Indirect effects of a 7 year PCV7/PCV13 mass vaccination program in children on the incidence of pneumonia among adults: a comparative study based on two Polish cities.

BACKGROUND AND OBJECTIVES: In 2006 the city of Kielce, Poland, introduced a mandatory PCV7 (replaced by PCV13 in 2011) vaccination program against S. pneumoanie for all children under 2 years old. At that time, the neighboring city of Ostrowiec Swietokrzyski had no such large-scale vaccination program in place. This created an opportunity to observe the results of the vaccination by comparing the incidence of pneumonia in these two cities. The aim of this study was to analyze how the incidence of pneumonia among adults was indirectly affected by the PCV7/PCV13 vaccination program in children during the 7 year follow-up period. METHODS: We performed a retrospective study. PCV7/PCV13 vaccinations were delivered according to a 2 + 1 schedule. The vaccination rate in the analyzed period amounted to almost 99%. The following age groups were analyzed: 30-49, 50-64 and 65+. The Cochran-Armitage test was used to investigate the significance of the observed trend in pneumonia morbidity. The significance of deviations from a linear trend was also tested. In addition, the importance of the trend (in the case of deviations from linearity) was confirmed with the use of the Mantel test. RESULTS: In the 65+ age group there was a decrease of 66.5% in the incidence of diagnosed pneumonia (p < 0.0001). This was followed by smaller, but statistically significant, declines in the other age groups: 30.75% in the 30-49 age group (p = 0.001) and 56.8% in the 50-64 age group (p < 0.0001). This decreasing trend continued for seven consecutive years of observation. In addition, we demonstrated a statistically significant higher rate of pneumonia in all age groups in the City of Ostrowiec Swietokrzyski. CONCLUSIONS: The results clearly indicate that the indirect effectiveness of the PCV7/PCV13 vaccine program, performed according to the 2 + 1 schedule and applied in Kielce, Poland, is statistically significant.

Indirect population impact of universal PCV7 vaccination of children in a 2 + 1 schedule on the incidence of pneumonia morbidity in Kielce, Poland.

The aim of this study was an analysis of the population effects of a seven-valent pneumococcal conjugate vaccine (PCV7) on pneumonia incidence rates in the 5-year follow-up period after the introduction in 2006 of a universal PCV7 vaccination programme in the city of Kielce, Poland. Vaccinations were carried out according to a 2 + 1 schedule. The vaccination compliance rate amounted to approximately 99 %. The age groups 0-2, 30-49, 50-65 and 65+ years were analysed. The Cochran-Armitage test was used to investigate the significance of observed trends in pneumonia morbidity. The significance of deviations from a linear trend was also tested. The importance of the trend was confirmed by the Mantel test. Between 2005 and 2010, the greatest decline, 82.9 % (2005, 25.31/1,000; 2010, 4.34/1,000), in pneumonia morbidity was observed for children <2 years of age. In the 65+ years age group, this amounted to 43.5 %. Lesser declines, but still of statistical significance, were observed for the other age groups: 16.5 % in the 30-49 years group and 40.4 % in the 50-64 years group. All reductions are statistically significant and confirmed by the Mantel test. Five years after the introduction of a universal PCV7 vaccination programme in Kielce, Poland, its effectiveness in pneumonia prevention has been demonstrated in both the <2 years of age group and indirectly for other groups.

Significant decline in pneumonia admission rate after the introduction of routine 2+1 dose schedule heptavalent pneumococcal conjugate vaccine (PCV7) in children under 5 years of age in Kielce, Poland.

This study was performed to estimate the effect of heptavalent pneumococcal conjugate vaccine (PCV7) on the pneumonia admission rate in children younger than 5 years of age, after the introduction of routine 2+1 dose schedule immunization. We compared the pneumonia admission rate (number of cases per 1,000 population) 2 years before and 2 years after the introduction of PCV7 in 2006. Only children with radiologically confirmed pneumonia were analyzed. The vaccination rate in the analyzed periods was around 99%. In the period preceding the implementation of PCV7, the average pneumonia admission rate was 41.48/1,000 and 6.15/1,000 for 1-year-old and 2-4-year-old children, respectively. Statistical analysis showed a significant fall in this rate in two consecutive years after PCV7 implementation (p < 0.0000001 for 1-year-old and p = 0.011 for 2-4-year-old children, respectively). In the first year of vaccination, the admission number decreased in these two groups by about 65 and 23%, respectively. In the second year, only a few percent fall in the admission rate was noted. In children younger than 2 years of age, the age group targeted for vaccination, pneumonia-related healthcare utilization declined substantially following PCV7 introduction. These results suggest that PCV7 may play an important role in reducing the burden of pneumonia in Poland.

