BACKGROUND: Streptococcus pneumoniae is the primary causative agent of pneumonia in older adults. Vaccination is the only tool to protect against pneumococcal infection; however, vaccination rates remain far below the Healthy People 2010 objective of 90% coverage. The number one reason for such low rates is attributed to controversy over the protective efficacy of the vaccine in preventing nonbacteremic pneumonia (eg, community-acquired pneumonia [CAP]). OBJECTIVES: The primary objectives of this study were to assess the incidence of pneumonia, pneumonia requiring hospitalization, and pneumonia hospitalization costs. METHODS: In this retrospective cohort study of Medicare beneficiaries aged 65 years in 2003, subjects were selected based on exposure status. Exposure was defined as receipt of the 23-valent pneumococcal polysaccharide vaccine (PPV23). Vaccinated persons were then matched 1:1 on gender and the presence of any comorbidity to unvaccinated persons. Subjects were followed up for 1 year (January 1, 2004 through December 31, 2004). The primary outcomes were pneumonia, pneumonia requiring hospitalization, and hospitalization costs. Mantel-Haenszel chi-square or logit was used to estimate the relative risk (RR) associated with vaccination and each outcome and Proc Ttest was used to test the difference between mean hospital costs of the vaccinated and non-vaccinated. RESULTS: During the follow-up period, 443 patients were diagnosed with pneumonia; 266 had previously been vaccinated and 177 had no documented receipt of prior vaccination. Results of the Chi-square analysis revealed a significant association between vaccination and the risk of pneumonia, as the vaccinated were 50% more likely to develop pneumonia than were the non-vaccinated (Adjusted RR: 1.50; 95% CI: 1.25, 1.81). Approximately 67% of patients diagnosed with pneumonia required hospitalization; of which, 183 were previously vaccinated and 115 had no documented receipt of prior vaccination. There was no association between vaccination and risk of pneumonia requiring hospitalization (P value 0.4001). However, the vaccine was associated with a significant reduction in hospital costs (P value 0.004). CONCLUSIONS: The results of this study suggest that use of the vaccine may be associated with cost savings due to a reduction in hospitalization.

JESSICA MASTRODOMENICO An Examination of the Socio-Demographic Characteristics Associated with Adult Vaccination Prevalence for Preventable Diseases in the United States Background: An estimated 50,000 adults in the United States (U.S.) die each year from one of 10 vaccine preventable diseases. For those who survive vaccine preventable infections, health care costs and loss of income become more significant. While children in the U.S. aged 0-2 exhibit vaccine prevalence rates of almost 90%, some adult vaccine prevalence rates in the U.S. population are reported to be nearly 30-40% less than the goals set forth by Healthy People 2010. The purpose of this study was to examine the associations between socio-demographic characteristics of U.S. adults and adult vaccination prevalence for pneumococcal, hepatitis A, hepatitis B, tetanus, and pertussis. Methods: Data from the 2008 National Health Interview Survey were assessed examining various health indicators and characteristics of non-institutionalized adults and children. The sample was restricted to adults ≥18 years of age. Odds ratios were calculated and multivariate logistic regression was also conducted. P-values of <0.05 and 95% confidence intervals were used to determine statistical significance. Results: There were 21781 total observations; 19.3% received the pneumococcal vaccine, 9.4% received the hepatitis A vaccine, 27.2% received the hepatitis B vaccine, 55.1% received the tetanus vaccine, and 15.2% received the pertussis vaccine. Of the socio-demographic characteristics examined, age, health insurance, marital status, and education were significant for either all five or at least four of the vaccines included in this study. As one might expect those who reported health insurance and those who had a higher level of education usually had a higher likelihood of vaccine receipt as compared to those without health insurance and those with less than a high school education. Age associations varied due to age-related recommendations for certain vaccines such as pneumococcal (recommended for adults ≥65). Compared to the married population (referent), marital status results varied, but for reasons unclear. Whites, the referent group, were the most likely to be vaccinated as compared to Blacks, Hispanics/Latinos, and Asians. Hispanics/Latinos typically had the lowest likelihood of vaccination in this examination. Conclusions: This study further explores the impact of socio-demographic disparities on vaccination status and adds new information to the literature regarding adult vaccination rates for preventable diseases. While research exists related to strengthening interventions such as patient reminder systems, those who do not see the same health care providers on a regular basis remain at risk for lower vaccination prevalence. It is important to better understand the role of social determinants of health, specifically in terms of vaccinations. Future research is needed to further characterize the association of socio-demographic factors with receipt of optional vaccines in adults.

