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Benefit of Conjugate Pneumococcal Vaccination in Preventing Influenza Hospitalization in Children: A Case-control Study

Domínguez, Angela MD, PhD*†; Castilla, Jesús MD, PhD†‡; Godoy, Pere MD, PhD†§; Delgado-Rodríguez, Miguel MD, PhD†¶; Saez, Marc BSc, PhD†‖; Soldevila, Núria BSc; Astray, Jenaro MD, MSc**; María Mayoral, José MD, PhD††; Martín, Vicente MD, PhD† ‡‡; María Quintana, José MD, PhD† §§; González-Candelas, Fernando BSc, PhD† ¶¶; Galán, Juan Carlos BSc, PhD† ‖‖; Tamames, Sonia MD, PhD***; Acosta, Ady Castro MD†††; Baricot, Maretva BSc, PhD; Garín, Olatz MPH† ‡‡‡; José García, Juan MD, PhD§§§; Moraga, Fernando MD¶¶¶; Pumarola, Tomás MD, PhD‖‖‖for the CIBERESP Cases and Controls in Pandemic Influenza Working Group, Spain

The Pediatric Infectious Disease Journal: April 2013 - Volume 32 - Issue 4 - p 330–334
doi: 10.1097/INF.0b013e318280a34b
Original Studies

Background: The pneumococcal conjugate vaccine (PCV) might prevent hospitalizations in children because of the role of Streptococcus pneumoniae in the complications of influenza infection. We investigated the benefit of PCV vaccination in preventing influenza hospitalization in children <5 years of age during the 2009 to 2010 pandemic wave and the 2010 to 2011 influenza epidemic in Spain.

Methods: A multicenter matched case-control study was undertaken in 27 hospitals from 7 Spanish regions between July 2009 and April 2011. A case was defined as a hospitalized patient between 6 months and 5 years of age with influenza virus infection confirmed by real-time reverse-transcription polymerase chain reaction. We selected 2 matched controls for each case from patients with unplanned hospital admission for reasons other than acute respiratory infection or influenza-like illness. Cases and controls were matched according to age, date of hospitalization and province of residence. Crude and adjusted odds ratios were calculated for associations between influenza hospitalization and PCV vaccination.

Results: One hundred ninety-four cases and 342 controls were included in the study. In the 2009 to 2010 pandemic wave, the adjusted benefit in preventing hospitalization was 48% (95% confidence interval: 1 to 76) in fully vaccinated children compared with –79% (95% confidence interval: –341 to 27) in the 2010 to 2011 influenza season.

Conclusions: The results obtained suggest that, in children <5 years of age, PCV vaccination reduced hospitalization during the 2009 to 2010 pandemic wave. By contrast, there was no observed benefit of vaccination in the 2010 to 2011 influenza season.

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From the *Department de Salut Pública, Universitat de Barcelona, Barcelona; CIBER Epidemiología y Salud Pública, Madrid; Instituto de Salud Pública de Navarra, Pamplona; §Department de Salut, Generalitat de Catalunya, Barcelona; Universidad de Jaen, Jaen; GRECS, Universitat de Girona, Girona; **Área de Epidemiología, Comunidad de Madrid, Madrid; ††Servicio de Vigilancia de Andalucia; ‡‡Instituto de Biomedicina, Universidad de Leon, León; §§Unidad de Investigación, Hospital Galdakao-Usansolo, San Sebastian; ¶¶Centro Superior de Investigación en Salud Pública, Universidad de Valencia; ‖‖Hospital Universitario Ramón y Cajal, Madrid; ***Dirección General de Salud Pública e Investigación, Desarrollo e Innovación, Junta de Castilla y León; †††CIBER Enfermedades Respiratorias; ‡‡‡Institut Municipal d’ Investigació Mèdica, Barcelona; §§§Hospital Universitari San Joan de Déu, Esplugues; ¶¶¶Hospital Universitari Vall d’ Hebrón; and ‖‖‖Red Española de Investigación en Patología Infecciosa, Spain.

This study was supported by the Ministry of Science and Innovation, Institute of Health Carlos III, Programme of Research on Influenza A/H1N1 (Grant GR09/0030) and the Catalan Agency for the Management of Grants for University Research (AGAUR Grant number 2009/ SGR 42). The funders had no role in the study design, data collection, analysis, the decision to publish or the preparation of the article. The authors have no other funding or conflicts of interest to disclose.

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Address for correspondence: Angela Domínguez, MD, PhD, Departament de Salut Pública, Universitat de Barcelona, c/ Casanova 143, 08036 Barcelona, Spain. E-mail:

© 2013 Lippincott Williams & Wilkins, Inc.