Impact of Pneumococcal Conjugate Vaccines on Pneumonia Hospitalizations in High- and Low-Income Subpopulations in Brazil

TY - JOUR

T1 - Impact of Pneumococcal Conjugate Vaccines on Pneumonia Hospitalizations in High- and Low-Income Subpopulations in Brazil

AU - Warren, Joshua L.

AU - Shioda, Kayoko

AU - Kürüm, Esra

AU - Schuck-Paim, Cynthia

AU - Lustig, Roger

AU - Taylor, Robert J.

AU - Simonsen, Lone

AU - Weinberger, Daniel M.

PY - 2017/12/1

Y1 - 2017/12/1

N2 - Background: Pneumococcal conjugate vaccines (PCVs) are being used worldwide. A key question is whether the impact of PCVs on pneumonia is similar in low- and high-income populations. However, most low-income countries, where the burden of disease is greatest, lack reliable data that can be used to evaluate the impact. Data from middle-income countries that have both low- and high-income subpopulations can provide a proxy measure for the impact of the vaccine in low-income countries. Methods: We evaluated the impact of PCV10 on hospitalizations for all-cause pneumonia in Brazil, a middle-income country with localities that span a broad range of human development index (HDI) levels. We used complementary time series and spatiotemporal methods (synthetic controls and hierarchical Bayesian spatial regression) to test whether the decline in pneumonia hospitalizations associated with vaccine introduction varied across the socioeconomic spectrum. Results: We found that the declines in all-cause pneumonia hospitalizations in children and young and middle-aged adults did not vary substantially across low and high HDI subpopulations. Moreover, the estimated declines seen in infants and young adults were associated with higher levels of uptake of the vaccine at a local level. Conclusions: These results suggest that PCVs have an important impact on hospitalizations for all-cause pneumonia in both low- and high-income populations.

AB - Background: Pneumococcal conjugate vaccines (PCVs) are being used worldwide. A key question is whether the impact of PCVs on pneumonia is similar in low- and high-income populations. However, most low-income countries, where the burden of disease is greatest, lack reliable data that can be used to evaluate the impact. Data from middle-income countries that have both low- and high-income subpopulations can provide a proxy measure for the impact of the vaccine in low-income countries. Methods: We evaluated the impact of PCV10 on hospitalizations for all-cause pneumonia in Brazil, a middle-income country with localities that span a broad range of human development index (HDI) levels. We used complementary time series and spatiotemporal methods (synthetic controls and hierarchical Bayesian spatial regression) to test whether the decline in pneumonia hospitalizations associated with vaccine introduction varied across the socioeconomic spectrum. Results: We found that the declines in all-cause pneumonia hospitalizations in children and young and middle-aged adults did not vary substantially across low and high HDI subpopulations. Moreover, the estimated declines seen in infants and young adults were associated with higher levels of uptake of the vaccine at a local level. Conclusions: These results suggest that PCVs have an important impact on hospitalizations for all-cause pneumonia in both low- and high-income populations.

KW - Brazil

KW - disparities

KW - pneumococcal conjugate vaccines

KW - pneumonia

U2 - 10.1093/cid/cix638

DO - 10.1093/cid/cix638

M3 - Journal article

C2 - 29020195

AN - SCOPUS:85034861549

SN - 1058-4838

VL - 65

SP - 1813

EP - 1818

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

IS - 11

ER -