RESUMO
Introducción. Streptococcus pneumoniae es el principal agente de las neumonías consolidantes de causa bacteriana. En 2012, se introdujo la vacuna contra neumococo de 13 serotipos al Calendario Nacional en Argentina para niños inmunocompetentes a partir de los dos meses de edad (2 + 1). Objetivo. Analizar la influencia de los virus respiratorios en la evaluación de la efectividad de la vacuna conjugada contra el neumococo de 13 serotipos en relación con el número de hospitalizaciones por neumonías consolidantes confirmadas por radiología (NCCR). Métodos. Estudio observacional analítico de series temporales. Se incluyeron todos los niños internados con diagnóstico de NCCR según criterios de la Organización Mundial de la Salud, marzo-noviembre de 2001-2013. El diagnóstico viral (virus sincicial respiratorio, adenovirus, influenza y parainfluenza) se realizó por inmunofluorescencia indirecta de aspirados nasofaríngeos o por reacción en cadena de la polimerasa con transcriptasa inversa. Se desarrollaron series temporales que compararon los períodos prevacunación 20012011 y posvacunación 2012-2013. Resultados. De un total de 11 306 niños menores de 5 años con infecciones respiratorias agudas bajas, se incluyeron 4974 con NCCR. Promedio anual de internación por NCCR: 394,8 prevacunación; 315,5 posvacunación (reducción del 20,1%; IC 95% 13,13-26,49%; p <0,001). Promedio anual de internación por NCCR no viral: 255,5 prevacunación; 183 posvacunación (reducción del 28,4%; IC 95% 20,5-35,78%; p <0,001). Promedio anual de internación por NCCR viral: 139,2 prevacunación; 132 posvacunación (reducción del 4,8%; IC 95% 8,38-16,49%; p= 0,4758). La proporción de NCCR con diagnóstico viral positivo fue 35,3% prevacunación y 42% posvacunación (p= 0,001). Conclusiones. Se observó un descenso significativo de las internaciones por NCCR en forma global luego de la introducción de la vacuna contra neumococo de 13 serotipos, particularmente en aquellas de etiología no viral. Es fundamental continuar la vigilancia epidemiológica para evaluar el impacto de esta medida y el comportamiento viral en relación con las NCCR.
Introduction. S treptococcus pneumoniae is the main agent in bacterial consolidated pneumonias. In 2012, the 13-valent pneumococcal conjugate vaccine was introduced in the Argentine national immunization schedule for immunocompetent children as of two months old with a two-dose schedule plus a booster. Objective.To analyze the influence of respiratory viruses on the evaluation of the 13-valent pneumococcal conjugate vaccine effectiveness in relation to the number of hospitalizations for radiologically-confirmed consolidated pneumonias (RCCP). Methods. Observational, analytical, time-series study. All children hospitalized with a diagnosis of RCCP as per the World Health Organization's criteria between March and November throughout the2001-2013period were included. Viral diagnosis (respiratory syncytial virus, adenovirus, influenza and parainfluenza) was performed by indirect immunofluorescence using nasopharyngeal aspirates or by reverse transcription polymerase chain reaction. Time-series were developed to compare preimmunization 2001-2011 and post-immunization 2012-2013 periods. Results. Out of a total of 11,306 children under 5 years old with acute lower respiratory tract infections, 4974 with RCCP were included. Annual average number of hospitalizations for RCCP: 394.8 pre-immunization, 315.5 post-immunization (reduction of 20.1%, 95% confidence interval --CI--: 13.13-26.49%, p < 0.001). Annual average number of hospitalizations for non-viral RCCP: 255.5 pre-immunization, 183 post-immunization (reduction of 28.4%, 95% CI: 20.5-35.78%, p < 0.001). Annual average number of hospitalizations for viral RCCP: 139.2 pre-immunization, 132 post-immunization (reduction of 4.8%, 95% CI: 8.38-16.49%, p= 0.4758). The proportion of RCCP with positive viral diagnosis was 35.3 % pre-immunization and 42% post-immunization (p= 0.001). Conclusions. An overall significant reduction in the number of hospitalizations for RCCP was observed following the introduction of the 13-valent pneumococcal conjugate vaccine, especially in the case of non-viral pneumonias. It is critical to continue with the epidemiological surveillance to evaluate the impact of this intervention and viral behavior in relation to RCCP.
