High Immunization Rates Research Articles

High Immunization Rate is Critical to Future Course of COVID-19 Pandemic, Computer Demonstrating Shows

The Mayo Clinic information researchers who developed profoundly exact computer displaying to anticipate patterns for COVID-19 cases cross country have new research that shows how significant a high pace of vaccination is to reduce case numbers and controlling the pandemic.

1419. National ambulatory health resource utilization and geographic disparities of influenza in the United States, 2009 to 2016

BackgroundInfluenza can affect up to 10% of adults and 30% of children and, in specific populations, can lead to severe illness and death. Although epidemiological surveillance on influenza patterns have been expanded since 2009, it is also imperative to observe specific trends for influenza immunization and treatment to inform and potentially prevent future outbreaks. The primary objective of this study was to describe influenza prevalence, immunization, and treatment among outpatients in the United States (US).MethodsThis was a cross-sectional study using the Centers for Disease Control and Prevention’s National Ambulatory and Hospital Ambulatory Medical Care Surveys from 2009 to 2016. All patient visits were eligible for inclusion, and prevalence rates were described as influenza visits per 1,000 patient visits. Patient visits were categorized by year, month, and US geographic region. Influenza vaccinations and treatments were defined by their respective Multum code(s) and diagnosis was identified using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) and ICD-10 codes for the appropriate survey years. Data were presented descriptively.ResultsOver 7 billion visits were included for analysis. Overall, influenza rates varied over the study period with the highest rate in 2009 (5.0) and lowest in 2015 (0.9). Immunization rates were highest in 2014 (25.4) and lowest in 2016 (12.5). The South had the highest influenza rates (3.6) and proportion of influenza visits that included treatment (45.6%), as well as the lowest immunization rates (17.6). The Northeast had the lowest influenza rate (1.5), while the West had the lowest proportion of influenza treatment (24.9%) and highest immunization rates (23.4). December and February had the highest rates of influenza (5.2 and 5.7, respectively), while rates of immunization were the highest in September and October (48.9 and 71.7, respectively).ConclusionImmunization rates were highest in the fall months and influenza rates were highest in the winter months. Overall, this study found that regions with lower influenza vaccination had higher influenza rates, and vice versa. Future campaigns should promote immunizations against the influenza virus particularly in underserved regions (e.g., South).Disclosures All Authors: No reported disclosures

Abstract PO-195: Factors affecting disparities in delivery of preventive services to cancer survivors

Abstract Background: Current guidelines promulgate annual influenza immunization and pneumococcal vaccination in cancer patients. Cancer disparities in preventive services affected by multiple socioeconomic and behavioral factors have not been studied systematically. The goal of this study was to identify potential disparities in influenza and pneumonia vaccinations and to analyze association of socioeconomic factors and health behaviors in delivery of immunization preventive services in adult cancer survivors. Methods: Data from the National Health Interview Survey (NHIS) from 2010 to 2018 were used to analyze vaccination status among adult cancer survivors. After pooling the data with proportionally adjusted weights, SAS procedures PROC SURVEYFREQ and PROC SURVEYLOGISTIC were performed to adjust for hierarchical sampling. Chi-square tests were applied to determine whether differences in vaccination prevalence stratified by patient characteristics were statistically significant. Multiple logistic regression was used to estimate the association between predictors (racial/ethnic groups, gender, education, income, body mass index (BMI), marital, smoking and drinking status) and immunization services. Results: Overall, 16,450 (63.4%) and 14,489 (54.1%) cancer survivors reported having a flu shot and pneumonia immunization, respectively, with over 90% of them being non-Hispanic. Also, 90.2% of cancer patients with flu shots and 91.1% with pneumococcal vaccination were White. The lowest influenza vaccination rate was found in cancer patients with low socioeconomic status (less than 12 years of education: 9.4%, total income below the poverty threshold of the year: 6.7%, single people: 5.8%). Lower immunization rates were associated with poor health behaviors. Results further indicated that racial/ethnic, as well as socioeconomic status disparities in flu and pneumonia immunization, were maximal at the aggregate level: Non-Hispanic cancer patients had higher immunization rates than Hispanic patients. Immunization rates in Asians and Whites were much higher than in Blacks and other races. Additionally, gender disparity in immunization was found with women having significantly lower immunization rates. After adjusting for covariates, logistic regression demonstrated that Hispanic cancer patients had 0.66 and 0.54 times the probability of having flu and pneumonia immunization as compared to non-Hispanic patients, respectively. Comparing to Whites, Odds Ratio of having flu shot for Blacks was 0.73 (0.64-0.83, p<0.0001) Conclusions: Our analysis demonstrated significantly higher odds of receiving flu and pneumonia vaccination by non-Hispanic cancer patients as compared with Hispanic cancer patients. People with higher socioeconomic status were more likely to receive preventive services than those with low socioeconomic status. Significant disparity existed in immunization of Blacks as compared to White and Asians. Citation Format: Xingyue Huo, Joseph Finkelstein. Factors affecting disparities in delivery of preventive services to cancer survivors [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-195.

