Abstract
The impact of the 13-valent pneumococcal conjugate vaccine (PCV13) on overall community-acquired pneumonia (CAP) and disease severity still needs thorough evaluation. In this study, we retrieve both pneumococcal CAP (P-CAP) and unspecific CAP (U-CAP) inpatient data from the Taiwan National Health Insurance Database (NHID) between 2005 and 2016. The interrupted time-series (ITS) analysis was performed to compare the incidence trend before and after the implementation of PCV13. After PCV13 implementation, there is a significant decreasing trend of P-CAP hospitalization, especially in children <1 year, 2–5 years, adults aged 19–65 years, 66 years, or older (all p value < 0.05). This corresponds to a 59% reduction in children <1 year, 47% in children aged 2–5 years, 39% in adult aged 19–65 years, and 41% in elderly aged 66 years or older. The intensive care rate (6.8% to 3.9%), severe pneumonia cases (21.7 to 14.5 episodes per 100,000 children–years), and the need for invasive procedures (4.3% to 2.0%) decreased in children aged 2–5 years (p value < 0.0001) with P-CAP. This PCV13 implementation program in Taiwan not only reduced the incidence of P-CAP, but also attenuated disease severity, especially in children aged 2–5 years.
Highlights
Pneumonia is the single largest infectious cause of death among all age populations worldwide
The P-community-acquired pneumonia (CAP) and unspecific CAP (U-CAP) yearly hospitalization rate among all ages is shown in Supplementary Table S2 and Figure 2
For pneumococcal CAP (P-CAP), the hospitalization rate was highest among children aged 1 year (101.9–254.0 admissions per 100,000 person–years) and 2–5 years (109.3–232.9 admissions per 100,000 person–years), followed by children aged under 1 year (79.5–144.8 admission per 100,000 person–years) during the study period
Summary
Pneumonia is the single largest infectious cause of death among all age populations worldwide. The 7-valent pneumococcal conjugate vaccine (PCV7), introduced in 2002, has dramatically decreased invasive pneumococcal disease (IPD), which most commonly manifests with occult bacteremia, bacteremic pneumonia, and meningitis [3]. The 13-valent pneumococcal conjugate vaccine (PCV13) later replaced PCV7 with six additional serotypes and especially includes serotype 19A, which is notorious for its antimicrobial resistance and pulmonary invasion in the post-PCV7 era. The PCV13 effectively eliminated the residual IPD caused by nonPCV7 serotypes, mainly 19A thereafter [4]. These conjugate pneumococcal vaccines decrease invasive disease, and decrease nasopharyngeal pneumococcal carriage in vaccinated children, thereby causing less mucosal infection such as sinusitis, or otitis media [5]. In contrast to the evidence supporting the impact of the conjugate pneumococcal vaccine on IPD, its influence on non-invasive pneumococcal disease, especially overall
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