Abstract
BackgroundThe objective of this study is to evaluate rates of all-cause pneumonia among “at-risk” and “high-risk” children and adults in Germany—in comparison with age-stratified healthy counterparts—during the period following the 2006 recommendation for universal immunization of infants with pneumococcal conjugate vaccine.MethodsRetrospective cohort design and healthcare claims information for 3.4 M persons in Germany (2009–2012) were employed. Study population was stratified by age and risk profile (healthy, “at-risk” [with chronic medical conditions], and “high-risk” [immunocompromised]). At-risk and high-risk conditions, as well as episodes of all-cause pneumonia, were identified via diagnosis, procedure, and drug codes.Results and discussionRates of all-cause pneumonia were 1.7 (95 % CI 1.7-1.8) to 2.5 (2.4-2.5) times higher among children and adults with at-risk conditions versus healthy counterparts, and 1.8 (1.8-1.9) to 4.1 (4.0-4.2) times higher among children and adults with high-risk conditions. Rates of all-cause pneumonia among at-risk persons increased in a graded and monotonic fashion with increasing numbers of conditions (i.e., risk stacking).ConclusionsAn increased risk for all-cause pneumonia in German children and adults with a spectrum of medical conditions persists in the era of widespread pneumococcal vaccination, and pneumonia risk in persons with ≥2 at-risk conditions is comparable or higher than those with high-risk conditions.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-015-1162-y) contains supplementary material, which is available to authorized users.
Highlights
The objective of this study is to evaluate rates of all-cause pneumonia among “at-risk” and “high-risk” children and adults in Germany—in comparison with age-stratified healthy counterparts—during the period following the 2006 recommendation for universal immunization of infants with pneumococcal conjugate vaccine
An increased risk for all-cause pneumonia in German children and adults with a spectrum of medical conditions persists in the era of widespread pneumococcal vaccination, and pneumonia risk in persons with ≥2 at-risk conditions is comparable or higher than those with high-risk conditions
Ewig and colleagues observed that the incidence of Community-acquired pneumonia (CAP) increased with advancing age, and that overall inhospital mortality of CAP patients was 14 %, with the highest mortality in persons with comorbid conditions; among persons with malignancies, dementia, and pulmonary diseases, mortality was more than two-fold
Summary
The objective of this study is to evaluate rates of all-cause pneumonia among “at-risk” and “high-risk” children and adults in Germany—in comparison with age-stratified healthy counterparts—during the period following the 2006 recommendation for universal immunization of infants with pneumococcal conjugate vaccine. While it is widely recognized that persons with immunocompromising conditions, as well as those with certain chronic illnesses, were at increased risk of pneumococcal disease prior to the widespread introduction of seven-valent pneumococcal conjugate vaccine (PCV7) in the US and western Europe, recent assessments of disease risk in populations following mass vaccination of children with PCVs are limited. Further confirmation from additional populations as to the magnitude of the increased risk of pneumococcal disease associated with certain chronic medical conditions following introduction of pneumococcal conjugate vaccines would be valuable for developing future vaccine policies for the prevention of pneumonia
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