Murdoch Children's Research Institute, Melbourne, VIC, Australia.
Ministry of Health and Medical Services, Suva, Fiji.
Lancet Glob Health. 2021 Jan;9(1):e91-e98. doi: 10.1016/S2214-109X(20)30421-6. Epub 2020 Nov 20.
In October, 2012, Fiji introduced routine infant immunisation with a ten-valent pneumococcal conjugate vaccine (PCV10) using three primary doses and no booster dose (3 + 0 schedule). Data are scarce for the effect of PCV in the Asia and Pacific region. We aimed to evaluate the effect of PCV10 on pneumonia hospital admissions in children younger than 5 years and adults aged 55 years and older in Fiji, 5 years after vaccine introduction.
We did a time-series analysis assessing changes in pneumonia hospital admissions at three public tertiary hospitals in Fiji. Four pneumonia outcomes were evaluated: all-cause pneumonia, severe or very severe pneumonia, hypoxic pneumonia, and radiological pneumonia. Participants aged younger than 2 months, 2-23 months, 24-59 months, and 55 years and older were included. Data were extracted from the national hospital admission database according to International Classification of Diseases-tenth revision codes J10·0-18·9, J21, and J22 for all-cause pneumonia. Medical records and chest radiographs were reviewed for the main tertiary hospital to reclassify hospital admissions in children aged younger than 2 years as severe or very severe, hypoxic, or radiological pneumonia as per WHO definitions. Time-series analyses were done using the synthetic control method and multiple imputation to adjust for changes in hospital usage and missing data.
Between Jan 1, 2007, and Dec 31, 2017, the ratio of observed cases to expected cases for all-cause pneumonia was 0·92 (95% CI 0·70-1·36) for children aged younger than 2 months, 0·86 (0·74-1·00) for children aged 2-23 months, 0·74 (0·62-0·87) for children aged 24-59 months, and 1·90 (1·53-2·31) in adults aged 55 years and older, 5 years after PCV10 introduction. These findings indicate a reduction in all-cause pneumonia among children aged 24-59 months and an increase in adults aged 55 years and older, but no change among children aged younger than 2 months. Among children aged 2-23 months, we observed declines of 21% (95% CI 5-35) for severe or very severe pneumonia, 46% (33-56) for hypoxic pneumonia, and 25% (9-38) for radiological pneumonia. Mortality reduced by 39% (95% CI 5-62) for all-cause pneumonia, bronchiolitis, and asthma admissions in children aged 2-23 months.
The introduction of PCV10 was associated with a decrease in pneumonia hospital admissions in children aged 2-59 months. This is the first study in a middle-income country in the Asia and Pacific region to show the effect of PCV on pneumonia, filling gaps in the literature on the effects of PCV10 and 3 + 0 schedules. These data support decision making on PCV introduction for other low-income and middle-income countries in the region.
Department of Foreign Affairs and Trade of the Australian Government.
2012 年 10 月，斐济开始为所有婴儿常规接种十价肺炎球菌结合疫苗（PCV10），共接种 3 针，无加强针（3+0 程序）。在亚洲及太平洋地区，PCV 的效果数据十分有限。我们旨在评估 PCV10 在引入疫苗 5 年后对斐济 55 岁及以上年龄人群和 5 岁以下儿童的肺炎住院的影响。
我们进行了一项时间序列分析，评估了斐济 3 家公立三级医院的肺炎住院人数的变化。评估了 4 种肺炎结果：所有原因肺炎、严重或极严重肺炎、低氧血症性肺炎和影像学肺炎。参与者年龄小于 2 个月、2-23 个月、24-59 个月和 55 岁及以上。数据根据国际疾病分类第十版 J10·0-18·9、J21 和 J22 代码从国家住院数据库中提取，用于所有原因肺炎。主要三级医院的病历和胸部 X 光片被用于重新分类 2 岁以下儿童的住院病例为严重或极严重、低氧血症或影像学肺炎，按照世界卫生组织的定义。使用合成控制法和多重插补进行时间序列分析，以调整医院使用率的变化和缺失数据。
2007 年 1 月 1 日至 2017 年 12 月 31 日，PCV10 引入后 5 年，2 个月以下儿童所有原因肺炎的观察病例与预期病例的比值为 0.92（95%CI 0.70-1.36），2-23 个月儿童为 0.86（0.74-1.00），24-59 个月儿童为 0.74（0.62-0.87），55 岁及以上成年人为 1.90（1.53-2.31）。这些发现表明，24-59 个月儿童的所有原因肺炎有所减少，55 岁及以上成年人有所增加，但 2 个月以下儿童没有变化。在 2-23 个月儿童中，我们观察到严重或极严重肺炎下降了 21%（95%CI 5-35），低氧血症性肺炎下降了 46%（33-56），影像学肺炎下降了 25%（9-38）。2-23 个月儿童的所有原因肺炎、细支气管炎和哮喘住院率降低了 39%（95%CI 5-62）。
PCV10 的引入与 2-59 个月儿童的肺炎住院人数减少有关。这是亚太地区中等收入国家首次开展的研究，显示了 PCV 对肺炎的影响，填补了关于 PCV10 和 3+0 程序效果的文献空白。这些数据支持了为该地区其他低收入和中等收入国家决定是否引入 PCV 的决策。
澳大利亚外交贸易部。
