Dataset Information

Impact of pneumococcal conjugate vaccine 13 introduction on severe lower respiratory tract infections associated with respiratory syncytial virus or influenza virus in hospitalized children in Ulaanbaatar, Mongolia.

ABSTRACT:

Objectives

Limited data indicate a beneficial effect of pneumococcal conjugate vaccines (PCVs) on respiratory syncytial virus (RSV) and influenza infections in young children. We evaluated the impact of 13-valent PCV (PCV13) introduction on the incidence of severe lower respiratory tract infections (LRTIs) associated with RSV or influenza in hospitalized children.

Methods

Our study was restricted to children aged <2 years with arterial oxygen saturation <93% and children with radiologically confirmed pneumonia nested in a pneumonia surveillance project in four districts of Ulaanbaatar city, Mongolia. We tested nasopharyngeal swabs collected on admission for RSV and influenza using quantitative reverse transcription-polymerase chain reaction. The impact of PCV13 on the incidence of LRTI outcomes associated with RSV or with influenza for the period April 2015-March 2020 was estimated. Incidence rate ratios comparing pre- and post-vaccine periods were estimated for each outcome for each district using negative binomial models and for all districts combined with a mixed-effects negative binomial model. Adjusted models accounted for seasonality. Sensitivity analyses were conducted to assess the robustness of our findings.

Results

Among 5577 tested cases, the adjusted incidence rate ratios showed a trend toward a reduction in RSV-associated outcomes: all LRTIs (0.77, 95% confidence interval [CI] 0.44-1.36), severe LRTIs (0.88, 95% CI 0.48-1.62), very severe LRTIs (0.76, 95% CI 0.42-1.38), and radiologically confirmed pneumonia (0.66, 95% CI 0.32-1.38) but inconsistent trends in outcomes associated with influenza.

Conclusions

No significant reductions were observed in any outcomes associated with RSV and influenza after PCV introduction.

SUBMITTER: Do LAH

PROVIDER: S-EPMC10992709 | biostudies-literature | 2024 Jun

REPOSITORIES: biostudies-literature

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Publications

Impact of pneumococcal conjugate vaccine 13 introduction on severe lower respiratory tract infections associated with respiratory syncytial virus or influenza virus in hospitalized children in Ulaanbaatar, Mongolia.

Do Lien Anh Ha LAH Tsedenbal Naranzul N Khishigmunkh Chimidregzen C Tserendulam Bazarkhuu B Altanbumba Lkhagvadorj L Luvsantseren Dashtseren D Ulziibayar Munkhchuluun M Suuri Bujinlkham B Narangerel Dorj D Tsolmon Bilegtsaikhan B Demberelsuren Sodbayar S Nguyen Cattram C Mungun Tuya T von Mollendorf Claire C Badarch Darmaa D Mulholland Kim K

IJID regions 20240319

<h4>Objectives</h4>Limited data indicate a beneficial effect of pneumococcal conjugate vaccines (PCVs) on respiratory syncytial virus (RSV) and influenza infections in young children. We evaluated the impact of 13-valent PCV (PCV13) introduction on the incidence of severe lower respiratory tract infections (LRTIs) associated with RSV or influenza in hospitalized children.<h4>Methods</h4>Our study was restricted to children aged <2 years with arterial oxygen saturation <93% and children with radi ...[more]

PMID: 38577554

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Project description:ObjectiveThe Ministry of Health (MOH), Mongolia, is considering introducing 13-valent pneumococcal conjugate vaccine (PCV13) in its national immunization programme to prevent the burden of disease caused by Streptococcus pneumoniae. This study evaluates the cost-effectiveness and budget impact of introducing PCV13 compared to no PCV vaccination in Mongolia.MethodsThe incremental cost-effectiveness ratio (ICER) of introducing PCV13 compared to no PCV vaccination was assessed using an age-stratified static multiple cohort model. The risk of various clinical presentations of pneumococcal disease (meningitis, pneumonia, non-meningitis non-pneumonia invasive pneumococcal disease and acute otitis media) at all ages for thirty birth cohorts was assessed. The analysis considered both health system and societal perspectives. A 3+0 vaccine schedule and price of US$3.30 per dose was assumed for the baseline scenario based on Gavi, the Vaccine Alliance's advance market commitment tail price.ResultsThe ICER of PCV13 introduction is estimated at US$52 per disability-adjusted life year (DALY) averted (health system perspective), and cost-saving (societal perspective). Although indirect effects of PCV have been well-documented, a conservative scenario that does not consider indirect effects estimated PCV13 introduction to cost US$79 per DALY averted (health system perspective), and US$19 per DALY averted (societal perspective). Vaccination with PCV13 is expected to cost around US$920,000 in 2016, and thereafter US$820,000 every year. The programme is likely to reduce direct disease-related costs to MOH by US$440,000 in the first year, increasing to US$510,000 by 2025.ConclusionIntroducing PCV13 as part of Mongolia's national programme appears to be highly cost-effective when compared to no vaccination and cost-saving from a societal perspective at vaccine purchase prices offered through Gavi. Notwithstanding uncertainties around some parameters, cost-effectiveness of PCV introduction for Mongolia remains robust over a range of conservative scenarios. Availability of high-quality national data would improve future economic analyses for vaccine introduction.

Project description:Abstract Background Pneumococcal conjugate vaccines (PCV) reduced the risk of respiratory syncytial virus (RSV) in a randomized clinical trial. We aimed to assess the real-world effectiveness of PCV on RSV-hospitalizations among Western Australian infants. Methods We conducted a population-based cohort study of births during 2000–2012, using probabilistically linked individual-level immunization, hospitalization, respiratory microbiology testing, and perinatal data. We performed Cox proportional hazard models with time-varying exposure (receipt of infant PCV doses) against the first RSV-confirmed hospitalization 0–12 months adjusted for perinatal and sociodemographic factors. Results From 360 994 children, 3-dose PCV coverage in Aboriginal infants ranged from 29% to 51% in 2001–2004 when PCV was funded for Aboriginal children only. Following universal funding in 2005, coverage increased to 85% for Aboriginal and 73% for non-Aboriginal infants. RSV-hospitalization rates were highest in young infants aged 0–5 months (22.5/1000 child-years) and >2 times higher in Aboriginal infants than in non-Aboriginal infants. Receipt of ≥3 PCV doses in the universal funded period was associated with a 30% reduction in RSV-hospitalization in Aboriginal infants (adjusted hazard ratio, aHR 0.70 [95% confidence interval, CI 0.46–1.06]) and 21% reduction in non-Aboriginal infants (aHR 0.79 [95% CI 0.63–0.99]) compared with unvaccinated infants. Conclusions Prior to the introduction of RSV vaccines, our study suggests that universal childhood PCV vaccination may result in a reduction in severe RSV infections in children and may be important for countries that are yet to consider PCV programs. Through population-based linked data analysis, we show a real-world protective benefit of pneumococcal conjugate vaccines (PCV) on respiratory syncytial virus (RSV) hospitalizations in infants. These findings are relevant for settings with a high RSV burden but no current universal PCV program.

Dataset Information

Impact of pneumococcal conjugate vaccine 13 introduction on severe lower respiratory tract infections associated with respiratory syncytial virus or influenza virus in hospitalized children in Ulaanbaatar, Mongolia.

Objectives

Methods

Results

Conclusions

Publications

Impact of pneumococcal conjugate vaccine 13 introduction on severe lower respiratory tract infections associated with respiratory syncytial virus or influenza virus in hospitalized children in Ulaanbaatar, Mongolia.

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