Becker-Dreps Sylvia, Amaya Erick, Liu Lan, Moreno Gilberto, Rocha Julio, Briceño Rafaela, Alemán Jorge, Hudgens Michael G, Woods Christopher W, Weber David J
From the *Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, NC; †Department of Microbiology, National Autonomous University of Nicaragua, León, Nicaragua; ‡Department of Biostatistics, UNC Gillings School of Global Public Health, Chapel Hill, NC; §Sistemas Locales de Atención Integral a la Salud, León (SILAIS-León); ¶Hospital Epidemiology, ||Department of Pediatrics, Hospital Escuela Oscar Danilo Rosales Argüello (HEODRA), León, Nicaragua; **Division of Infectious Diseases, Duke University School of Medicine, Durham, NC; and ††Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC.
Pediatr Infect Dis J. 2014 Jun;33(6):637-42. doi: 10.1097/INF.0000000000000269.
In 2010, Nicaragua became the first developing nation to add 13-valent pneumococcal conjugate vaccine (PCV-13) to its national immunization schedule, using a "3+0" dosing schedule. We assessed changes in incidence rates of health facility visits for childhood pneumonia and infant mortality after PCV-13 introduction in the Department of León, Nicaragua.
We collected visit diagnoses from all 107 public health facilities in León between 2008 and 2012. We compared rates of pneumonia hospitalizations, ambulatory visits for pneumonia and infant mortality during the prevaccine (2008-2010) and vaccine (2011-2012) periods among different age groups of children using generalized estimating equations, accounting for clustering by municipality. Exposure time was estimated by official municipality population estimates.
The adjusted incidence rate ratio for pneumonia hospitalization in the vaccine versus prevaccine period was 0.67 (0.59-0.75) among infants and 0.74 (0.67-0.81) among 1-year olds. The adjusted incidence rate ratio for ambulatory visits for pneumonia was 0.87 (0.75-1.01) among infants, and 0.84 (0.74, 0.95) among 1-year olds. The adjusted incidence rate ratio for infant mortality was 0.67 (0.57-0.80). We also observed lower rates of health facility visits for pneumonia among age groups (2- to 4-year old and 5- to 14-year old) not eligible to receive PCV-13.
Within the first 2 years of a PCV-13 immunization program in Nicaragua, we observed lower rates of hospitalizations and ambulatory visits for pneumonia among children of all ages and a lower infant mortality rate. Lower rates of pneumonia among age groups not eligible to receive PCV-13 suggest an indirect effect of the vaccine.
2010年，尼加拉瓜成为首个将13价肺炎球菌结合疫苗（PCV - 13）纳入其国家免疫规划的发展中国家，采用“3 + 0”接种程序。我们评估了在尼加拉瓜莱昂省引入PCV - 13后，儿童肺炎的医疗机构就诊发病率和婴儿死亡率的变化。
我们收集了2008年至2012年期间莱昂省所有107家公共卫生机构的就诊诊断信息。我们使用广义估计方程比较了疫苗接种前（2008 - 2010年）和疫苗接种期间（2011 - 2012年）不同年龄组儿童的肺炎住院率、肺炎门诊就诊率和婴儿死亡率，并考虑了按市聚类的因素。暴露时间通过官方市人口估计数进行估算。
疫苗接种期间与疫苗接种前相比，婴儿肺炎住院的校正发病率比值为0.67（0.59 - 0.75），1岁儿童为0.74（0.67 - 0.81）。婴儿肺炎门诊就诊的校正发病率比值为0.87（0.75 - 1.01），1岁儿童为0.84（0.74，0.95）。婴儿死亡率的校正发病率比值为0.67（0.57 - 0.80）。我们还观察到在不符合接种PCV - 13条件的年龄组（2至4岁和5至14岁）中，肺炎的医疗机构就诊率较低。
在尼加拉瓜的PCV - 13免疫规划的头两年内，我们观察到各年龄段儿童的肺炎住院率和门诊就诊率较低，婴儿死亡率也较低。在不符合接种PCV - 13条件的年龄组中肺炎发病率较低，表明该疫苗具有间接作用。
