title: Impact of PCV7/PCV13 introduction on community-acquired alveolar pneumonia in children <5 years.
abstract: BACKGROUND
  Alveolar community-acquired pneumonia (A-CAP) is mostly considered a bacterial disease, mainly pneumococcal. This study was conducted to document the impact of sequential 7-valent and the 13-valent pneumococcal conjugate vaccines (PCV7; PCV13) on emergency room and hospitalization for A-CAP among children <5 years of age.
  
  
  METHODS
  This is an ongoing prospective population-based study in southern Israel. The current analysis spans over the period July 2002 through June 2013. A-CAP was defined using the World Health Organization (WHO)'s criteria for radiologically-confirmed pneumonia. PCV7 was introduced in Israel in July 2009 and gradually replaced by PCV13 in November 2010. Pneumococcal conjugate vaccine (PCV) impact was calculated by comparing incidences during 3 pre-defined periods: pre-PCV (2002-2008), PCV7 (2010-2011) and PCV13 (2012-2013).
  
  
  RESULTS
  Overall, 10,142 A-CAP episodes occurred. The annual incidences (per 1,000 inhabitants) in children <5 years old declined from a mean (±standard deviation) of 13.8 ± 0.9 in the pre-PCV period to 11.2 ± 2.7 in the PCV7 period and 7.4 in the PCV13 period, representing a reduction of 13% and 47%, respectively. The overall decrease was significantly faster among outpatients than among hospitalized children (42% and -8%, respectively in the PCV7 period; 68% vs. 32% in hospitalized children in the PCV13 period). While in children 12-23 months a significant decline was observed during the PCV7 and PCV13 periods, significant declines in A-CAP rates were observed only during the PCV13 period in the <12 months and 24-59 months age groups (44% and 46%, respectively).
  
  
  CONCLUSIONS
  A moderate decline in hospital A-CAP visits in children <5 years old was observed after PCV7 introduction. In contrast, after PCV13 introduction a substantial reduction in all visits was evident.
authors.affiliation: The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel; The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel. Electronic address: dudi@bgu.ac.il.
authors.forename: David
authors.initials: D
authors.lastname: Greenberg
authors.affiliation: The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel; The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Noga
authors.initials: N
authors.lastname: Givon-Lavi
authors.affiliation: The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel; The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Shalom
authors.initials: S
authors.lastname: Ben-Shimol
authors.affiliation: Department of Radiology, Hadassah University Medical Center, Jerusalem, Israel.
authors.forename: Jacob Bar
authors.initials: JB
authors.lastname: Ziv
authors.affiliation: The Pediatric Infectious Disease Unit, Soroka University Medical Center, Beer-Sheva, Israel; The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Ron
authors.initials: R
authors.lastname: Dagan
mesh_terms: D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000517:prevention & control*; D004632:Emergency Medical Services; D005260:Female; D000069443:Heptavalent Pneumococcal Conjugate Vaccine / Q000008:administration & dosage / Q000276:immunology*; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007223:Infant; D007557:Israel / Q000453:epidemiology; D008297:Male; D022242:Pneumococcal Vaccines / Q000008:administration & dosage / Q000276:immunology*; D011018:Pneumonia, Pneumococcal / Q000453:epidemiology* / Q000517:prevention & control*; D011446:Prospective Studies
chemical_list: C538862:13-valent pneumococcal vaccine; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D022242:Pneumococcal Vaccines
keywords: Children; Community-acquired pneumonia; Impact; Pneumococcal conjugated vaccines