title: The impact of pneumococcal conjugate vaccine on community-acquired pneumonia hospitalizations in children with comorbidity.
abstract: The burden of community-acquired pneumonia (CAP) in high-income countries is still significant. The introduction of pneumococcal conjugate vaccines (PCV) has reduced the overall need for hospitalization for CAP. However, it is not clear whether children with underlying disease also have benefitted from the PCV immunization programme. Children 0 to <5 years of age hospitalized with CAP and discharged with an ICD-10 code of J13-J18.9 between November 1, 2005, and April 30, 2007 (pre-vaccination period), and November 1, 2010, and April 30, 2012 (post-vaccination period), were eligible for this study. Data on hospitalization and discharge diagnoses were retrieved from the Hospital Registry. In addition, chart review was performed in 50% of the patients. Our result confirmed a decrease in hospitalization rate for CAP in the PCV13 period. Chart review revealed that half of the patients had underlying comorbidity and these children had more severe symptoms and required longer hospital stay. Intensive care was provided to less than 10% of the children and mostly for children with an underlying neurological disease.
  
  
  CONCLUSIONS
  We show that all children have benefitted from the reduction of CAP hospitalization after introduction of PCV. Our finding emphasizes the importance of children with chronic diseases receiving adequate vaccinations that may protect from lower respiratory diseases. What is known? • Community-acquired pneumonia is a leading infectious cause of hospitalizations and death among children <5 years of age globally • Pneumococcal conjugate vaccine reduces the hospitalizations of all-cause pneumonia What is new? • We show that also children with underlying comorbidities have benefitted from PCV immunization with a reduction of CAP hospitalization • We show that approximately half of all children hospitalized with CAP also have underlying comorbidities.
authors.affiliation: Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Ellinor
authors.initials: E
authors.lastname: Sterky
authors.affiliation: Public Health Agency of Sweden, Solna, Sweden.
authors.forename: Rutger
authors.initials: R
authors.lastname: Bennet
authors.affiliation: Paediatric Infectious Diseases Unit, Paediatric Emergency Department, Astrid Lindgren's Children Hospital, Stockholm, Sweden.
authors.forename: Ann
authors.initials: A
authors.lastname: Lindstrand
authors.affiliation: Public Health Agency of Sweden, Solna, Sweden.
authors.forename: Margareta
authors.initials: M
authors.lastname: Eriksson
authors.affiliation: Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden. anna.nilsson.1@ki.se.|Childhood Cancer Research Unit Q6:05, Astrid Lindgren Childrens Hospital, Stockholm, Sweden. anna.nilsson.1@ki.se.
authors.forename: Anna
authors.identifier: http://orcid.org/0000-0001-5885-7101
authors.initials: A
authors.lastname: Nilsson
mesh_terms: D016009:Chi-Square Distribution; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D022242:Pneumococcal Vaccines / Q000008:administration & dosage*; D011024:Pneumonia, Viral / Q000453:epidemiology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013548:Sweden / Q000453:epidemiology; D018074:Vaccines, Conjugate / Q000008:administration & dosage
chemical_list: D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate
keywords: Childhood pneumonia; Comorbidity; Hospitalization; Pneumococcal vaccination