Published online September 1, 2006
PEDIATRICS Vol. 118 No. 3 September 2006, pp. 865-873 (doi:10.1542/peds.2006-0492)
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via ISI Web of Science (18)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Grijalva, C. G.
Right arrow Articles by Griffin, M. R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Grijalva, C. G.
Right arrow Articles by Griffin, M. R.
Related Collections
Right arrow Infectious Disease & Immunity

ARTICLE

National Impact of Universal Childhood Immunization With Pneumococcal Conjugate Vaccine on Outpatient Medical Care Visits in the United States

Carlos G. Grijalva, MD, MPHa, Katherine A. Poehling, MD, MPHb, J. Pekka Nuorti, MD, DScc, Yuwei Zhu, MD, MSd, Stacey W. Martin, MScc, Kathryn M. Edwards, MDb and Marie R. Griffin, MD, MPHa,e,f

a Departments of Preventive Medicine
b Pediatrics
d Biostatistics
e Medicine
f Center For Education and Research on Therapeutics, Vanderbilt University School of Medicine, Nashville, Tennessee
c Bacterial Vaccine-Preventable Diseases Branch, National Immunization Program, Centers for Disease Control and Prevention, Atlanta, Georgia

BACKGROUND. Since introduction of the heptavalent pneumococcal conjugate vaccine in the United States in 2000, rates of invasive pneumococcal disease have declined. However, the national impact of heptavalent pneumococcal conjugate vaccine on pneumonia and otitis media remains unknown.

OBJECTIVES. We compared national rates of outpatient visits for pneumonia and otitis media in children before and after heptavalent pneumococcal conjugate vaccine introduction.

METHODS. Rates of ambulatory visits for pneumococcal and nonspecific pneumonia, otitis media, and other acute respiratory infections were compared before (1994–1999) and after (2002–2003) heptavalent pneumococcal conjugate vaccine introduction using the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. To evaluate vaccine effects while accounting for temporal variability, ratios of pneumococcal-related disease rates in children <2 years old (vaccine target population) and in children 3 to 6 years old (not routinely vaccinated) were evaluated using a Poisson regression analysis. For children <2 years old, the differences between observed and expected rates were the estimated vaccine effects.

RESULTS. After the introduction of heptavalent pneumococcal conjugate vaccine, otitis media visit rates declined by 20% in children aged <2 years. This decline represented 246 fewer otitis media visits per 1000 children aged <2 years annually. There were no significant decreases in outpatient visit rates for pneumonia or other acute respiratory infections for children aged <2 years.

CONCLUSIONS. After heptavalent pneumococcal conjugate vaccine introduction, national rates of otitis media visits declined significantly in children <2 years old. Persistence of this trend will produce a significant reduction of the otitis media burden and further enhance the cost-effectiveness of heptavalent pneumococcal conjugate vaccine.

Key Words: pneumococcal conjugate vaccine • otitis media • pneumonia

Abbreviations: PCV7—heptavalent pneumococcal conjugate vaccine • NAMCS—National Ambulatory Medical Care Survey • NHAMCS—National Hospital Ambulatory Medical Care Survey • ICD-9-CM—International Classification of Diseases, Clinical Modification, Ninth Revision • ARI—acute respiratory infection • RR—rate ratio • CI—confidence interval

Accepted Apr 19, 2006.




This article has been cited by other articles:


Home page
 PediatricsHome page
J. Ongkasuwan, T. A. Valdez, K. G. Hulten, E. O. Mason Jr, and S. L. Kaplan
Pneumococcal Mastoiditis in Children and the Emergence of Multidrug-Resistant Serotype 19A Isolates
Pediatrics, July 1, 2008; 122(1): 34 - 39.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
F. Zhou, A. Shefer, Y. Kong, and J. P. Nuorti
Trends in Acute Otitis Media-Related Health Care Utilization by Privately Insured Young Children in the United States, 1997-2004
Pediatrics, February 1, 2008; 121(2): 253 - 260.
[Abstract] [Full Text] [PDF]

Home page
 Arch Pediatr Adolesc MedHome page
F. Zhou, M. H. Kyaw, A. Shefer, C. A. Winston, and J. P. Nuorti
Health Care Utilization for Pneumonia in Young Children After Routine Pneumococcal Conjugate Vaccine Use in the United States
Arch Pediatr Adolesc Med, December 1, 2007; 161(12): 1162 - 1168.
[Abstract] [Full Text] [PDF]

Home page
 JAMAHome page
M. E. Pichichero and J. R. Casey
Emergence of a Multiresistant Serotype 19A Pneumococcal Strain Not Included in the 7-Valent Conjugate Vaccine as an Otopathogen in Children
JAMA, October 17, 2007; 298(15): 1772 - 1778.
[Abstract] [Full Text] [PDF]

Home page
 PediatricsHome page
K. A. Poehling, P. G. Szilagyi, C. G. Grijalva, S. W. Martin, B. LaFleur, E. Mitchel, R. D. Barth, J. P. Nuorti, and M. R. Griffin
Reduction of Frequent Otitis Media and Pressure-Equalizing Tube Insertions in Children After Introduction of Pneumococcal Conjugate Vaccine
Pediatrics, April 1, 2007; 119(4): 707 - 715.
[Abstract] [Full Text] [PDF]