Impact of a combined pediatric and adult pneumococcal immunization program on adult pneumonia incidence and mortality in Nicaragua
Impact of a combined pediatric and adult pneumococcal immunization program on adult pneumonia incidence and mortality in Nicaragua
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DOI：
10.1016/j.vaccine.2014.10.073
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发表时间：
2015-01-01
期刊：
影响因子：
5.5
通讯作者：
Weber, David J.
中科院分区：
文献类型：
--
作者：
Becker-Dreps, Sylvia;Amaya, Erick;Weber, David J.
工作背景：2010年，尼加拉瓜实施了23价肺炎球菌多糖疫苗（PPSV-23）成人免疫方案和13价肺炎球菌结合疫苗（PCV-13）儿童免疫方案。我们评估的发病率门诊就诊和住院治疗的肺炎和肺炎相关的死亡率在50岁以上的成年人之前和之后，该计划的实施在莱昂，尼加拉瓜。方法：我们收集了访问诊断从所有107个公共卫生设施之间的2008年和2012年在莱昂。我们使用Poisson回归和广义估计方程（GEE），控制年龄组、城市和接种流感疫苗的成年人比例，比较了接种疫苗前（2008-2009年）和接种疫苗（2011-2012年）期间老年人的肺炎门诊就诊率、肺炎住院率和肺炎相关死亡率。暴露时间估计官方直辖市人口estimation.Results：我们没有观察到较低的发病率门诊就诊或住院治疗的成人肺炎在疫苗接种期间与疫苗前期间。然而，肺炎相关死亡率在疫苗接种期低于疫苗接种前，调整后的发病率比（IRRa）为0.73（0.56，0.94）在50-64岁的成年人中，（0.43，0.70）。结论：尼加拉瓜引入儿童和成人肺炎球菌联合免疫计划后的这些早期结果表明，该计划可能对减少老年人肺炎相关死亡产生影响，但对减少因肺炎就诊的卫生设施的影响不太明显。(C)2014爱思唯尔有限公司版权所有。
Background: In 2010, Nicaragua implemented an adult immunization program with the 23-valent pneumococcal polysaccharide vaccine (PPSV-23) and a pediatric immunization program with the 13-valent pneumococcal conjugate vaccine (PCV-13). We assessed incidence rates of ambulatory visits and hospitalizations for pneumonia and pneumonia-related mortality in adults over the age of 50 years before and after the program's implementation in the Department of Leon, Nicaragua.Methods: We collected visit diagnoses from all 107 public health facilities between 2008 and 2012 in Leon. We compared incidence rates of ambulatory visits for pneumonia, pneumonia hospitalizations, and pneumonia-related mortality in the pre-vaccine (2008-2009) and vaccine (2011-2012) periods among older adults using Poisson regression with generalized estimating equations (GEE), controlling for age group, municipality, and proportions of adults who were immunized against influenza. Exposure time was estimated by official municipality population estimates.Results: We did not observe lower incidence rates of ambulatory visits or hospitalizations for pneumonia among adults during the vaccine period versus the pre-vaccine period. However, pneumonia-related mortality was lower in the vaccine period versus the pre-vaccine period, with an adjusted incidence rate ratio (IRRa) of 0.73 (0.56, 0.94) among adults aged 50-64 years, and 0.55 (0.43, 0.70) among adults aged >= 65 years.Conclusions: These early results following introduction of a combined pediatric and adult pneumococcal immunization program in Nicaragua show a probable impact of the program on the reduction of pneumonia-related deaths in older adults, but a less clear impact on the reduction of health facility visits for pneumonia. (C) 2014 Elsevier Ltd. All rights reserved.