Risk of pneumococcal disease in children with chronic medical conditions in the era of pneumococcal conjugate vaccine.
BACKGROUND
In the current era of universal immunization of young children with pneumococcal conjugate vaccine, it is unclear whether the high risk ratios for pneumococcal disease previously attributed to specified chronic conditions have persisted. In addition, further analysis of pneumococcal disease risk may clarify whether certain chronic conditions that currently are not specified as significantly increasing the risk of pneumococcal disease should be so considered.


METHODS
We conducted a retrospective cohort analysis utilizing healthcare claims data from the period 2007-2010 to compare rates of pneumococcal disease among children <5 and 5-17 years of age with high-risk and at-risk conditions to rates among children without these conditions in the same age group. Risk profiles and manifestations of pneumococcal infection were ascertained from diagnosis, procedure, and drug codes.


RESULTS
Among at-risk children, rate ratios for invasive pneumococcal disease (vs children without at-risk/high-risk conditions) were 1.8 (95% confidence interval [CI], 1.4-2.3) in children <5 years of age and 3.3 (95% CI, 2.4-4.4) in children 5-17 years of age. Corresponding rate ratios for high-risk children were 11.2 (95% CI, 7.0-17.9) and 40.1 (95% CI, 28.8-56.0). Rate ratios increased in asthmatic children with increasing disease severity and in all at-risk children by the number of concurrent at-risk conditions. Rate ratios for pneumococcal pneumonia and all-cause pneumonia demonstrated similar patterns.


CONCLUSIONS
Children with high-risk and at-risk conditions continue to demonstrate an increased burden of pneumococcal disease. Pneumococcal disease rates are high among asthmatic children with moderate and severe disease and children with multiple at-risk conditions.
Schools of Medicine and Public Health, Boston University Boston Medical Center.
Stephen I
SI
Pelton
Policy Analysis Inc, Brookline, Massachusetts.
Derek
D
Weycker
Pfizer Inc, Collegeville, Pennsylvania.
Raymond A
RA
Farkouh
Pfizer Inc, Collegeville, Pennsylvania.
David R
DR
Strutton
Schools of Medicine and Public Health, Boston University.
Kimberly M
KM
Shea
Policy Analysis Inc, Brookline, Massachusetts.
John
J
Edelsberg
D000293:Adolescent; D001249:Asthma / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D017589:Immunization Programs; D007223:Infant; D008297:Male; D011008:Pneumococcal Infections / Q000175:diagnosis / Q000453:epidemiology*; D022242:Pneumococcal Vaccines; D011018:Pneumonia, Pneumococcal / Q000175:diagnosis / Q000453:epidemiology*; D012189:Retrospective Studies; D012306:Risk; D018074:Vaccines, Conjugate
D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate
Streptococcus pneumoniae; comorbidity; pneumococcal infections; pneumonia