Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China; Anhui Province Key Laboratory of Major Autoimmune Disease, Hefei, China.
International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
Environ Res. 2022 Sep;212(Pt A):113156. doi: 10.1016/j.envres.2022.113156. Epub 2022 Mar 21.
Studies have shown that ambient extreme temperatures (heat and cold) were associated with an increased risk of childhood pneumonia, but the evidence is very limited in low-middle-income countries. It also remains unknown whether pneumococcal conjugate vaccine (PCV) could prevent temperature-related childhood pneumonia. This study collected data on ambient temperature and hospitalizations for childhood pneumonia in Matlab, Bangladesh from 2012 to 2016. Interrupted time series (ITS) analysis was employed to assess the impact of PCV (10-valent) intervention on childhood pneumonia hospitalizations. A time-stratified case-crossover analysis with a conditional logistic regression was performed to examine the association of childhood pneumonia hospitalizations with extreme temperatures and heatwaves before and after PCV10 intervention. Subgroup analyses were conducted to explore the modification effects of seasons, age, gender, and socioeconomic levels on temperature-related childhood pneumonia hospitalizations. We found that after PCV10 intervention, there was a sharp decrease in hospitalizations for childhood pneumonia (relative risk (RR): 0.59, 95% confidence interval (CI): 0.43-0.83). During the study period, heat effects on childhood pneumonia appeared immediately on the current day (odds ratio (OR): 1.28; 95% CI: 1.02-1.60, lag 0), while cold effects appeared 4 weeks later (OR: 1.53, 95% CI: 1.06-2.22, lag 28). Importantly, cold effects decreased significantly after PCV10 (p-value＜0.05), but heat and heatwave effects increased after PCV10 (p-value＜0.05). Particularly, children from families with a middle or low socioeconomic level, boys, and infants were more susceptible to heat-related pneumonia. This study suggests that PCV10 intervention in Bangladesh may help decrease cold-related not heat-related childhood pneumonia.
研究表明，环境极端温度（高温和低温）与儿童肺炎的风险增加有关，但在中低收入国家，这方面的证据非常有限。此外，肺炎球菌结合疫苗（PCV）是否能预防与温度相关的儿童肺炎也尚未可知。本研究收集了 2012 年至 2016 年孟加拉国 Matlab 地区环境温度和儿童肺炎住院的数据。采用中断时间序列（ITS）分析评估 10 价肺炎球菌结合疫苗（PCV10）干预对儿童肺炎住院的影响。采用条件逻辑回归进行时间分层病例交叉分析，以研究儿童肺炎住院与 PCV10 干预前后极端温度和热浪的相关性。进行了亚组分析，以探讨季节、年龄、性别和社会经济水平对与温度相关的儿童肺炎住院的影响。结果发现，PCV10 干预后，儿童肺炎住院率显著下降（相对风险（RR）：0.59，95%置信区间（CI）：0.43-0.83）。在研究期间，高温对儿童肺炎的影响在当前日立即显现（比值比（OR）：1.28；95%CI：1.02-1.60，滞后 0），而低温的影响在 4 周后显现（OR：1.53，95%CI：1.06-2.22，滞后 28）。重要的是，PCV10 干预后，低温的影响显著降低（p 值＜0.05），但高温和热浪的影响增加（p 值＜0.05）。特别是来自中低社会经济水平家庭的男孩和婴儿更容易受到热相关肺炎的影响。本研究表明，孟加拉国的 PCV10 干预可能有助于降低与温度相关的但非与温度相关的儿童肺炎。
