Effectiveness of Pneumococcal Conjugate Vaccine in Infants by Maternal Influenza Vaccination Status

Abstract Background Efficacy of 13-valent pneumococcal conjugate vaccine (PCV13) against pneumococcal pneumonia in adults aged >65 years was shown in a 2014 clinical trial. However, its benefits in countries with a mature PCV infant program remain unclear. In August 2014, PCV13 was recommended for all US adults aged >65 years. We evaluated the direct effect of this recommendation on pneumonia hospitalizations among the elderly. Methods We analyzed claims data from US Medicare beneficiaries aged >65 years enrolled in part A/B during September 1, 2014 through December 31, 2017. Participants were followed until they died, left part A/B, or developed a study outcome: community-acquired pneumonia (CAP), non-healthcare-associated CAP (non-HA CAP) or lobar pneumonia (LP). We identified outcomes using inpatient diagnosis codes, and vaccination status using procedure codes. We used discrete-time survival models, stratified by influenza season (October–April) and influenza vaccination status, to estimate incidence rate ratios (IRR) by pneumococcal vaccination status (PCV13-only vs. no pneumococcal vaccination). We adjusted for demographic factors, healthcare utilization, month/year of hospital discharge, and underlying conditions. We derived vaccine effectiveness (VE) and number of hospitalizations averted by PCV13 from the IRRs. Results Of 26.6 million beneficiaries in September 2014, 43.4% were male, 54.2% were aged 65–74 years, and 28.9% had a Charlson comorbidity score >3. PCV13 coverage increased from 0.8% in September 2014 to 41.5% in December 2017. Annual incidence of CAP, non-HA CAP, and LP are shown in the figure. PCV13-vaccinated persons were more likely to be older, sicker, and have received flu vaccine than unvaccinated persons. VE estimates for CAP, non-HA CAP, and LP ranged from 6.0–11.4%, 5.0–11.0%, and 1.3–11.0%, respectively. From September 2014 to December 2017, an estimated 28,600 (95% CI: 21,000–36,000) CAP, 18,700 (12,000–25,800) non-HA CAP and 1,100 (190–1,900) LP hospitalizations were averted. Conclusion Within 40 months after implementation of the adult PCV13 program, 2.0% (28,600) of US CAP hospitalizations were averted. Despite PCV13 effectiveness against adult CAP, only a small fraction of CAP hospitalizations was prevented. Disclosures All authors: No reported disclosures.

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2632. Cord Blood Vitamin D and Maternal Vaccination Status Associated with Decreased Laboratory Confirmed Influenza Infections in Infants

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.2310 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S918-S919

Author(s):

Kristina Betz ◽

Matthew Fenchel ◽

Mark C Steinhoff ◽

Elizabeth P Schlaudecker

Keyword(s):

Vitamin D ◽

Socioeconomic Status ◽

Birth Weight ◽

Influenza Vaccine ◽

Influenza Vaccination ◽

Gestational Age ◽

Respiratory Illness ◽

Vaccination Status ◽

Vitamin D Levels ◽

Maternal Influenza

Abstract Background Maternal influenza vaccination has been demonstrated to reduce influenza infections in infants. Influenza infections generally peak during the winter season, and several studies support the association between low levels of vitamin D during winter months and an increase in respiratory infections, including influenza. We examined the effects of vitamin D and maternal influenza vaccination status on laboratory confirmed influenza infections in infants less than 6 months of age. Methods Pregnant Bangladeshi mothers were randomized to receive influenza vaccine or pneumococcal vaccine as part of the Mother’s Gift study. Mothers reported breastfeeding frequency, along with episodes of infant respiratory illness with fever, every week for the first 6 months of life. If a respiratory illness with fever was reported, nasal swabs were obtained from the infant and tested with a commercial rapid influenza test. Infants with confirmed influenza disease were matched with four controls by birth month and sex, for a total of 84 controls. We measured 25-hydroxyvitamin D levels from cord blood in all cases and controls. A conditional logistic regression was performed to test the effect of vitamin D on the odds of laboratory confirmed influenza while controlling for birth weight, gestational age, crowding, number of siblings, and socioeconomic status score. Results A total of 21 infants had laboratory confirmed influenza disease. There were no significant differences in birth weight, crowding, family size, gestational age, socioeconomic status score, infant gender, and smokers in the home between cases and controls (Table 1). Frequency of maternal influenza vaccine was lower in cases when compared with controls (23.81% vs. 58.33%). Serum vitamin D was lower in cases than in controls (8.73 ± 3.34 vs. 10.67 ± 4.08, Table 2). Conclusion Both vitamin D levels and maternal vaccination status have medically relevant, and statistically significant, independent effects on the odds of infants contracting influenza. Although the vitamin D levels in the infants at birth were low, there was a significant association of lower levels at birth with an increased risk of influenza virus infection. Further study with a larger sample-size is needed to explore these effects. Disclosures All authors: No reported disclosures.

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