Introdução: Pessoas infectadas pelo vírus da imunodeficiência humana (HIV) têm alto risco de desenvolver doença pneumocócica. Infecções invasivas pelo Streptococcus pneumoniae (pneumococo) lideram a morbidade e a mortalidade entre crianças, idosos e pessoas com doenças de base que comprometem o sistema imune ou diminuem a função esplênica. A infecção pelo HIV está associada a um aumento de até dez vezes na incidência das pneumonias bacterianas no mundo. S. pneumoniae é o agente mais comum identificado. A imunização contra S. pneumoniae tem sido recomendada para indivíduos infectados pelo HIV em vários países, incluindo o Brasil, onde a vacina de polissacarídeos antipneumococo com 23 sorotipos (PPV-23) está sendo utilizada desde 1993. A efetividade da vacina de polissacarídeos antipneumococo varia entre 60 a 80% entre adultos com função imunológica relativamente normal. Entre adultos infectados pelo HIV, os estudos realizados até o momento apresentam resultados inconclusivos ou mesmo contraditórios. Objetivo: o objetivo deste estudo é avaliar a efetividade da vacina de polissacarídeos antipneumococo 23-valente (PPV-23) em uma amostra da população adulta infectada pelo HIV, em São Paulo. Métodos: Estudo de caso controle, tipo caso-incidente, entre adultos infectados pelo HIV, em São Paulo. A exposição é ter sido vacinado com a vacina 23 valente e o desfecho é infecção invasiva causada pelo S. pneumoniae. Caso: pessoa infectada pelo HIV, >=18 anos de idade, com doença invasiva por pneumococo, diagnosticada por meio de cultura positiva (isolamento de S. pneumoniae) em material biológico obtido de qualquer fluido corporal normalmente estéril. Controle: pessoa infectada pelo HIV, com >=18 anos de idade, recebendo cuidados nas mesmas instituições, sem doença invasiva por pneumococo, com o mesmo nível de células T CD4+ no mesmo período do diagnóstico do caso, estratificadas por faixas (CD4<200; CD4>=200<=499; >=500) cels/mm3. Foram conduzidas análise univariada e regressão logística condicional. Resultados: 79 casos e 241 controles foram incluídos, média de 39 anos, 63% do sexo masculino, mais de 50% com escolaridade entre média e fundamental, 63,5% brancos, 19% vivendo em condições precárias de habitação. Idade, sexo e raça não diferiram entre casos e controles. Bacteremia foi a manifestação clínica mais freqüente. Fatores de risco associados à doença pneumocócica incluíram: uso de alcool, de drogas injetáveis, ter menor nível de escolaridade, condições precárias de habitação, contato próximo com criança <10 anos e hospitalizações prévias por pneumonia. O uso de anti-retrovirais e a vacina antipneumocócica estiveram associados com uma diminuição do risco. A efetividade da vacina foi de aproximadamente 65% (OR=0,35 IC95%:0,18-0,70). Após ajustar por alguns fatores associados à doença invasiva (uso de drogas injetáveis, hospitalização prévia por pneumonia e uso de ARV), o possível efeito protetor da vacina (OR=, EV=54%) perdeu sua significância estatística (IC95% 0,27-1,13). Amostras de 47 casos foram sorotipadas. Conclusão: Este é o primeiro estudo a avaliar a efetividade da vacina de polissacarídeos antipneumocócica entre os indivíduos infectados pelo HIV no Brasil, e a incluir dados sobre a distribuição dos sorotipos de pneumococo neste subgrupo. A vacina anti-pneumocócica e o uso de anti-retrovirais atuaram como fatores protetores contra doença pneumocócica invasiva. Estes resultados reforçam a recomendação do uso da vacina no Brasil, e indicam a necessidade de estudos com amostras maiores que possam elucidar de forma inequívoca o efeito da vacina antipneumocócica entre portadores do HIV / Background: HIV-infected individuals are at increased risk of bacterial pneumonia in general and of pneumonia due to S. pneumoniae in particular. S. pneumoniae is the leading cause of morbidity and mortality among children, elderly and those with underlying conditions that compromise the immune system or diminish the splenic function. HIV infection is associated to a tenfold increase in the incidence of bacterial pneumonias worldwide and S. pneumoniae is the most common causal agent identified. Immunization