ImmunizziAMO: A School-Based Field Trial to Teach New Generations the Importance of Vaccination through Games and to Fight Vaccine Hesitancy in Italy.

Background: Vaccines simulate the first contact with infectious agents and evoke the immunological response without causing the disease and its complications. High rates of immunization among the population guarantee the interruption of the transmission chain of infectious diseases. Therefore, the population should be aware of the value of vaccination and motivated. In order to implement the spread of a correct culture about these issues, schools were recognized as a privileged operational setting. The aim of this project was to transmit knowledge and convey educational messages on the importance of vaccines, through the use of games, in elementary school children, their families and teachers. Materials and Methods: A field trial study was implemented between April and October 2019. Sample size calculations highlighted the need to recruit at least 136 students in the schools. The intervention involved 10 classes (five first grade and five s grade classes) and was structured in frontal teaching sessions and gaming sessions. Knowledge was assessed comparing the results of a questionnaire administered before and after the intervention. The questionnaires referred to the following items: dangerousness of bacteria and viruses; capability of defending from microorganisms; the role of antibodies; functioning of the vaccine in a child; type of disease for which a vaccine is efficacious; duration of a vaccine; mother- child transmission of antibodies; herd immunity. Results: 143 children participated in all the phases of the study. The comparison between the scores at the beginning and end of the intervention showed a significant increase in the knowledge about vaccines and immunity. The mean knowledge score arose from 3.52 (SD = 1.67) to 5.97 (SD = 1.81). Conclusions: This study suggests that the use of games in an elementary school effectively increase the knowledge related to the important topic of vaccination starting at childhood.

Grounding evaluation design in the socio-ecological model of health: a logic framework for the assessment of a national routine immunization communication initiative in Kyrgyzstan

Childhood routine immunization (RI) is a highly effective public health intervention for the prevention of infectious diseases. Despite high immunization rates, a 2018 Knowledge, Attitudes, and Practices (KAP) study by the United Nations Children's Fund (UNICEF) noted a growing practice of vaccine refusal among parents and primary caregivers as well as clusters of significantly lower immunization coverage in some provinces. Moreover, a 2018 Joint Appraisal report by GAVI (Global Vaccine Alliance) has highlighted a decrease in immunization rates among children under 1 year of age from 96.1% to 92% for some vaccines. As a result, UNICEF is spearheading a national communication initiative to increase the rates of RI in Kyrgyzstan. This initiative includes strengthening interpersonal communication skills of local healthcare workers, improving the quality and accuracy of media coverage via a tailored outreach to the Kyrgyz media, as well as fostering community engagement to give voice to local champions and engage hesitant parents and vaccine refuters. UNICEF has also partnered with a research team for the design phase of a suitable evaluation framework. Grounded in the socio-ecological model (SEM) of health, the framework recognizes the interconnection of behavioral, social, and policy change, and includes not only activity-specific indicators (process indicators) but also progress, outcome, and impact indicators to document results among key groups and stakeholders at different levels of the SEM, and, ultimately, on immunization rates in Kyrgyzstan. The framework reflects the importance of an integrated and multilevel approach to intervention and communication design, and integrates the SEM with a logic model that connects different components of the initiative. This paper introduces this evaluation framework, including implications for the evaluation of child health programs, and other public health, communication, and international development interventions.

Strategies Needed to Ensure Higher Immunization Rates in the Americas.

In their MEDICC Review Perspective, Galindo-Santana and colleagues highlight the challenges presented by anti-vaccination groups, stressing that immunization is an essential cost-effective preventive measure that promotes population health.[1] In 2019, WHO identifi ed vaccine hesitancy, fragile and vulnerable settings and weak primary health care as 3 of 10 main global health threats. Close attention to these threats can detect potential areas of missed opportunities for immunization across populations and mitigate risk of preventable diseases.

