Changes in Hospitalizations for Pneumonia After Universal Vaccination With Pneumococcal Conjugate Vaccines 7/13 Valent and Haemophilus influenzae Type b Conjugate Vaccine in a Pediatric Referral Hospital in Uruguay

Pírez, María Catalina MD*; Algorta, Gabriela MD*; Chamorro, Flavia MD*; Romero, Claudia MD*; Varela, Adriana MD; Cedres, Alejandra MD*; Giachetto, Gustavo MD*; Montano, Alicia MD*

Pediatric Infectious Disease Journal: July 2014 - Volume 33 - Issue 7 - p 753–759
doi: 10.1097/INF.0000000000000294
Vaccine Reports

Background: In 1994, Uruguay included Haemophilus influenzae b (Hib) conjugated vaccine in a 3 + 1 schedule. In March 2008, 7-valent pneumococcal conjugate vaccines (PCV7) was included in a 2 +1 schedule. In 2010, 13-valent PCV replaced PCV7. Catch-up immunization was offered. The aim of this study was to describe the etiology of community-acquired pneumonia (CAP) in children 0–14 years of age hospitalized at the Hospital Pediatrico-Centro Hospitalario Pereira Rossell between 2003 and 2012.

Methods: Annual hospitalization rates (per 10,000 discharges) for CAP and bacterial-confirmed CAP in children 0–14 years of age was described prior PCV7 vaccination (2003–2007), during the year of implementation of PCV7 (2008) and after the introduction of PCV7 (2009–2012). Data regarding age, strains isolated from pleural fluid and/or blood, vaccination status, pneumococcal and H. influenzae serotypes were obtained from Hospital Pediatrico-Centro Hospitalario Pereira Rossell databases and vaccination records.

Results: Hospitalization rates for CAP and pneumococcal CAP between prevaccine years and the last year after introduction of vaccination with PCV (2012) significantly decreased by 78.1% and 92.4%, respectively. Significant reduction for 13-valent PCV vaccine serotypes and significant increase for nonvaccine serotypes was observed. A decrease in Staphylococcus aureus pneumonia was observed. Hospitalization rates for H. influenzae CAP remain stable before and after pneumococcal vaccination.

Conclusions: Three years after PCV7/13 introduction into the routine vaccination schedule, there was a rapid and significant reduction in rates of CAP and P-CAP. An increase of etiology of CAP by other agents was not observed.

From the *Facultad de Medicina, Universidad de la República; and Laboratorio de Microbiología, Hospital Pediátrico, Centro Hospitalario Pereira Rossell, Montevideo, Uruguay.

Accepted for publication January 21, 2014.

M.C.P. has received travel or honorarium support for participation in external expert committees or advisory boards for Merck Sharp & Dohme, Sanofi Pasteur, Pfizer, GlaxoSmithKline, Novartis and Instituto Sabin, has received honorarium support for consulting for Amsud Pasteur Foundation/Banco interamericano de Desarrollo and has received speaker honoraria for presentations for Pfizer. G.A. has received travel or honorarium support for participation in external expert committees or advisory boards for Pfizer and Sanofi Pasteur. A.V. has received travel or honorarium support for participation in external expert committees or advisory boards for Pfizer and Pan American Health Organization. G.G. has received funding from Pfizer to conduct clinical investigation unrelated to this study and has received travel or honorarium support for participation in external expert committees for Pfizer, Merck Sharp & Dohme and Pan American Health Organization. A.M. has received travel or honorarium support for participation in external expert committees for Pfizer and has received honorarium support for consulting for Amsud Pasteur Foundation/Banco Interamericano de Desarrollo. The authors have no other funding or conflicts of interest to disclose.

Address for correspondence: María Catalina Pírez, MD, Centro Hospitalario Pereira Rossell, Boulevard Artigas 1550, Montevideo 11600, Uruguay. E-mail: mcpirez@yahoo.com.

© 2014 by Lippincott Williams & Wilkins, Inc.