The Effect of Selective and Mass Immunization Against Pneumococcal Infection on the Morbidity and Mortality due to Community-Acquired Pneumonia in Children Under 5 Years of Age

Background. It is required to perform estimation of epidemiological and cost efficacy (regarding morbidity rate) of mass routine vaccination against pneumococcal infection in Russian children and carried out earlier selective vaccination of children from high-risk groups on the basis of four-year experience. It is also important to estimate the rate of hospital admissions in this patient group, long-term and annual cycles, morbidity age and etiology structure, and mortality due to community-acquired pneumonia as one of the most common form of pneumococcal disease. The aim is to study the effect of selective and mass immunization against pneumococcal infection on the morbidity and mortality due to community-acquired pneumonia in children under 5 years of age. Methods. The analysis of communityacquired pneumonia morbidity (in 2003–2018) and mortality due to pneumonias (in 2003–2018) in children under the 14 years old in Perm was carried out. Serotypes of circulating pneumococcus, etiology of community-acquired pneumonias and immunization cost efficacy (direct expense on health care) were further studied. The analysis of study indexes was carried out following selective (vaccination of at-risk children in 2011–2014) and mass (vaccination of infants in 2015–2018) immunization strategies. Results. The morbidity rate of community-acquired pneumonias decreased by 4.0 times (from 267.0 to 66.7 for 1000) after performing selective vaccination (2011–2014) in at-risk children (frequently and chronically ill children). The morbidity rate of community-acquired pneumonias in non vaccinated children of the same group increased by 2.0 times (from 40.0 to 80.0 for 1000 non-vaccinated). The prophylactic efficacy index was 46.0. Whereby the antibacterial index among vaccinated frequently and chronically ill children was 0.11 on one child. This index has decreased by 2.6 times (from 0.11 to 0.04 on one child) in a year within the framework of prospective controlled randomized clinical study. The antibacterial index among non-vaccinated children of this group remained slightly the same: 0.09 and 0.12 respectively. During the selective vaccination the mortality rate among infants decreased by 2 times: long-term average index was 17.9 (2011–2014) against 35.2 (2003-2010) on 100 thousand children. Mass vaccination of infants against pneumococcal infection has reduced the incidence of community-acquired pneumonias among children under 2 years of age and has led to absence of multiple sites of pneumococcal infection in children’s organizations. It also has reduced the number of hospitalized children and achieved zero mortality due to pneumonias in infants by the third year of this immunization strategy implementation. The obtained results were achieved mainly due to circulation of 7 pneumococcal serotypes (6A, 6B, 9V, 14, 19A, 19F, 23F) in children under 5 years of age. The threshold level of vaccination against pneumococcal infection advancing morbidity and mortality due to pneumonias in children was specified. The strategy of mass vaccination of infants was cost-effective. Conclusion. The new data on epidemiological and cost efficacy of various immunization strategies against pneumococcal infection in children was obtained.

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Epidemiological and economic efficiency of mass vaccinal prevention against pneumococcal infection in children compared with selective immunization at the example of community-acquired pneumonia

Perm Medical Journal ◽

10.17816/pmj36463-73 ◽

2019 ◽

Vol 36 (4) ◽

pp. 63-73 ◽

Cited By ~ 1

Author(s):

Vadislav V. Semerikov ◽

Elena S. Zubova ◽

Lyudmila V. Sofronova

Keyword(s):

