Direct and indirect impact of 10-valent pneumococcal conjugate vaccine introduction on pneumonia hospitalizations and economic burden in all age-groups in Brazil: A time-series analysis.
<h4>Background</h4>Ten-valent pneumococcal conjugate vaccine (PCV10) was introduced in the National Immunization Program of Brazil in March/2010. Although there are recent reports of PCV10 impact on pneumonia hospitalizations, there is still uncertainty regarding the indirect impact in i...
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Public Library of Science (PLoS)
2017-01-01
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| Series: | PLoS ONE |
| Online Access: | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0184204&type=printable |
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| author | Ana Lucia Andrade Eliane T Afonso Ruth Minamisava Ana Luiza Bierrenbach Elier B Cristo Otaliba L Morais-Neto Gabriela M Policena Carla M A S Domingues Cristiana M Toscano |
| author_facet | Ana Lucia Andrade Eliane T Afonso Ruth Minamisava Ana Luiza Bierrenbach Elier B Cristo Otaliba L Morais-Neto Gabriela M Policena Carla M A S Domingues Cristiana M Toscano |
| author_sort | Ana Lucia Andrade |
| collection | DOAJ |
| description | <h4>Background</h4>Ten-valent pneumococcal conjugate vaccine (PCV10) was introduced in the National Immunization Program of Brazil in March/2010. Although there are recent reports of PCV10 impact on pneumonia hospitalizations, there is still uncertainty regarding the indirect impact in individuals non-targeted by vaccination. We assessed both direct and indirect effect of PCV10 on pneumonia hospitalizations and the impact on the economic burden of pneumonia hospitalizations.<h4>Methods</h4>An interrupted time-series analysis was conducted considering monthly rates of pneumonia hospitalizations and comparison groups, in all age-groups, from January/2005-December/2015. We used records of the National Hospitalizations Information System. Observed pneumonia rates in the post-vaccination period (2011–2015) were compared to predicted rates, should PCV10 had not been introduced. Relative percent difference in rates and its 95% confidence interval were estimated. The number of pneumonia hospitalizations averted by vaccination was calculated as the difference between the predicted and observed cumulative number of pneumonia hospitalizations in the post-vaccination period. The impact of PCV10 on economic burden was presented as averted costs of pneumonia hospitalization.<h4>Results</h4>Significant decrease in rates of pneumonia hospitalization was observed in both children targeted by vaccination (17.4%–26.5%; p<0.01), and in age-groups not targeted by vaccination (11.1%–27.1%, in individuals 10–49 years; p<0.01). In contrast, PCV10 introduction did not alter the increasing trends in pneumonia hospitalization among elderly ≥65 years. A total of 457,564 pneumonia hospitalizations was averted in Brazil for individuals aged <50 years, with a total averted costs of BRL 383.2 million (Int$ 225.2 million, and USD 147 million) for the 5 year period after PCV introduction.<h4>Conclusion</h4>Vaccination with PCV10 5 years after its introduction in Brazil was associated with a relevant reduction in pneumonia hospitalization in the target age-groups, with an indirect effect in individuals aged 10–49 years, and significant reduction in associated economic burden. The increasing trends in pneumonia hospitalization rates in the elderly is a matter of concern for public health and should be further investigated. |
| format | Article |
| id | doaj-art-d42ff7dc3926444cbc7bb1a8cddb3395 |
| institution | DOAJ |
| issn | 1932-6203 |
| language | English |
| publishDate | 2017-01-01 |
| publisher | Public Library of Science (PLoS) |
