Trends in all-cause pneumonia and otitis media in children aged <2 years following pneumococcal conjugate vaccine introduction in Colombia

Figures & data

Figure 1. PCV introduction and study analysis time period

•PCV7: 7-Valent Pneumococcal Conjugate Vaccine; UMV: Universal Mass Vaccination; PHiD-CV: Pneumococcal polysaccharide protein D-conjugate vaccine.

Table 1. % reductions in all-cause pneumonia mortality and overall all-cause mortality in post-PCV period compared to pre-PCV introduction period in children <2 y by vaccine period in selected cities and nationwide

	All-cause mortality and pneumonia mortality (deaths per 100,000 persons)
	Overall period		Pre-PCV period (pre PCV-7 introduction)		Transition period		Post-PCV period (post PHiD-CV switch)
	Years	Mean period estimate	Years	Mean period estimate	Years	Mean period estimate	Years	Mean period estimate	% Reduction (95%CI)*
Pneumonia mortality
National	2005–2016	26.2	2005–2008	37.6	2009–2011	22.7	2012–2016	19.3	48.8 (45.5, 51.9)
Bogota DC	2005–2016	18.2	2005–2008	33.8	2009–2011	15.4	2012–2016	7.8	77.1 (71.1, 81.8)
Barranquilla	2005–2016	61.5	2005–2009	81.6	2010–2011	52.0	2012–2016	43.7	46.4 (30.5, 58.7)
Cartagena	2005–2016	62.8	2005–2009	66.0	2010–2011	47.1	2012–2016	65.8	0.3 (– 29.7, 23.4)
Cali	2005–2016	41.3	2005–2010	52.4	2011	45.0	2012–2016	27.3	47.8 (33.8, 58.9)
Medellin	2005–2016	51.5	2005–2010	67.5	2011	66.3	2012–2016	29.5	56.4 (44.1, 65.9)
All-cause mortality
National	2005–2016	560.1	2005–2008	688.1	2009–2011	552.0	2012–2016	464.1	32.6 (31.7, 33.5)
Bogota DC	2005–2016	620.6	2005–2008	792.0	2009–2011	631.9	2012–2016	481.2	39.2 (37.1, 41.3)
Barranquilla	2005–2016	1707.9	2005–2009	1862.7	2010–2011	1466.0	2012–2016	1640.8	11.9 (7.7, 15.9)
Cartagena	2005–2016	1041.3	2005–2009	1082.7	2010–2011	939.9	2012–2016	1021.4	5.7 (–0.8, 11.7)
Cali	2005–2016	901.3	2005–2010	1030.7	2011	1060.1	2012–2016	716.4	30.5 (27.0, 33.8)
Medellin	2005–2016	1097.9	2005–2010	1251.4	2011	1452.7	2012–2016	843.5	32.6 (29.2, 35.8)

* % reduction = (mortality proportion [pre-vaccination period] – mortality proportion [post-vaccination period])/mortality proportion [pre-vaccination period] *100); Wald-type 95% confidence intervals (CIs) were calculated using Poisson regression.

Figure 2. Annual mortality due to all-cause pneumonia (a) and annual all-cause mortality (b) in children <2 y of age (2005–2016)

•No legend.

Table 2. Percentage reductions in all-cause pneumonia incidence and otitis media incidence in post-PCV period compared to pre-PCV introduction period in children <2 y by vaccine period in selected cities

	All-cause pneumonia Incidence and otitis media incidence (cases per 1000 persons)
	Overall period		Pre-PCV period (pre PCV-7 introduction)		Transition period		Post-PCV period (post PHiD-CV switch)
	Years	Mean period estimate	Years	Mean period estimate	Years	Mean period estimate	Years	Mean period estimate	% Reduction (95%CI)*
Pneumonia Incidence
Bogota DC	2008–2016	47.0	2008	105.3	2009–2011	46.9	2012–2016	35.7	66.0 (65.5, 66.6)
Barranquilla	2008–2016	25.1	2008–2009	16.9	2010–2011	21.6	2012–2016	30.1	– 78.5 (–89.2, – 68.4)
Cartagena	2008–2016	39.6	2008–2009	44.0	2010–2011	40.5	2012–2016	37.4	15.0 (11.2,18.6)
Cali	2008–2016	50.5	2008–2010	28.1	2011	52.5	2012–2016	63.5	–125.5 (–132.0, – 119.2)
Medellin	2008–2016	68.7	2008–2010	93.1	2011	62.5	2012–2016	55.4	40.6 (39.3, 41.9)
Otitis Media Incidence
Bogota DC	2008–2016	63.9	2008	98.2	2009–2011	79.4	2012–2016	48.0	51.1 (50.3, 51.8)
Barranquilla	2008–2016	17.1	2008–2009	10.4	2010–2011	16.1	2012–2016	20.4	–95.8 (–110.8, – 81.9)
Cartagena	2008–2016	27.5	2008–2009	58.0	2010–2011	20.5	2012–2016	17.7	ND
Cali	2008–2016	36.3	2008–2010	50.1	2011	31.1	2012–2016	29.1	ND
Medellin	2008–2016	88.7	2008–2010	120.6	2011	87.3	2012–2016	69.8	42.1 (41.0, 43.2)

* % reduction = (incidence proportion [pre-vaccination period] – incidence proportion [post-vaccination period])/incidence proportion [pre-vaccination period] *100); Wald-type 95% confidence intervals (CIs) were calculated using Poisson regression. ND, not done due to large biases observed with outliers and possible underreporting in the dataset.

Figure 3. Annual incidence of pneumonia and otitis media in children <2 y of age (2008–2016)

•No legend.

Figure 4. PCV vaccination coverage across the study period (2009–2016)

•No legend.

Figure 5. Reductions in all-cause pneumonia and otitis media

•Data represents percent reductions in mortality/incidence in the period following PHiD-CV introduction compared with those prior to use of any PCV. Below is a schematic representation of the pattern of disease reduction since PHiD-CV introduction and the mean vaccine coverage across 2013–2016. •NA, not available; nationwide pneumonia and otitis media (OM) incidence data were not available•* ND, not done; due to substantial biases observed with outliers and possible underreporting of otitis media, these cities were not included in the formal analyses for incidence reductions. † For Cartagena, reductions in pneumonia mortality were minimal.

Figure 6. Focus on the patient

•No legend.