High Risk ◽

Economic Efficiency ◽

Pneumococcal Infection ◽

Economic Benefits ◽

Community Acquired Pneumonia ◽

High Risk Group ◽

Mass Vaccination ◽

Morbidity And Mortality ◽

First Year ◽

First Year Of Life

Aim. To study the epidemiological pattern of community-acquired pneumonias in children and the influence of mass vaccinal prevention on morbidity and mortality. Materials and methods. Vaccination of children against pneumococcal infection on the territory of a large industrial center of Western Urals was analyzed, influence of mass vaccination against pneumococcal infection on pneumonia morbidity and mortality in children was determined. Results. Mass vaccinal prevention of children of the first year of life against pneumococcal infection (vaccination volume 102 353.6 per 100 thousand children under 6) significantly influenced morbidity level regarding community-acquired pneumonias in the group of vaccinated children under 2 (1619.9 0.78 versus 15233.7 2.5 per 100 thousand in the group of unvaccinated, odds ratio and its confidence interval was 9.40 [95 % CI 8.4610.44]), on community-acquired streptococcal morbidity of children under 6 (r = 0.97; regression coefficient = 36.30, р 0.001; R2 = 91.0 %, significance F = 0.01 and possibility 95.0 %) and 5-fold decreased the mortality level (from 35.2 before vaccination started to 6.8 per 100 thousand) till its full absence in the third year of realization of this strategy. No analogous influence on the main manifestations of epidemiological process of community-acquired pneumonia was noted in case of selective immunization against pneumococcal infection among 25 year olds, belonging to high risk groups (vaccination volume 10 417.08 per 100 thousand children under 6). Conclusions. The strategy of mass vaccination of children of the first year of life was characterized by the greatest epidemiological and economic benefits. Economic efficiency taking into account vaccination costs in terms of 1000 of vaccinated children was 17.1 times higher and was equal to 8.3656 mln rub per 1000 inhabitants versus 0.4890 mln rub in case of selective immunization of high risk group children.

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ANALYSIS OF THE EFFECTIVENESS OF THE IMPLEMENTATION OF THE PILOT PROJECT OF VACCINATION AGAINST PNEUMOCOCCAL INFECTION IN RISK GROUPS IN THE MUNICIPALITIES LEADING ON INDICATORS OF MORTALITY FROM COMMUNITY-ACQUIRED PNEUMONIA

ЗДОРОВЬЕ НАСЕЛЕНИЯ И СРЕДА ОБИТАНИЯ - ЗНиСО / PUBLIC HEALTH AND LIFE ENVIRONMENT ◽

10.35627/2219-5238/2018-198-1-24-26 ◽

2018 ◽

pp. 24-26

Author(s):

I.I. Kozlova ◽

E.I. Sisin ◽

N.A. Ostapenko ◽

O.A. Ezhova ◽

N.G. Kashapov

Keyword(s):

Pneumococcal Disease ◽

Pneumococcal Infection ◽

Risk Groups ◽

Pilot Project ◽

Mortality Rates ◽

Community Acquired Pneumonia ◽

Morbidity And Mortality

There were established municipalities with the highest mortality rates from community-acquired pneumonia (CAP). When etiological deciphering of CAP confirmed the role of S. pneumoniae (Klein) Chester in the development and outcome of this disease. Among the risk contingents were vaccinated against pneumococcal disease, which had an impact on morbidity and mortality from CAP. It is proved that the vaccination of contingent risk against pneumococcal disease reduces the morbidity and mortality from CAP.

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Pneumococcal infection in Russia: state of the issue

Annals of the Russian academy of medical sciences ◽

10.15690/vramn1404 ◽

2021 ◽

Vol 76 (1) ◽

pp. 28-42

Author(s):

Nikolay I. Briko ◽

Vladimir A. Korshunov ◽

Kirill S. Lomonosov

Keyword(s):