against S. pneumoniae with Polysaccharide pneumococcal vaccine is recommended for use in HIV-infected adults in Brazil. The effectiveness of PPV23 ranges from to approximately 30 to 80%, among those with normal immune function. Among HIV-infected adults, studies have suggested contradictory or inconclusive results. Objective: To assess the effectiveness of the 23-valent polysaccharide pneumococcal vaccine among HIV-infected adult patients in São Paulo, Brazil. Methods: A prospective matched case-control study among HIV-infected adults in São Paulo. Exposure is vaccination with PPV-23 and outcome is invasive disease. Case definition: HIV-infected individual over 18 years old, with invasive pneumococcal disease, defined as recovery of S. pneumoniae from a normally sterile site (e.g. such as blood, pleural fluid, spinal fluid, pericardial fluid). Controls: HIV-infected individuals over 18 years of age, with o history of documented or strong suspicion of invasive pneumococcal disease, receiving medical care at the same group of institutions, matched to the cases by level of CD4 lymphocyte cell counts, according to the following (<200; 200=500 cells/mm3), measured during the same period. Results: 79 cases and 241 controls were included; mean age of 39 years; 63% male; education level lower than high school for 50% of the sample; 63,5% whites, 19% reported living in \"sub-standard\" housing. Bacteremia was the most frequent clinical manifestation. Risk factors associated with invasie disease: alcohol use, IDU, lower level of education, \"sub-standard\" housing, close contact with child less than 10 years old and previous hospitalization with pneumonia. ARV use and pneumococcal vaccine were associated to decreased risk. Overall vaccine effectiveness was 65% (OR=0,35 IC95%:0,18-0,70). After adjustment for confounding factors (IDU, hospitalization with pneumonia, and ARV use) the point estimate for the effectiveness of 23-valent polysaccharide against all invasive pneumococcal infection was 45% (95% CI: <0% to 73%). Isolates from 47 were available for serotyping. 40 (85%) were of serotypes included in the PPV-23. All 11 isolates from previously vaccinated cases were of serotypes included in the vaccine. Conclusion To our knowledge this is the first study to evaluate vaccine effectiveness among HIV-infected persons in Brazil and the first to include data on pneumococcal serotype distribution among HIV-infected adults in Sao Paulo. Although we were not able to provide definitive answers regarding vaccine effectiveness among the specific population, we reinforce the role of anti-retroviral therapy on preventing invasive disease. Our findings support the continuity of the recommendation on immunizing HIV-infected patients with the polysaccharide vaccine at the same time that reinforces the need of more data on the subject

This thesis aimed to elucidate the demographic characteristics associated with elevated or reduced rates of pneumococcal conjugate 13 (PCV13) vaccination. A retrospective cohort study was performed using the Truven Health MarketScan® Database. Three cohorts were created corresponding to populations for which the CDC recommends PCV13 vaccination. Cohort 1: children < 36 months of age. Cohort 2: adults 19-64 years of age with high infection risk. Cohort 3: adults > 65 years of age. Odds of having a PCV13 claim were calculated for each cohort. For Cohort 1, 78% out of a total of 353,214 subjects had a sufficient number of PCV13 doses to meet CDC recommendations. For Cohort 2, 3.7% out of a total of 673,157 subjects had a PCV13 claim. For Cohort 3, 18% of 1,262,531 subjects had a PCV13 claim. Odds of vaccination were generally lower in younger subjects, those with fewer outpatient claims, and those with residence in the Northeast and South regions. In Cohort 2, odds were reduced in subjects with generalized malignancy. Gender and urban residence were poor predictors of vaccination status. By understanding the demographic factors associated with lower rates of vaccination, clinicians may more effectively direct their efforts to increase pneumococcal vaccination coverage.

