Department of Biostatistics.
Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut.
Clin Infect Dis. 2017 Nov 13;65(11):1813-1818. doi: 10.1093/cid/cix638.
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.
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.
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.
These results suggest that PCVs have an important impact on hospitalizations for all-cause pneumonia in both low- and high-income populations.
肺炎球菌结合疫苗（PCV）正在全球范围内使用。一个关键问题是 PCV 对肺炎的影响在低收入和高收入人群中是否相似。然而，大多数疾病负担最大的低收入国家缺乏可用于评估疫苗影响的可靠数据。具有低收入和高收入亚人群的中等收入国家的数据可以为评估疫苗在低收入国家的影响提供替代衡量标准。
我们评估了 10 价肺炎球菌结合疫苗（PCV10）对巴西全因肺炎住院的影响，巴西是一个中等收入国家，其地理位置涵盖了广泛的人类发展指数（HDI）水平。我们使用补充的时间序列和时空方法（合成对照和分层贝叶斯空间回归）来检验与疫苗接种相关的肺炎住院人数下降是否因社会经济状况而异。
我们发现，儿童和年轻及中年人群中全因肺炎住院人数的下降在低和高 HDI 亚人群之间没有显著差异。此外，在当地疫苗接种率较高的情况下，婴儿和年轻成年人的估计下降与较高水平的疫苗接种率有关。
这些结果表明，PCV 对低收入和高收入人群的全因肺炎住院有重要影响。
