Sinusitis and pneumonia hospitalization after introduction of pneumococcal conjugate vaccine.
OBJECTIVE
Streptococcus pneumoniae is a major cause of pneumonia and sinusitis. Pneumonia kills >1 million children annually, and sinusitis is a potentially serious pediatric disease that increases the risk of orbital and intracranial complications. Although pneumococcal conjugate vaccine (PCV) is effective against invasive pneumococcal disease, its effectiveness against pneumonia is less consistent, and its effect on sinusitis is not known. We compared hospitalization rates due to sinusitis, pneumonia, and empyema before and after sequential introduction of PCV7 and PCV13.


METHODS
All children 0 to <18 years old hospitalized for sinusitis, pneumonia, or empyema in Stockholm County, Sweden, from 2003 to 2012 were included in a population-based study of hospital registry data on hospitalizations due to sinusitis, pneumonia, or empyema. Trend analysis, incidence rates, and rate ratios (RRs) were calculated comparing July 2003 to June 2007 with July 2008 to June 2012, excluding the year of PCV7 introduction.


RESULTS
Hospitalizations for sinusitis decreased significantly in children aged 0 to <2 years, from 70 to 24 cases per 100 000 population (RR = 0.34, P < .001). Hospitalizations for pneumonia decreased significantly in children aged 0 to <2 years, from 450 to 366 per 100 000 population (RR = 0.81, P < .001) and in those aged 2 to <5 years from 250 to 212 per 100 000 population (RR = 0.85, P = .002). Hospitalization for empyema increased nonsignificantly. Trend analyses showed increasing hospitalization for pneumonia in children 0 to <2 years before intervention and confirmed a decrease in hospitalizations for sinusitis and pneumonia in children aged 0 to <5 years after intervention.


CONCLUSIONS
PCV7 and PCV13 vaccination led to a 66% lower risk of hospitalization for sinusitis and 19% lower risk of hospitalization for pneumonia in children aged 0 to <2 years, in a comparison of 4 years before and 4 years after vaccine introduction.
Public Health Agency of Sweden, Solna, Sweden; Departments of Public Health Sciences, Division of Global Health, ann.lindstrand@folkhalsomyndigheten.se.
Ann
A
Lindstrand
Astrid Lindgren Children's Hospital, and.
Rutger
R
Bennet
Public Health Agency of Sweden, Solna, Sweden;
Ilias
I
Galanis
Sachs' Children and Youth Hospital, South General Hospital, Stockholm, Sweden; Clinical Sciences and Education, and.
Margareta
M
Blennow
Sachs' Children and Youth Hospital, South General Hospital, Stockholm, Sweden;
Lina Schollin
LS
Ask
Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden;
Sofia Hultman
SH
Dennison
Sachs' Children and Youth Hospital, South General Hospital, Stockholm, Sweden;
Malin Ryd
MR
Rinder
Astrid Lindgren Children's Hospital, and.
Margareta
M
Eriksson
Public Health Agency of Sweden, Solna, Sweden; Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden; Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska University Hospital, Solna, Sweden;
Birgitta
B
Henriques-Normark
Department of Communicable Disease Control and Prevention, Stockholm County Council, Sweden; and Department of Medicine, Unit of Infectious Diseases, Karolinska Institutet, Karolinska, Solna, Sweden.
Ake
A
Ortqvist
Departments of Public Health Sciences, Division of Global Health, Sachs' Children and Youth Hospital, South General Hospital, Stockholm, Sweden;
Tobias
T
Alfvén
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000276:immunology / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000276:immunology / Q000627:therapeutic use*; D011018:Pneumonia, Pneumococcal / Q000453:epidemiology* / Q000276:immunology / Q000517:prevention & control*; D012852:Sinusitis / Q000453:epidemiology* / Q000276:immunology / Q000517:prevention & control*; D013548:Sweden; D018074:Vaccines, Conjugate / Q000276:immunology / Q000627:therapeutic use
C538862:13-valent pneumococcal vaccine; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate
Streptococcus pneumoniae; pneumococcal conjugated vaccine; pneumonia; sinusitis