The effectiveness of the 13-valent pneumococcal conjugate vaccine against hypoxic pneumonia in children in Lao People's Democratic Republic: An observational hospital-based test-negative study

Rupert Weaver; Cattram D. Nguyen; Jocelyn Chan; Keoudomphone Vilivong; Jana Y.R. Lai; Ruth Lim; Catherine Satzke; Malisa Vongsakid; Paul N. Newton; Kim Mulholland; Amy Gray; Audrey Dubot-Pérès; David A.B. Dance; Fiona M. Russell

The Lancet Regional Health. Western Pacific (Sep 2020)

The effectiveness of the 13-valent pneumococcal conjugate vaccine against hypoxic pneumonia in children in Lao People's Democratic Republic: An observational hospital-based test-negative study

Rupert Weaver,
Cattram D. Nguyen,
Jocelyn Chan,
Keoudomphone Vilivong,
Jana Y.R. Lai,
Ruth Lim,
Catherine Satzke,
Malisa Vongsakid,
Paul N. Newton,
Kim Mulholland,
Amy Gray,
Audrey Dubot-Pérès,
David A.B. Dance,
Fiona M. Russell

Affiliations

Rupert Weaver: Centre for International Child Health, Department of Paediatrics (WHO Collaborating Centre for Child and Neonatal Health Research and Training), The University of Melbourne, Melbourne, Victoria, Australia
Cattram D. Nguyen: Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
Jocelyn Chan: Centre for International Child Health, Department of Paediatrics (WHO Collaborating Centre for Child and Neonatal Health Research and Training), The University of Melbourne, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Australia
Keoudomphone Vilivong: Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Lao PDR
Jana Y.R. Lai: Murdoch Children's Research Institute, Melbourne, Australia; Australian National University, Canberra, Australia
Ruth Lim: Murdoch Children's Research Institute, Melbourne, Australia
Catherine Satzke: Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia; Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
Malisa Vongsakid: Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Lao PDR
Paul N. Newton: Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Lao PDR; Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, UK
Kim Mulholland: Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia; London School of Hygiene and Tropical Medicine, London, UK
Amy Gray: Department of Paediatrics, The University of Melbourne, Melbourne, Australia
Audrey Dubot-Pérès: Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Lao PDR; Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, UK; Unite des Virus Emergents (UVE: Aix-Marseille Univ – IRD 190 – Inserm 1207 – IHU Mediterranee Infection), Marseille, France
David A.B. Dance: Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Lao PDR; Centre for Tropical Medicine & Global Health, University of Oxford, Oxford, UK; London School of Hygiene and Tropical Medicine, London, UK
Fiona M. Russell: Centre for International Child Health, Department of Paediatrics (WHO Collaborating Centre for Child and Neonatal Health Research and Training), The University of Melbourne, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Australia; Corresponding author at: Centre for International Child Health, Department of Paediatrics (WHO Collaborating Centre for Child and Neonatal Health Research and Training), The University of Melbourne, Melbourne, Victoria, Australia

Journal volume & issue: Vol. 2
p. 100014

Abstract

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Background: Pneumococcal pneumonia is a leading cause of childhood mortality. Pneumococcal conjugate vaccines (PCVs) have been shown to reduce hypoxic pneumonia in children. However, there are no studies from Asia examining the effectiveness of PCVs on hypoxic pneumonia. We describe a novel approach to determine the effectiveness of the 13-valent PCV (PCV13) against hypoxia in children admitted with pneumonia in the Lao People's Democratic Republic. Methods: A prospective hospital-based, test-negative observational study of children aged up to 59 months admitted with pneumonia to a single tertiary hospital in Vientiane was undertaken over 54 months. Pneumonia was defined using the 2013 WHO definition. Hypoxia was defined as oxygen saturation <90% in room air or requiring oxygen supplementation during hospitalisation. Test-negative cases and controls were children with hypoxic and non-hypoxic pneumonia, respectively. PCV13 status was determined by written record. Vaccine effectiveness was calculated using logistic regression. Propensity score and multiple imputation analyses were used to handle confounding and missing data. Findings: There were 826 children admitted with pneumonia, 285 had hypoxic pneumonia and 377 were PCV13-vaccinated. The unadjusted, propensity-score adjusted and multiple-imputation adjusted estimates of vaccine effectiveness against hypoxic pneumonia were 23% (95% confidence interval: -9, 46%; p=0•14); 37% (6, 57%; p=0•02) and 35% (7, 55%; p=0•02) respectively. Interpretation: PCV13 is effective against hypoxic pneumonia in Asia, and should be prioritised for inclusion in national immunisation programs. This single hospital-based, test-negative approach can be used to assess vaccine effectiveness in other similar settings. Funding: Funded by the Bill & Melinda Gates Foundation.

Published in The Lancet Regional Health. Western Pacific

ISSN: 2666-6065 (Online)
Publisher: Elsevier
Country of publisher: United Kingdom
LCC subjects: Medicine: Public aspects of medicine
Website: https://www.thelancet.com/journals/lanwpc/home

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