The stage at diagnosis is the single most important predictor of lung cancer outcome. Therefore, detecting lung cancer early is of utmost importance. Low-dose computed tomography (LDCT) has proven beneficial in the early detection and mortality reduction of lung cancer. Despite this, very few of the high-risk population get annual LDCT done. Patients' attitudes towards tobacco usage and preventive care can be a factor in getting LDCT. We analyzed the relationship between the willingness to undergo LDCT and a person's readiness to try tobacco cessation medication or get the pneumococcal vaccine. We also analyzed the relationship between patients who had tobacco cessation counseling and their willingness to get LDCT and pneumococcal vaccine. Medical records of high-risk patients seen in the East Tennessee State University (ETSU) clinics between January 1, 2016, and November 30, 2020, were analyzed retrospectively. In the data obtained, a total of 2,834 patients were current smokers and were included in the research. The study subjects were assessed in two ways, which from here on will be referred to as method one and method two. In the first method, patients who underwent LDCT were assessed, and the outcome investigated was tobacco cessation counseling, tobacco cessation medication prescription, and pneumococcal vaccination. In the second method, patients who had tobacco cessation counseling were assessed, and the outcome evaluated was LDCT, tobacco cessation medication prescription, and pneumococcal vaccination. In the first method, out of 2,834 total population, 570 had undergone at least one LDCT screening during the study period. Of the 570 patients who underwent LDCT, 22.8% tried one of the tobacco cessation medications at least once during the study period (vs. 9.8% in patients who did not get the LDCT). Also, 71.5% of patients who had LDCT received at least one dose of pneumonia vaccine (vs. 35.5% in patients who did not get the LDCT). In the second method, 1,673 out of 2,834 patients received at least one tobacco cessation counseling, and out of those, 27.5% had LDCT screening (vs. 9.5% among those who never received counseling). Also, 54.9% received a pneumococcal vaccine (vs. 45.1% among those who did not receive counseling). The study demonstrates a relationship between getting LDCT and getting a pneumococcal vaccine or tobacco cessation medications. It also reveals that tobacco cessation counseling increases the odds of getting LDCT, tobacco cessation medications, and pneumococcal vaccine.

No description available.

Thesis (Ph.D.)--University of Melbourne, The School of Population Health and Department of Medicine, 2007. / Typescript. Includes bibliographical references (leaves 174-186).