Assuntos
Humanos , Lactente , Pré-Escolar , Pneumonia Viral/imunologia , Streptococcus pneumoniae , Efetividade , Estudos de Séries Temporais , Vacinas Conjugadas , Vacinas Pneumocócicas , Imunogenicidade da VacinaRESUMO
Introducción. Streptococcus pneumoniae es el principal agente de las neumonías consolidantes de causa bacteriana. En 2012, se introdujo la vacuna contra neumococo de 13 serotipos al Calendario Nacional en Argentina para niños inmunocompetentes a partir de los dos meses de edad (2 + 1). Objetivo. Analizar la influencia de los virus respiratorios en la evaluación de la efectividad de la vacuna conjugada contra el neumococo de 13 serotipos en relación con el número de hospitalizaciones por neumonías consolidantes confirmadas por radiología (NCCR). Métodos. Estudio observacional analítico de series temporales. Se incluyeron todos los niños internados con diagnóstico de NCCR según criterios de la Organización Mundial de la Salud, marzo-noviembre de 2001-2013. El diagnóstico viral (virus sincicial respiratorio, adenovirus, influenza y parainfluenza) se realizó por inmunofluorescencia indirecta de aspirados nasofaríngeos o por reacción en cadena de la polimerasa con transcriptasa inversa. Se desarrollaron series temporales que compararon los períodos prevacunación 20012011 y posvacunación 2012-2013. Resultados. De un total de 11 306 niños menores de 5 años con infecciones respiratorias agudas bajas, se incluyeron 4974 con NCCR. Promedio anual de internación por NCCR: 394,8 prevacunación; 315,5 posvacunación (reducción del 20,1%; IC 95% 13,13-26,49%; p <0,001). Promedio anual de internación por NCCR no viral: 255,5 prevacunación; 183 posvacunación (reducción del 28,4%; IC 95% 20,5-35,78%; p <0,001). Promedio anual de internación por NCCR viral: 139,2 prevacunación; 132 posvacunación (reducción del 4,8%; IC 95% 8,38-16,49%; p= 0,4758). La proporción de NCCR con diagnóstico viral positivo fue 35,3% prevacunación y 42% posvacunación (p= 0,001). Conclusiones. Se observó un descenso significativo de las internaciones por NCCR en forma global luego de la introducción de la vacuna contra neumococo de 13 serotipos, particularmente en aquellas de etiología no viral. Es fundamental continuar la vigilancia epidemiológica para evaluar el impacto de esta medida y el comportamiento viral en relación con las NCCR.(AU)
Introduction. S treptococcus pneumoniae is the main agent in bacterial consolidated pneumonias. In 2012, the 13-valent pneumococcal conjugate vaccine was introduced in the Argentine national immunization schedule for immunocompetent children as of two months old with a two-dose schedule plus a booster. Objective.To analyze the influence of respiratory viruses on the evaluation of the 13-valent pneumococcal conjugate vaccine effectiveness in relation to the number of hospitalizations for radiologically-confirmed consolidated pneumonias (RCCP). Methods. Observational, analytical, time-series study. All children hospitalized with a diagnosis of RCCP as per the World Health Organizations criteria between March and November throughout the2001-2013period were included. Viral diagnosis (respiratory syncytial virus, adenovirus, influenza and parainfluenza) was performed by indirect immunofluorescence using nasopharyngeal aspirates or by reverse transcription polymerase chain reaction. Time-series were developed to compare preimmunization 2001-2011 and post-immunization 2012-2013 periods. Results. Out of a total of 11,306 children under 5 years old with acute lower respiratory tract infections, 4974 with RCCP were included. Annual average number of hospitalizations for RCCP: 394.8 pre-immunization, 315.5 post-immunization (reduction of 20.1%, 95% confidence interval |-CI-|: 13.13-26.49%, p < 0.001). Annual average number of hospitalizations for non-viral RCCP: 255.5 pre-immunization, 183 post-immunization (reduction of 28.4%, 95% CI: 20.5-35.78%, p < 0.001). Annual average number of hospitalizations for viral RCCP: 139.2 pre-immunization, 132 post-immunization (reduction of 4.8%, 95% CI: 8.38-16.49%, p= 0.4758). The proportion of RCCP with positive viral diagnosis was 35.3 % pre-immunization and 42% post-immunization (p= 0.001). Conclusions. An overall significant reduction in the number of hospitalizations for RCCP was observed following the introduction of the 13-valent pneumococcal conjugate vaccine, especially in the case of non-viral pneumonias. It is critical to continue with the epidemiological surveillance to evaluate the impact of this intervention and viral behavior in relation to RCCP.(AU)
RESUMO
INTRODUCTION: S treptococcus pneumoniae is the main agent in bacterial consolidated pneumonias. In 2012, the 13-valent pneumococcal conjugate vaccine was introduced in the Argentine national immunization schedule for immunocompetent children as of two months old with a two-dose schedule plus a booster. OBJECTIVE: To analyze the influence of respiratory viruses on the evaluation of the 13-valent pneumococcal conjugate vaccine effectiveness in relation to the number of hospitalizations for radiologically-confirmed consolidated pneumonias (RCCP). METHODS: Observational, analytical, time-series study. All children hospitalized with a diagnosis of RCCP as per the World Health Organization's criteria between March and November throughout the2001-2013period were included. Viral diagnosis (respiratory syncytial virus, adenovirus, influenza and parainfluenza) was performed by indirect immunofluorescence using nasopharyngeal aspirates or by reverse transcription polymerase chain reaction. Time-series were developed to compare preimmunization 2001-2011 and post-immunization 2012-2013 periods. RESULTS: Out of a total of 11,306 children under 5 years old with acute lower respiratory tract infections, 4974 with RCCP were included. Annual average number of hospitalizations for RCCP: 394.8 pre-immunization, 315.5 post-immunization (reduction of 20.1%, 95% confidence interval |-CI-|: 13.13-26.49%, p < 0.001). Annual average number of hospitalizations for non-viral RCCP: 255.5 pre-immunization, 183 post-immunization (reduction of 28.4%, 95% CI: 20.5-35.78%, p < 0.001). Annual average number of hospitalizations for viral RCCP: 139.2 pre-immunization, 132 post-immunization (reduction of 4.8%, 95% CI: 8.38-16.49%, p= 0.4758). The proportion of RCCP with positive viral diagnosis was 35.3 % pre-immunization and 42% post-immunization (p= 0.001). CONCLUSIONS: An overall significant reduction in the number of hospitalizations for RCCP was observed following the introduction of the 13-valent pneumococcal conjugate vaccine, especially in the case of non-viral pneumonias. It is critical to continue with the epidemiological surveillance to evaluate the impact of this intervention and viral behavior in relation to RCCP.
