Abstract
BackgroundIn late 2007, some Swedish County Councils started 7-valent pneumococcal conjugate vaccine (PCV7) implementation for children, and PCV7 was included in the national immunization program in 2009. By 2010, both PCV10 and PCV13 were licensed, and the selection of vaccine was subject to County Councils tenders. This study investigated the impact of the order of PCV introduction into vaccination programs on the incidence of all-cause pneumonia hospitalizations in children <2 years-old.MethodsUsing population-based data from the publicly available National Inpatient Registry, the incidence of inpatient pneumonia (ICD-10 J12-J18) hospitalizations by County Councils among children <2 years old was identified between 1998 and 2012. Incidence rate ratios (IRR; 95% CI) were calculated during the nationwide implementation of PCV7 and then between County Councils, as based on the higher-valent vaccine chosen for a program.ResultsThere was a lower risk of all-cause pneumonia hospitalization among <2 year-old children following the introduction of PCV7, as compared to the pre-PCV7 period (0.77; 0.63–0.93). A decreased risk of all-cause pneumonia was also observed in the County Councils that followed the order PCV7 then PCV13 (0.82; 0.66–1.01), while no trend was observed in County Councils with a program in the order PCV7 then PCV10 (1.03; 0.82–1.30). When comparing the higher-valent vaccines, there was a 21% (0.79; 0.66–0.96) lower risk for childhood pneumonia hospitalization in County Councils finally using PCV13 as compared to the experience in County Councils that ultimately adopted PCV10.ConclusionsAmong children <2 years-old, all-cause pneumonia hospitalizations were significantly reduced by 23% one to two years after introduction of PCV7 vaccination in Sweden. In those County Councils that next introduced PCV13, a further decline in all-cause pneumonia hospitalization was observed, in contrast to those County Councils that followed with PCV10; this 21% lower risk for childhood pneumonia hospitalization was statistically significant.
Highlights
All-cause pneumonia remains a common cause of hospitalizations among infants throughout the world [1,2,3]
In 2010, both PCV10 and PCV13 were registered with a 3-dose schedule, and the selection of a highervalent PCV was subject to County Council tenders that resulted in different choices between County Councils
In 2012, 15 of 21 County Councils were vaccinating with PCV10 and 6 of 21 with PCV13
Summary
All-cause pneumonia remains a common cause of hospitalizations among infants throughout the world [1,2,3]. In Sweden, PCV7 was included in the NIP for infants in 2009, some County Councils already began implementation of PCV7 in late 2007. The aim of the present study was to evaluate the impact of diverse PCV programs (i.e., pre-PV7 to PCV7, either PCV7 to PCV10 or PCV7 to PCV13) on the rate of hospitalization due to all-cause pneumonia in children ,2 years of age in Sweden. In late 2007, some Swedish County Councils started 7-valent pneumococcal conjugate vaccine (PCV7) implementation for children, and PCV7 was included in the national immunization program in 2009. By 2010, both PCV10 and PCV13 were licensed, and the selection of vaccine was subject to County Councils tenders. This study investigated the impact of the order of PCV introduction into vaccination programs on the incidence of all-cause pneumonia hospitalizations in children ,2 years-old
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