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2015-01-27T13:46:56Z No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Tese - Yves Mauro Fernandes Ternes - 2014.pdf: 5561765 bytes, checksum: 46838b1cfdd58678c8db3a46e445ce06 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2015-01-28T11:32:01Z (GMT) No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Tese - Yves Mauro Fernandes Ternes - 2014.pdf: 5561765 bytes, checksum: 46838b1cfdd58678c8db3a46e445ce06 (MD5) / Made available in DSpace on 2015-01-28T11:32:01Z (GMT). No. of bitstreams: 2 license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Tese - Yves Mauro Fernandes Ternes - 2014.pdf: 5561765 bytes, checksum: 46838b1cfdd58678c8db3a46e445ce06 (MD5) Previous issue date: 2014-04-28 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / Fundação de Apoio à Pesquisa - FUNAPE / 10-valent conjugate pneumococcal vaccine (PCV10) was introduced in the routine immunization at Goiania in June, 2010. The aims of this study were: (i) to evaluate the direct effect of PCV10 in preventing vaccine types nasopharyngeal/NP pneumococcal carriage in younger children according to different schedules; (ii) to investigate possible genetic changes that could interfere in the pneumococcal capsular typing. Methods: A cross-sectional population-based household survey was conducted in Goiania, Brazil, from December/2010-February/2011, targeting children aged 7-18 months. To evaluate PPCV10 effectiveness/VE, NP swabs, clinical and demographic data, and vaccination dates were collected from 1,287 children during home visits. Main outcome and exposure of interest were PCV10 vaccine-type (VT) carriage and dosing schedules (3p+0, 2p+0, and one catch-up dose), respectively. Pneumococcal carriage was defined by positivity in culture after of NP secretions in enrichment broth and isolates serotyping was performed by Quellung reaction. The nontypeable isolates were processed by conventional multiplex PCR (cmPCR). Rate ratio/RR was calculated as the ratio between the prevalence of VTs carriage in children vaccinated with different schedules (exposed) and not vaccinated to PCV10 (non-exposed). Adjusted RR was estimated using Poisson regression. VE on VT carriage was calculated as 1-RR*100. Results: The prevalence of pneumococcal carriage in a total of 1,287 children was 41.0% (95%CI: 38.4%-43.7%). Serotypes covered by PCV10 and PCV13 were 35.2% and 53.0%, respectively. Serotypes 6B (11.6%), 6A (9,8%), 23F (7.8%), 14 (6.8%), 19F (6.6%), and 19A (6,3%) were the most frequently observed. After adjusted for confounders, children who had received 2p+0 or 3p+0 dosing schedule presented a significant reduction on pneumococcal VT carriage, with PCV10 VE equal to 35.9% (95%CI: 4.2%-57.1%; p=0.030) and 44.0% (95%CI: 14.2%-63.5%; p=0.008), respectively, when compared with unvaccinated children. For children who received one catch-up dose, no significant VE was detected (p=0.905). We identified 13 samples with a genetic variation that underestimated the capsular typing for 19F by cmPCR. Conclusion: PCV10 was associated with high protection against vaccine-type carriage for children vaccinated before the second year of life, for 2p+0 and 3p+0 schedules. The identification of genetic variations (19Fv) allowed adapt the molecular technique (cmPCR) for capsular typing samples from Latin America. The continuous evaluation of carriage serotype is mandatory to evaluate the long-term effectiveness and impact of pneumococcal vaccine on serotypes reduction. / A vacina pneumocócica conjugada 10-valente (PCV10) foi introduzida no calendário básico de imunização em Goiânia em junho de 2010. Este estudo teve como objetivos: (i) Avaliar o efeito direto da PCV10 na redução de sorotipos vacinais de Streptococcus pneumoniae (pneumococo) na nasofaringe (NP) de crianças, de acordo com diferentes esquemas vacinais; (ii) investigar possíveis alterações genéticas que possam interferir na tipagem capsular dos pneumococos isolados. Métodos: Um estudo de corte transversal aninhado a um inquérito domiciliar de base populacional foi conduzido em Goiânia, de dezembro/2010 a fevereiro/2011, em crianças de 7-18 meses. Para avaliar a efetividade da PCV10 (VE), swabs de NP, dados clínicos e demográficos e datas da administração da vacina foram obtidos de 1.287 crianças durante as visitas domiciliares. As variáveis de desfecho e de exposição foram portador (colonização) por tipos vacinais (VTs) da PCV10 e esquemas vacinais (3p+0, 2p+0 e dose única – catch-up), respectivamente. A colonização pelo pneumococo foi definida pela positividade à cultura das secreções de NP em caldo enriquecido, e a sorotipagem dos isolados foi realizada pela reação de Quellung. Os isolados não tipáveis foram submetidos à PCR multiplex convencional (cmPCR). A razão de prevalência (rate ratio/RR) foi calculada como a