Abstract
BackgroundPneumonia plays an important role in children’s morbidity and mortality. In Brazil, epidemiological and social changes occurred concomitantly with the universal introduction of the 10-valent pneumococcal conjugate vaccine. This study identified risk factors for pneumonia following the implementation of a pneumococcal vaccination program.MethodsA hospital-based, case-control study involving incident cases of pneumonia in children aged 1–59 months was conducted between October 2010 and September 2013 at a tertiary hospital in northeastern Brazil. The diagnosis of pneumonia was based on the World Health Organization (WHO) criteria. The control group consisted of children admitted to the day-hospital ward for elective surgery. Children with comorbidities were excluded. The risk factors for pneumonia that were investigated were among those classified by the WHO as definite, likely and possible. A multivariate analysis was performed including variables that were significant at p ≤ 0.25 in the bivariate analysis.ResultsThe study evaluated 407 children in the case group and 407 children in the control group. Household crowding (OR = 2.15; 95 % CI, 1,46–3,18) and not having been vaccinated against the influenza virus (OR = 3.59; 95 % CI, 2,62–4.91) were the only factors found to increase the likelihood of pneumonia. Male gender constituted a protective factor (OR = 0.53; 95 % CI, 0,39–0,72).ConclusionChanges on risk factors for pneumonia were most likely associated with the expansion of the vaccination program and social improvements; however, these improvements were insufficient to overcome inequalities, given that household crowding remained a significant risk factor. The protection provided by the influenza vaccine must be evaluated new etiological studies. Furthermore, additional risk factors should be investigated.
Highlights
Pneumonia plays an important role in children’s morbidity and mortality
According to the World Health Organization (WHO) estimates, 156 million new cases of pneumonia occur annually worldwide in children under five, with 95 % of these cases occurring in developing countries [1, 2]
We considered that children who were immunized according to the immunization card received: a) at least one dose if they received the prime vaccination previously and had been immunized with two doses Or b) two doses of the prime vaccination Children under 6 months of age and those over 6 months of age who had not been immunized were classified as unvaccinated
Summary
Pneumonia plays an important role in children’s morbidity and mortality. In Brazil, epidemiological and social changes occurred concomitantly with the universal introduction of the 10-valent pneumococcal conjugate vaccine. This study identified risk factors for pneumonia following the implementation of a pneumococcal vaccination program. Community-acquired pneumonia (CAP) is a major public health issue and a principal cause of morbidity and mortality in children under 5 years of age [1]. CAP has been associated with various child-related and environmental risk factors that contribute to increasing the incidence and/or severity of the disease [3, 4]. A reduction in all-cause of child mortality occurred worldwide between 2000 and 2011, including a reduction in pneumonia-related deaths, in 2011, CAP was estimated to account for more than one million child deaths, 80 % of which occurred in children under 2 years of age [1, 8]
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