Compliance with immunization and a biological risk assessment of health care workers as part of an occupational health surveillance program: The experience of a university hospital in southern Italy

The active immunization of health care workers (HCWs) is a primary measure to prevent nosocomial infection; despite this, vaccine coverage among HCWs in most countries is low. To increase vaccine coverage in the health care setting, the hygiene and occupational medicine departments of Bari Policlinico General University-Hospital implemented a vaccination procedure. This operative procedure requires that during the occupational medical examination, all employees are evaluated for immunity/susceptibility to vaccine-preventable diseases, with vaccination offered to those determined to be susceptible. The study sample comprised HCWs who attended the biological risk assessment program from December 2017 to January 2019 (n = 449). Susceptibility was higher for hepatitis B virus (23%), followed by rubella (11%), varicella (9%), mumps (8%), and measles (7%). The seroconversion rate after the administration of booster dose(s) was >80% for all vaccines. Overall, 15% of the HCWs refused the offered vaccine(s), and the main determinants of vaccination compliance were younger age (P < .0001) and being a physician (P < .05). Despite the several recommendations and campaigns to promote vaccinations, achieving high immunization rates among HCWs is still a challenge. In this scenario, public health institutions have to choose between the enforcement of the promotion or the adoption of a mandatory policy.

Automated phone call and text reminders for childhood immunisations (PRIMM): a randomised controlled trial in Nigeria

BackgroundSub-Saharan Africa has high under-5 mortality and low childhood immunisation rates. Vaccine-preventable diseases cause one-third of under-5 deaths. Text messaging reminders improve immunisation completion in urban but not rural settings...

Lessons learned from the 2009\u20132010 H1N1 outbreak for the management of the 2013 silent polio outbreak

BackgroundThe Israeli Ministry of Health (MoH) encountered two substantial outbreaks during the past decade: the H1N1 swine flu outbreak during 2009–2010 and the silent polio outbreak during 2013. Although both outbreaks share several similar characteristics, the functioning of the Israeli MoH was different for each case. The aim of this study was to identify factors that contributed to the change in the MoH response to the polio outbreak in light of the previous 2009–2010 H1N1 outbreak.MethodsWe conducted a qualitative research using semi-structured interviews with 18 Israeli policymakers from the MoH, relevant specialists and politicians. Each interview was transcribed and a thematic analysis was conducted independently by two researchers.ResultsThree main themes were found in the interview analysis, which reflect major differences in the MoH management policy during the polio outbreak. 1) clinical and epidemiological differences between the two disease courses, 2) differences in the functioning of the MoH during the outbreaks, 3) differences in the risk communication strategies used to reach out to the local health community and the general public. Most interviewees felt that the experience of the 2009–2010 H1N1 outbreak which was perceived as unsuccessful, fueled the MoH engagement and proactiveness in the later polio outbreak.ConclusionThese findings highlight the importance of learning processes within health care organizations during outbreaks and may contribute to better performance and higher immunization rates.

What will it take to end human suffering from measles?