Adult Population ◽

Herd Immunity ◽

Pneumococcal Infection ◽

Community Acquired Pneumonia ◽

Morbidity And Mortality ◽

School Age Children ◽

Economic Significance ◽

Chronic Lung Diseases ◽

One Year ◽

High Level

Background: Pneumococcal disease is common cause of morbidity and mortality in adults and children worldwide. The severity of pneumococcal diseases determines their high socio-economic significance. Aims: Estimate the burden of pneumococcal infection and vaccination coverage in Russia. Methods: The data was obtained from federal surveillance system. The information obtained was analyzed using descriptive statistics methods. Results: The annual incidence of community-acquired pneumonia in Russia was 491.7/100000 in 2011-2019. It ranges from 359.8/100000 among adults of working age to 1505.4/100000 among children 1-2 years old. The upward trend of incidence is observed throughout the period, most expressive among school-age children (7-17 years old). Total 29.2% of all pneumonia have an identified etiology. 94% of pneumonia with known etiology are bacterial, 8.4% among it are pneumococcal. Pneumonia accounts for 57% of all deaths from respiratory diseases among children under five (3.7/100000) and 34% among elderly. The death rate from pneumonia in 2009-2018 tends to decrease. In 2018, 25.5 thousand deaths from pneumonia were registered (17.5/100000). The highest rate is observed among children under one year (14.0 /100000) and elderly (41.2 /100000). There is a downward trend in incidence of otitis media. The incidence in children under 14 was 2612.6/100 000 in 2018. The incidence of bacterial meningitis is 1.4/100 000. Every year 2-3 thousand cases are registered, 43-52% of which are among children (3.04/100000., maximally in children under one year old, 13.2/100000). The level of vaccination against pneumococcal infection is increasing annually, but the proportion of children who have received a completed course of vaccination remains insufficient (64.6% in 2019). Coverage among the adult population was 2.3% (3.8% among those over 60). The main contingents of vaccinated adults are conscripts (coverage 67.4%) and people with chronic lung diseases (coverage 15.1%). Conclusions: The socio-economic and epidemiological burden of diseases associated with pneumococcal infection in Russia remains high. Accurate assessment of morbidity and mortality rates caused by St. pneumoniae diseases isnt possible due to the insufficient level of their ethological identification. Further efforts are required to achieve high level of herd immunity against pneumococcal infection through vaccine prevention during COVID-19 pandemic.

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The Results of a Three-Year Pneumococcal Vaccination of Children in Russia

Педиатрическая фармакология ◽

10.15690/pf.v15i4.1943 ◽

2018 ◽

Vol 15 (4) ◽

pp. 287-299 ◽

Cited By ~ 2

Author(s):

Nikolay I. Briko ◽

Vladimir A. Korshunov ◽

Leyla S. Namazova-Baranova ◽

Juriy V. Lobzin ◽

Alexander A. Baranov ◽

...

Keyword(s):

Otitis Media ◽

Russian Federation ◽

Pneumococcal Infection ◽

Acute Otitis Media ◽

Pneumococcal Vaccination ◽

Vaccination Schedule ◽

Community Acquired Pneumonia ◽

Morbidity And Mortality ◽

Prophylactic Vaccination ◽

The Russian Federation

Background.After inclusion of pneumococcal vaccination in the National Vaccination Schedule, it is very important to evaluate the efficacy of routine immunisation of the child population for more than 3 years. The obtained results provide opportunity to analyse the problems in achieving the goal, determine their causes, and suggest the ways of overcoming. Our aim was to study the results of a three-year period of pneumococcal vaccination of children.Methods.The quality of immunoprophylaxis of pneumococcal infection in the territory of the Russian Federation were assessed by analysing the coverage of vaccination and timeliness of its conduct after the inclusion of pneumococcal vaccine in the National Vaccination Schedule. The actual epidemiological efficacy of pneumococcal vaccination was assessed based on morbidity and mortality due to community-acquired pneumonia, incidence of acute otitis media among children. By questioning parents (n = 352) who applied to the Federal State Autonomous Institution of the Russian Federation Ministry of Health ‘National Medical Research Centre for Children’s Health, the timeliness of pneumococcal vaccination for infants was established.Results.In most regions, a high level of pneumococcal vaccination coverage was reached (87% of children). Despite the fact that the majority of children (73%) were vaccinated untimely. In particular, the results of a questionnaire survey conducted in the Moscow vaccination centre indicate insufficient awareness of parents for the need to vaccinate infants against pneumococcal infection by primary care professionals and, as a consequence, a low level of timely initiated vaccine introduction (40.1%). The introduction of routine prophylactic pneumococcal vaccination in Russia resulted in a 35% reduction in the death rate of children from community-acquired pneumonia, led to a decrease in the incidence of acute otitis media.Conclusion.The introduction of routine prophylactic vaccination of children against Streptococcus pneumoniae helps to reduce morbidity and mortality from pneumococcal infections. The surveillance system for community-acquired pneumonia requires further improvement. It is advisable to conduct an additional analysis on the reasons for refusals and medical exemptions to vaccination. It is important to increase the professional level of paediatricians in prophylactic vaccination.

