Effectiveness of 13-valent pneumococcal conjugate vaccine on radiological primary end-point pneumonia among cases of severe community acquired pneumonia in children: A prospective multi-site hospital-based test-negative study in Northern India

Community acquired pneumonia (CAP) is a leading cause of under-five mortality in India and Streptococcus pneumoniae is the main bacterial pathogen for it. Pneumococcal Conjugate Vaccine 13 (PCV13) has been introduced in a phased manner, in the national immunization program of India since 2017/2018....

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Published in:PloS one 2022-12, Vol.17 (12), p.e0276911-e0276911
Main Authors: Awasthi, Shally, Kohli, Neera, Agarwal, Monika, Pandey, Chandra Mani, Rastogi, Tuhina, Pandey, Anuj Kumar, Roy, Chittaranjan, Mishra, Kripanath, Verma, Neelam, Kumar, Chandra Bhushan, Jain, Pankaj Kumar, Yadav, Rajesh, Dhasmana, Puneet, Chauhan, Abhishek, Mohindra, Namita, Shukla, Ram Chandra
Format: Article
Language:English
Subjects:
Age
Biology and Life Sciences
Breastfeeding & lactation
Care and treatment
Caregivers
Child
Children
Children & youth
Community-Acquired Infections - diagnostic imaging
Community-Acquired Infections - microbiology
Community-Acquired Infections - prevention & control
Conjugates
Consciousness
Cyanosis
Data collection
Development and progression
Dosage and administration
Effectiveness
Exposure
Families & family life
Health surveillance
Hospital Mortality
Hospitalization
Hospitals
Humans
Immunization
Malnutrition
Medicine and Health Sciences
Mortality
Oxygen saturation
Parents & parenting
People and Places
Pneumococcal Infections - prevention & control
Pneumococcal vaccine
Pneumococcal Vaccines - therapeutic use
Pneumonia
Pneumonia in children
Pneumonia, Pneumococcal - diagnostic imaging
Pneumonia, Pneumococcal - epidemiology
Pneumonia, Pneumococcal - prevention & control
Prospective Studies
Pulse oximetry
Respiratory syncytial virus
Sociodemographics
Statistical analysis
Vaccine efficacy
Vaccines
Vaccines, Conjugate
Variables
Citations: Items that this one cites
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Description
Summary:Community acquired pneumonia (CAP) is a leading cause of under-five mortality in India and Streptococcus pneumoniae is the main bacterial pathogen for it. Pneumococcal Conjugate Vaccine 13 (PCV13) has been introduced in a phased manner, in the national immunization program of India since 2017/2018. The primary objective of this study was to evaluate the effectiveness of PCV13 on chest radiograph (CXR)-confirmed pneumonia, in children hospitalized with WHO-defined severe CAP. This prospective, multi-site test-negative study was conducted in a hospital-network situated in three districts of Northern India where PCV13 had been introduced. Children aged 2-23 months, hospitalized with severe CAP and with interpretable CXR were included after parental consent. Clinical data was extracted from hospital records. CXRs were interpreted by a panel of three independent blinded trained radiologists. Exposure to PCV13 was defined as ≥2 doses of PCV13 in children aged ≤ 12 months and ≥ 1 dose(s) in children > 12 months of age. Our outcome measures were CXR finding of primary endpoint pneumonia with or without other infiltrates (PEP±OI); vaccine effectiveness (VE) and hospital mortality. From 1st June 2017-30th April 2021, among 2711 children included, 678 (25.0%) were exposed to PCV1. CXR positive for PEP±OI on CXR was found in 579 (21.4%), of which 103 (17.8%) were exposed to PCV. Adjusted odds ratio (AOR) for PEP±OI among the exposed group was 0.69 (95% CI, 0.54-0.89, p = 0.004). Adjusted VE was 31.0% (95% CI: 11.0-44.0) for PEP±OI. AOR for hospital mortality with PEP±OI was 2.65 (95% CI: 1.27-5.53, p = 0.01). In severe CAP, children exposed to PCV13 had significantly reduced odds of having PEP±OI. Since PEP±OI had increased odds of hospital mortality due to CAP, countrywide coverage with PCV13 is an essential priority.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0276911