In The Lancet Infectious Diseases, Filippo Trentini and colleagues 1 Trentini F Poletti P Merler S Melegaro A Measles immunity gaps and the progress towards elimination: a multi-country modelling analysis. Lancet Infect Dis. 2017; (published online Aug 11.)http://dx.doi.org/10.1016/S1473-3099(17)30421-8 PubMed Google Scholar presented the results of a comprehensive modelling analysis that examined the transmission of measles in nine countries with diverse demographic and vaccination histories. The results emphasised that to achieve and maintain measles elimination, countries will need to focus immunisation efforts on reaching different age groups and improving immunisation coverage. 1 Trentini F Poletti P Merler S Melegaro A Measles immunity gaps and the progress towards elimination: a multi-country modelling analysis. Lancet Infect Dis. 2017; (published online Aug 11.)http://dx.doi.org/10.1016/S1473-3099(17)30421-8 PubMed Google Scholar Specifically, in low-income (and high-fertility) countries, susceptibility remains concentrated in early childhood, and periodic Supplementary Immunization Activities continue to contribute substantially to population immunity. 1 Trentini F Poletti P Merler S Melegaro A Measles immunity gaps and the progress towards elimination: a multi-country modelling analysis. Lancet Infect Dis. 2017; (published online Aug 11.)http://dx.doi.org/10.1016/S1473-3099(17)30421-8 PubMed Google Scholar The authors suggest that these countries need to increase immunisation coverage, which could occur by improving the performance in routine immunisation delivered as part of the national Expanded Programme on Immunization or making Supplementary Immunization Activities more frequent, regular, and also of higher quality. 1 Trentini F Poletti P Merler S Melegaro A Measles immunity gaps and the progress towards elimination: a multi-country modelling analysis. Lancet Infect Dis. 2017; (published online Aug 11.)http://dx.doi.org/10.1016/S1473-3099(17)30421-8 PubMed Google Scholar By contrast, in relatively high-income (and low-fertility) countries, the relatively high immunisation rates and low levels of transmission allow unvaccinated individuals to remain susceptible at older ages. This observation led the authors to suggest the need for Supplementary Immunization Activities that target adolescents and adults in countries in which the susceptibility in these age groups will otherwise sustain measles circulation. 1 Trentini F Poletti P Merler S Melegaro A Measles immunity gaps and the progress towards elimination: a multi-country modelling analysis. Lancet Infect Dis. 2017; (published online Aug 11.)http://dx.doi.org/10.1016/S1473-3099(17)30421-8 PubMed Google Scholar Measles immunity gaps and the progress towards elimination: a multi-country modelling analysisFuture vaccination strategies in high-fertility countries should focus on increasing childhood immunisation rates, either by raising first-dose coverage or by making erratic SIAs more frequent and regular. Immunisation campaigns targeting adolescents and adults are required in low-fertility countries, where the susceptibility in these age groups will otherwise sustain measles circulation. Full-Text PDF

Should Nurse Practitioners be Required to Record Immunizations in Immunization Information Systems?

Should Nurse Practitioners be Required to Record Immunizations in Immunization Information Systems?

Comparison of immunization rates of adults ages 65 years and older managed within two nurse practitioner-owned clinics with national immunization rates.

Adults ages ≥65 years are at increased risk for infectious diseases. Ensuring these individuals are fully vaccinated is imperative. The purpose of this study was to assess the immunization rates of adults ages ≥65 years managed by nurse practitioners (NPs) and compare the results with national immunization rates and Healthy People 2020 goals. A convenience sample of adults ages ≥65 years was obtained from two NP-managed clinics. The vaccine records of each subject were reviewed for documentation of having received five vaccines (tetanus, diphtheria, and pertussis; influenza; pneumococcal polysaccharide vaccine 23; pneumococcal conjugate vaccine 13; and herpes zoster vaccine). One hundred and fifty females (70.8%) and 62 males (29.2%) met inclusion criteria. NP-managed patients had higher immunization rates than the national averages across all five major vaccines. The herpes zoster vaccination rates exceeded the recommendations from Healthy People 2020 whereas pneumococcal and influenza rates were below. The stocking of vaccines within the NP-managed clinics, direct billing to Medicare for Part D vaccines, and previsit care planning likely contributed to the high vaccination rates. These high immunization rates in patients managed by NPs provide support for the important role that NPs play in the care of older adults.

Variations in Influenza and Pneumonia Immunizations for Medicare Beneficiaries Served by Rural Health Clinics.

The availability of a rural health clinic (RHC) database over the period of 6years (2008-2013) offers a unique opportunity to examine the trends and patterns of disparities in immunization for influenza and pneumonia among Medicare beneficiaries in the southeastern states. The purpose of this exploratory study was twofold. First, it examined the rural trends and patterns of immunization rates before (2008-2009) and after (2010-2013) the Affordable Care Act (ACA) enactment by state and year. Second, it investigated how contextual, organizational, and aggregate patient characteristics may influence the variations in immunization for influenza and pneumonia of Medicare beneficiaries served by RHCs. Four data sources from federal agencies were merged to perform a longitudinal analysis of the influences of contextual, organizational, and aggregate patient characteristics on the disparities in immunization rates of rural Medicare beneficiaries for influenza and pneumonia. We included both time-varying and time-constant predictors in a multivariate analysis using Generalized Estimating Equation. This study revealed the increased immunization rates for both influenza and pneumonia over a period of 6years. The ACA had a positive effect on increased immunization rates for pneumonia, but not for influenza, in rural Medicare beneficiaries in the eight states. The RHCs that served more dually-eligible patients had higher immunization rates. For influenza immunization, provider-based RHCs had a higher rate than the independent RHCs. For pneumonia immunization, no organizational variables were relevant in the explanation of the variability. The results also showed that no single dominant factor influenced health care disparities. This investigation suggested further improvements in preventive care are needed to target poor and isolated rural beneficiaries. Furthermore, the integration of immunization data from multiple sources is critically needed for understanding health disparities.