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Preventive Efficacy of Pneumococcal Conjugated Vaccine (Population Aspects)

Epidemiology and Vaccinal Prevention ◽

10.31631/2073-3046-2021-20-6-37-55 ◽

2022 ◽

Vol 20 (6) ◽

pp. 37-55

Author(s):

I. N. Protasova ◽

I. V. Feldblium ◽

N. V. Bakhareva ◽

O. P. Ovchinnikova ◽

S. V. Domracheva

Keyword(s):

Herd Immunity ◽

Pneumococcal Infection ◽

Public Health Problem ◽

Incidence Rates ◽

Community Acquired Pneumonia ◽

Clinical Forms ◽

Structure Changes ◽

Mass Immunization ◽

The Impact ◽

Infants And Young Children

Relevance. Pneumococcal disease remains an urgent public health problem, despite mass immunization of infants and young children. The impact of children’s universal vaccination on the morbidity and etiological structure in various clinical forms of infection remains unclear in children and adults. Аim. Тo evaluate the herd effect of children’s mass immunization with a 13-valent conjugated pneumococcal vaccine. Materials and Methods. The prophylactic efficacy of mass vaccination is studied within comparative retrospective epidemiological analysis of incidence rates and etiological structure of bacterial meningitis, ear diseases and mastoiditis, and community-acquired pneumonia in children and adults of Krasnoyarsk region in the pre- and post-vaccination periods, according to the official statistics and microbiological monitoring. Results. The changes in decrease of incidence rates with all clinical forms of pneumococcal infection except community-acquired pneumonia are revealed both in children and adults during mass immunization. Etiological structure changes and also changes of S. pneumoniae serotype distribution are detected in major clinical forms of infection. Conclusion. Reducing the incidence rates in children is determined predominantly by vaccinal prevention. The observed decrease of incidence rates in adults is the result of reducing the number of pneumococcal infection sources among children (herd immunity).

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Open and laparoscopic surgeries are associated with comparable 90 day morbidities and mortalities following ERAS protocols- A retrospective Study. (Preprint)

10.2196/preprints.19313 ◽

2020 ◽

Author(s):

BHAVIN VASAVADA ◽

Hardik Patel

Keyword(s):

Multivariate Analysis ◽

Retrospective Study ◽

Mortality Rate ◽

Operative Time ◽

Univariate Analysis ◽

Morbidity And Mortality ◽

Morbidity Rate ◽

Blood Products ◽

Asa Score

UNSTRUCTURED All the gastrointestinal surgeries performed between April 2016 to march 2019 in our institution have been analysed for morbidity and mortality after ERAS protocols and data was collected prospectively. We performed 245 gastrointestinal and hepato-biliary surgeries between April 2016 to march 2019. Mean age of patients was 50.96 years. 135 were open surgeries and 110 were laparoscopic surgeries. Mean ASA score was 2.40, mean operative time was 111 minutes, mean CDC grade of surgery was 2.56. 40 were emergency surgeries and 205 were elective surgeries. Overall 90 days mortality rate was 8.5% and over all morbidity rate was around 9.79% . On univariate analysis morbidity was associated significantly with higher CDC grade of surgeries, higher ASA grade, more operative time, more blood products use, more hospitalstay, open surgeries,HPB surgeries and luminal surgeries(non hpb gastrointestinal surgeries) were associated with higher 90 days morbidity. On multivariate analysis no factors independently predicted morbidity. On univariate analysis 90 days mortality was predicted by grade of surgeries, higher ASA grade, more operative time, more blood products use, open surgeries and emergency surgeries. However on multivariate analysis only more blood products used was independently associated with mortality There is no difference between 90 day mortality and moribidity rates between open and laparoscopic surgeries.