razão entre a prevalência de VTs em crianças vacinadas com diferentes esquemas vacinais (expostas) e não vacinadas pela PCV10 (não expostas). A RR ajustada foi estimada utilizando a regressão de Poisson. A VE no estado de portador por VTs foi calculada como (1-RR) x 100. Resultados: A prevalência de portador pelo pneumococo no total de 1.287 crianças foi 41,0% (IC95%; 38,4-43,7). Os sorotipos presentes na PCV10 e PCV13 foram 35,2% e 53,0%, respectivamente. Os sorotipos mais frequentes foram 6B (11,6%), 6A (9,8%), 23F (7,8%), 14 (6,8%), 19F (6,6%) e 19A (6,3%). Após ajustar pelas variáveis de confusão, crianças que receberam os esquemas 2p+0 ou 3p+0 apresentaram uma redução significativa dos VTs, com VE igual a 35,9% (IC95%: 4,2-57,1; p=0,030) e 44,0% (IC95%: 14,2-63,5; p=0,008), respectivamente, quando comparado com crianças não vacinadas. Crianças que receberam dose única catch-up não apresentaram VE significante (p=0.905). Foram identificadas 13 amostras que apresentaram uma variação gênica que subestimava a tipagem capsular do 19F pela técnica cmPCR. Conclusões: a PCV10 foi associada a uma proteção significativa contra colonização nasofaringeana de VTs crianças menores de um ano, quando utilizados os esquemas vacinais 3p+0 ou 2p+0. A identificação de variações genéticas do sorogrupo 19 (19Fv) permitiu adequar a técnica de cmPCR para tipagem de amostras da América Latina. O monitoramento contínuo de sorotipos no portador é fundamental na avaliação da efetividade a longo prazo e o impacto da vacinação na redução dos sorotipos vacinais.

[Truncated abstract] Pneumococcal exposure is high and life-long in developing countries including Papua New Guinea (PNG), with children under 2 years of age being at most risk for early upper respiratory tract pneumococcal carriage and infection. Deaths from pneumococcal diseases such as pneumonia and meningitis are common and likely the result of an absence of vaccination programmes. The need for effective and affordable pneumococcal vaccines has led to the testing of protein antigens including pneumolysin (Ply) and pneumococcal surface protein A (PspA) as novel vaccine antigens. Little is known on the immune responses to these proteins in humans, particularly in high-risk populations where such vaccines will be of most benefit. In this study, we examined the roles of naturally acquired antibody and cellular immune responses in mothers and newborns to Ply and PspA family 1 (PspA1) and family 2 (PspA2) in protection against or risk for early carriage in a high-risk PNG population. Antibodies to Ply, PspA1 and PspA2 were measured in plasmas of 241 mothers and 115 newborns (cords) from PNG, and 50 Australian mothers using an enzyme-linked immunosorbent assay (ELISA). Pernasal swabs were collected from PNG mothers at the time of delivery, one month post-partum, and weekly within the first month of life from their newborns to determine pneumococcal carriage. Cellular immune responses to Ply, PspA1 and PspA2, the TLR2/TLR4 ligands, LTA and LPS and to PHA were measured in cord blood mononuclear cells (CBMC) of 84 PNG versus 33 Australian newborns. Innate and T-cell cytokine responses in the PNG newborns were then analysed to determine their effect on infant pneumococcal carriage. ... No protective effect against infant pneumococcal carriage was observed with maternal and cord IgG levels for all antigens. Maternal carriage at time of delivery increased the risk for infant pneumococcal carriage in the first month of life (HR: 1.93, 95% CI 1.36 – 2.73, p = 0.001) with 70% of infants being colonised. Papua New Guinean newborns produced higher innate IL-10 and IFN-¿ (p = 0.003) and TNF-a (p < 0.001) to Ply compared to Australian newborns with no significant differences observed for IL-6 or IL-12. IFN-¿ responses to LPS and LTA (p = 0.005 and p < 0.001) were higher in PNG than Australian newborns, while IL-6, IL-10 (p < 0.001) and TNF-a (p = 0.002) to LPS with LTA-induced IL-6 and IL-10 (p < 0.001) were higher in Australian newborns. T-cell IL-5, IL-10, IL-13, IFN-¿, IL-6 and TNF-a response levels to PspA and PHA stimulation were significantly high in PNG newborns. No differences were observed for cytokine responses to Ply and PspA between PNG infant pneumococci carriers and non-carriers. Papua New Guinean infants are colonised by pneumococci very early in life and this may be influenced by high maternal carriage rates. PspA- and Ply-IgG levels are high in PNG mothers and undergo cross placental transfer but do not appear to be protective against early pneumococcal carriage. In PNG newborns, PspA elicits T-cell responses, while Ply drives more innate cellular responses, neither were demonstrated to have a protective effect against early carriage though further work is required to better define these and their relation to immune development in early childhood.