Tetanus: A Potential Public Health Threat in Times of Disaster.

Tetanus is a potentially fatal condition that is rare in urban environments but is seen in developing countries and post-natural-disaster. Therefore, the purpose of this report was to review the epidemiology, pathogenesis, and management of tetanus in the trauma patient. A thorough literature review was conducted to look for the most current and thorough guidelines on the prophylaxis and treatment of tetanus. PUBMED (National Center for Biotechnology Information, National Institutes of Health; Bethesda, Maryland USA), MEDLINE (US National Library of Medicine, National Institutes of Health; Bethesda, Maryland USA), and Cochrane Library (The Cochrane Collaboration; Oxford, United Kingdom) databases were searched for articles in English, published from 2005 to 2015, using the keywords "Tetanus," "Trauma/Surgery," and "Disaster." Controlled trials, randomized controlled trials, trials of adult patients, published guidelines, expert opinions, and review articles were selected and extracted. Current vaccination schedules in developed countries provide prophylaxis for tetanus. However, when severe natural disasters occur, many patients may not be able to provide a reliable vaccination history. In these situations, tetanus immune globulin (TIG) is indicated; if resources are not limited, both tetanus toxoid and TIG should be given to those with high-risk wounds. If resources are limited, TIG should be reserved for those that would benefit most or those least likely to have the protective antibodies. Although tetanus is a disease that has a low incidence in the developed world due to high rates of immunization, during large-scale natural disasters, compounding factors like the types of injuries, lack of medical services and supplies, and the delay in treatment associated with an already low immunization rate result in an increased incidence and outbreaks of the disease that has higher mortality in an underdeveloped society. It is important for the urban physician that cares for trauma and critical patients to become familiar with the protocols for treatment and immunization of patients that have tetanus-prone wounds, as well as recognize the potential for outbreaks in the settings of major natural disasters. Finkelstein P , Teisch L , Allen CJ , Ruiz G . Tetanus: a potential public health threat in times of disaster. Prehosp Disaster Med. 2017;32(3):339-342.

Modelling Risk to US Military Populations from Stopping Blanket Mandatory Polio Vaccination.

Objectives Transmission of polio poses a threat to military forces when deploying to regions where such viruses are endemic. US-born soldiers generally enter service with immunity resulting from childhood immunization against polio; moreover, new recruits are routinely vaccinated with inactivated poliovirus vaccine (IPV), supplemented based upon deployment circumstances. Given residual protection from childhood vaccination, risk-based vaccination may sufficiently protect troops from polio transmission. Methods This analysis employed a mathematical system for polio transmission within military populations interacting with locals in a polio-endemic region to evaluate changes in vaccination policy. Results Removal of blanket immunization had no effect on simulated polio incidence among deployed military populations when risk-based immunization was employed; however, when these individuals reintegrated with their base populations, risk of transmission to nondeployed personnel increased by 19%. In the absence of both blanket- and risk-based immunization, transmission to nondeployed populations increased by 25%. The overall number of new infections among nondeployed populations was negligible for both scenarios due to high childhood immunization rates, partial protection against transmission conferred by IPV, and low global disease incidence levels. Conclusion Risk-based immunization driven by deployment to polio-endemic regions is sufficient to prevent transmission among both deployed and nondeployed US military populations.

Role of health care professionals in preventative activities and vaccination programs during outbreaks.

The general purpose of TELL ME study was to give an insight into the experiences of European family physicians with management of H1N1 pandemic flu. Qualitative research methods (focus group discussions, one-to-one interviews, and online data collection) were used to explore family doctors' opinion and suggestions. Overall 158 family physicians took part in the study from six European countries. Family doctors' most important experience was that the official campaign was not able to compensate negative effects of the mass media. Due to the poor evidence-based information about new vaccines, it was difficult to convince the public and some health care professionals too. Lack of unified directives - under unclear circumstances - made the routine patient care more difficult and hampered the collaboration between different health care providers. Family physicians felt a pressure from health authorities to achieve high immunization rate, but got only a little support from them. Despite the difficulties, vaccination program was a success, mainly among high-risk population. For better handling of a future pandemic, Hungarian family physician made many general and practical suggestions.

