The Impact of Pneumococcal Vaccination on Bacterial and Viral Pneumonia in Western Australian Children: Record Linkage Cohort Study of 469589 Births, 1996-2012

Parveen Fathima, Christopher C. Blyth, Deborah Lehmann, Faye J. Lim, Tasnim Abdalla, Nicholas De Klerk, Hannah C. Moore

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Abstract

Background. Pneumococcal conjugate vaccine (PCV) was included in Australia s National Immunisation Program for all children from 2005. We assessed the impact of PCV on all-cause and pathogen-specific pneumonia hospitalizations in Western Australian (WA) children aged ?16 years. Methods. All hospitalizations with pneumonia-related International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification diagnosis codes occurring in WA-born children (1996 2012) were linked to pathology records. Age-specific incidence rate ratios and temporal trends for all-cause and pathogen-specific pneumonia hospitalizations were calculated before and after PCV introduction. Results. Among 469 589 births, there were 15 175 pneumonia-related hospitalizations. Hospitalization rates were 6.7 (95% confidence interval, 6.4 6.9) times higher in Aboriginal than in non-Aboriginal children. Following PCV introduction, all-cause pneumonia hospitalizations showed significant declines across all age groups. A pathogen was identified in 2785 of 6693 (41.6%) pneumonia hospitalizations that linked to a pathology record. Respiratory syncytial virus (RSV) was most frequently identified, with RSV-associated pneumonia hospitalization rates of 89.6/100 000 child-years in Aboriginal and 26.6/100 000 child-years in non-Aboriginal children. The most common bacterial pathogen was Streptococcus pneumoniae in Aboriginal children (32.9/100 000 childyears) and Mycoplasma pneumoniae in non-Aboriginal children (8.4/100 000 child-years). Viral pneumonia rates declined in all children following PCV introduction, with the greatest declines seen in non-Aboriginal children; declines in bacterial pneumonia were observed in non-Aboriginal children. Conclusions. Based on our ecological analyses, PCV seems to have had an impact on hospitalizations for pneumonia, suggesting that the pneumococcus is likely to play a role in both bacterial and viral pneumonia. Respiratory viruses remain an important pathogen in childhood pneumonia. Vaccines targeting respiratory viruses are needed to combat the residual burden of childhood pneumonia.

Original languageEnglish
Pages (from-to)1075-1085
Number of pages11
JournalClinical Infectious Diseases
Volume66
Issue number7
DOIs
Publication statusPublished - 19 Mar 2018

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