Submitted by Marlene Santos (marlene.bc.ufg@gmail.com) on 2016-04-20T19:18:23Z No. of bitstreams: 2 Tese - Eliane Terezinha Afonso - 2015.pdf: 3480407 bytes, checksum: db146d8884a4aedac166a73ef268d89d (MD5) license_rdf: 19874 bytes, checksum: 38cb62ef53e6f513db2fb7e337df6485 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-04-25T15:00:31Z (GMT) No. of bitstreams: 2 Tese - Eliane Terezinha Afonso - 2015.pdf: 3480407 bytes, checksum: db146d8884a4aedac166a73ef268d89d (MD5) license_rdf: 19874 bytes, checksum: 38cb62ef53e6f513db2fb7e337df6485 (MD5) / Made available in DSpace on 2016-04-25T15:00:31Z (GMT). No. of bitstreams: 2 Tese - Eliane Terezinha Afonso - 2015.pdf: 3480407 bytes, checksum: db146d8884a4aedac166a73ef268d89d (MD5) license_rdf: 19874 bytes, checksum: 38cb62ef53e6f513db2fb7e337df6485 (MD5) Previous issue date: 2015-08-19 / BACKGROUND: Pneumonia causes substantial morbidity and mortality in all age groups around the world. The 10-valent pneumococcal conjugate vaccine (PCV10) was introduced into the routine infant immunization in Brazil, free of charge, in March 2010. The aim of this study was to evaluate the impact PCV10 vaccination on rates of all cause pneumonia hospitalizations one year and three years after its introduction in Brazil. METHODS: We conducted two interrupted time series analysis studies. The first evaluated only the direct effect of PCV10 vaccination, in five Brazilian cities (Belo Horizonte, Curitiba, Porto Alegre, São Paulo and Recife), and was conducted one year after starting the vaccination. The second study evaluated the direct and indirect impact (individuals not vaccinated) of PCV10 vaccination in Brazil, and was conducted three years after vaccination. We used data from the Brazilian Hospitalization System from 2005-2013. The main outcome was monthly rates of all-cause pneumonia hospitalizations identified by ICD-10 codes J12-J18. We used hospitalization rates for congenital malformations and non-respiratory causes as a comparison groups. The time-series analysis was based on a generalized linear model. Pneumonia rates observed in the pre-vaccination period were used to estimate the hospitalization rates in the post-vaccination period of each study, adjusting for seasonality and secular trends. To estimate the direct (2-23 months of age) and indirect (≥5 years of age) impact of PCV10 vaccination, we calculated the percentage change in hospitalization rates, as the observed divided by the predicted rates of hospitalization in the post-intervention period minus one, with respective 95% CI and p values. The number of all-cause pneumonia hospitalizations averted by vaccination was calculated taking into account the difference between the predicted and observed number in the PCV10 post vaccination period. RESULTS: One year after introduction of PCV10 in Brazil, significant declines in hospitalizations for pneumonia in children aged 2-23 months were noted in Belo Horizonte (28.7%), Curitiba (23.3%), and Recife (27.4%). After three years of the introduction of PCV10, 461,519 pneumonia hospitalizations were averted in Brazil, and a significant decrease in rates of pneumonia hospitalization was observed in unvaccinated individuals aged 5-39 years, ranging from 14.1-17.4% (p<0.05). In contrast, an increased trend in pneumonia hospitalizations (p=0·004) was