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Increased risk of hospitalization for acute lower respiratory tract infection among Australian indigenous infant 5-23 month of age following pneumococcal vaccination: a cohort study

O'Grady, Kerry-Ann, Lee, Katherine J., Carlin, John B., Torzillo, Paul J., Chang, Anne B., Mulholland, E. Kim, Lambert, Stephen B. and Andrews, Ross M. (2010). Increased risk of hospitalization for acute lower respiratory tract infection among Australian indigenous infant 5-23 month of age following pneumococcal vaccination: a cohort study. Clinical Infectious Diseases,50(7):970-978.

Document type: Journal Article

IRMA ID 81704288xPUB302
Title Increased risk of hospitalization for acute lower respiratory tract infection among Australian indigenous infant 5-23 month of age following pneumococcal vaccination: a cohort study
Author O'Grady, Kerry-Ann
Lee, Katherine J.
Carlin, John B.
Torzillo, Paul J.
Chang, Anne B.
Mulholland, E. Kim
Lambert, Stephen B.
Andrews, Ross M.
Journal Name Clinical Infectious Diseases
Publication Date 2010
Volume Number 50
Issue Number 7
ISSN 1058-4838   (check CDU catalogue  open catalogue search in new window)
Start Page 970
End Page 978
Total Pages 8
Place of Publication United States
Publisher Oxford University Press
HERDC Category C1 - Journal Article (DIISR)
Abstract BACKGROUND:
Australian Indigenous children are the only population worldwide to receive the 7-valent pneumococcal conjugate vaccine (7vPCV) at 2, 4, and 6 months of age and the 23-valent pneumococcal polysaccharide vaccine (23vPPV) at 18 months of age. We evaluated this program's effectiveness in reducing the risk of hospitalization for acute lower respiratory tract infection (ALRI) in Northern Territory (NT) Indigenous children aged 5-23 months.

METHODS:
We conducted a retrospective cohort study involving all NT Indigenous children born from 1 April 2000 through 31 October 2004. Person-time at-risk after 0, 1, 2, and 3 doses of 7vPCV and after 0 and 1 dose of 23vPPV and the number of ALRI following each dose were used to calculate dose-specific rates of ALRI for children 5-23 months of age. Rates were compared using Cox proportional hazards models, with the number of doses of each vaccine serving as time-dependent covariates.

RESULTS:
There were 5482 children and 8315 child-years at risk, with 2174 episodes of ALRI requiring hospitalization (overall incidence, 261 episodes per 1000 child-years at risk). Elevated risk of ALRI requiring hospitalization was observed after each dose of the 7vPCV vaccine, compared with that for children who received no doses, and an even greater elevation in risk was observed after each dose of the 23vPPV (adjusted hazard ratio [HR] vs no dose, 1.39; 95% confidence interval [CI], 1.12-1.71; P=.002). Risk was highest among children vaccinated with the 23vPPV who had received <3 doses of the 7vPCV (adjusted HR, 1.81; 95% CI, 1.32-2.48).

CONCLUSIONS:
Our results suggest an increased risk of ALRI requiring hospitalization after pneumococcal vaccination, particularly after receipt of the 23vPPV booster. The use of the 23vPPV booster should be reevaluated.
DOI http://dx.doi.org/10.1086/651079   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
 
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