
KW - Pneumococcal polysaccharide vaccine
KW - Pneumonia
KW - Vaccine effectiveness
UR - http://www.scopus.com/inward/record.url?scp=85166216843&partnerID=8YFLogxK
U2 - 10.1016/j.vaccine.2023.07.042
DO - 10.1016/j.vaccine.2023.07.042
M3 - Article
C2 - 37507273
AN - SCOPUS:85166216843
SN - 0264-410X
VL - 41
SP - 5454
EP - 5460
JO - Vaccine
JF - Vaccine
IS - 37
ER -