observed for elderly (≥ 65 years). CONCLUSION: Vaccination with PCV10 in Brazil was associated with reduction of pneumonia hospitalizations in vaccinated individuals. Herd effect was observed in individuals aged 5-39 years after three years of vaccination. Potential reasons for the increased trend in pneumonia hospitalization rates in the elderly should be investigated. / INTRODUÇÃO: As pneumonias contribuem com alta carga de morbimortalidades em todo mundo. No Brasil, a vacina pneumocócica conjugada 10 valente (PCV10) foi introduzida na rotina de imunização da infância em março de 2010. Este estudo teve como objetivo avaliar o impacto da vacinação nas taxas de hospitalizações por pneumonia no Brasil no curto e médio prazo do início da vacinação. METODOLOGIA: Dois estudos de séries temporais interrompidas foram conduzidos. O primeiro avaliou o efeito direto da vacinação em cinco capitais brasileiras (Belo Horizonte, Curitiba, Porto Alegre, São Paulo e Recife) e foi conduzido após um ano de introdução da PCV10 no país. O segundo estudo avaliou o impacto direto e indireto (população não vacinada) da vacinação em todo país e foi conduzido três anos após sua introdução. Os dados de hospitalizações foram obtidos do Sistema de Informações Hospitalares (SIH-SUS) de 2005 a 2013. O desfecho principal foi a taxa mensal de hospitalização por pneumonia definida pelos códigos J12-J18 da CID10. As taxas de hospitalizações por malformações congênitas e causas não respiratórias foram utilizadas como grupos de comparações. A análise de série temporal utilizou um modelo de regressão linear generalizado. As taxas de hospitalizações por pneumonia observadas no período pré-PCV10, ajustadas por tendência secular e sazonalidade, foram utilizadas para estimar as taxas no período pós-PCV10. O impacto da vacinação para cada faixa etária foi calculado como o percentual de mudança nas taxas de hospitalizações, dividindo-se as taxas observadas pelas taxas preditas do período pós PCV10, menos um. Os respectivos IC95% e os valores de p foram apresentados. O número de hospitalizações por pneumonia evitadas após três anos de vacinação foi estimado pela diferença entre os números de hospitalizações por pneumonia preditos e observados no período pós-vacinação. RESULTADOS: Após um ano de introdução da PCV10 no Brasil, observou-se significativo declínio nas taxas de hospitalizações por pneumonia em crianças de 2 a 23 meses em três das cinco capitais estudadas: Belo Horizonte (28,7%), Curitiba (23,3%), e Recife (27,4%). Após três anos da introdução da PCV10, 461.519 hospitalizações por pneumonia foram evitadas no Brasil e um significativo declínio nas taxas de pneumonia foi observado em indivíduos não vacinados de 5 a 39 anos variando de 14,1% a 17,4% (p<0,05). No entanto, observou-se um aumento significativo (9,9%, p=0,004) nas taxas de hospitalizações por pneumonia para idosos ≥65 anos. CONCLUSÕES: A vacinação com a PCV10 foi associada à significativa redução das hospitalizações por pneumonia na infância. Adicionalmente, o estudo evidenciou importante redução das hospitalizações por pneumonia em grupos etários não vacinados, sinalizando efeito indireto conferida pela vacina. A tendência de aumento das hospitalizações por pneumonias em idosos necessita de investigações para elucidação dos fatores envolvidos nesse fenômeno.