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| spelling | doaj-art-d42ff7dc3926444cbc7bb1a8cddb33952025-08-20T02:45:57ZengPublic Library of Science (PLoS)PLoS ONE1932-62032017-01-01129e018420410.1371/journal.pone.0184204Direct and indirect impact of 10-valent pneumococcal conjugate vaccine introduction on pneumonia hospitalizations and economic burden in all age-groups in Brazil: A time-series analysis.Ana Lucia AndradeEliane T AfonsoRuth MinamisavaAna Luiza BierrenbachElier B CristoOtaliba L Morais-NetoGabriela M PolicenaCarla M A S DominguesCristiana M Toscano<h4>Background</h4>Ten-valent pneumococcal conjugate vaccine (PCV10) was introduced in the National Immunization Program of Brazil in March/2010. Although there are recent reports of PCV10 impact on pneumonia hospitalizations, there is still uncertainty regarding the indirect impact in individuals non-targeted by vaccination. We assessed both direct and indirect effect of PCV10 on pneumonia hospitalizations and the impact on the economic burden of pneumonia hospitalizations.<h4>Methods</h4>An interrupted time-series analysis was conducted considering monthly rates of pneumonia hospitalizations and comparison groups, in all age-groups, from January/2005-December/2015. We used records of the National Hospitalizations Information System. Observed pneumonia rates in the post-vaccination period (2011–2015) were compared to predicted rates, should PCV10 had not been introduced. Relative percent difference in rates and its 95% confidence interval were estimated. The number of pneumonia hospitalizations averted by vaccination was calculated as the difference between the predicted and observed cumulative number of pneumonia hospitalizations in the post-vaccination period. The impact of PCV10 on economic burden was presented as averted costs of pneumonia hospitalization.<h4>Results</h4>Significant decrease in rates of pneumonia hospitalization was observed in both children targeted by vaccination (17.4%–26.5%; p<0.01), and in age-groups not targeted by vaccination (11.1%–27.1%, in individuals 10–49 years; p<0.01). In contrast, PCV10 introduction did not alter the increasing trends in pneumonia hospitalization among elderly ≥65 years. A total of 457,564 pneumonia hospitalizations was averted in Brazil for individuals aged <50 years, with a total averted costs of BRL 383.2 million (Int$ 225.2 million, and USD 147 million) for the 5 year period after PCV introduction.<h4>Conclusion</h4>Vaccination with PCV10 5 years after its introduction in Brazil was associated with a relevant reduction in pneumonia hospitalization in the target age-groups, with an indirect effect in individuals aged 10–49 years, and significant reduction in associated economic burden. The increasing trends in pneumonia hospitalization rates in the elderly is a matter of concern for public health and should be further investigated.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0184204&type=printable |
| spellingShingle | Ana Lucia Andrade Eliane T Afonso Ruth Minamisava Ana Luiza Bierrenbach Elier B Cristo Otaliba L Morais-Neto Gabriela M Policena Carla M A S Domingues Cristiana M Toscano Direct and indirect impact of 10-valent pneumococcal conjugate vaccine introduction on pneumonia hospitalizations and economic burden in all age-groups in Brazil: A time-series analysis. PLoS ONE |
| title | Direct and indirect impact of 10-valent pneumococcal conjugate vaccine introduction on pneumonia hospitalizations and economic burden in all age-groups in Brazil: A time-series analysis. |
| title_full | Direct and indirect impact of 10-valent pneumococcal conjugate vaccine introduction on pneumonia hospitalizations and economic burden in all age-groups in Brazil: A time-series analysis. |
| title_fullStr | Direct and indirect impact of 10-valent pneumococcal conjugate vaccine introduction on pneumonia hospitalizations and economic burden in all age-groups in Brazil: A time-series analysis. |
| title_full_unstemmed | Direct and indirect impact of 10-valent pneumococcal conjugate vaccine introduction on pneumonia hospitalizations and economic burden in all age-groups in Brazil: A time-series analysis. |
| title_short | Direct and indirect impact of 10-valent pneumococcal conjugate vaccine introduction on pneumonia hospitalizations and economic burden in all age-groups in Brazil: A time-series analysis. |
| title_sort | direct and indirect impact of 10 valent pneumococcal conjugate vaccine introduction on pneumonia hospitalizations and economic burden in all age groups in brazil a time series analysis |
| url | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0184204&type=printable |
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