[Changes in the epidemiological situation of hepatitis B in Kielce region, after introduction of vaccination of infants against hepatitis B]. / Sytuacja epidemiologiczna wzw B w województwie kieleckim po wprowadzeniu szczepien ochronnych u dzieci.

The study presents epidemiology of hepatitis B in the region Kielce in the central part of Poland. The number of registrated cases and their age distribution were analyzed in the prevaccination period of 1990-92 and 1995-97 when the obligatory vaccination of infants against hepatitis B was introduced. The significant decrease in the number of cases among young, below 4 years old children was recorded. There were no new cases of hepatitis B in the group of vaccinated children during hitherto 4-year period of observation. The analysis of the role of hospital contacts in the spread of infection, suggest that still more than half of infections occurred in hospitals, although the role of surgical departments in the spread of infections has been reduced in last three years.

[Etiologic factors for purulent meningitis in children. Twenty years of personal observations]. / Czynniki etiologiczne ropnego zapalenia opon mózgowo-rdzeniowych u dzieci. Dwadziescia lat obserwacji wlasnych.

Etiological agents in purulent meningitis cases hospitalized during two 9 years periods: 1977-1985 and 1988-1996 were compared. While the percentage of cases caused by Neisseria meningitidis was similar in the two analyzed periods (55.7% i 66.5%, respectively), the percentage of cases caused by Streptococcus pneumoniae decreased from 33.5% to 8.4% and the percentages of cases caused by Haemophilus influenzae type b increased from 0.6% to 14.2%. The analysis of the sensitivity of isolated strains of H. influenzae type b shows the occurrence of strains resistant to ampicillin and chloramphenicol.

[Subglottic hemangioma as a rare cause of dyspnea in infants]. / Naczyniak podglosniowy krtani jako jedna z rzadko obserwowanych przyczyn dusznosci u niemowlat.

A case of congenital subglottic hemangioma of the larynx in a 7-month-old infant is presented. The dominant clinical symptoms were: laryngeal stidor, dyspnoea and recurrent obstructive bronchitis and pneumonia with unsatisfactory response to treatment. Early diagnosis and proper surgical therapy were life-saving in this child.

[Vaccination and intensified sanitary regime for prevention of viral hepatitis type B among medical personnel at the Center for Health of the Child]. / Szczepienia ochronne i zaostrzenie rezimu sanitarnego w zapobieganiu wirusowemu zapaleniu watroby typu B wsród personelu Centrum Zdrowia Dziecka.

Paper concerns the question of infections by hepatitis B virus among health care workers. Authors have reported the improvement of epidemiological situation among employees of the Child Health Center in the years 1987-1994 and analysed factors which were the probably cause of improvement (protective vaccination, infection control, and education of workers). In the first year of observation, among ca. 1700 health care workers 32 new hepatitis B infections were noted, while in 1994 there were no hepatitis B cases.

[Infectious mononucleosis with IgM antibodies against cytomegalovirus]. / Mononukleoza zakazna z obecnoscia przeciwcial przeciwko wirusowi cytomegalii w klasie IgM.

In four of studied children (age 3-12 yrs) with serologically confirmed infectious mononucleosis we found IgM antibodies to CMV. This can be explained by coincidence of both infections or by nonspecific stimulation of B lymphocytes in the course of mononucleosis. Disappearance of IgM antibodies to CMV after 3 months, and concomitant presence of IgG antibodies after 6 months suggests the former.

[Clinical course of symptomatic toxocariasis in a 10-year-old boy]. / Przebieg jawnej toksokarozy u 10-letniego chlopca.

A case is described of symptomatic toxocariasis in a boy, with massive invasion of the parasites and strong response of the organism. The course of the disease was very serious.

[Incidence of Toxoplasma gondii infections among children in the Kielce province]. / Wystepowanie zarazen Toxoplasma gondii wsród dzieci województwa kieleckiego.

Toxoplasma antibodies were investigated among 639 children inhabiting the province of Kielce. The percentage of seropositive children appeared high in newborns (58.4), then dropped to 1.48 in one-year-old infants and increased to 17.4 among 6-7 year old children. The percentage was significantly higher among country children.

[Comparison of the incidence of various developmental anomalies in Kielce during the years 1970-1971 and 1986-1987]. / Porównanie czestosci wystepowania niektórych wad rozwojowych na terenie Kielc w latach 1970-71 i 1986-87.

The environmental conditions in Kielce in the years 1970-1971 and 1986-1987 and the incidence of developmental anomalies in newborns in these periods were compared. The incidence of these anomalies in Kielce was similar in the periods 1970-1971 and 1986-1987, and it resembled the values reported in literature.