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Miliary tuberculosis in a paediatric patient with psoriasis

BMJ Case Reports ◽

10.1136/bcr-2020-237580 ◽

2021 ◽

Vol 14 (3) ◽

pp. e237580

Author(s):

Jacob Kilgore ◽

Jonathon Pelletier ◽

Bradford Becken ◽

Stephen Kenny ◽

Samrat Das ◽

...

Keyword(s):

Brain Mri ◽

Miliary Tuberculosis ◽

Pulmonary Nodules ◽

Chronically Ill ◽

Community Acquired Pneumonia ◽

Oral Antibiotic ◽

Cavitary Lesion ◽

Oral Antibiotic Therapy ◽

History Of ◽

Chest X Ray

We present a 16-year-old girl with a history of well-controlled psoriasis, on immunosuppression, who sought evaluation in the emergency department for 4 months of fever, cough and unintentional weight loss. The patient had seen multiple providers who had diagnosed her with community-acquired pneumonia, but she was unimproved after oral antibiotic therapy. On presentation, she was noted to be febrile, tachycardic and chronically ill-appearing. Her chest X-ray showed diffuse opacities and a right upper lobe cavitary lesion concerning for tuberculosis. A subsequent chest CT revealed miliary pulmonary nodules in addition to the cavitary lesion. The patient underwent subsequent brain MRI, which revealed multifocal ring-enhancing nodules consistent with parenchymal involvement. The patient was diagnosed with miliary tuberculosis and improved on quadruple therapy. Though rates of tuberculosis are increasing, rates remain low in children, though special consideration should be given to children who are immunosuppressed.

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Global COVID-19 trends: Gender and age impacts

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11ispl1.4451 ◽

2020 ◽

Vol 11 (SPL1) ◽

pp. 1846-1860

Author(s):

Tahmina A ◽

Kevin F ◽

Das S ◽

Habib N ◽

Rashid M

Keyword(s):

Asian American ◽

Age Distribution ◽

Cross Sectional Study ◽

Morbidity And Mortality ◽

Morbidity Rate ◽

Fatality Rate ◽

African Countries ◽

Cross Sectional ◽

Gender And Age ◽

Gender Based

COVID -19 pandemic is creating an uncertainty about the demographic trends of morbidity and mortality rates across countries worldwide. Hence, this study is aimed to characterize the gender and age distribution of morbidity and mortality from COVID-19 across populations. This cross-sectional study uses aggregate data on COVID-19 cases and deaths by gender and age. Considering gender-based morbidity, men diagnosed with COVID-19 substantially outnumber infected women with statistically significant findings (*p=<0.05, □ RR>2) in Asian, American, and African countries, whereas women diagnosed higher morbidity rate in European countries. However, gender-based fatality showed higher among men in most of the analyzed countries of all those continents except Australia where female fatality was higher. This study revealed 50 years old were mostly associated with the infection and death in all continents except Australia, showing more morbidity above 20 years of age, whereas, fatality rate was more in the above 80 years group. The study concludes that, across countries, COVID-19 morbidity and fatality rate is age specific rather than gender specific. Infection rates showed rising steeply with age; nevertheless, children do not stand on equal footing when COVID-19 crisis is transforming their day-to-day lives.

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Adverse events in emergency oncological spine surgery: a prospective analysis

Journal of Neurosurgery Spine ◽

10.3171/2014.7.spine131007 ◽

2014 ◽

Vol 21 (5) ◽

pp. 698-703 ◽

Cited By ~ 53

Author(s):

Nicolas Dea ◽

Anne Versteeg ◽

Charles Fisher ◽

Adrienne Kelly ◽

Dennis Hartig ◽

...

