TRENDS IN MORTALITY OF POTENTIAL PNEUMOCOCCAL PNEUMONIA IN COLOMBIA, 2006-2019

Abstract

Intro: In 2010, PCV10 was introduced in the Colombian National Immunization Program (NIP) for children, with good vaccination coverage >82% since 2012. However, the NIP does not include routine pneumococcal vaccination for older adults. We assessed trends in mortality rate (MR) due to potential pneumococcal pneumonia (PPP) from 2006-2019. Methods: This ecological time-series study used Colombian nationwide administrative databases. We analyzed the pre-PCV10 (2006-2009) and post-PCV10 (2012-2019) periods, excluding the years 2010 and 2011 (transition period). ICD-10 codes included J13-J18. MRs were calculated per 100,000 people and stratified by age groups (<1, 1-4, 5-17, 18-49, 50-59, 60-64 and ≥65 years). The percent of change was calculated by the difference between the average rate in the pre-PCV and post-PCV periods for each age group. Joinpoint regression analysis was performed to assess changes in MRs. Annual percent changes (APCs) for each line segment and average APC (AAPC) over 2006-2019 were estimated. Findings: During 2006-2019, there were 102,082 deaths due to PPP. The highest MRs were seen for the age groups <1 and ≥65 years. Mean MRs decreased in age groups <18 years in the post-PCV10 period. A decreasing trend was seen primarily in those <1 year (AAPC -6.8; 95%CI: -8.6;-5.1) and 1-4 years (AAPC -5.0; 95%CI: -7.2;-2.8%) from 2006-2019. In contrast, for the age groups 50-59 years and 60-64 years, there was a significant increasing trend (AAPC 1.6%;95%CI 1.7%-5.1% and AAPC 3.4; 95%CI: 1.7;5.1, respectively) from 2006-2019. In ≥65 years, there was a significant increasing trend from 2011-2016 (APC 6.6; 95% CI: 0.5;13.1), followed by a non-significative decrease trend from 2016-2019 (APC -2.8; 95%CI-10.4;5.5). Conclusion: This study provided additional evidence for the benefits of childhood PCV programs. For older adults, MR has been consistently higher in post-vaccination period compared to pre-vaccination. These findings can inform decision-makers about the needs for pneumococcal vaccination among older adults in Colombia.