title: Distance to health services affects local-level vaccine efficacy for pneumococcal conjugate vaccine (PCV) among rural Filipino children.
abstract: Pneumococcal conjugate vaccines (PCVs) have demonstrated efficacy against childhood pneumococcal disease in several regions globally. We demonstrate how spatial epidemiological analysis of a PCV trial can assist in developing vaccination strategies that target specific geographic subpopulations at greater risk for pneumococcal pneumonia. We conducted a secondary analysis of a randomized, placebo-controlled, double-blind vaccine trial that examined the efficacy of an 11-valent PCV among children less than 2 y of age in Bohol, Philippines. Trial data were linked to the residential location of each participant using a geographic information system. We use spatial interpolation methods to create smoothed surface maps of vaccination rates and local-level vaccine efficacy across the study area. We then measure the relationship between distance to the main study hospital and local-level vaccine efficacy, controlling for ecological factors, using spatial autoregressive models with spatial autoregressive disturbances. We find a significant amount of spatial variation in vaccination rates across the study area. For the primary study endpoint vaccine efficacy increased with distance from the main study hospital from -14% for children living less than 1.5 km from Bohol Regional Hospital (BRH) to 55% for children living greater than 8.5 km from BRH. Spatial regression models indicated that after adjustment for ecological factors, distance to the main study hospital was positively related to vaccine efficacy, increasing at a rate of 4.5% per kilometer distance. Because areas with poor access to care have significantly higher VE, targeted vaccination of children in these areas might allow for a more effective implementation of global programs.
authors.affiliation: Department of Geography and Institute of Behavioral Sciences, University of Colorado Boulder, Boulder, CO 80309.
authors.forename: Elisabeth Dowling
authors.initials: ED
authors.lastname: Root
authors.forename: Marilla
authors.initials: M
authors.lastname: Lucero
authors.forename: Hanna
authors.initials: H
authors.lastname: Nohynek
authors.forename: Peter
authors.initials: P
authors.lastname: Anthamatten
authors.forename: Deborah S K
authors.initials: DS
authors.lastname: Thomas
authors.forename: Veronica
authors.initials: V
authors.lastname: Tallo
authors.forename: Antti
authors.initials: A
authors.lastname: Tanskanen
authors.forename: Beatriz P
authors.initials: BP
authors.lastname: Quiambao
authors.forename: Taneli
authors.initials: T
authors.lastname: Puumalainen
authors.forename: Socorro P
authors.initials: SP
authors.lastname: Lupisan
authors.forename: Petri
authors.initials: P
authors.lastname: Ruutu
authors.forename: Erma
authors.initials: E
authors.lastname: Ladesma
authors.forename: Gail M
authors.initials: GM
authors.lastname: Williams
authors.forename: Ian
authors.initials: I
authors.lastname: Riley
authors.forename: Eric A F
authors.initials: EA
authors.lastname: Simões
mesh_terms: D040362:Geographic Information Systems; D005843:Geography; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D032541:Mass Vaccination / Q000379:methods*; D010679:Philippines / Q000453:epidemiology; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*; D011018:Pneumonia, Pneumococcal / Q000453:epidemiology* / Q000517:prevention & control*; D012044:Regression Analysis; D012424:Rural Population / Q000706:statistics & numerical data*; D062206:Spatial Analysis
chemical_list: D022242:Pneumococcal Vaccines
keywords: GIS; randomized controlled trial; spatial analysis; spatial epidemiology; targeted intervention