Studies assessing the effectiveness of routine use vaccination with pneumococcal conjugate vaccines on pneumonia prevention
Country
Schedule Observation Data source
period
Case
detection
Canada1
3+1
1989-2001
ICD-9
Australia2
3+0
1998--2007
US3
3+1
US4
3+1
US5
3+1
1997-2004
US6
3+1
ICD-9-CM
US7
3+1
1997-1999 vs National Inpatient Sample
2001-2004
database
1998-2004
Group Health (Washington
state) database
Australia8
3+PPS
ICD-9, ICD-10
AM
Australia9
3+PPS
1996-2000
Western Australia Data
vs 2001-2005 Linkage System, indigenous
population
1998-2005
Historical indigenous cohort
Italy10
2+1
US11
3+1
Med-Echo administrative
database
Australian Institute of Health
ICD-10-AM
and Welfare National Hospital
Morbidity Database
1994-2003
National Ambulatory Medical ICD-9-CM
Care Survey, National Hospital
Ambulatory Medical Care
Survey
1996-1999 vs Nationwide Inpatient Sample ICD-9-CM
2001-2007
and Census
Market Scan Database
2000-2002 vs Regional database
2003-2005
1997 vs 2006 Kids’ Inpatient Database
ICD-9
% reduction in pneumonia outcome [95% CI]
All cause pneumonia (age in years)
Pneumococcal pneumonia (age in years)
Ambulatory visits Hospital
Radiological
Complicated
Ambulatory Hospital
Radiological
discharges
pneumonia
pneumonia
visits
discharges
pneumonia
Empyema: No trend
13·2% (<5)
72·3 (<5) (Lobar)
observed
(0·8/100,000
population <5)
38% [36-40](<2)
28% [21-34] (2-4)
31% [-23-85]†
(<2)
33% (<2)
+0·5% (2-4)
41·1% [40-42]
(<2)
ICD-9-CM
61%[(<2)
26% (2-4)
46·9% [35- 57·6% [41-75]
58] (<2)
(<2)
65% [47-77] (<2)
73% [53-85](2-4)
52·4% [48-53]
(<2)
39% [22-52] (<2)
17% [-3-34] (2-4)
ICD-9-CM
Retrospective
CXR review
ICD-9-CM
Empyema: +100%
3·5 to 7·0 per
100,000 population
(<2). +180% 3·7 to
10·3 per 100,000 (24)
Inpatient
40% [-4- 65] (<1)
Outpatient
36% [5-42](<1)
No change (1-4)**
34% (1-2)
44% (2-6)
24% [-9-47] (>518m)
15·2% [2·8-26·1]
(<2)
29% (<2) ║
70·5 [9·7-90·4]
(<2)
Empyema
+100% (3·8 to 7·6
per 100,000
1
population, <5)
+131% (3·1 to 8·1
per 100,000
population, 2-4)
US12
3+1
1996-1999 vs Health Care Utilization Project ICD-9
2005-2006
State Inpatient Database
28% [27-30] (<2)
1% [-1-4] (2-4)
US13
3+1
1997 vs 2006 Kids’ Inpatient Database
ICD-9-CM
21·9% (<1)
+1·9 (1-5)
US14
3+1
ICD-9-CM
35% (<2)
0% [-1-1](2-4)
US15
3+1
UK16
2+1
1997-1999 vs National Inpatient Sample
2005-2006
database
1994-2007
National Ambulatory, National
Hospital Ambulatory Medical
Care Survey
1997-2006 vs Hospital Episodes Statistics
2007-2008
database
Poland17
2+1
Uruguay18
2+1
2004-2008
ICD-9-CM
ICD-10
Polyclinic children hospital
ICD-10
database/ National Heath
Fund
2005-2007 vs Reports of Disease of
not stated
2009
Mandatory Reporting (Ministry
of Public Health), HP-CHRP
database, HP-CHRP
Microbiology Laboratories
Database
47% [38-54] (<2)*
12 [-2-24](2-4)
Any 25·5% (54·9 to
40·9 per 100,000
population, <1)
+31·5 (19·7 to 25·9
per 100,000
population, 1-5)
Local + 67·2% (6·7
to 11·2 per 100,000
population, <1)
+79·3% (9·2 to 16·5
per 100,000
population, 1-5)
Systemic 35·5%
(49·0 to 31·6 per
100,000 population,
<1).
No change (1-5)
No change (1-5)
p=0·96
19 %(<15)║
Empyema
22% (18 to 14 per
million population,
<15)
65% (<2)
23% (2-5)
56% (<14)
Empyema
35% (106 to 69 per
10,000 discharges,
<2)
40% (237 to 143 per
10,000 discharges,
2-4)
51% (<14)
2
39·2% (111 to 67·6
per 10,000
discharges, <14)
Prospective post-licensure studies
Italy19
2+1
2001-2002
Germany20
3+1
2001-2002
(first dose)
follow-up for
1 year postbooster
Prospective cohort trial
Interview of
caregivers
and
pediatricians
Physicians
diagnosis
65% [47-78] (6-30
months)
Non-randomised controlled
Clinically diagnosed pneumonia 6·3% [-15·9 – 23·7]
vaccine trial:
Clinical pneumonia controlling for risk factors 24·8% [0·9-43·1]
Children with underlying
Clinical pneumonia in children with at least 1 risk factor: 38·4% [10·7-55·9]
medical conditions
Clinical pneumonia in children without risk factor: 10·9% [-20·2-33·9]
preferentially included in PCV7
group
IP = inpatient, OP = outpatient, ER = emergency department, Dx – diagnosis, VE = vaccine efficacy, RR= respiratory rate *non-bacteraemic pneumococcal pneumonia, ** results for 2001-2002 vs 2003-2004
comparison. No significant differences noted for 1998-199 vs 2003-204 comparisons. † pneumococcal and non-specific pneumonia, PPS = pneumococcal polysaccharide vaccine, ║bacterial pneumonia
3
References
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Pneumonia after implementation of the pneumococcal conjugate vaccine program
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2.
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3.
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9.
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