Bordetella pertussis.

Pertussis is a highly infectious vaccine-preventable cough illness that continues to be a significant source of morbidity and mortality around the world. The majority of human illness is caused by Bordetella pertussis, and some is caused by Bordetella parapertussis. Bordetella is a Gram-negative, pleomorphic, aerobic coccobacillus. In the past several years, even countries with high immunization rates in early childhood have experienced rises in pertussis cases. Reasons for the resurgence of reported pertussis may include molecular changes in the organism and increased awareness and diagnostic capabilities, as well as lessened vaccine efficacy and waning immunity. The most morbidity and mortality with pertussis infection is seen in infants too young to benefit from immunization. Severe infection requiring hospitalization, including in an intensive care setting, is mostly seen in those under 3 months of age. As a result, research and public health actions have been aimed at better understanding and reducing the spread of Bordetella pertussis. Studies comparing the cost benefit of cocooning strategies versus immunization of pregnant women have been favorable towards immunizing pregnant women. This strategy is expected to prevent a larger number of pertussis cases, hospitalizations, and deaths in infants <1 year old while also being cost-effective. Studies have demonstrated that the source of infection in infants usually is a family member. Efforts to immunize children and adults, in particular pregnant women, need to remain strong.

Medicaid Pay for Performance Programs and Childhood Immunization Status.

Although pay for performance (P4P) programs are being increasingly used by state Medicaid programs to provide incentives for managed care plans to provide high-quality care, no national study has examined the effects of these plans on commonly targeted outcomes such as childhood immunization rates. Information from the 1999-2011 National Immunization Survey combined with information on state Medicaid P4P programs from the Centers for Medicare and Medicaid Services was used to study the effect of Medicaid P4P programs on the immunization status of children aged 19-35 months. Difference-in-difference-in-difference models were used to study whether adoption of Medicaid P4P programs was associated with higher immunization rates among Medicaid-eligible children relative to non-Medicaid eligible children within states that adopted Medicaid P4P programs compared with states that did not. Linear probability models were used in all estimations, and models controlled for demographic factors. The study found no overall effect of Medicaid P4P on the chance that children aged 19-35 months had completed the 4:3:1:3:3:1 vaccination series. However, there was a 4 percentage point increase in the chance that a child 19-23 months had completed the series. This study provides some evidence that Medicaid P4P programs may be helpful in improving childhood vaccination rates. Further study of the effects on other targeted outcomes as well as the effects of different P4P program designs may increase understanding of the potential role of these programs in improving the quality of health care.

Eliminating Vaccine- Preventable Diseases Around The World.

To ensure immunization access, equity, and sustainability, vaccines must remain a top priority for governments across the globe.

Bacteremic Pneumonia before and after Withdrawal of 13-Valent Pneumococcal Conjugate Vaccine from a Public Vaccination Program in Spain: A Case-Control Study

To compare the incidence and epidemiology of bacteremic community-acquired pneumonia (CAP) in the setting of changes in 13-valent pneumococcal conjugate vaccine (PCV13) coverage. In the region of Madrid, universal immunization with the PCV13 started in May 2010. In July 2012, public funding ceased. Vaccination coverage decreased from >95% to 82% in 2013 and to 67% in 2014. We performed a multicenter surveillance and case-control study from 2009-2014. Cases were hospitalized children with bacteremic CAP. Controls were children selected 1:1 from next-admitted with negative blood cultures and typical, presumed bacterial CAP. Annual incidence of bacteremic CAP declined from 7.9/100,000 children (95% CI 5.1-11.1) in 2009 to 2.1/100,000 children (95% CI 1.1-4.1) in 2012. In 2014, 2 years after PCV13 was withdrawn from the universal vaccination program, the incidence of bacteremic CAP increased to 5.4/100,000 children (95% CI 3.5-8.4). We enrolled 113 cases and 113 controls. Streptococcus pneumoniae caused most of bloodstream infections (78%). Empyema was associated with bacteremia (P = .003, OR 3.6; 95% CI 1.4-8.9). Simple parapneumonic effusion was not associated with bacteremia. Incomplete PCV immunization was not a risk factor for bacteremic pneumonia. High rate of PCV13 immunization was associated with decreased incidence of bacteremic CAP; this incidence increased when rate of immunization fell. Empyema (but not parapneumonic pleural effusion) was associated with bacteremia.