PURPOSE OF THE STUDY.
The purpose of the study was to evaluate the impact of pneumococcal vaccination (PCV) with PCV7 and PCV13 on the incidence of hospitalization due to sinusitis, bacterial pneumonia, and empyema.
The study included all children hospitalized with sinusitis, pneumonia, or empyema in Stockholm County between July 2003 and June 2012.
This was a retrospective, population based study in which the children were identified by International Classification of Diseases, 10th Revision–coded hospital registries. Discharge codes used were J13–J18 (bacterial pneumonia or pneumonia unspecified), J86 (empyema), or J01 (sinusitis). Pyelonephritis was used as a control for the effect of PCV on number of admissions. The number of children admitted with asthma, RSV, and viral pneumonia were also recorded to control for possible changes in diagnostics. The children were divided into age groups 0 to <2, 2 to <5, and 5 to <18.
Between July 2003 and June 2012, 678 children were discharged from the hospital with the diagnosis of sinusitis. Of those cases, 76 cases were excluded because of incorrect diagnosis or no clinical signs of sinusitis, based on chart review. The incidence of hospitalization was then compared before and after PCV7 introduction by age. The incidence of hospitalization for sinusitis in children <2 years of age decreased significantly from 70 to 24 per 100 000 person-years (P < .001). In children between aged 2 and 5, there was a trend toward a decrease, but it was not statistically significant. The incidence of hospitalization remained stable in children 5 years or older. During the study years, 5018 children were discharged with a diagnosis of pneumonia. The incidence of hospitalization for pneumonia decreased significantly in the children aged <2, from 450 to 366 per 100 000 person-years (P < .001) before and after the vaccination periods. There was also a significant decrease seen in the age group of 2 to <5, from 250 to 212 person-years (P = .002). The incidence did not change in the children aged >5. There was a trend for increased hospitalization for empyema (2.5–4.4 per 100 000 person-years) in the children aged <2; however, this was not significant. There was a slight increase in admissions for pyelonephritis in the children < 2 but not among the older children. The incidence of hospitalization for asthma remained stable during the study period; however, the incidence of hospitalization for respiratory syncytial virus infections, and viral pneumonia increased significantly in children aged <2.
This study found that the incidence of hospitalization for sinusitis and pneumonia in children aged <2 decreased significantly after introduction of the PCV7 and PCV13 vaccination program. There was also a significant decrease in pneumonia hospitalization and a trend toward decrease in sinusitis in children ages 2 to <5. There was a trend for increased hospitalizations for empyema in children aged <2, but this was not significant.
Interestingly, the data show that the most effective change is in the youngest age group, of <2 years. The data also serve to reinforce the importance of vaccination on both personal and public health levels. The major strength of this study was inclusion of all the hospitals in the area of interest and a 98% vaccination rate among children. Limitations include the diagnosis being based on proper coding by providers and lack of ethnic diversity in the population.
- Copyright © 2015 by the American Academy of Pediatrics