Abstract
Background
In 2012, the 13-valent conjugate vaccine (PCV13) for children < 2 years was introduced in the Argentinean National Immunization Program (NIP) with sustained coverage >80% since then. The 23-valent polysaccharide vaccine (PPSV23) has been available for ≥65 years and at-risk populations in NIP since 2001 and in 2017, it was replaced by the sequential regimen(PCV13/PPSV23). The 2013 National Survey of Risk Factors estimated a coverage of 23.1% for ≥65 years and 16.2% for at-risk populations. We evaluated mortality rates of clinical syndromes potentially associated with pneumococcal disease (PPD)in a 10-year period by age groups, before (2008-2011) and after childhood PCV introduction (2013-2018) in the NIP in Argentina.
Methods
All-age death cases related to clinical syndromes PPD were obtained from Dirección de Estadísticas e Información de la Salud between 2008-2018. ICD-10 codes were used to define PPD: pneumonia (J13-J18) and invasive disease (sepsis – A.40.*, A41.*, A49.*; meningitis – G00.*, G03.9; and other - M00.1, J86.*, J90-J91, B95.3). The yearly mortality rate was calculated per 100,000 people, estimated by the national census, and stratified by age groups. The percentage of change was the difference between the average rate in the pre (2008-2011) and post-vaccination (2013-2018) periods.
Results
In total, 65,947 deaths due to pneumonia (56.7%) and invasive disease (43.3%) occurred from 2008 and 2018. In the younger age groups (< 1, 1-4, 5-17), a 44% reduction was seen in both invasive disease and pneumonia compared to pre-childhood vaccination period, mainly in infants (from 22.2 to 10.2 per 100,000 people). In adult population, a less pronounced reduction was noted in mortality by invasive disease, however an inverse trend occurred in pneumonia in the age groups 18-49 years, 50-59 years, and 60-69 years, from 1.9 to 2.1 (7%), 9.3 to 10.2 (10%) and 18.3 to 19.2 (5%) per 100,00 people, respectively (Fig 1).
Mortality rate change (%) pre and post- pneumococcal childhood introduction
Figure 1. Mortality rate change (%) of clinical syndromes potentially associated with pneumococcal disease before (2008-2011) and after infant vaccination introduction (2013-2018) in Argentina.
Conclusion
Mortality rates declined mostly for infants, and despite the differences observed for the older population, it remains significant. Evaluation of mortality trends are key for decision-making process on current and future prevention strategies using pneumococcal vaccines.
Disclosures
Norberto Giglio, MD, Merck Sharp & Dohme Corp (Consultant)Pfizer (Other Financial or Material Support, Speaker)Sanofi (Other Financial or Material Support, Speaker)SEQUIRUS (Other Financial or Material Support, Speaker) Marina Gabriela Birck, n/a, IQVIA (Independent Contractor) Guilherme Julian, BSc, MSc, iQVIA (Independent Contractor) Virginia Verdaguer Babic, MD, MSD Argentina (Employee) Cintia Parellada, MD, PhD, MSD Brazil (Employee, Shareholder)
2016 Infectious Diseases Society of America (IDSA) Clinical Practice
Guideline for the Treatment of Coccidioidomycosis
