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Observational Study
. 2019 Jun 10;19(1):510.
doi: 10.1186/s12879-019-4119-8.

The impact of childhood pneumococcal vaccination on hospital admissions in England: a whole population observational study

Tinevimbo Shiri  1   2 , Noel D McCarthy  3 , Stavros Petrou  4
Affiliations
Observational Study

The impact of childhood pneumococcal vaccination on hospital admissions in England: a whole population observational study

Tinevimbo Shiri et al. BMC Infect Dis. .

Abstract

Background: Pneumococcal infections are major causes of morbidity and mortality worldwide. We use routine hospital admissions data and time-series modelling analysis to estimate the impact of the seven and thirteen valent pneumococcal conjugate vaccines (PCV7 and PCV13) on hospital admissions due to pneumococcal disease in England.

Methods: Hospital admissions for pneumococcal meningitis, bacteraemia and pneumonia between January 1, 2003 and December 31, 2015 were identified from the national Hospital Episode Statistics database for all age groups in England. We model the impact of pneumococcal vaccination using interrupted time series analysis. Hospital admissions prior to vaccine introduction were extrapolated to predict the expected number of admissions in the absence of pneumococcal vaccines. Admissions avoided over time were estimated by comparing the fitted interrupted time series and the expected model for no vaccination in a Bayesian framework.

Results: Overall, there were 43,531 (95% credible interval (CrI): 36486-51,346) fewer hospital admissions due to bacteraemia, meningitis and pneumonia in England during the period from 2006 to 2015 than would have been expected if pneumococcal vaccines had not been implemented, with the majority of hospital admissions avoided due to pneumonia. Among young children reductions in meningitis were more common, while among adults reductions in pneumonia admissions were relatively more important, with no evidence for reduced bacteraemia and meningitis among older adults. We estimated that 981 (95% CrI: 391-2018), 749 (95% CrI: 295-1442) and 1464 (95% CrI: 793-2522) bacteraemia, meningitis and pneumonia related hospital admissions, respectively, were averted in children < 2 years of age.

Conclusions: Substantial reductions in hospital admissions for bacteraemia, meningitis and pneumonia in England were estimated after the introduction of childhood vaccination, with indirect effects being responsible for most of the hospital admissions avoided.

Keywords: Hospital admissions; Indirect effects; Interrupted time series analysis; Pneumococcal conjugate vaccines; Pneumococcal disease.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Observed and fitted monthly trends in all pneumococcal disease -related hospitalisations between 2003 and 2015 by age category. Vertical grey lines represent the months when PCV7 and PCV13 were introduced into the immunisation programme, respectively. Counterfactual – expected hospital admissions in the absence of vaccination (blue lines). 95% credible intervals are given in light blue lines
Fig. 2
Fig. 2
Estimated monthly pneumococcal disease admissions averted due to the introduction of the vaccination programmes by age category. Error bars represent the 95% credible intervals. Vertical lines represent the months when PCV7 and PCV13 were introduced into the immunisation programme, respectively
See this image and copyright information in PMC

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