Keyword(s):

Adverse Events ◽

Spine Surgery ◽

Patient Population ◽

Infectious Complications ◽

Morbidity And Mortality ◽

Morbidity Rate ◽

Inclusion Criteria ◽

True Incidence ◽

Related Quality ◽

Incidental Durotomy

Object Most descriptions of spine surgery morbidity and mortality in the literature are retrospective. Emerging prospective analyses of adverse events (AEs) demonstrate significantly higher rates, suggesting underreporting in retrospective and prospective studies that do not include AEs as a targeted outcome. Emergency oncological spine surgeries are generally palliative to reduce pain and improve patients' neurology and health-related quality of life. In individuals with limited life expectancy, AEs can have catastrophic implications; therefore, an accurate AE incidence must be considered in the surgical decision-making process. The purpose of this study was to determine the true incidence of AEs associated with emergency oncological spine surgery. Methods The authors carried out a prospective cohort study in a quaternary care referral center that included consecutive patients admitted between January 1, 2009, and December 31, 2012. Inclusion criteria were all patients undergoing emergency surgery for metastatic spine disease. AE data were reported and collected on standardized AE forms (Spine AdVerse Events Severity System, version 2 [SAVES V2] forms) at weekly dedicated morbidity and mortality rounds attended by attending surgeons, residents, fellows, and nursing staff. Results A total of 101 patients (50 males, 51 females) met the inclusion criteria and had complete data. Seventysix patients (76.2%) had at least 1 AE, and 11 patients (10.9%) died during their admission. Intraoperative surgical AEs were observed in 32% of patients (9.9% incidental durotomy, 16.8% blood loss > 2 L). Transient neurological deterioration occurred in 6 patients (5.9%). Infectious complications in this patient population were significant (surgical site 6%, other 50.5%). Delirium complicated the postoperative period in 20.8% of cases. Conclusions When evaluated in a rigorous prospective manner, metastatic spine surgery is associated with a higher morbidity rate than previously reported. This AE incidence must be considered by the patient, oncologist, and surgeon to determine appropriate management and preventative strategies to reduce AEs in this fragile patient population.

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Efficacy of the CoronaVac® Vaccine in a Region of the Colombian Amazon, Was Herd Immunity Achieved?

10.21203/rs.3.rs-593936/v1 ◽

2021 ◽

Author(s):

Salim Mattar ◽

Héctor Serrano-Coll ◽

Hollman Miller ◽

Camilo Guzmán ◽

Ricardo Rivero ◽

...

Keyword(s):

Developing Countries ◽

Observational Study ◽

Urban Population ◽

Herd Immunity ◽

Severe Infection ◽

Mass Vaccination ◽

Mild Disease ◽

Immunization Strategies ◽

Mass Immunization ◽

Colombian Amazon

Abstract Introduction. Currently, more than 1.8 billion doses of SARS-CoV-2 vaccines have been applied worldwide. However, some developing countries are still a long way from achieving herd immunity through vaccination. In some territories, such as the Colombian Amazon, mass immunization strategies have been implemented with the CoronaVac® vaccine. Due to its proximity to Brazil, where one of the variants of interest of SARS-CoV-2 circulates. Objective. To determine the efficacy of the CoronaVac® vaccine in a population of the Colombian Amazon. Methods. Between February 24, 2021, and May 19, 2021, a descriptive observational study was carried out in which a population of individuals over 18 years of age immunized with two doses of the CoronaVac® vaccine was evaluated. The study site was in the municipality of Mitú, Vaupés, in southeastern Colombia, a region located in the Amazon bordering Brazil. Results. 87% of the urban population of the Mitú municipality were vaccinated with CoronaVac®. To date, 2.1% of vaccinated individuals have become ill, and only 0.1% of these require hospitalization. No deaths attributable to COVID-19 have been reported among vaccinated individuals, and the vaccine has shown 97% efficacy against mild disease and 100% against severe infection. Conclusions. The herd immunity achieved through mass vaccination in this population has made it possible to reduce the rate of complicated cases and mortality from COVID-19 in this region of the Colombian Amazon.

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