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Impact of National Ten-Valent Pneumococcal Conjugate Vaccine Programme on Reducing Antimicrobial Use and Tympanostomy Tube Placements in Finland

Palmu, Arto A. MD, PhD; Rinta-Kokko, Hanna MSc; Nohynek, Hanna MD, PhD; Nuorti, J. Pekka MD, PhD; Jokinen, Jukka PhD
The Pediatric Infectious Disease Journal: Post Acceptance: October 28, 2017
doi: 10.1097/INF.0000000000001810
Vaccine Reports: PDF Only

Background.

Otitis media in young children is associated with major resource use including antimicrobial consumption and tympanostomy tube placements (TTP). We evaluated the impact of ten-valent pneumococcal conjugate vaccine (PCV10) introduction into the Finnish National Vaccination Programme (NVP) against these outcomes in vaccine-eligible children.

Methods.

PCV10-NVP began 09/2010 with a 2+1 schedule; uptake in 2012 was estimated at 92%. The relative and absolute reduction in the NVP-eligible target cohort was compared with a season and age-matched (3-54 months) cohort before NVP introduction. Outpatient antimicrobial purchase data were collected from the Social Insurance Institution register. Data on purchases of antimicrobials recommended for treatment of acute otitis media by the Finnish Current Care Guidelines (amoxicillin with/without enzyme inhibitor, cefuroxime, cefaclor, clarithromycin, azithromycin) were collected but full data on penicillin, and sulfadiazine/trimethoprim were not available. Data on all TTP procedures were obtained from national hospital discharge register and Social Insurance Institution benefits register. Generalized Cox regression was used in the analysis.

Results.

The incidence rates of antimicrobial purchases in the reference and target cohorts were 1.09 and 0.89 per person-year, respectively. The relative rate reduction was 17.5% (95%CI 17.0-18.1) and the absolute rate reduction 0.20 per person-year. The rates of TTP in the reference and target cohorts were 5.41/100 and 4.56/100 person-years, respectively. The relative rate reduction was 14.8% (95%CI 13.1-16.5) and the absolute rate reduction 0.86/100 person-years.

Conclusions.

Use of antimicrobials and tympanostomy tube placements reduced after PCV10 was introduced into a routine vaccination program. This suggests considerable savings in health care resource use.

Reprints: no reprints available

Funding source. THL internal funding.

Financial Disclosure Statement for all authors. This study was publicly funded. All authors are employees of the National Institute for Health and Welfare, which has received research funding from GlaxoSmithKline Vaccines for the conduct of a nationwide effectiveness trial of the 10-valent pneumococcal conjugate vaccine.

Conflict of Interest Statement for all authors. National Institute for Health and Welfare has received research funding from GlaxoSmithKline Vaccines for the conduct of a nationwide effectiveness trial of the 10-valent pneumococcal conjugate vaccine. Arto A. Palmu, Hanna Rinta-Kokko and Jukka Jokinen are co-investigators in these studies. The other authors have no conflicts to disclose. Current study was entirely publicly funded.

Corresponding author: Arto A. Palmu, MD, PhD, National Institute for Health and Welfare (THL), Finn-Medi I, Biokatu 6, 33520 Tampere, Finland. Tel. +358 29 524 7910, arto.palmu@thl.fi, Fax. +358 32532 390

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