title: Impact of 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) on childhood pneumonia hospitalizations in Brazil two years after introduction.
abstract: BACKGROUND
  Pneumococcal disease is a major public health problem worldwide. From March to September of 2010, 10-valent pneumococcal non-typeable Haemophilus influenzae protein conjugate vaccine (PHiD-CV) was introduced in the Brazilian childhood National Immunization Program (NIP) in all 27 Brazilian states. The aim of the present study is to report national time-trends in incidence of hospital admissions for childhood pneumonia in Brazil before and after two years of introduction of this new pneumococcal conjugate vaccine.
  
  
  METHODS
  Analysis of hospitalization data of children aged 0-4 years in Brazilian public health system with an admission diagnosis of pneumonia from 2002 to 2012 was performed comparing pre (2002-2009) and post-vaccination periods (2011-2012). Hospital number of admission due to pneumonia and all non-respiratory diseases were obtained from DATASUS, the Brazilian government open-access public health database system. Incidence of pneumonia hospitalization was compared to incidence of all non-respiratory admissions.
  
  
  RESULTS
  Admission rates for pneumonia decreased steadily from 2010 to 2012. In children aged less than four years, incidence of pneumonia hospitalizations decreased 12.65% when pre (2002-2009) and post-vaccination introduction periods (2011-2012) were compared and adjusted for seasonality and secular-trend (p<0.001). On the other hand, non-respiratory admission rates remained stable comparing both periods (p=0.39).
  
  
  CONCLUSIONS
  Childhood pneumonia hospitalization rates were fluctuating prior to 2010 and decreased significantly in the two years after PHiD-CV introduction. Conversely, rate of non-respiratory admissions has shown no decrease. These data are an evidence of the effectiveness and public health impact of this new pneumococcal vaccine.
authors: Centro Infant, Biomedical Research Institute, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenida Ipiranga 6690, 2nd floor, Porto Alegre 90610-000, RS Brazil; Aliança Infant, Argentina-Brasil (Comprises partnership between institutions "a" and "c"). Electronic address: marcelo.scotta@acad.pucrs.br.
authors: Marcelo Comerlato
authors: MC
authors: Scotta
authors: Jeser Amarante Faria Children's Hospital, Araranguá Street, 554, Joinville 89204-310, SC, Brazil. Electronic address: tnveras@hotmail.com.
authors: Tiago Neves
authors: TN
authors: Veras
authors: Centro Infant, Biomedical Research Institute, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenida Ipiranga 6690, 2nd floor, Porto Alegre 90610-000, RS Brazil. Electronic address: paulack@gmail.com.
authors: Paula Colling
authors: PC
authors: Klein
authors: Centro Infant, Biomedical Research Institute, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenida Ipiranga 6690, 2nd floor, Porto Alegre 90610-000, RS Brazil. Electronic address: virginiatronco@yahoo.com.br.
authors: Virgínia
authors: V
authors: Tronco
authors: Fundacion INFANT, Gavilán 94, (C1234BAA), Ciudad de Buenos Aires, Argentina; Vanderbilt University, 2201 West End Ave, Nashville 37235, TN, USA; Aliança Infant, Argentina-Brasil (Comprises partnership between institutions "a" and "c"). Electronic address: fernando.p.polack@vanderbilt.edu.
authors: Fernando P
authors: FP
authors: Polack
authors: Centro Infant, Biomedical Research Institute, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenida Ipiranga 6690, 2nd floor, Porto Alegre 90610-000, RS Brazil; Aliança Infant, Argentina-Brasil (Comprises partnership between institutions "a" and "c"). Electronic address: rita.mattiello@pucrs.br.
authors: Rita
authors: R
authors: Mattiello
authors: Centro Infant, Biomedical Research Institute, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenida Ipiranga 6690, 2nd floor, Porto Alegre 90610-000, RS Brazil; Aliança Infant, Argentina-Brasil (Comprises partnership between institutions "a" and "c"). Electronic address: pmpitrez@pucrs.br.
authors: Paulo M C
authors: PMC
authors: Pitrez
authors: Centro Infant, Biomedical Research Institute, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenida Ipiranga 6690, 2nd floor, Porto Alegre 90610-000, RS Brazil; Aliança Infant, Argentina-Brasil (Comprises partnership between institutions "a" and "c"). Electronic address: mhjones@pucrs.br.
authors: Marcus H
authors: MH
authors: Jones
authors: Centro Infant, Biomedical Research Institute, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenida Ipiranga 6690, 2nd floor, Porto Alegre 90610-000, RS Brazil; Aliança Infant, Argentina-Brasil (Comprises partnership between institutions "a" and "c"). Electronic address: rstein@pucrs.br.
authors: Renato T
authors: RT
authors: Stein
authors: Centro Infant, Biomedical Research Institute, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenida Ipiranga 6690, 2nd floor, Porto Alegre 90610-000, RS Brazil. Electronic address: leonardo.pinto@pucrs.br.
authors: Leonardo A
authors: LA
authors: Pinto
mesh_terms: D001938:Brazil / Q000453:epidemiology; D002675:Child, Preschool; D005260:Female; D006192:Haemophilus Infections / Q000276:immunology / Q000517:prevention & control*; D006291:Health Policy; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D017589:Immunization Programs; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D022242:Pneumococcal Vaccines / Q000008:administration & dosage / Q000276:immunology*; D011018:Pneumonia, Pneumococcal / Q000276:immunology / Q000517:prevention & control*; D012189:Retrospective Studies
chemical_list: C547294:PHiD-CV vaccine; D022242:Pneumococcal Vaccines
keywords: Brazil; Child; Conjugate vaccines; Hospitalization; Pneumococcal vaccines; Pneumonia